Editorial| Volume 19, ISSUE 12, P1033-1034, December 2018

Psychosocial Care Is Basic, Improves Medical Outcomes, and Can Be Taught—But Must Be Better Understood

      A few years back, I was part of research team collecting data in a nursing home from residents, staff, and family members for a study about end-of-life care. Most of the residents in the study were older adults in the late stages of advanced chronic illness. On this particular day, after collecting data in the morning, I took a break and plopped down on a lounge chair in front of the TV alongside half a dozen residents at various stages of listening to the Maury Povitch show. Two men railed at the TV from their wheelchairs. One waved a fisted arm at the TV and the other shouted at the teenagers who were being chastised by Mr. Povitch for their weak work ethic. When the commercial came, the two men calmed down and continued exchanging comments about “kids these days.” One of the men looked past a fellow resident dozing in her wheelchair at me and asked what I was doing there. I told him I was from the university there to talk with people and collect information about their experiences. “Experiences about what?” he wanted to know. I replied, “I'm here to find out about how we can improve the experience as the end of life approaches.” He looked bewildered and replied to his buddy, loud enough for me to hear, “Why do we have to be dying to have someone interested in improving our lives?” I received a similar response from a family member the following week. After she answered 30 minutes of questions for our end-of-life study, she wanted to know where I was two years before when her mother was first admitted during a medical crisis. “Seems odd there would be so much attention on her now that she is almost gone.” She had a point. And yet, the problem is not that we are paying too much attention to people at the end of their lives; instead, the problem is that we are not paying enough attention earlier in their lives, and specifically, we are not paying enough attention to psychosocial issues. Articles in this issue of JAMDA are part of an effort to address a variety of psychosocial concerns at different points in the lived experience, and to push the field forward in important ways.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Vourlekis B.
        • Zlotnik J.L.
        • Simons K.
        Toward quality psychosocial care and its measurement: A report to the profession and blueprint for action.
        (Institute for Advancement in Social Work Research, National Association of Social Workers)2005 (Available at:) (Accessed October 5, 2018)
        • Welsh T.J.
        • Gordon A.L.
        • Gladman J.R.
        Comprehensive geriatric assessment—A guide for the non-specialist.
        Int J Clin Pract. 2014; 68: 290-293
        • Nazir A.
        • Unrue K.
        • Tegeler M.
        • et al.
        Systematic review of interdisciplinary interventions in nursing homes.
        J Am Med Dir Assoc. 2013; 14: 471-478
        • Abbott K.M.
        • Heid A.
        • Kleban M.
        • et al.
        The change in nursing home residents’ preferences over time.
        J Am Med Dir Assoc. 2018; 19: 1092-1098
        • Koren M.J.
        Person-centered care for nursing home residents: The culture-change movement.
        Health Aff (Millwood). 2010; 29: 312-317
        • Sloane P.D.
        • Hoeffer B.
        • Mitchell C.M.
        • et al.
        Effect of person-centered showering and the towel bath on bathing-associated aggression, agitation, and discomfort in nursing home residents with dementia: A randomized, controlled trial.
        J Am Geriatr Soc. 2004; 52: 1795-1804
        • Zimmerman S.
        • Sloane P.D.
        • Cohen L.W.
        • Barrick A.L.
        Changing the culture of mouth care: Mouth care without a battle.
        Gerontologist. 2014; 54: S25-S34
        • Berkman L.F.
        • Syme S.L.
        Social networks, host resistance, and mortality: A nine-year follow-up study of Alameda County residents.
        Am J Epidemiol. 1979; 109: 186-204
        • Yamada M.
        • Hidenori A.
        Social frailty predicts incident disability and mortality among community-dwelling Japanese older adults.
        J Am Med Dir Assoc. 2018; 19: 1099-1103
        • García-Casares N.
        • Martin-Colom J.E.
        • García-Arnés J.A.
        Music therapy in Parkinson’s disease.
        J Am Med Dir Assoc. 2018; 19: 1054-1062
        • Szlejf C.
        • Suemoto C.K.
        • Brunoni A.R.
        • et al.
        Depression is associated with sarcopenia due to low muscle strength: Results from the ELSA-Brasil study.
        J Am Med Dir Assoc. 2018; (This issue)
      1. The Chinese Text Project, Confucius, The Analects. Available at: Accessed October 5, 2018.

        • Cen X.
        • Li Y.
        • Hasselberg M.
        • et al.
        Aggressive behaviors among nursing home residents: Association with dementia and behavioral health disorders.
        J Am Med Dir Assoc. 2018; 19: 1104-1109
        • Volicer L.
        • Galik E.
        Agitation and aggression are 2 different syndromes in persons with dementia.
        J Am Med Dir Assoc. 2018; 19: 1035-1038
        • Leontjevas R.
        • Fredrix L.
        • Smalbrugge M.
        • et al.
        Bayesian analyses showed more evidence for apathy than for depression being associated with cognitive functioning in nursing home residents.
        J Am Med Dir Assoc. 2018; 19: 1110-1117
        • Guion V.
        • de Souto Barreto P.
        • Sourdet S.
        • Rolland Y.
        Effect of an educational and organizational intervention on pain in nursing homes residents: A non-randomized controlled trial.
        J Am Med Dir Assoc. 2018; 19: 1118-1123
        • Shaw C.
        • Williams K.N.
        • Perkhounkova Y.
        Educating nursing home staff in dementia sensitive communication: Impact on antipsychotic medication use.
        J Am Med Dir Assoc. 2018; 19: 1129-1132
        • Kolanowski A.
        • Fortinsky R.H.
        • Calkins M.
        • et al.
        Advancing research on care needs and supportive approaches for persons with dementia: Recommendations and rationale.
        J Am Med Dir Assoc. 2018; 19: 1047-1053