Wednesday, June 11, 2014

Aging Family Members and Hidden Mental Health Issues

Associate Professor of Social Work Richard Francoeur first became interested in hidden mental health issues early in his career, as a medical social worker at a Veteran’s Administration hospital in Pennsylvania. He went on to compare the financial strain-related coping processes of patients over 65 who were undergoing outpatient palliative radiation for cancer with those of younger patients undergoing similar treatment.

Dr. Francoeur’s study revealed that older patients were more concerned about not having enough resources for the future, while younger patients were more concerned with difficulty meeting their current obligations. “Most screening for financial vulnerability and stress focus on present issues [like] paying bills,” says Dr. Francoeur, “so clinicians can miss older patients who are struggling, but who frame the issue differently.”

Similarly, in research with epidemiological data from an inner-city outpatient population receiving palliative care, Dr. Francoeur has found that screens for depression often miss older minority men. “Older adults are less likely to say that they feel sad, and yet they very much may be depressed even though they don’t use those kinds of terms,” Dr. Francoeur explains.

As an outgrowth of his work on hidden mental health issues, Dr. Francoeur’s research has more recently turned to symptom clusters. In his latest study, the experience of pain predicts depressive affect more strongly when pain occurred with fatigue and weakness or with sleeping difficulties, but only in patients reporting fever. When pain and either of these symptoms manifest together, interventions to relieve fever could reduce pain sensitivity and sickness malaise, which are concerns to multidisciplinary healthcare teams and smoking cessation programs.

Dr. Francoeur’s recent work has also focused on methodological advancement, in particular statistical innovations in moderated regression that make detecting and analyzing symptom clusters easier. Using his new methods, he plans next to look at symptom clusters in nonmalignant conditions that are related to the abuse of prescription drugs.

This piece appeared in the Erudition 2013 edition.