CH 27: Mental Health Disorders

Question 1

aging and mental health

Answer 1

mental health is an effort to achieve emotional homeostasis
mental health in older adults is individualized
one in four older adults struggle with mental health disorders
barriers related to myths of mental health
–mental incompetence, rigid behavior, and child-like mannerisms are “normal” with aging
2/3 of older adults with mental health disorders dont seek attention
people >85 have highest rate of suicide of any age group
mental health issues stem from..
–loss of loved ones
–altered sensory function
–alterations, discomforts, and demands of chronic diseases

Question 2

promoting mental health in older adults

Answer 2

no single profile for mental health dysfunction, so assessment should be objective and unbiased
good mental health practices early in life affect later life
maintain interests and activities that are satisfying
reinforce self-worth
meet basic human needs first and provide security
promote connection and socialization
promote optimum physical health
–eliminate limitations by condition
–promote independence
–strengths individuals capacity to manage condition

Question 3

challenges in mental health homeostasis

Answer 3

illness
death
retirement
increased vulnerability
social isolation
sensory deficits
greater awareness of own mortality
increased risk of institutionalization and dependency

address the cause of the problem rather than the effects alone

Question 4

s/s of depression**

Answer 4

fatigue, insomnia, weight loss, constipation, decreased libido, lack of interest in activities, hopelessness, helplessness, feelings of being a burden, changes in sleep, self-care neglect, etc.

Question 5

treatment for depression

Answer 5

psychotherapy and antidepressants; ECT; St. John’s wort, acupressure, acupuncture, reg. exercise

Question 6

depression in older adults

Answer 6

Most frequent problem in older adults
Presence of depressive symptoms is more common among older adults than a diagnosis of major depressive disorder
Can be a life-long or new problem
Certain meds can cause or aggravate depression (BBs, dig, estrogens, alcohol, benzos, haldol, steroids)
Older adults may have cognitive deficits from depression (pseudodementia)
Assess with Geriatric Depression Scale-Short Form
Missed diagnosis can delay treatment
Depression tends to last longer with older adults
Consider antidepressant effects on older adult

Question 7

assessment for depression

Answer 7

Approach mental health assessments in a matter-of-fact manner
Reassure the client that the assessment is part of every assessment
Get eye-level, provide ample time for response, establish rapport before assessment

Question 8

care for depression

Answer 8

Develop sense of positive self-concept
Encourage the expression of feelings
Avoid minimalizing feelings
Ensure that physical needs are met
Offer hope

Question 9

risk factors for suicide in older adults

Answer 9

previous suicide attempts
family history
history of alcohol/drug use
isolation
barriers to accessing mental health treatment
physical illness
easy access to lethal methods
unwillingness to seek help

Question 10

s/s of suicide risk

Answer 10

medication misuse
self-starvation
engaging in activities that pose threats/harm (intoxicated driving)

Question 11

SUICIDE risk in older adults

Answer 11

all threats should be taken seriously
need close observation, protection, and prompt intervention
keep environment safe
encourage open dialogue on thoughts of suicide
–ask direct questions
–don’t belittle or underestimate feelings

Question 12

causes of anxiety in older adults

Answer 12

physical
emotional
socioeconomic limitations

Question 13

s/s of anxiety in older adults

Answer 13

somatic complaints
increased dependency
insomnia
fatigue
fantasizing
hostility
pacing
chain-smoking
VS increase
changes in appetite
restlessness
obsess over tasks
difficulty concentrating

Question 14

treatment for anxiety

Answer 14

Depends on cause:
Relaxation therapy, psychotherapy, guided imagery
Control environmental stimuli
Allow adequate time for conversation, procedures, and activities
Encourage and respect client’s decisions
Prepare client for all activities
Provide thorough, honest, basic explanations
Adhere to routines
Keep and use familiar objects
Prevent overstimulation of the senses (reduced noise, using soft lights, maintaining room temp.)

Question 15

substance use in older adults

Answer 15

Threatens physical, emotional, and social health
Can increase risk for falls, reduced cognitive function, abuse, adverse drug effects, and self-neglect
Possible have used substances throughout their life; abusing late in life from situational factors
Can go unnoticed
Nursing: Remain objective

Question 16

s/s of alcohol abuse in older adults

Answer 16

blackouts
confusion
withdrawal
disrupted relationships
anxiety
irritability
mood swings
injuries
insomnia
clumsiness
GI distress
drinking to calm nerves/tremors
continued drinking when warned about the consequences
elevated blood alcohol level

Question 17

alcohol use in older adults

Answer 17

Alcohol consumption ages >65: 1 standard drink/day; 7 standard drinks/week, no more than 3 on occasion
AA & other support groups; possible family involvement
SBIRT, AUDIT, and Short Michigan Alcohol Screening Test-Geriatric version, CAGE
Long-term consequences
Long-term goal is sobriety

Question 18

paranoia in older adults occurs due to:

Answer 18

sensory losses
illness
disability
living alone
ageism
victims of crime
adverse reaction of drugs
sleep deprivation

Question 19

paranoia can impact:

Answer 19

nutritional status (belief of poisoned food)
sleep patterns (stranger in house)
health problems
mistrust of medical team (we are out to get them)

Question 20

interventions for paranoia in older adults

Answer 20

Explore mechanisms that reduce insecurity and misperception
Psychotherapy and meds as later options
Honest, basic explanations
Therapeutic communication
Do NOT support delusions

Question 21

monitoring mental health meds in older adults

Answer 21

Can have significant adverse effects
Monitor for any effects
Start off with lowest dose possible
Drugs should be used in supplement with therapy

Question 22

promoting self-concept for older adults mental health

Answer 22

Need to feel like their lives have meaning
Take sincere interest in their lives
Life-review, oral history, scrapbook of their life
Participate in relevant activities and engage in social interaction
Exercise maximum control of their lives
Maintain religious and cultural practices
RESPECT

Question 23

behavioral problems in older adults

Answer 23

Physical/verbal abuse
resistance to care
repetitive actions
wandering
restlessness
suspiciousness
inappropriate sexual behavior
undressing for those with altered cognition

Question 24

Using the least restrictive interventions first

Answer 24

Identify and correct the underlying problem FIRST
Document
Avoid precipitating factors
Avoid arguing, reasoning, and reacting to comments; “don’t take it personal”
Prepare for activities
Break activities into simple steps
Schedule times for supervised walks
Address basic needs
Familiarize them with the environment
Keep room temp 70-75F
Use simple patterns on walls
Limit traffic flow
Control noise
Install safety devices
Recognize warning signs
Distract; address in a calm manner
Provide time for rest
Move away from others
Reinforce positive behaviors
Set limits
Prevent dramatic transitions from day to night