[NYAPRS Enews] NYT: Doctor Focuses on the Minds of the Elderly

Tue May 3 09:58:31 EDT 2011

Doctor Focuses on the Minds of the Elderly

By Jane Gross New York Times  April 30, 2011

MIAMI - The Merry Widows, as they call themselves, were blinged out,
Florida-style, to celebrate Elayne Weisburd's 79th birthday at a
sprawling community for seniors. Mylar balloons levitated above their
table, and sparklers twinkled from a cake.

The guest of honor and her two friends were beaming when Dr. Marc E.
Agronin <http://www.psychologytoday.com/blog/bloggers/marc-e-agronin-md>
, a geriatric psychiatrist and the director of mental health
<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto
pics/mentalhealthanddisorders/index.html?inline=nyt-classifier> ,
arrived with a hug for everyone long after what would be normal office
hours.

The Merry Widows moved to the community when their husbands developed
Alzheimer's disease
<http://health.nytimes.com/health/guides/disease/alzheimers-disease/over
view.html?inline=nyt-classifier>  and looked to Dr. Agronin to prepare
them for what lay ahead. But while treating their husbands' disease, he
became their psychiatrist, too. He urged the women to attend therapy
groups, made suggestions about medication for anxiety and encouraged new
bonds of friendship.

Dr. Agronin calls them his graduates - a trio of success stories among
3,700 patients he is responsible for, in what, by all accounts, is the
largest geriatric psychiatry
<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto
pics/psychiatry_and_psychiatrists/index.html?inline=nyt-classifier>
practice in the nation, at the Miami Jewish Health Systems.

The doctor is a rare breed even in Florida, which has the highest
proportion of people older than 65. There are only 17 board-certified
geriatricpsychiatrists
<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto
pics/psychiatry_and_psychiatrists/index.html?inline=nyt-classifier>  in
the state, and a mere six here in southeast Florida, where snowbirds
from New York often come to perch. In March, acknowledging the crisis in
care, the federal Institute of Medicine <http://iom.edu/>  began a study
of the shortage of geriatric mental health workers nationwide.

Dr. Agronin, 45, is unusual not just because of his specialty but
because he is a salaried staff member immersed in the fabric of life for
patients and caregivers. Residents in most senior facilities must await
a shifting cast of mental health professionals, who are available - even
for a prescription - only one or two days a week or in an emergency.

Now, a growing number of experts are calling for integrating mental
health professionals into all levels of communities for the rising
population of aging Americans, from nursing homes
<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto
pics/nursing_homes/index.html?inline=nyt-classifier>  to assisted-living
centers.

Gary Kennedy, the director of geriatric psychiatry at Montefiore Medical
Center
<http://topics.nytimes.com/top/reference/timestopics/organizations/m/mon
tefiore_medical_center/index.html?inline=nyt-org>  in the Bronx, says
psychological care is "equally if not more important than" medical care
for this group. "Health policy continues to lag behind the reality that
these are now mental health facilities," Dr. Kennedy said of communities
for the elderly.

While Alzheimer's receives the lion's share of public attention,
garden-variety depression, anxiety and sleep disorders
<http://health.nytimes.com/health/guides/disease/sleep-disorders/overvie
w.html?inline=nyt-classifier>  also accompany old age. Particularly for
late-life depression, Dr. Agronin points to data assembled
<http://ucsfhr.ucsf.edu/index.php/assist/article/elderly-caregiving-choi
ces-challenges-and-resources-for-the-family/>  by the psychiatry
department at the University of California, San Francisco
<http://topics.nytimes.com/topics/reference/timestopics/organizations/u/
university_of_california/index.html?inline=nyt-org> , supporting
behavioral and group therapy, treatment rarely tried with patients from
generations typically considered averse to discussing such issues.

But treatment that focuses on talking, rather than on medical
procedures, has a lower Medicare
<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto
pics/medicare/index.html?inline=nyt-classifier>  reimbursement rate. The
economic difficulties may explain why more doctors have not entered the
time-intensive field.

