Week of January 6 - 10

Elder LifeCare Foundation Presents Testamony to Key Florida Legislators

A Commentary on the Current State of Eldercare
John G. Cull, PhD

Recently, a colleague, Bill Lenhard, and I participated in a public hearing before the Board of the Commission on Aging in a neighboring state. As we listened to leaders in the field of aging, gerontology, medicine, housing, and numerous related fields testifying before the Commission regarding the needs of the elderly in that state, we had the sense we were in a time warp. We felt as if we were back in the early 1960s rather than being here in the new millennium. As each eldercare authority presented concerns, assessments, and needs of the elderly, one might close his eyes and be carried back to that earlier time.

In the 1960s our eldercare facilities desperately needed more funds to raise the reimbursement rates for eldercare, changes in staffing ratios to yield more staff, and legislative changes to counter the trend of legislatively micro managing eldercare. These were precisely the problems and solutions we heard last week.

We believe it can be stated rather strongly that if, after forty years, one is considering the same failing solutions to the same set of problems it goes without fear of contradiction that either we are misunderstanding the problem or we have not pinpointed the solutions to the problem. Yet these authoritative persons were persuasively presenting the same problems and the same old, failing solutions with the same stale rationales. Our conclusion is that we have a failing system with systemic problems and the professionals and experts are offering symptomatic solutions rather than attempts to understand the systemic ills of our services to the elderly.

Also bandied about were attempts to match the needs of individual elderly persons and programs of services designed to meet their needs. The underlying theme of this discussion was the recognition that many elderly persons are placed in programs that are inappropriate but are considered the least wrong placement. These persons essentially were discussing how much of a misfit between program offering and individual needs is acceptable. We felt that on other occasions this cast of characters had discussed this misfit repeatedly without arriving at a satisfying conclusion. The participants were unable to establish a distance from their positions and the problem at hand. We feel the solution is to look not at "forcing" the misfit, but to design a broader continuum of care in the service offerings. Thus providing more alternatives in the placement and treatment of the elderly.

It is axiomatic that clinical depression and generalized anxiety disorders are not a natural consequence of the aging process. Many who age never experience either of these serious psychiatric disorders. Yet, data available from the Center for Disease Control, from studies sponsored by the National Institutes of Health, and studies sponsored and led by the American Psychiatric Association and the American Psychological Association consistently indicate that over 60% of the residents in eldercare facilities meet the diagnostic criteria of clinical depression and almost 50% of the residents in eldercare facilities meet the diagnostic criteria of generalized anxiety disorder. If these two serious psychiatric maladies are not a natural consequence of the aging process, but they are found in the majority of the population in eldercare facilities receiving treatment, we are forced into a sad and serious indictment of the treatment in these facilities. We are led to the conclusion that depression and anxiety are iatrogenic disorders; that is, they are disorders caused by factors inherent in the treatment. These psychiatric disorders are being created by those very persons charged with the responsibility of treating the elderly and interjecting an increased quality of life to these fragile, frail friends, relatives, and neighbors.

We must hold the medical practitioners accountable for these iatrogenic disorders. We believe that by focusing on this problem, our medical colleagues will respond and will work with us to identify treatment modalities and treatment regimes that will end these "treatment produced" conditions. Depression and anxiety are the primary conditions that preclude achieving an increased quality of life among the elderly.