157 Mental Health Concerns and The Older Adult
are at significant risk of experiencing iso - lation and loneliness (CDC, 2021c). This can be due to the death of a spouse/sig- nificant other, estrangement from family, worsening disabilities, or perceived feel- ings of burden to others. Groups most at risk within the older adult population are immigrants; those who are lesbian, gay, bisexual, and transgender; and those suf- fering abuse (CDC, 2021c). While there is not a clear measure for loneliness, there is evidence of related health risks that ac- company it. Health risks of loneliness include the following (CDC, 2021c): ● Higher risk for premature death from disease, especially related to smoking, obesity, and sedentary lifestyle. ● Dementia risk increases by 50%. ● Heart disease risk increases by 32%, leading to higher rates of stroke. ● Coincides with higher rates of depression, anxiety, and suicide. ● Specific to heart failure: risk of death increases four times, risk of hospitalization increases by 68%, and emergency visits increase by 57%. Determinant 5: Economic stability Poverty contributes to clients not being able to meet their basic needs. Approxi- mately 9.3% of the older adult population in the U.S. lives below the poverty line (SAMHSA, 2019). Housing, healthcare, and nutritious food and drink are major concerns for older adults that could con- tribute to mental health conditions. Case managers are a prudent referral for the older adult lacking the financial means to meet their needs. The five Healthy People 2030 social determinants from the U.S. Department of Health and Human Services {ODPHP, 2022 #17}—education access and quali- ty, healthcare access and quality, neigh-
borhood and built environment, social and community context, and economic stability—can be used as a circular frame- work for the healthcare worker assessing older adult mental health needs (ODPHP, 2022). A deficiency in any of the determi - nants for the older adult can be a barrier to accessing mental health services and treatment. More than one social determi - nant can be missing for a client. Assess- ing social determinants can lead to better understanding of the obstacles an old- er adult must overcome to seek mental healthcare. Insufficient coverage in social determinants might require additional as- sistance from case management, family, or peer interventions. Stigma can stand in the way of access to care and treatment. Breaking stigma is everyone’s job, but it can start with one healthcare worker. The healthcare worker capable of fostering a therapeutic alliance built on trust and rooted in empathy will enhance the pos- sibility for healthy communication and connection, naturally decreasing stigma. Friends, family, and caregivers can also be educated in empathetic communi- cation with the older adult to normalize mental illness and treatment. ASSESSMENT CONSIDERATIONS FOR THE OLDER ADULT Addressing mental health needs in the older adult will depend on the assessment recorded or provided to the healthcare worker. Assessment is not a single inter- action; rather, it is a calculated and con- tinuous process that evolves throughout the care for the older adult client (Boyd, 2017). The first interview can set the tone. Preparation prior to meeting the client is encouraged. The healthcare worker can review com- mon developmental tasks of the older adult at any point while providing mental
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