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Harbour, K. and Nehmad, A., 1995. CAT For The Elderly. Reformulation, ACAT News Winter, p.x.
1. Many elderly clients with mental health problems are not appropriate for CAT because they have memory and orientation difficulties or because they lack motivation.
However, others who may have possibly been kept going for years with medication, and/or have been expected to accept a lower quality of life, may well make good clients for CAT. Some of these will appreciate the interest taken in their problems and will on current experience be cooperative and positive. They are able to look back objectively, and may even have better insight due to a greater accumulation of experiences and the greater number of repeated instances of their problem procedures. However, their patterns of behaviour might well be more entrenched.
With elderly clients because of the difficulty in accepting new ideas and concepts, a slower pace is necessary. However, this has not meant more sessions.
For a selected few, years of monitoring and care can be replaced by three or four months of CAT, giving not only an improved quality of life for the elderly client but also freedom and relief for the carers.
I am a Community Psychiatric Nurse for the Elderly. I have treated three clients with CAT. The resulting improvements in their insight, coping strategies and mood mean that I no longer visit them. Had I not offered them CAT, I would probably have been visiting them every month or so for many years, perhaps indefinitely.
Ken Harbour
2. I supervised Ken's three cases, and a fourth case undertaken by another CPN for the elderly, Annette Lurch, who has now left Huntingdon.
I asked Ken to write a short piece on CAT for the elderly, and then decided to add my own perspective, as a supervisor and as a "non-specialist" in the care of the elderly.
Until recently, I had neither treated nor supervised "elderly CATs". When Ken and Annette joined my supervision group in Huntingdon, I was enthusiastic about the idea of using CAT with the elderly, but thought it might be somehow different, and/or more difficult. I suggested to Ken and Annette that they take on a non-elderly client for their first case as it might be "more straightforward". Neither of them followed this advice, and they were quite right not to! In fact there were practically no differences between these clients and younger ones, as far as their CAT was concerned.
They were not easy clients, especially for beginners in CAT. One was a difficult narcissist, another a borderline personality disorder, another was judged by Ken (correctly, as events proved) to be suffering mainly from severe anxiety, but her demeanour and garbled speech when she "got in a state" had resulted in both dementia and psychosis being tentatively diagnosed by other health professionals. Only the fourth was an "ordinary neurotic". One of the clients had had a recent brief psychotic episode. Another was severely disabled physically but was cared for only by a relative, because District Nurses had stopped visiting due to her appalling behaviour. Two of the clients had 16 sessions, and two had 12. Of the three who have had a follow-up to date, all remain well and have not required further interventions.
Both Ken and Annette required a lot of support during their first cases, but that was because both had a very difficult first case, and nothing to do with the age of the clients, who probably wouldnt have been any easier 20 or 30 years ago.
So I feel pretty upbeat about offering CAT to the elderly. Though it is too early to say for sure, I suspect it is also cost-effective in the long run, so service providers and budget holders take note!
Annie Nehmad