Seniors living in residential care can still go through a period of personal growth, says William Reichman, president and CEO of Baycrest.
“Our world, at first, is small. Then it expands, and then it contracts. Our mental health challenge is to change that.”
Reichman was a keynote speaker at the Dr. Ira Pollock Clinic Day, held June 4 at the Joseph E. and Minnie Wagman Centre.
Other speakers included Dr. Michael Gordon, medical program director for palliative care at Baycrest, who delivered the Wulf Grobin Memorial Lecture on “End of Life Care in Dementia”; Dr. Robert Josse, who spoke on osteoporosis, and Dr. Brian Murray, who spoke on sleep disorders in the older adult.
Reichman, a professor of psychiatry in the University of Toronto’s faculty of medicine, said that for too many years, seniors living in residential care have been over-medicated.
He said that that was the case when he co-wrote a book on the state of psychiatric care in nursing homes about a decade ago, and now that he is editing a second book on the subject, “I’m not seeing significant progress. There have not been enough advances in treating mental health challenges.
“Nursing homes are de facto geriatric mental institutions, and I’m concerned about where the field is going. We need to shift away from the heavy medical approach.”
Quality of life depends on a number of factors, he said, including mood, cognition, family, spiritual needs, culture, and the environment.
“Good physical health is important, but it’s not enough. We all need activities that are satisfying. When we admit a resident, to what extent do we think about who this person is? What is their core identity?”
He said that we pay attention to pain management and continence, “but do we pay attention to other matters? From what means did this person extract a sense of purpose? [We need to know] what they did to attach themselves to the world around them. No drug will reduce our need to have a sense of purpose.”
He said that today’s seniors need practical suggestions about how they can get themselves back to where they want to be.
“They need cognitive psychology, peer support, reminiscence therapy – a form of therapeutic intervention that respects the life and experiences of the individual with the aim to help the patient maintain good mental health – and they need to engage in recreational activities that are meaningful. Nothing about today’s generation of seniors says that they were life-long bingo players. There are other things they want to do.”
Reichman said that his most important activity of the day is sitting with the residents. “I’ve learned that people accept that they have become dependent on others, but they have difficulty giving up their autonomy. [They] may need someone to help them eat, but [they] want to determine when and what they eat. That is autonomy.”
