Mental Health Concerns and The Older Adult
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healthcare. Developmental tasks of the older adult are to maintain body image and physical integrity, to conduct a life re- view, to maintain sexual interests and ac- tivities, to deal with the death of significant loved ones, to accept the implications of retirement, to accept the genetically pro- grammed failure of organ systems, to divest oneself of the attachment to pos- sessions, and to accept changes in rela- tionships with grandchildren (Sadock et al., 2015). Any of these tasks can be ex- plored in more depth to establish known protective factors or barriers to the men- tal health of the older adult. An assessment is a deliberate and sys- tematic gathering of information with the goal of formulating a plan. A mental health assessment includes biopsycho- social data to show current and previous health, functional ability, and problems/ diseases/illnesses both present and fu- ture (Boyd, 2017). The mental health as- sessment includes the biological domain, that is, the physical status of the client. This assessment is often carried out in conjunction with the client’s primary care provider. Biological data is important to the mental healthcare worker; however, a team approach to the older adult can serve the client best by allowing multiple disciplines to focus on their specialty area of practice. The medical record for the older adult can be quite involved. How- ever, a records review and collaboration with the older adult client’s primary care provider can benefit the holistic picture of the mental health needs to be ad- dressed. Physical problems or disorders can be exacerbated or accounted for by addressing the underlying psychiatric dis- turbance. The overlap of biological prob- lems and psychosocial problems can be complicated. The American Geriatric So-
ciety (AGS) organizes geriatric health via alliteration for ease of remembrance. The five M’s of older age are multicomplexi - ty, mind, mobility, medication, and what matters most (AGS, 2020). Multicomplex - ity is the description of the older adult as a client with comorbid biopsychosocial needs that can challenge the healthcare worker. Mobility refers to the level of au - tonomous or diminished functionality of the older adult, especially the ability to ambulate and care for themselves. Medi - cation is typically remarkable for the older adult; polypharmacy can be common and problematic and often results in undesir- able side effects that signal a strict need for regular consolidation evaluation. The final ideal, mattering most, encompasses the notion of aging and decision making to include the older adult as an advo- cate for health decisions and goals. This depiction can aid the mental healthcare worker to conceptualize the older adult’s biopsychosocial needs. Assessing the older adult as they pres- ent in their current level of functioning is paramount and requires establishing trust and building rapport. The psychiatric in- terview is the most important part of the mental health assessment. It provides an opportunity to positively impact older adults suffering from mental health issues and illnesses. Approaches that can enhance the ther- apeutic alliance include the following aspects (Boyd, 2017): ● Establishing a relationship rooted in cultural competence and cultural humility. ● Availability to assist in times of crisis. ● Awareness of acute safety issues related to the patient. ● Ability to provide education and manage expectations.
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