Mental Health and Older Adults PDF

MENTAL HEALTH AND OLDER ADULTS Common Mental Illnesses experienced by Older Adults including anxiety, psychosis, depression and substance use disorder Learning Objectives List symptoms, assessments, pathology, treatments and nursing interventions for common mental illnesses in older a...

MENTAL HEALTH AND OLDER ADULTS Common Mental Illnesses experienced by Older Adults including anxiety, psychosis, depression and substance use disorder Learning Objectives List symptoms, assessments, pathology, treatments and nursing interventions for common mental illnesses in older adulthood Anxiety, Psychosis, and substance use disorder Discussing coping mechanisms and supports for older adults. Link to CAMH Mental Health and Older Adult Video Series  WHAT IS THE DIFFERENCE BETWEEN MENTAL HEALTH AND MENTAL ILLNESS? ARE THEY THE SAME THING? Mental Health and Mental Disorder in Later Life According to the World Health Organization (WHO, 2018), mental health is “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” Stress and Stressors The experience of stress is an internal state accompanying threats to oneself. Healthy stress levels motivate one toward growth. Stress overload diminishes one’s ability to cope e^ectively. Stress Tolerance is variable and based on current and ongoing stressors, as well as coping ability. 23-2 Mental Health Care One in three Canadians experiences mental illness at some time in their lives. Mental disorders are associated with increased use of health care resources and overall costs of care for older Canadians. Up to 30% of older adults will experience a mental illness. The most prevalent mental health problems are: Anxiety Severe cognitive impairment Mood disorders Alcohol abuse and dependence 23-3 Assessment of Social Supports Considers an individual’s surrounding network of signibcant others, friends, and family and their ability to provide companionship and assistance in times of need Social Network and Support Scale (IMIASS-SNSS) has shown to be useful Focuses on the emotional support and feelings of usefulness provided by the four cited types of social ties (friends, family members, children, and partner) 13-8  Caregiver Burden This assessment is vital to prevent potential family burnout and elder abuse. Caregiver Strain Index (CSI) is frequently used. It measures strain related to care provision within the domains of employment, bnancial, physical, social, and time. inrelationtostress 13-9  The most commonly used tools related to safety consist of lists of potential dangers and the status of the danger (present or absent) and provide suggestions or opportunities for planning to reduce the potential dangers. Environmental and Safety Assessment In addition to falls risks, safety issues such as the following should be considered: Problems Vision or Crime and Fire hazards Poisoning with hearing victimization temperature impairments 13-10 Integrated Assessment Tools – OARS The most well-known integrated assessment tool is the Older American’s Resources and Services (OARS) This was taken into consideration when the MDS was developed. OARS evaluates the ability, disability, and capacity level at which the person is able to function. Five subscales include: 1. Social resources 2. Economic resources 3. Mental health 4. Physical health 5. Ability to perform ADLs 13-11 Integrated Assessment Tool – Fulmer SPICES Fulmer SPICES is useful as an overall assessment tool in any setting. SPICES stands for six common syndromes of the older person that require nursing interventions: Sleep disorders Problems with eating or feeding Incontinence Confusion Evidence of falls Skin breakdown Several of these domains can be further assessed using more specibc tools once noted. 13-12  Case Study: Emily Emily Williams is a 74-year-old, retired teacher. She lived with her husband Joe. Joe and Emily had one son who was killed in a car accident 10 years ago. They have a daughter-in-law, Camelia, who is a nurse, and a grandson Joey. Emily has experienced a lot of changes this past year. Joe was hospitalized for COPD and he became more concerned about Emily as she has been experiencing frequent memory lapses. They were able to get an apartment in an assisted living facility. Joe noticed Emily wandering so he was barricading the door with furniture to keep Emily from leaving their apartment. Neither of them could drive. 3 months later, Joe passed away. Emily became more confused and cried frequently. She was often found wandering looking for Joe. She was not eating well, refused to bathe, and had lost weight. The nurse at the assisted living home felt that Emily no longer met their criteria and needed to move to a long-term care home with a higher level of care in a skilled nursing facility. Another 4 months later, Emily has been in the long-term care home for 2 months. She is even more confused and wanders into other residents’ rooms looking for Joe and stealing items. She recently began striking out at other residents and the sta^ found food stashed under her mattress. She continues to refuse bathing and has urinary incontinence in her sleep. She is taking 2 antidepressant medications, an anti- anxiety medication and Aricept (for symptoms of Alzheimer’s like memory loss and confusion) but there has been no