Responsive Care, Behavioral Interventions with Elderly Persons. Hussian RL, Davis RL. Champaign, Ill, Research Press, 1985, 197 pages, softcover.
This book was written by two clinical psychologists for mental health professionals and geropsychiatric clinicians and was intended to serve as a practical guide for analyzing and treating behavioral disorders among elderly people in institutions or on home care.
Chapter 1 presents the reader with a brief section on relevant physiological changes in the sensory system, and cognitive changes in the elderly that may contribute to inappropriate behavior. The authors provide tips for assessment of these disorders, and appropriate interventions for specific physiological changes.
In Chapter 2, the authors discuss concepts and principles of behavior therapy or management based on principles of learning and conditioning, such as reinforcement, contiguity, avoidance, and modeling. A table illustrating the major differences between the behavioral and medical models is presented. Definitions of terms that form part of the basic vocabulary of the behavioral model explained by the authors throughout the book help the reader understand these terms.
In Chapter 3, an in-depth discussion of behavioral deficits, such as group activity attendance, self-care, and ambulation, is provided. Case studies and relevant exhibits illustrating these deficits help reinforce the concepts being presented.
Chapter 4 focuses on behavioral excesses - shouting, cursing, stripping, shadowing, and physical aggression - and their appropriate interventions. The authors clearly explain what most of these behaviors are, and how to control, reduce, modify and treat these behaviors. Chapter 5, "Stimulus Control," builds on the information presented in the preceding chapters regarding specific behavioral disorders and management techniques that are worthwhile in treating these behaviors.
Chapters 6 and 7 deal with special considerations that caregivers should remember in both inpatient and outpatient settings. The authors' intent in writing this book is clearly communicated, and that is, to help clinicians assess and treat common behavioral disorders in elderly persons. This book would serve as a valuable guide and reference for mental health-geropsychiatric professionals, but I would question the practicality of implementing the treatment programs proposed by the authors in view of the severe shortage of qualified nursing and mental health staff in geriatric facilities.
Actual implementation of these programs could be possible only if there were adequate numbers of qualified personnel who could enforce these treatment modalities. Otherwise, it would require long hours of in-service training, educating of personnel, and constant follow-through in evaluating the effectiveness of the programs, which administrators in these facilities would find burdensome.
The quality of the content presented by the authors is more descriptive and informative rather than analytical, and at times, the authors make questionable generalizations and value judgments about nurses. Unless supported by relevant data that could justifiably prove that all nursing staff members act and feel in the manner described by the authors, there should be a more objective and unbiased approach on the part of the authors in analyzing the situations. To the lay reader, and to other readers, these generalizations contribute to the negative image of nurses that has already been portrayed in the media. These statements also reflect a failure to implement a holistic, multidisciplinary, client-centered approach that underlies the philosophy behind gerontological care.
The material presented in this book is useful for clinicians who deal with behavioral disorders in their elderly clients and require a basic knowledge and understanding of psychiatric and theoretical concepts possessed by clinicians who have advanced training and specialization in clinical psychiatry and geriatric psychiatry. I therefore recommend this book to these specialists, and as a reference guide for allied healthcare professionals working with elderly clients in need of behavior therapy.