Gerontological Nursing Assessment Quiz

Ebersole and Hess' Gerontological Nursing & Healthy Aging in Canada 3rd Edition

• This is a gerontological nursing textbook, focusing on Canada.
• It was published in 2023.
• The authors are Veronique Boscart, Lynn McCleary, Linda Sheiban Taucar, Theris A. Touhy, and Kathleen Jett.

Chapter 23: Mental Health and Wellness in Later Life

• Mental health is defined by the WHO as a state of well-being where individuals realize potential, manage life stresses, work productively, and contribute to their communities.
• Stress is the internal state accompanying threats to oneself. Healthy stress can be motivating for growth, whereas overload diminishes coping ability.
• Stress tolerance is variable, depending on current stressors, coping ability, and ongoing stress.
• One in three Canadians experiences mental illness at some point in their lives.
• Mental disorders in older adults increase healthcare costs.
• Up to 30% of older adults experience mental illness, with anxiety, severe cognitive impairment, mood disorders, and alcohol abuse/dependence among the most prevalent problems.
• Cultural and ethnic disparities impact mental health.
• Lack of knowledge about cultural differences and mental health concerns, lack of culturally competent treatment, and limited research create barriers.
• Barriers to accessing services include cultural beliefs, lack of culturally appropriate services, lack of services in the older person's language, lack of awareness of services, and ageism.
• Approximately 400,000 older adults self-identify as members of the LGBTQ2 community.
• Stigma associated with sexual orientations (other than heterosexual) persisted in society and older adults often had to hide their orientations.
• Most Indigenous older adults experience significant trauma, particularly from residential school experiences.
• Those in long-term care facilities who have moved away from family and community can experience social isolation.

Learning Objectives (1 of 2)

• Discuss factors contributing to mental health and wellness in later life.
• List symptoms of late-life anxiety and depression, and discuss assessment, treatment, and nursing interventions.
• Recognize older adults at suicide risk, and use appropriate techniques for suicide prevention, assessment, and intervention.
• Specify several indications of substance abuse disorder in older adults and discuss appropriate nursing responses.

Learning Objectives (2 of 2)

• Recognize signs of problem gambling and use appropriate techniques to screen for it.
• Provide culturally safe and competent mental health care to older adults.
• Evaluate interventions aimed at promoting mental health and well-being in older adults.

Mental Health and Mental Disorder in Later Life

• Mental health is vital to well-being.

Mental Health Care

• Mental illness affects many Canadians, increasing the demand for health services for the elderly.

Cultural Disparities

• Cultural differences and beliefs about mental health may create barriers to access and understanding.

LGBTQ2 Older Adults

• Sexual orientation is associated with social stigma and barriers.

Indigenous Older Adults

• Indigenous older adults often have experienced trauma from historical and current injustices in society.

Assessment and Mental Illness

• Assessment of mental status includes examining appearance, cognitive function, and functional abilities, while also considering anxiety, adjustment, reactions, depression, substance abuse, and suicidal risk.

Anxiety Disorders

• Anxiety is a normal human reaction. It becomes problematic when prolonged and exaggerated, interfering with function.
• 11% of older adults experience anxiety disorders, which may include GAD, phobic disorder, obsessive-compulsive disorder, panic disorder and PTSD.
• Gerontological nurses must assess physical, social, and environmental factors along with past life history and recent events, to consider when evaluating anxiety.

Implications for Gerontological Nursing and Healthy Aging

• Anxiety in older adults often leads to more visits and longer consultations with primary care physicians, and includes an assessment of physical, social and environmental factors along with past life history and recent events.
• Treatment for anxiety disorders may include non-pharmacological interventions like cognitive behavioural therapy (CBT) in individual or group formats, aiming to modify thought patterns, improve skills, and alter the environmental factors, and relaxation training, and/or cognitive restructuring.
• Pharmacological interventions with consideration for antidepressants (SSRIs), short-acting benzodiazepines, and nonbenzodiazepine anxiolytics can also be helpful.

Other Anxiety Disorders

• Discuss Obsessive-Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD) symptoms and interventions.

Psychosis and Paranoia

• Psychosis is a constellation of psychotic symptoms observed in a number of disorders; its symptoms mainly include hallucinations and delusions.
• Paranoid symptoms in older adults are attributed to social isolation, sensory loss, physical conditions, cognitive impairment, and polypharmacy.
• Paranoia can manifest as a feeling of loss of control, inability to evaluate the social situation appropriately, and the feeling that external forces control their lives.

Delusions

• Delusions are fixed false beliefs not shared by others, which guide the individual's interpretation of life events.
• Common delusions among older adults involve being poisoned, having assets stolen, being held prisoner, or being deceived by a spouse or partner.