"Approximating what I do is hardly economically feasible," said Dr.
Agronin, the author of "How We Age." "Caregivers need assessment and
services as well, and this is not reimbursable time."

For Dr. Agronin, and for the social worker and the psychologist who work
with him, there is no such thing as the 50-minute billing hour. Rather,
on a routine day, his work is often done ad hoc as he wanders the
corridors, dining rooms and garden here. He loosens the boundaries set
by most schools of psychiatry, which discourage clinicians from
befriending patients. Here, staff members are physically affectionate
and may even give patients a personal cellphone number.

"He is a lifesaver," Mrs. Weisburd said as Dr. Agronin helped blow out
the candles on her cake. "He helps you walk down the mountain."

The mountain is old age, with its physical and cognitive decline, its
steady loss of loved ones and its inevitable outcome. Dr. Agronin says
his mission is to restore dignity and hope to people who were raised at
a time when mental issues were often stigmatized.

Some 700 of Dr. Agronin's patients live on the main campus of Miami
Jewish Health Systems, in independent or assisted-living apartments, a
nursing home or an Alzheimer's unit. The rest of them come to his clinic
or are served by the system's community programs throughout South
Florida.

Dr. Agronin and other geriatricians find that behavioral therapy
(changing the way one thinks and solving current problems) works better
than analysis (excavating the past). And Dr. Agronin, who has written
about some of his cases for the Science section of The New York Times,
said he relied on group therapy because patients often benefit from the
insights of their peers.

That was the case with Francoise Dorville, a 78-year-old Haitian
immigrant who uses a wheelchair and is on dialysis
<http://health.nytimes.com/health/guides/test/dialysis/overview.html?inl
ine=nyt-classifier>  and oxygen. Mr. Dorville, a widower estranged from
his four surviving children, was stabilized with medication for
depression and then agreed - reluctantly - to participate in a group.

Though he did not make eye contact with anyone in the group for the
first month, Mr. Dorville did show up for the daily two-hour sessions.
Eventually, the group persuaded him to contact his children, discussing
his old-country idea that being a good father meant providing food and
shelter and little else.

Mr. Dorville told his children that he would welcome a chance to be a
more loving parent. Now they visit regularly; one son brings dinner
weekly, and a daughter-in-law assembled a family photo album. Mr.
Dorville describes himself as "a happy man."

Dr. Agronin said that older people were not by definition miserable. "We
have to be very careful in the assumptions we make," he said, "and not
project our own fears of aging. Their lives can be way better than we
imagine."

The Merry Widows - Mrs. Weisburd, Muriel Cohen, 91, and Sandra Sachs, 78
- made their way here by a common route: from homes at the edge of golf
courses. Wives and mothers for 50-plus years, they arrived with their
husbands but remained here after their deaths.

"It's like being on a cruise," Mrs. Weisburd said. "You don't have to
change the sheets, and there's always something to do."

Dr. Agronin sees them daily as they hurry between knitting classes and
lectures on current events. Recently, he wandered into the library where
they were chatting. Out of the blue, the usually buoyant Mrs. Weisburd
lost her composure. Two of their regular dinner companions had recently
died, she told him, breaching a dam of tears.

Mrs. Cohen added, "I cried so bitterly - more than I did for my
husband."

Why, Mrs. Sachs asked, "do they send buses of psychologists
<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto
pics/psychology_and_psychologists/index.html?inline=nyt-classifier>  to
a high school every time there's a tragedy," but here, where death is
constant, "there's only a brief memorial service and cookies?"

Dr. Agronin talked to them about accumulated grief, how one death
re-opens others, how they had held themselves together for their
families' sake. He said grief is part of the human condition, not a
psychiatric problem.

"You are doing exactly what you should be doing: talking to other
people," he reassured them. "But maybe we need to do that more
deliberately."

So a new therapy group was born.

http://www.nytimes.com/2011/05/01/us/01elderly.html?emc=eta1

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