The following is the Needs Statement of a boilerplate grant proposal composed for Grant Writing for Non-Profits, a UCSD Extension program.
Resounding Joy developed Mindful Music, its music therapy program, in response to the silent cries of a suffering demographic of San Diegans: seniors in long-term care. “The single most significant change in US population demographics over the past 50 years is the aging of the population,” Doctors Thakar and Blazer write concerning the plight of aging Americans confined to assisted living facilities. San Diego is getting older too. The Union Tribune reported in 2016 that, according to census data, 13.1 percent of San Diego County was 65 or older in 2015. In the year 2050, one in five San Diegans will be 65 or older. Across our nation, the trend is even more accelerated; by 2050, the elderly will number 88.5 million. Going into the next quarter of the century, over 70% of Americans older than 65 will need long-term care.
For San Diegans in long-term care, a host of factors contribute to daily suffering. Physically, seniors face challenge of coping with fading memories. An estimated 50.4% of nursing home patients experience memory loss, suffering from Alzheimer’s, which on average is responsible for 93,541 mortalities in a year, according to 2014 CDC statistics. Memories disappear, but as they do, patients’ fear of death does not. Many patients in long-term care are losing their memory and simultaneously living with the shadow of stroke: the leading cause of adult disability, the second most prevalent cause of dementia and the third biggest killer of all Americans. Every 53 seconds someone is dying from a stroke.
Seniors who live with family members or spouses may fight the same battles as those in assisted living do, their loved ones watching as the person they knew ebbs, their risk of death by stroke and a host of other ailments increasing with each passing day. Residents of long-term care facilities, however, are commonly preyed upon by another demon too: depression.
“Right now, the overwhelming majority of Medicare expenditures and provider attention in post-acute settings go toward medical, as opposed to mental health conditions,” writes Dr. Richard Junman concerning the dearth of resources living homes and rehabilitation facilities encounter in caring for their patients. “Staff members who have not received adequate training in mental health are frequently overwhelmed by the challenges that residents may present.”
This revelation invites chilling questions:
How many long-term care patients are suffering from depression?
To what degree do they suffer each day from this malady of the spirit?
How do care providers recognize depression in patients who lack the cognitive functions to articulate a soul in agony?
Dr. Mugdha Thakur and Dr. Dan G. Blazer explored this burgeoning mental health crisis in a 2008 article featured in JAMDA entitled “Depression in Long-Term Care.” Their findings are striking; Thakur and Blazer report that “up to 35% of residents in long-term care facilities may experience either major depression or clinically significant depressive symptoms.” Living in a public facility without friends or family, and for some patients without the ability to think or communicate as they once did, is isolating, and catastrophic to mental health. Visits are rare; 40% of long-term care residents, who are generally low-income seniors, receive visitors once a week or even less.
“Depressive disorders are widely prevalent in nursing homes, contributing substantially to disability in this frail population, and yet are often overlooked,” Mugdha and Thakar write. Their analysis illuminates the devastating hold depression has over an already struggling population, and the urgent need for more attention to the hidden wars seniors wage each day. Sadly, the two researchers go on to discuss how the symptoms of depression often go unrecognized. They theorize that two factors contribute:
1) Depression is, in many cases, not the primary focus of physicians and nursing personnel caring for residents.
2) Depression tends to accompany severe diseases and conditions, and thus possibly is cloaked by the coincidence of the two ailments.
The agents Mugdha and Thakar describe in concealing residents’ depression are sobering realities: one the practicality of medical doctors lacking mental health training, and the other the inevitability of disease and the body’s failure.
Depression in long-term care clients is vicious, widespread, in some cases undetectable.
What hope is there, then?
Jules Rosen, MD, writes of such a hope in his article “A Doctor’s View: Depression in Long-Term Care Residents.” Rosen researched possibilities for how depression in residential homes could be alleviated. His results do not align with the traditional approach of pharmacotherapy. Rather, Rosen premised his study on a universal human insight:
“We…understand, intuitively, that recreation (“re-creation”) is essential for all of us, at any age and in all settings… Nursing-home placement interrupts these recreational opportunities.”
In Rosen’s study, his team of researchers hand-crafted “recreational opportunities” for residents. His goal? To recreate the authentic experiences of joy in long-term care patients which are far more common in the world outside of residential home confinement. His team interviewed patients, found what they loved to do, and organized a weekly activity which would fulfill these wishes. Theater, watching football, and especially music consisted of the activities. Rosen describes the resulting effect on seniors as follows:
“The residents who recovered were more likely to indicate, prior to the intervention, that the environment in the nursing home did not meet their social needs. Following successful intervention, they reported that their social needs were adequately met.”
Patients in long-term care suffer from isolation, depression and severe mental and physical disabilities and lack a social, recreational catharsis to combat these demons.
Mindful Music invokes a life-changing euphoria essential to the mental health of seniors, a portion of our society experiencing rapid growth.
A people who, one day, we are all destined to become.
Richard Freeland 