Page 76 nursing.elitecme.com Complete Your CE Test Online - Click Here ● ● The most common neuropsychiatric disorders in this age group are dementia and depression. ● ● Anxiety disorders affect 3.8% of the older adult population, and substance use problems affect almost 1%. ● ● About 25% of deaths from self-harm are among persons aged 60 or older. EBP alert! Research shows that mental health problems are under-identified (and hence under-treated) by older adults and by healthcare professionals as well. Additionally, the stigma sometimes associated with mental illness makes some people reluctant to seek help [34]. Other reasons older adults do not access mental health services include: lack of insurance coverage; a shortage of trained geriatric mental health providers; and lack of coordination among primary care providers, aging service providers, and mental health providers. Thus, it is critical that nurses and other healthcare professionals incorporate mental health assessment as part of their routine assessments of older adults. Multiple physical, social, and biological factors influence mental health. Risk factors for mental health problems in older adults include [34]: ● ● Loss of ability to live independently due to chronic pain, fragility or other physical/mobility issues. ● ● Existence of chronic health problems, especially cardiac disease. ● ● Bereavement. ● ● Reduction in socioeconomic status. ● ● Medications. ● ● Abusive situations. Mental health problems may develop at any time in an individual’s life. As we age there are some normal aging changes that may influence mental health and cognition. We will review some mental health and cognition problems found in older adults and how they can be identified. As we age, our mental health and cognition stay comparatively stable. Alterations that do take place are usually not dramatic enough to cause major problems in activities of daily living. Changes in cognition can be slowly progressive as seen in Alzheimer’s disease or may be a sudden altered level of consciousness as seen in the stroke or delirium. During assessment nurses must distinguish between the onsets of symptoms. Although the overall picture might seem to be one of cognitive decline, enormous variability exists across individuals as areas of cognitive strength may be employed to compensate for areas of weakness. The ability to acquire practical experience and wisdom continues until the end of life. Normal age-related changes in mental health and cognition may include some of the following [9]: ● ● The speed with which information is processed generally decreases with age. This means that older adults take a longer time to learn new information and require information to be repeated. ● ● The ability to deal with multiple tasks slows. ● ● The capability of dividing or switching of attention among multiple inputs or tasks has been found to be impaired in older adults. ● ● Deficits in tasks that involve active manipulation, reorganization, or integration of the working memory can be found in older adults. For example: ○ ○ The use of language is maintained, but word finding and naming ability decreases. ○ ○ The ability to use abstract thought and demonstrate mental flexibility decreases. Grief and bereavement Older adults, generally, must often deal with the loss of loved ones, including spouses, siblings, parents and others. Grief is considered to be a normal response to such losses within a two-year period. Grief that lasts longer than two years is considered to be pathological. However, the length of grief varies with cultural norms. The American Psychological Association’s standard of care concerning grief in the older adult encourages the health care professional not to focus on time, but on the way grief is presented. Profound depression, extensive guilt, overwhelming senses of loss, preoccupation with death, difficulty performing activities of daily living, and social incapacitation indicate pathological grief and require medical intervention [9]. Depression While the prevalence of major depression declines with age, the symptoms of depression increase. Eight to twenty percent of older adults living in the community and up to 37% in primary care settings experience depressive symptoms [33]. Depressive symptoms are often associated with chronic illness and pain [9]. Older adults suffering from depression frequently report numerous somatic complaints, including chronic pain. They may not consider themselves depressed and focus on physical rather than mental symptoms [9]. Nursing consideration: Older people may feel that it is a sign of weakness to report feelings of depression. They may believe it is more “acceptable” to have a physical illness, thus the focus is on physical complaints. Your first clue to depression in older adults may be the reporting of somatic complaints [9,33]. A number of tools for the assessment of geriatric depression are available. One such tool is the Geriatric Depression Scale, which consists of 30 questions (a shortened 15-question version may also be used) that can be answered with “yes” or “no”. Examples of questions include [9]: ● ● Are you basically satisfied with your life? ● ● Do you feel full of energy? ● ● Do you feel happy most of the time? ● ● Do you think that most people are better off than you are? Criteria for major depression as noted in the Diagnostic and Statistical Manual of Mental Disorders-5TR (DSM-5) include [35]: ● ● Depressed mood most of the day, nearly every day. ● ● Significant decrease in interest or pleasure in activities most of the day, nearly every day. ● ● Significant weight loss or weight gain or decrease or increase in appetite nearly every day. ● ● Insomnia or hypersomnia nearly every day. ● ● Psychomotor agitation or retardation nearly every day. ● ● Fatigue or loss of energy nearly every day. ● ● Feelings of worthlessness or excessive or inappropriate guilt. ● ● Decreased ability to think or concentrate, or indecisiveness. ● ● Persistent thoughts of death, suicidal ideation, a suicide attempt, or a specific plan for committing suicide. The incidence of depression is twice as high in older women compared to older men. Some of the possible reasons for this difference is that older women are more likely to experience loneliness, financial problems, and a reduction in independence caused by functional disabilities [9]. EBP alert! Depression is a major risk factor for suicide. Adults age 65 and older have the highest suicide rates of all age groups. Suicide is highest among Caucasians, followed by Asians, Hispanics and non-Hispanic blacks. Older adults suffering from alcoholism have a greater risk for suicide as well. Nurses must not only assess for depression but for suicidal ideation [9]! When evaluating older adult patients for depression, it is very important to obtain a good medication/drug history. Many medications and illicit drugs can have the potential for depressive/suicidal side effects. Common mediations taken by older adults that may have these types of side effects can include [36]: ● ● Anticonvulsants. ● ● Barbiturates. ● ● Benzodiazepines. ● ● Beta-adrenergic blockers. ● ● Calcium-channel blockers. ● ● Estrogens. ● ● Opioids. ● ● Statins. ● ● Illegal drugs.