1. Chapter 29 Mental Health Disorders

2. Introduction
Mental health indicates a capacity to cope effectively with and manage life stressors in an effort to achieve emotional homeostasis
Advantages of older adults in dealing with stressors
Unique strengths, losses, and challenges
Need to promote mental health, detect problems early, and minimize the impact of existing psychiatric problems

3. Aging and Mental Health
Myths and stereotypes
Cognitive function in later life is highly individualized
Incidence
Depression prevalence
Suicide

4. Question Is the following statement true or false?
The rate of completed suicide among older persons is the lowest of any age group in the United States.

5. Answer
False
Rationale: The rate of completed suicide among older persons continues to be the highest of any age group in the United States, with nearly ¼ of all suicides committed by persons aged 65 years and older.

6. Promoting Mental Health in Older Adults
Mental health implies satisfaction and interest in life
No single profile for mental health
Good mental health practices throughout a lifetime promote mental health in later life
Need to maintain satisfying interests and activities

7. Promoting Mental Health in Older Adults (cont.)
Opportunities to sense value as a member of society and have self-worth reinforced
Security to meet basic human needs
Support and assistance through stressful situations
Connection with others
Importance of optimum physical health

8. Principles Guiding Mental Health Problems
Strengthen the individual’s capacity to manage the condition
Eliminate or minimize the limitations imposed by the condition
Act for or do for the individual only when absolutely necessary

9. Other Issues Related to Mental Health and the Older Adult
Problems that older adults confront that may challenge emotional homeostasis
Assess symptoms as they may be “normal” reactions to life circumstances
Address the cause of the problem rather than effects/symptoms alone
Need for accurate and astute assessment

10. Depression Most frequent psychiatric problem treated in older adults
Major versus minor depression
Incidence/prevalence
May be a lifelong problem or new onset in old age

11. Question Is the following statement true or false?
The incidence of major depression declines with age, but the rate of minor depression increases with age.

12. Answer
True
Rationale: Depression is the most frequent problem that psychiatrists treat in older adults. Major depression declines with age while minor depression increases in incidence with age.

13. Depression (cont.) Signs and symptoms Vegetative symptoms
Self-deprecation, guilt, apathy, remorse, hopelessness, helplessness, feelings of being a burden
Problems with personal relationships and social interactions
Changes in sleep and psychomotor activity

14. Depression (cont.) Signs and symptoms (cont.) Hygiene neglect
Physical complaints
Altered cognition
Can mimic dementia

15. Depression (cont.) Assessment Crucial to avoid misdiagnosis
During routine health visits
Short assessment tools
Missed diagnosis factors
Atypical presentation of symptoms

16. Depression (cont.) Assessment (cont.)
Assess relationship of life events and/or serious or terminal illness with depression
Assess underlying problem
Prompt treatment can hasten recovery

17. Depression (cont.) Treatment/management Psychotherapy Antidepressants
Electroconvulsive therapy (ECT)
Herbs
Complementary/alternative (CAM) therapies
Good basic health practices

18. Depression (cont.) Suicide risk Real and serious risk
Incidence/prevalence
Take all suicide threats (obvious and subtle) seriously
Suicide gestures:
Medication misuse
Self-starvation

19. Depression (cont.) Suicide gestures (cont.):
Activities that oppose a therapeutic need
Activities that threaten a medical problem
Subjecting oneself to unnecessary risks

20. Depression (cont.) Needs of suicidal older adults Close observation
Careful protection
Prompt therapy
Treatment of underlying depression
Environmental safety
Nurses’ willingness to listen and discuss thoughts and feelings related to suicide

21. Anxiety Causes Clinical manifestations Treatment/management
Depends on underlying cause
Nursing interventions

22. Substance Abuse Often a problem that goes unnoticed in the older adult
Threatens physical, emotional, and social health
Potential for adverse drug reactions (ADRs)
Increases risk for falls, decreased cognition, abuse, and self-neglect
Chronic abuser versus situational abuser

23. Substance Abuse (cont.)
Health care professional stereotyping
No specific profile for alcoholics
Symptoms
Secondary to complications
Screening tools for identifying abuse
Complications
Diagnosis

24. Criteria for Diagnosing Alcoholism
Drinks a fifth of whiskey a day or its equivalent in wine or beer (for a 180-lb person)
Alcoholic blackouts
Blood alcohol level greater than 150 mg/100 mL
Withdrawal syndrome: hallucinations, convulsions, gross tremors, delirium tremens
Continued drinking despite medical advice or problems caused by drinking

25. Substance Abuse (cont.)
Treatment/management
Long-term goal is sobriety
Patient must acknowledge the problem and take responsibility
Family involvement in the treatment plan
Medication monitoring
Alcoholism treatment programs for older adults are rare
Alcoholics anonymous

26. Question
Which of the following statements is true related to alcoholism and the older adult?
Alcoholism is easily treated in the older adult.
There is a decreased incidence of alcoholism with age.
Health care professionals can easily detect alcoholism in an older adult.
The long-term goal for the older adult with alcoholism is limited alcohol intake.

27. Answer B. There is a decreased incidence of alcoholism with age
Rationale: Most older adults who are alcoholics are chronic EtOH abusers who have used it heavily throughout their lives. A significant number of chronic abusers die before reaching old age, contributing to a decreased incidence of alcoholism with age.

28. Paranoia Frequent occurrence in older adults Predisposing factors
Social
Physical
Need to explore mechanisms to reduce insecurity and misperception
Interventions
Treatment/management

29. Nursing Considerations for Mental Health Conditions
Monitoring medications
May bring significant improvement
Potential for adverse effects
Use the lowest possible dosage
Monitor for problems
Complement other forms of treatment

30. Nursing Considerations for Mental Health Conditions (cont.)
Promoting a positive self-concept
People need to feel their lives have had meaning and that there is hope
Take interest in the lives and accomplishments of the older adult
Promote self-esteem
Life review, oral histories, and scrapbook of life events may assist in the sense of worth

31. Nursing Considerations for Mental Health Conditions (cont.)
Promoting a positive self-concept (cont.)
Encourage participation in relevant activities
Ensure engagement in meaningful social interactions that allow opportunities to “do for” others
Allow individual to have as much control over own life as possible
Respect religious and cultural practices

32. Nursing Considerations for Mental Health Conditions (cont.)
Managing behavioral problems
Occurs in persons with altered cognitive status who are incapable of thinking rationally, making good judgments, and coping
Types of behavioral problems
First step is assessing the cause of the behavior

33. Nursing Considerations for Mental Health Conditions (cont.)
Managing behavioral problems (cont.)
Factors that precipitate the problem should be avoided
Identify signs/symptoms that precipitate the behaviors
Intervene in a timely manner
Environmental considerations
Correct the underlying cause when possible

34. Question Is the following statement true or false?
The first nursing intervention necessary to address problem behaviors in the older adult population is assessment.

35. Answer
True
Rationale: Assessing the cause of the behavior is the first step in assisting the patient who displays behavioral problems. Factors associated with the behavior should be closely observed and documented.