improvement. You are Emily’s Nurse. USE SPICES to review Emily’s care plan. What are your recommendations? Cultural and Ethnic Disparities Lack of knowledge and awareness of cultural di^erences about meaning of mental health Di^erences in the way concerns may present Lack of culturally competent mental health treatment Limited research 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 Ageism 23-4  LGBTQ2 Older Adults Approximately 400,000 older adults self-identify as members of the lesbian, gay, bisexual, transgender, queer or questioning, and Two-Spirit (LGBTQ2) community. Sexual identities other than heterosexuality have not always been accepted in society, and many older adults who identify as LGBTQ2 were stigmatized or felt the need to hide their sexual orientation to prevent discrimination. Sexual orientation was thought of as a mental illness and was not protected under the Canadian Charter of Rights and Freedoms until 1996. 23-5 Indigenous Older Adults Most Indigenous older adults have experienced severe trauma in their lives. Feelings of anxiety and depression stem from residential school experiences build on previous trauma of injustice and oppression. Many Indigenous people are cared for in the community; those who move into LTC homes away from their community may experience social isolation. 23-6 TAKE 5: BREAK TIME IT’S KAHOOT TIME Mental Status Assessment As people age, there is an increased rate of illnesses a^ecting the person’s cognition. Cognitive ability is easily threatened by any disturbance in health. Cognitive Measures: Mini-Mental State Exam (MMSE) Clock Drawing Test Mini-Cog MoCA Screening Cognitive Performance Scale (CPS and CPS2) Confusion Assessment Method Delirium Index (DI)  Includes a Mental Status Exam and Holistic Assessment: Observation of appearance Assessment Behaviour and examination of cognitive function Functional abilities and Mental Anxiety Adjustment Illness Reactions Depression Substance abuse Suicidal risk 23-7  Should be evaluated separately from cognition Often used to screen for the absence or Mood presence of depression Measures Persons with untreated depression are more functionally impaired and will have prolonged hospitalizations, lower quality of life, and shortened length of life. Geriatric Depression Commonly used measures Scale include: Cornell Scale for Depression in Dementia Anxiety Disorders Anxiety disorders are debned as unpleasant and unwarranted feelings of apprehension, which may be accompanied by physical symptoms. Anxiety is a normal human reaction and part of the fear response; it is rational, within reason. It becomes problematic when it is prolonged and exaggerated and begins to interfere with function. About 11% of older persons experience anxiety. Anxiety disorders that may occur in older people include: General Anxiety Disorder (GAD) Phobic Disorder Obsessive-Compulsive Disorder Panic Disorder Post-Traumatic Stress Disorder (PTSD) 23-8 Implications for Gerontological Nursing and Healthy Aging Assessment Anxiety in older adults is associated with more visits to primary care providers and an increase in the average length of visits Focuses on physical, social, and environmental factors, as well as past life history and recent events Factors That Reduce the Chances of Seeking Help for and Recognizing Anxiety 1. Stigmatization of mental illness; discomfort when talking to health care providers about anxiety 2. Attribution of psychological symptoms to physical causes 3. Nonrecognition of the impact of symptoms on daily life and functioning 4. Labels and words that are used to describe anxiety (e.g., “worry,” as opposed to “concerns” or “issues”) 5. Ageist attitudes and beliefs 6. Pessimism about treatment e^ectiveness 7. Diagnostic dinculties 8. Time constraints in primary care settings 23-9  Interventions for Anxiety Treatment choices depend on the symptoms, specibc anxiety diagnosis, comorbid medical conditions, and current medication regimen. Nonpharmacological interventions are preferred, and are often used in conjunction with medication. Cognitive behavioural therapy (CBT) Individual or group formats Designed to modify thought patterns, improve skills, and alter the environmental states that contribute to anxiety May involve relaxation training and cognitive restructuring, and education about signs and symptoms of anxiety Pharmacological interventions Antidepressants (SSRIs) Short-acting benzodiazepines (alprazolam, lorazepam ) Nonbenzodiazepine anxiolytic agents (buspirone) 23-10 Other Anxiety Disorders Obsessive Compulsive Disorder Recurrent and persistent thoughts, impulses, or images (obsessions) that are repetitive, purposeful, and intentional urges Ritualistic behaviours (compulsions) that improve comfort level, but are recognized as excessive and unreasonable Post-Traumatic Stress Disorder Development of symptoms after a traumatic event Involves experiencing, witnessing, or unexpectedly hearing about actual or threatened death or serious injury to oneself or another closely anliated person 23-11 Psychosis and Paranoia Psychosis A syndrome or constellation of psychiatric symptoms that occur in a number of physical and mental disorders. Predominating symptoms include hallucinations and delusions. Risk factors for psychosis in older persons are social