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培养韧性:一家专门为有暴力和虐待风险的老年人开设的特色诊所。

Building resilience: A specialty clinic tailored to older adults at risk for violence and abuse.

机构信息

Louis A. Faillace, MD Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA.

Joan and Stanford Division of Geriatric and Palliative Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA.

出版信息

Int J Psychiatry Med. 2024 Nov;59(6):620-632. doi: 10.1177/00912174241272591. Epub 2024 Aug 4.

Abstract

OBJECTIVE

Both structural (e.g., ageism) and personal (e.g., stigma) barriers hinder older adults' access to and engagement with mental health care. These barriers are particularly problematic for those vulnerable to interpersonal violence and abuse (e.g., due to social isolation). This study presents a quality improvement program aimed at older adults who have experienced significant stressful events, particularly elder mistreatment, within a larger trauma specialty clinic. Leveraging home-based telemedicine, the clinic provides evidence-based psychotherapy tailored to the needs of older adults.

METHODS

From 2021 through 2023, the authors retrospectively examined treatment initiation, engagement, completion, and clinical outcomes among 231 older adults age 60+ who reported trauma that met DSM-5 criterion A criteria for post-traumatic stress disorder, depression, or other mental health comorbid conditions related to their traumatic event. The clinic uses an automated measurement-based care approach that facilitates Quality Improvement projects, allowing the tracking of treatment initiation, engagement, completion, and clinical outcomes for all patients.

RESULTS

The results indicated high treatment completion, high engagement with telemedicine-delivered interventions, and, most importantly, significant changes in clinical outcomes.

CONCLUSION

These findings highlight the importance of expanding telemedicine-based mental health services for older adults, challenging ageist norms, and prioritizing older adults' mental health needs by providing tailored services to this patient population.

摘要

目的

结构上的障碍(如年龄歧视)和个人上的障碍(如污名化)都阻碍了老年人获得和参与心理健康护理。这些障碍对于那些易受人际暴力和虐待影响的人(例如,由于社会孤立)尤其成问题。本研究介绍了一个质量改进计划,针对在较大创伤专科诊所中经历过重大应激事件(特别是虐待老人)的老年人。该诊所利用基于家庭的远程医疗,提供针对老年人需求的循证心理治疗。

方法

在 2021 年至 2023 年期间,作者回顾性地检查了 231 名 60 岁以上报告创伤的老年人的治疗启动、参与、完成和临床结果,这些创伤符合 DSM-5 后应激障碍、抑郁或其他与创伤事件相关的心理健康合并症的 A 标准。该诊所使用自动化基于测量的护理方法来促进质量改进项目,允许跟踪所有患者的治疗启动、参与、完成和临床结果。

结果

结果表明治疗完成率高、远程医疗干预参与度高,最重要的是临床结果有显著变化。

结论

这些发现强调了为老年人扩大基于远程医疗的心理健康服务的重要性,挑战了年龄歧视规范,并通过为这一患者群体提供量身定制的服务来优先考虑老年人的心理健康需求。

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