Mental Health Concerns and The Older Adult
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Sexual orientation, function, and dysfunction Sexual identification and function are assessed regardless of age. Older adults who identify as part of a sexual or gender minority (lesbian, gay, bisexual, transgen- der, etc.) are more prone to sexual diffi - culties and psychological distress later in life (NIA, 2022a). The healthcare provid- er is cautioned to assess with open em- pathy. Older adults often redefine the meaning of sexuality and intimacy in their life, and the healthcare provider must approach sexuality professionally and at the comfort level of the older adult. The healthcare provider needs to assess for the importance of sexual performance in the older adult’s life. For example, sexual dysfunctions that can include decreased desire, delayed or absent orgasm and ejaculation are known side effects of an- tidepressant medications (Sadock et al., 2015). The healthcare provider must know the expected physical changes that occur in the older adult female, shortening and narrowing of the vaginal walls and de- creased lubrication, which can decrease enjoyment of sexual activity (NIA, 2022a). The healthcare provider must also know the age-related physical changes that occur in the older adult male, erectile dysfunction (impotence) and decreased firmness with erection, which can cause stress in the older adult (NIA, 2022a). The healthcare provider can assess for sexu- al dysfunction distress. There are other common causes of sexual dysfunction: alcohol in excess, arthritis, chronic pain causing exhaustion and decreased ener- gy, dementia, depression, diabetes, heart disease, incontinence, obesity, and stroke (NIA, 2022a). The healthcare provider can prescribe or refer the older adult for eval- uation and treatment if desired.
Substance use, abuse, and treatment history Substance use and abuse are a crucial part of the psychiatric assessment for the older adult. The Substance Abuse and Mental Health Services Administration (SAMHSA) states that substance use and abuse in older adults is often “overlooked and undertreated” (SAMHSA, 2022d, p. xi). The healthcare provider is remind- ed to self-assess for ageism, conscious bias, and unconscious bias that might in- hibit the ability to evaluate substance dis- orders in the older adult. Substance use disorder (SUD) guidance for the older adult population includes the following (SAMHSA, 2022d): ● Substance misuse disorders occur more in younger populations than elderly populations; however, this does not void the importance for assessment. ● Substance misuse in older adults increases physical injury and mortality. ● Illicit drug use in the older adult population is currently on the rise, as is dual diagnosis (co-occurring mental health and substance use disorders). ● Alcohol is the most abused substance by older adults. ● Caution is warranted for the older adult due to the commonality of multiple prescriptions and possible detrimental interactions with substances. ● Substance abuse symptoms can mimic cognitive deficits (normal or clinical). ● Avoid assumptions that older adults are unwilling to change or seek treatment. ● Multiple approaches have been found to be effective in the older adult population (screening, brief intervention, and referral to treatment;
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