| With their John A.
Hartford Foundation funding, the University of Michigan's Drs.
Donna Algase and Elizabeth Beattie combined forces to develop
a graduate level gerontology-psychology nursing concentration
of 7 to 10 credits, that includes both the three-credit Bio-behavior,
Aging and Mental Illness, and the optional Issues in
Aging And Mental Illness. It attracts students from advanced
practice nursing and other graduate programs, including medicine,
social work, dentistry and public health. The concentration
is web based and employs use of exemplar cases and seminar discussion;
a clinical practicum and seminar are also required. Its interdisciplinary
nature reinforces the importance of team collaboration in achieving
the best outcomes for the vulnerable elderly.
This concentration prepares its students to address the mental
health issues of our country's fastest growing population,
the aging baby boomers, some with diagnosed mental illness,
and some who have yet to be diagnosed. Drs. Algase and Beattie
maintain as their ultimate goal for their students the ability
to recognize the complexity of mental illness in the aging
population against a backdrop of physical and psycho/social
aging.
A HRSA-funded frailty concentration for non-gerontology specialist
nurse practitioners served as the perfect template for framing
this concentration. Drs. Beattie and Algase contend that students
will learn to differentiate their elderly patient's symptoms
from expected aging changes in body systems, to examine the
complex interplay between aging and mental illness, and to
communicate effectively within a multidisciplinary team. For
example, regarding her older male patient who has a life long
history of schizophrenia, the nursing student will learn to
evaluate issues such as:How is this person functioning at
this time? What cognitive, functional and social challenges
is he facing? How do his current life circumstances impact
his choices? These elderly individuals with mental health
problems may face chronic illness, such as cardiac disease
or other co-morbidities which may be further complicated by
concomitant clinical depression or new onset alcohol abuse.
Such complex cases cannot be straightforwardly managed with
anti-depressant or anti-psychotic medications. Clearly, the
conventional mental health treatment frameworks that work
for younger adult patients are often inadequate with the elderly
population.
Drs. Algase and Beattie first conceptualized the Biobehavior,
Aging and Mental Illness coursework assuming that interested
students would bring with them a broader knowledge of foundational
concepts in both gerontology and psychopathology than was
actually demonstrated. The curriculum was adjusted accordingly,
by referencing AACN's Nurse Practitioner and Clinical Nurse
Specialist Competencies in Older Adult Care. The competencies
helped them determine the appropriate level of gerontology/psychopathology
knowledge to expect from students, an especially important
issue in a cross-disciplinary offering. An online pretest
evaluated student understanding of basic concepts, giving
both instructor and student insight into the likelihood of
student success.
Dr. Beattie contends that most of her students begin the
concentration unable to "pick the subtleties out of a
case study," and therefore need a great deal of exposure
to both real and simulated case studies. With systematic exposure
to elder psychopathology and mental status assessment, students
begin to recognize their aging patients' mental health symptoms,
especially when sub-clinical depression and/or complex co-morbidities
are involved. Using progressively revealed case study material,
Dr. Beattie determined her students' assessment and critical
thinking skills, most critically their ability to process
case study information about psychopathology within a bio-behavioral
framework.
Drs. Algase and Beattie hope for their concentration to give
students a new lens that brings into focus the mental/emotional
challenges in late life, allowing them to question assessment
bias, to communicate clearly with team members about their
elderly patients, and subsequently to work together with the
interdisciplinary team to resolve the patient's complicated
medical/psychological/social problems.
Course Syllabi
Student Evaluations
Lessons Learned/Advice to Schools
Principal Investigator Contact Information:
Donna L. Algase, PhD, RN FAAN, FGSA
Josephine M. Sana Collegiate Professor of Nursing
Room 2320
University of Michigan
School of Nursing Building
400 North Ingalls
Ann Arbor, Michigan 48109-0482
Phone: (734) 615-3714
FAX: (734) 936-5255
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