167 Mental Health Concerns and The Older Adult
can contact case management and other specialty areas to collaboratively form a holistic care plan that meets all the needs of the driving older adult. The healthcare worker is faced with a complicated decision matrix when it comes to addressing the older adult’s driving privilege; there are personal, clinical, ethical, and legal ramifications. The healthcare worker is often consulted about the safety of the older adult who drives and is faced with the weight of the older adult’s needs and safety versus the safety of society. The healthcare worker is encouraged to refer to state laws associ- ated with reporting of unsafe driving and prescribed revocation of driving privileg- es in addition to the information provid- ed. Social support system (Isolation) An important part of the social history is the social connectedness of the older adult. The older adult is capable of being physically and mentally healthy and main- taining autonomy. However, the inescap- ability of mortality often pushes the older adult living away from friends, family, and possibly their partner. An increased sense of isolation can cause symptoms of de- pression (Sadock et al., 2015). The health- care worker can assess the social support system the older adult utilizes on a daily/ weekly/as needed basis to better under- stand any deficits of care in the social his - tory section of the psychiatric interview. Where the older adult resides is an im- portant consideration for social support. The healthcare worker might work along with the long-term care facility team in coordinating the social needs of the older adult. Social isolation and loneliness have negative effects on the mental health for the older adult. They increase the risk for negative health consequences such as
obesity and smoking as well as shorten life span (Czaja et al., 2021). The members of an older adult’s social cohort and family structure will vary. There are objective and subjective measurements for social isola- tion and loneliness. The number of con- tacts and size of a social support network can be quantified, whereas loneliness is subjective. Loneliness is verbalized by the client and assessed qualitatively. Older adults who live alone are not always lone- ly. Loneliness is multifaceted and often intertwined with social interactions, which are unique to each client. Assessing lim- itations such as revoked driving privileges that can alter social interactions requires the healthcare provider to assess the so- cial domain. Social engagement (person- al, community, society connection) and individual productivity are major keys of successful aging (Czaja et al., 2021). This requires the healthcare provider to assess the quality of interactions and feelings of belonging when evaluating quality of life of the older adult. Family history The family history of an older adult can provide a genetic understanding and hint at vulnerabilities. Formal diagnosis can be lacking in older generations; howev- er, subjective data on family members is a worthwhile investigation for the health- care provider. Some mental health diag- noses are more likely than others to run in families. Obtaining historical family mental health diagnoses and medical di- agnoses can focus risks as well as treat- ment options for the healthcare provider to consider. The healthcare worker can obtain the family history from the older adult, the family of the older adult (with consent), or caregiver(s).
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