Care model for more than just medical condition needed in long-term care (McKnight’s LTC News)

Posted by Dr. El - September 20, 2013 - Depression/Mental illness/Substance Abuse, Transitions in care - No Comments

Here’s my latest article on McKnight’s Long-Term Care News:


Care model for more than just medical condition needed in long-term care

Of the most efficient countries for healthcare, the United States ranks second in healthcare costs per capita but 46th in efficiency (out of the 48 countries ranked!). The move from a biomedical to a biopsychosocial model of healthcare might be able to change that.

Consider the following scenario: Estelle’s fall at home sent her to the hospital. She was diagnosed with a hip fracture and diabetes and transferred to the nursing home for short-term rehab. A biomedical model would treat both conditions and send her home again. A biopsychosocial model would also address her need to make dietary changes, her fears of falling again, the alcoholism that contributed to both her diabetes and her fall, and her noncompliance with the rehab staff.

From biomedical to biopsychosocial

In her American Psychological Association presidential address, psychologist Suzanne Bennett Johnson discussed the change from a biomedical model of care to a biopsychosocial model of healthcare. The biomedical model of care that has “dominated Western medicine … for over 100 years” focuses solely on biologic factors to understand illness. It’s resulted in cures for infectious illnesses such as tuberculosis, pneumonia, and influenza, and increased life expectancy from 49 years in 1901 to 77 years in 2001. The biomedical model has been a great success in many respects.

As Johnson points out, however, “while infectious disease was the leading cause of death in 1900, today most Americans die of chronic disease: heart disease, cancer, chronic lower respiratory diseases, and stroke.”

Underlying these diseases are behaviors such as smoking, poor dietary habits, sedentary behavior, and substance abuse. In addition, she notes, “as many as 40% of medical patients are co-morbid for a mental health disorder and as many as 75% of seriously mentally ill patients are co-morbid for a physical health disorder.”

Implications for LTC

Clearly, in order to reduce chronic disease in this country (and to decrease medical costs), we need to address the behaviors – the psychological and social factors — underlying the diseases. But we work with elders, you might say, the damage caused by years of poor self-care has already been done! Perhaps.

But as a psychologist talking with seniors over the years, I’ve found that many of my lovely old dogs were ready for new tricks. We need to intervene, however, in certain key ways:

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Care model for more than just medical condition needed in long-term care