159 Mental Health Concerns and The Older Adult
● Review and modification of treatment to individual preferences. ● Realistic intervention and goal setting. ● Support for patient to maintain safe autonomy. Every interaction provides the oppor- tunity to strengthen or weaken this bond and to obtain facts, feelings, and thoughts that can be targeted for treatment. The psychiatric interview can be administered in any setting (e.g., hospital, clinic, nurs- ing home, residential facility). The length of time allotted or needed will vary by cli- ent and setting. Consult your facility for the proper organization of psychiatric as- Advanced care planning can be com- pleted for clients of any age; however, it is responsible to offer the option to all older adults prior to medical crises or the end of life. The mental healthcare provider can support the older adult in these legal and ethical plans according to policy. Ad- vanced care planning decisions include measures that can be taken in an emer- gency: cardiopulmonary resuscitation, use of a ventilator, artificial nutrition such as tube feedings or intravenous fluids, and comfort care measures (NIA, 2018). Older adults need to be aware of the risks and benefits of these differing emergency measures. Older adults with multiple co- morbidities are less likely to recover from cardiopulmonary resuscitation and might need extended ventilator care (NIA, 2018). The healthcare provider seeing the older adult for mental health needs can prompt the discussion with the inclusion of quality of life. Several options exist for an older adult in terms of an advanced directive: living will, durable power of at- torney, and other specific medical mea - sures such as a do not resuscitate order or sessment documentation. Healthcare directives
a tissue or organ donation request (NIA, 2018). The mental healthcare worker can assist the older adult and family with ad- vance care planning needs to increase the likelihood of receiving desired treatment during crises or the end of life. Healthcare provider exceptions to confidentiality There are notable exceptions to confi - dentiality for the healthcare worker meet- ing the mental health needs of the older adult. The healthcare provider should re- fer all scope of practice questions to their state regulatory agency. State laws de- fine the scope of practice. Understanding confidentiality, and when to breach it, is a necessary discussion when caring for old- er adults. Confidentiality is a client’s right for restricted information (Boyd, 2017). All healthcare workers play a role in main- taining client confidentiality. The HIPAA of 1996 is a federal guarantee of legal protection for privacy and confidentiality. Exceptions to confidentiality (when the need to inform outweighs confidentiality) include the following (Boyd, 2017): ● Client has an intent to harm self or others. ● Litigation if an attorney is involved. ● Insurance company need to know for coverage and billing purposes. ● Sending information to answer a court order, subpoena, or summons. ● State requirement to report. ● Tarasoff principle—warn victim of imminent homicidal danger. ● Elder abuse suspected or involved (refer to state laws for proper channels). Knowing when and how to provide no- tification when exceptions of confiden - tiality are in question varies per state. The healthcare provider will need to fol- low policies subject to their practice and
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