Hallucinations

• Hallucinations involve sensory perceptions of nonexistent objects.
• Psychotic disorders are often less common among older adults, and when they do occur can be linked to dementia, Parkinson's disease, medical conditions, and medications.

Schizophrenia

• Schizophrenia is a severe mental disorder diagnosed through the presence and persistence of two or more of these behaviours: delusions, hallucinations, disorganized thinking, disorganized or catatonic behavior, affective flattening, poverty of speech, and apathy.

Bipolar Disorder and Mania

• Bipolar disorder is less common in later life, but with increased numbers of older adults, the frequency is increasing.
• The disorder is characterized by periods of mania and depression, with longer periods of depression frequently observed in older individuals.
• Medical problems can potentially trigger the disorder.

Depression

• Depression is not a normal part of aging.
• It's the most common mental health problem for older adults, and is frequently under-diagnosed and under-treated, and may involve factors including health, gender, developmental needs, socioeconomics, environment, personality, losses and functional decline.
• Biological aspects like neurotransmitter imbalances and endocrine dysregulation can contribute to depression.
• Common somatic complaints like insomnia, appetite loss, weight loss, and memory problems may be associated with depression in older adults.

Implications for Gerontological Nursing and Healthy Aging (1 of 2)

• Assessment in older adults for depression includes a thorough evaluation, interviewing, history taking, and conducting physical, functional, and cognitive assessments.
• Considerations include laboratory tests, medication reviews, identifying iatrogenic or medical causes, and family interviews.

Implications for Gerontological Nursing and Healthy Aging (2 of 2)

• Interventions include pharmacotherapy, psychotherapy, psychosocial interventions, and electroconvulsive therapy (ECT).

Suicide

• Suicidal behaviour among older adults is often more lethal (e.g., hanging, poisoning and firearms) compared to younger adults.
• Older adults experiencing depression are at a higher risk for suicide compared to those without mental health diagnosis.
• Suicide in older adults may present with somatic symptoms; this could mask underlying suicidal intent and hinder detection by primary care physicians.

Implications for Gerontological Nursing and Healthy Aging (Suicide Assessment)

• Establishing trust and rapport is important for accurate assessment.
• Using direct, probing questions (e.g., "Have you considered killing yourself?") is beneficial.
• Hospitalization is recommended for high-risk patients and out-patient care with social support structures for moderate risk.

Substance Use Disorders: Alcohol (1 of 2)

• Problem drinking is the most common substance use disorder.
• Alcohol use can complicate diagnosis and treatment of other chronic conditions both as a causal and presenting feature.
• Men abuse alcohol at a significantly higher rate than women.
• Alcohol use disorder in women may go undiagnosed and undetected until the consequences become severe.

Substance Use Disorders: Alcohol (2 of 2)

• Alcohol interacts with many prescription medications, with significant effects on medication efficacy, and often in harmful ways.
• Age-related changes in how the body absorbs, distributes, and metabolizes alcohol can lead to higher blood alcohol levels in older adults.
• Reduced liver and kidney function in older adults can slow the metabolism and elimination of alcohol leading to potential complications.
• Ulcers and bleeding may be more likely among older adults who abuse alcohol.

Other Substances

• Illicit drug use does not necessarily indicate a substance use disorder.
• Problematic use occurs when the use interferes with health, responsibilities, relationships, or safety.
• Medication misuse is defined as using medication for reasons other than the prescribed use.
• Intentional or unintentional medication misuse is common in older adults.

Implications for Gerontological Nursing and Healthy Aging (Substance Use Assessment (1 of 2))

• Assessment involving comprehensive medical history, physical examination, cognitive assessment, functional assessment, medication review and screening for alcohol use and depression is necessary.

Implications for Gerontological Nursing and Healthy Aging (Substance Use Assessment (2 of 2))

• Nurses should educate older adults about safe alcohol consumption and harmful effects.
• Supportive and non-judgemental approach is key for therapeutic communication.
• Detoxification for alcohol withdrawal often needs inpatient care to address potential medical complications from extended or severe withdrawal symptoms.

Problem Gambling

• Problem gambling interferes with work, school, other activities, mental and physical health, finances, reputation, and family and social relationships.

Implications for Gerontological Nursing and Healthy Aging (Problem Gambling Assessment & Interventions)

• A non-judgmental approach is crucial for assessment.
• Screening for problem gambling can be incorporated into evaluating recreation, leisure activities, and financial well-being.
• Public education campaigns and creating awareness about problem gambling in older adults can help prevent and address the issue.
• Educational resources like the "Betting on Older Adults: A Problem Gambling Awareness Kit" can contribute to prevention, early identification, and early treatment.

Test your knowledge on key assessments and interventions in gerontological nursing. This quiz covers topics including mental health issues, alcohol use, and the importance of screening for conditions like depression and problem gambling in older adults. Enhance your understanding of critical aspects related to elderly care.