Mental Health Concerns and The Older Adult
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al awareness and acceptance are key for impartiality of assessment. Spirituality is a component of mental healthcare that is often woven into an older adult’s life- style, guiding their adherence to medica- tions and therapies (Rodgers et al., 2018). Proper understanding of an older adult’s belief system, spirituality, and feeling of belonging is essential during assessment for relevant intervention and treatment. Legal involvement Legal history can be notable for the older adult client. The mental healthcare worker will assess for legal involvement or ramifications that could hinder treat - ment. A history of problematic behavior related to disregard for rules and remorse can be diagnostic for antisocial personal- ity disorder (ASPD). ASPD is associated with younger populations; however, the presence of it historically must be taken into consideration, as it carries high rates of comorbidities, most commonly sub- stance use disorders (Holzer et al., 2022). The healthcare worker can also assess for caregivers, friends, or family members who have any legal stake in the older adult’s decision making. Elder abuse (physical/emotional/ sexual/financial) According to statistics, abuse is re- ported for around 10% of those age 65 years and older (Sadock et al., 2015). The healthcare worker must understand defi - nitions and classifications of abuse and assess for mistreatment in all older adults. The American Medical Association has three general definitions for elderly mis - treatment: abuse (something that causes harm or the withholding of something to cause harm to the health and well-being of an elderly person), neglect (the inability to do good or provide needed services or basic needs [food, shelter, medical care]
to an older adult), and exploitation (using an older adult’s money for self-purposes) (National Research Council, 2003) The older adult is vulnerable to all generalized types of abuse: physical, emotional, sexu- al, and financial. Physical abuse is defined as “bodily harm by hitting, pushing, or slapping. This may also include restrain- ing an older adult against his/her will, such as locking them in a room or tying them to furniture” (NIA, 2020). Emotional abuse, also called psychological abuse, includes “a caregiver saying hurtful words, yelling, threatening, or repeatedly ignor- ing the older adult. Keeping that person from seeing close friends and relatives is another form of emotional abuse” (NIA, 2020). Sexual abuse involves unwanted sexual acts or being forced to watch sex- ual acts (NIA, 2020). Financial abuse happens when money or belongings are stolen from an older adult. It can include forging checks, tak- ing someone else’s retirement or Social Security benefits, or using a person’s credit cards and bank accounts without their permission. It also includes chang- ing names on a will, bank account, life in- surance policy, or title to a house without permission (NIA, 2020). Older adults most at risk for abuse are female, those without support systems, those with disabilities, and those who are cognitively inhibited or have demen- tia (NIA, 2020). The healthcare provider must assess for physical and verbal signs of abuse when interacting with the older adult. Signs of abuse in the older adult include the following (NIA, 2020): ● Cessation of enjoyed activity. ● Unkempt appearance. ● Difficulty sleeping. ● Unexplained weight loss.
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