Intersection of Positive Psychology and Geriatrics

Editor’s Note: This is the first article for PositivePsychologyNews.com by Diana Boufford. She presented the idea of Comprehensive Geriatric Fitness at the 7th Biennial International Meaning Conference in Toronto in July 2012. We invited her to write about this idea using her experiences working with elders and their caregivers. Diana plans a separate article for each of the 5 nodes in the CGT picture below.

In his book, Flourish, Martin Seligman describes the Comprehensive Soldier Fitness initiative, an effort to take the basic ideas of positive psychology and adapt them to the needs of soldiers. I contend that we could use the same approach to adapt positive psychology interventions to the needs of elders and their caregivers, achieving a significant contribution to the quality of life of this growing part of our population. Perhaps we could think of this as the Comprehensive Geriatric Fitness initiative.

Comprehensive Soldier Fitness

First let’s review what went into Comprehensive Soldier Fitness. In 2008 General George Casey, a former commander of the force in Iraq, approached Dr. Seligman with the concern that the United States had one of the most physically fit and resource rich armies in the world, but the same army was experiencing record high rates of psychological distress including post traumatic stress disorder (PTSD), depression, addictions, familial discord, and divorce. According to Seligman, General Casey stated “I want to create an army that is just as psychologically fit as it is physically fit,” and “The key to psychological fitness is resilience, and from here on, resilience will be taught and measured throughout the United States Army.”

Following these instructions, Seligman focused on building resilience training into the culture of the U.S. Army. He contended that resilience skills could be taught and that doing so could prevent not only PTSD but also many of the other mental health challenges that afflicted military personnel.

Generalized Assessment Tool

As part of this initiative, Nansook Park and the late Chris Peterson worked with Colonel Carl Castro and a group of 10 test makers both military and civilian to develop the Global Assessment Tool (GAT). This self-report questionnaire measures a soldier’s well-being and strengths in five domains of functioning:

• Familial
• Spiritual
• Emotional
• Social
• Physical

Using questions with scales such as “Very dissatisfied” to “Very satisfied” and “Not at all like me” to “Very much like me,” the questionnaire explores the soldier’s strengths, weaknesses, challenges, positives, and negatives in response to challenges and opportunities of army life in these 4 domains. Soldiers receive reports describing both the aspects of their lives that are functioning well and the areas that may be contributing to suffering, along with suggestions for ameliorating them. They are then provided with education and support to strengthen themselves in each domain.

The GAT was rolled out in 2008 and is now mandatory for all U.S. Military personnel. Military civilians and family members are permitted to partake as well. A newsletter has been created to communicate ongoing support for this initiative across the military. This collaborative effort, does indeed change the culture not only in the military, but within the military family structure as well. For more information, see the Comprehensive Soldier Fitness: An Overview.

Wider Application?

I was born into a family of Canadian Air Force personnel. My father and grandfather both served in the Canadian Air Force, and my mother was a civilian employed by the Canadian military. We all lived on base and worked on base. I spent five years in the Canadian Army Reserves. I am familiar with the challenges that face so many soldiers going overseas and coming home. I know how this affects them and their families. I have also seen the incredible strength and resourcefulness that this challenging lifestyle can create. So when I read of these interventions I was very excited. I was happy to hear that these very salient and neglected aspects of a soldier’s humanity were being identified and addressed.

Taking the Idea to Another Population

Naturally, I started expanding my scope of thinking into my own line of work, and wondered how and if these ideas could be applied there.

I have committed over 10 years to working with the psychogeriatric population, typically people over the age of 65 who have been diagnosed with a serious mental illness, both in nursing homes and through a city hospital. I also serve as a psycho-geriatric social worker providing outreach into the community. I provide counseling to individuals, couples, and caregivers. The potential of improving the plight, the functioning, and the quality of life for both elders and their caregivers using a model similar to Comprehensive Soldier Fitness seems highly promising to me.

However, the assessment and training would have to be adjusted to meet the specific needs of these special elder and caregiver populations. For example changing the name to Comprehensive Geriatric Training is one adjustment. The screening tools and questions would have to be incorporated into the standard psychosocial assessments for elders and care-givers with a specific eye on strengths identification and use, building capabilities, and reinforcing resiliency.

What Needs to be Adapted for the Elder Population?

Although the environments and demands between soldiers and their families differ from elders and their families, the emotional challenges of coping are similar.

This leads me to ask:

• What if this model of assessment and intervention were to be applied to the geriatric, psycho-geriatric, and caregiver (familial and professional) populations?
   
• Could we teach people how to build upon their own resilience so that they would be better able cope and even thrive with the challenges of chronic illness, decreasing physical strengths, and diminishing cognitions, functioning, and mobility?
   
• Can the resiliency of the caregivers be strengthened and optimized to prevent burnout due to the over-taxing demands of caregiving?
   


    Taking a walk together

• Can the building of emotional fitness, familial fitness, social fitness and spiritual fitness stimulate inner resources to offset the aging challenges, to prevent isolation, and to reduce burnout so that elders and care providers continue to enjoy their lives and each other, despite the changes?
   
• Could we delay or lessen the severity of the chronic debilitation that occurs through the aging process or that occurs as a result of dementias?
   
• How would the quality of life be improved by focusing on building resilience and enhancing strengths as a central part of day-to-day life as opposed to focusing on the diseases, the limitations, the sufferings, and the losses?
   

These are some of the questions that occur to me as I look at bringing positive psychology into the field of psycho-geriatrics.

Conclusion

Comprehensive Soldier Fitness Training is a model of care which can be adapted with the eldercare population in mind. Elders, their family, and their caregivers can be assessed, prepared, and supported through the years of caring that come with advanced aging. Each of the five different domains of focus is important for them as well: physical, spiritual, emotional, familial and social. In future articles, I will explore ways of optimizing each area of geriatric fitness for elders themselves and for their care-givers.

References

Seligman, M. E. P. (2011). Flourish: A Visionary New Understanding of Happiness and Well-being. New York: Free Press.

Seligman, M. E. P. & Matthews, M. D. (Guest Eds.) (2011). Comprehensive Soldier Fitness: Special issue of American Psychologist, 66(1).

Contains articles by more than 25 psychologists and soldiers, including John and Julie Gottman, Nansook Park and Christopher Peterson, Karen Reivich, Barbara Fredrickson and Sarah Algoe, General Casey, General Kornum, and many others.

Comprehensive Soldier Fitness: An Overview

Comprehensive Solider & Family Fitness Newsletter – CSF2 Quarterly, Aug 2012..

CSF-Global Assessment Tool, entry in the US Army Blog

Reivich, K, & Shatté, A. (2002). The Resilience Factor: 7 Keys to Finding Your Inner Strength and Overcoming Life’s Hurdles. New York: Broadway Books.

CSF incorporates many of the concepts described in this book.

Images
A family that serves: 6 siblings in the US Army courtesy of the US Army

Diana with her mother used courtesy of Diana Boufford
CGT slide used courtesy of Diana Boufford

Taking a walk together courtesy of jseattle