isolation, sensory debcits, physical illness, cognitive impairment, and polypharmacy. Paranoia This is sometimes induced by alcoholism or medications; hearing impairment may accentuate feelings. Fear and a lack of trust based in reality may become magnibed. The dynamics of paranoia seem to be loss of control, inability to evaluate the social milieu appropriately, and the feeling of external forces controlling one’s life, which in many instances may be true. 23-12  Beliefs that guide one’s interpretation of events and help make sense of disorder May be comforting or threatening, but they form structure for understanding situations that might seem unmanageable Delusions Conceivable ideas, without foundation in fact, persisting for more than one month False bxed beliefs that are not shared by others and that guide the person’s interpretation of events Common delusions of older adults: being poisoned, children taking their assets, being held prisoner, or deceit by a spouse or lover. 23-13  Hallucinations are sensory perceptions of a nonexistent object and may be in relation to any of the bve senses. Hallucination Hallucinations arising from psychotic disorders are less common among s older adults. Many hallucinations are associated with disorders such as dementia, Parkinson’s disease, physiological and sensory disorders, and medications. 23-14 Schizophrenia A severe mental disorder characterized by two or more of the following symptoms: Delusions Hallucinations Disorganized thinking Disorganized or catatonic behaviour A^ective oattening Poverty of speech Apathy 23-15 Bipolar Disorder and Mania Bipolar disorder is not common in later life, but with the growing numbers of older adults, more cases will be seen. Characterized by periods of mania and depression Often levels out in late life; individuals tend to have longer periods of depression Frequent relapses may occur with aging and may be precipitated by medical problems 23-16  Substance Use Disorders: Alcohol The most common type of substance-use disorder is problem drinking. It can often go unrecognized, although the residual e^ects of alcohol abuse complicate the presentation and treatment of many chronic disorders. Gender Issues Men are four times more likely to abuse alcohol than women. Women of all ages are signibcantly more vulnerable to the e^ects of alcohol misuse. Often, alcohol abuse in women is undetected until the consequences are severe. Medication E^ects Alcohol interacts with at least 50% of prescription medications. Analgesics, antibiotics, antidepressants, benzodiazepines, H 2 receptor blockers, nonsteroidal anti- inoammatory drugs (NSAIDs), and herbal medications Diminishes the e^ects of oral hypoglycemics, anticoagulants, and anticonvulsants Physiology Older people develop higher blood alcohol levels because of age-related changes that alter absorption and distribution of alcohol. Reduced liver and kidney function slow alcohol metabolism and elimination. Risks of gastrointestinal ulceration and bleeding may be higher in older adults. 23-22  Illicit Drugs Use of illicit drugs does not mean that the person has a substance use disorder. Problematic illicit drug use is present Other when it interferes with health, functioning, relationships, responsibilities, or safety. Substances Prescription and Over-the- Counter (OTC) Medications Medication misuse is debned as use of a medication for reasons other than those for which it was prescribed. Most older adults who misuse medications do so unintentionally. 23-24  Assessment Comprehensive medical history Physical exam Cognitive assessment Functional assessment Review of medications Screening for alcohol use and depression Implications Alcohol for Nurses should share information with older adults about safe drinking and the deleterious e^ects of alcohol. Gerontological A caring and supportive approach that provides a safe and open atmosphere is the foundation for the Nursing and therapeutic relationship. Healthy Aging Acute alcohol withdrawal Withdrawal can become a life-threatening emergency. Detoxibcation should be done in an inpatient setting because of the potential medical complications and because withdrawal symptoms in older persons can be prolonged. Delirium tremens (DT) is the term used to describe alcohol withdrawal delirium. 23-25 Problem Gambling Problem gambling: 1. Interferes with work, school, or other activities 2. Harms mental or physical health 3. Hurts the person bnancially 4. Damages the person’s reputation 5. Causes problems with family or social relationships 24-37  Implications for Gerontological Nursing and Healthy Aging Assessmen A non-judgmental approach is important. Screening for problem gambling can be integrated into t the assessment of recreation and leisure activities and assessment of bnancial well-being. Public education and increased public awareness of Interventio problem gambling contributes to prevention, early identibcation, and earlier treatment of gambling. ns A good educational tool is Betting on Older Adults: A Problem Gambling Awareness Kit. 23-28  PAPER DUE MAR 20 AT 2100 SEMINAR 4 – Relational approach to collaborative patient-centered care planning with older adults with cognitive change and their care partners (even numbered seminars) NEXT WEEK: DEMENTIA CARE SURVEY SAYS… Midterm Check In