Mental health is the same later in life as it is earlier in life except that the challenges may be greater

Chapter 24

Mental Health

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  • Mental health is the same later in life as it is earlier in life except that the challenges may be greater
  • Interference can occur as a result of
  • Developmental transitions
  • Life events
  • Physical illness
  • Cognitive impairment
  • Situations calling for psychic energy

Mental Health Considerations

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  • Most older adults manage transitions and stressors through resilience, hardiness, and resourcefulness
  • Those who are not successful have
  • Lack of social supports
  • Accumulated stressors
  • Unresolved grief
  • Preexisting psychiatric illness
  • Cognitive impairment
  • Inadequate coping resources
  • Those most at risk have life transitions and a loss of social support

Mental Health Considerations (Cont.)

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  • Adults 55 years of age and older will experience mental health disorders that are not typically part of normal aging
  • Long-term consequences of military conflict
  • 20th century drug culture
  • Mental health disorders are typically underreported and not well researched, especially among racially and culturally diverse people

Mental Health Considerations (Cont.)

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  • Attitudes and beliefs: Older people are reluctant to seek help because
  • Pride of independence
  • Stoic acceptance of difficulty
  • Unawareness of resources
  • Fear of being “put away”
  • Health providers’ lack of knowledge
  • Culture
  • Availability of mental health care

Factors Influencing
Mental Health Care

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  • Wide range of settings, including
  • Acute and long-term inpatient psychiatric units
  • Primary care
  • Community and institutional settings
  • Residential care in long-term care
  • Must integrate mental health and substance abuse with other health services
  • In acute care, medical patients present with psychiatric disorders in 25% to 33% of cases

Mental Health Care Settings

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  • Shortage of trained personnel
  • Limited availability and access for psychiatric services
  • Lack of staff training related to mental health and mental illness
  • Inadequate Medicaid and Medicare reimbursement for mental health services

Barriers to Mental Health Care

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  • Anxiety is a normal human reaction and part of the fear response
  • When anxiety is prolonged, exaggerated, and interferes with function, a problem occurs
  • Anxiety disorders are not part of normal aging
  • Chronic illness, cognitive impairment, and emotional loss may contribute to anxiety
  • Types of anxiety disorders include generalized anxiety disorder, phobic disorder, obsessive-compulsive disorder (OCD), panic disorder, and posttraumatic stress disorder (PTSD)

Anxiety Disorders

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  • Estimated from 15% to 20%, with higher rates in medically ill populations
  • Older adults rarely report or acknowledge anxiety and attribute symptoms to physical health problems
  • Symptoms include agitation, irritability, pacing, crying, and repetitive verbalizations
  • Often the presenting symptom of depression

Prevalence of Anxiety Disorders

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  • Early-onset anxiety disorder
  • Frailty
  • Lack of social support
  • Poor self-rated health
  • Vision impairment
  • Medications
  • High-stress life events: losses, traumatic events
  • Presence of another psychiatric illness
  • Substance abuse
  • Cognitive decline and dementia

Risk Factors for Anxiety Disorders

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  • Assess for anxiety
  • Focus on physical, social, and environmental factors, as well as past life history, long-standing personality, coping skills, and recent events
  • Look for coexisting medical conditions that mimic symptoms of anxiety
  • Older adults deny psychological symptoms
  • Thorough medication review
  • Treatment includes nonpharmacologic and pharmacologic interventions

Implications for Gerontological Nursing and Healthy Aging

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  • Affect survivors of combat, terrorist attacks, natural disasters, serious accidents, assault or abuse, and sudden and major emotional losses
  • Occurs with both direct and indirect exposures to the experience
  • Four major symptom clusters
  • Reexperiencing
  • Avoidance
  • Persistent negative alterations in cognition and mood
  • Alterations in arousal and receptivity

Posttraumatic Stress Disorder

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  • Knowing an older adult’s history and life experiences is essential to treat PTSD
  • Interventions include
  • Cognitive behavioral therapy (CBT) and prolonged exposure (PE) therapy
  • Cognitive processing therapy
  • Eye movement desensitization
  • Reprocessing
  • Narrative exposure therapy
  • Medications

Assessment and Interventions

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  • Some differences in symptoms, management, and prognosis depending on the age of onset
  • Presence is associated with greater functional declines, morbidity, and mortality, as well as dementia
  • Treatment includes both medications and environmental interventions (combination of support, education, physical activity, and CBT)

Schizophrenia

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  • Are beliefs that guide one’s interpretation of events and help make sense out of disorder, although they are inconsistent with reality
  • Common delusions are being poisoned, children taking their assets, being held prisoner, or being deceived by a spouse or loved one

Delusions

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  • Are sensory perceptions of a nonexistent object
  • Become evident when one is feeling alone, abandoned, isolated, or alienated
  • Many are in response to physical disorders
  • Older people with hearing and vision deficits may hear voices or see people and objects that are not actually present (illusions)

Hallucinations

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  • Recurrent mood disorder with periods of mania or mixed episodes of mania and depression
  • Usually begins in adolescence, but 20% experience their first episode after 50 years
  • Older adults tend to have longer depressive periods
  • Mania is more frequently the cause of hospitalization
  • Treatment includes medications, patient and family education and support, psychotherapy, CBT, and interpersonal and rhythm therapy

Bipolar Disorder

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An older adult client shares with you that he still has flashbacks to his experiences in the Korean War. You notice that he is jumpy, has startle reactions, and has poor concentration. You realize he is experiencing

delusions.

hallucinations.

bipolar disorder.

posttraumatic stress.

Question

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  • D—The patient’s symptoms are consistent with PTSD.

Answer

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  • Is common in later life and most treatable; however, it can be life threatening if left unrecognized and untreated
  • Is the major reason older adults are admitted to nursing homes
  • Becoming depressed doubles the probability of becoming sick
  • Is underdiagnosed and undertreated in older adults
  • Failure to treat increases morbidity and mortality

Depression

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  • Physical symptoms
  • Insomnia
  • Loss of appetite and weight loss
  • Memory loss and cognitive impairment
  • Chronic pain
  • Hypochondriasis
  • Decreased energy and motivation, hopelessness, increased dependency, poor grooming, withdrawal from people, decreased sexual interest, “giving up”

Symptoms of Depression

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  • CBT
  • Family and social support and education
  • Grief management
  • Exercise
  • Humor, spirituality,
  • Psychodynamic therapy
  • Reminiscence and life review
  • Medications: antidepressants

Therapeutic Interventions

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  • Rates are higher in older adults than any other age
  • Common precipitants include physical or mental illness, death of spouse or partner, and substance abuse
  • Use of firearms in older men is the lethal method
  • Older adults rarely threaten suicide; they just do it
  • All providers need to inquire about recent life events, implement screening, recognize warning signs and risk factors, and intervene as needed

Suicide

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Suicide is a consequence of the depressed older adult client if adequate care is not obtained. Which older adult group is at the most risk for suicide?

60 to 68 years of age

69 to 76 years of age

77 to 84 years of age

85 years of age and older

Question

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  • D—Even though the suicide rates in older people have been decreasing over the past 8 years, the rate of suicide among older adults in most countries is higher than that for any other age group, and the suicide rate for white men 85 years and older is the highest of all—four times the national age-adjusted rate.

Answer

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  • Is a coping mechanism in response to loss, anxiety, depression, boredom, or pain associated with chronic illness
  • Illicit drugs such as cocaine and heroin are becoming more common in aging baby boomers
  • Heavy drinking is the most common form of alcohol abuse in older adults
  • Men are four times more likely than women to abuse alcohol
  • Women are more vulnerable to the effects of alcohol

Substance Abuse: Alcohol

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  • Problems include cirrhosis, cancer, immune system disorders, cardiomyopathy, cerebral atrophy, dementia, and delirium
  • Many medications can have adverse effects when combined with alcohol
  • Other effects include urinary incontinence, gait disturbances, peripheral neuropathy, depression, suicide, and sleep disturbances
  • Major factor in trauma, including falls, fires, drownings, crashes, and homicide

Consequence of Alcohol Use

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  • Assessment includes screening for
  • Alcohol use
  • Alcohol-related problems
  • Depression
  • Medication use
  • Physical signs of use
  • Interventions are a stepped-care approach
  • Patients will experience delirium tremens after alcohol withdrawal

Implications for Gerontological Nursing and Healthy Aging

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  • Prescription and over-the-counter medications can be misused
  • Older adults can become dependent on sedatives, hypnotics, or anxiolytic medications
  • Older adults may not be informed of the side effects of medications

Other Substance Abuse

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