171 Mental Health Concerns and The Older Adult
Crisis Prior to discussing loss, grief, and be- reavement, it is prudent for the health- care worker to understand crisis and its presentation to differentiate the state of being and possible intervention needed for the older adult. The definition of crisis is: A time-limited event that triggers adap- tive or non-adaptive responses to mat- urational, situational, or traumatic ex- periences. A crisis results from stressful events for which coping mechanisms fail to provide adequate adaptive skills to address the perceived challenge or threat. (Boyd, 2017, p. 211) Crisis is a crossroad. The direction tak- en in the context of crisis determines the positive or negative consequences of the outcome. If the older adult chooses to grow and strengthen from the crisis, pos- itive outcomes are expected. However, if the reverse is apparent or the client is incapable of coping, a negative and pos- sible destructive outcome can occur such as self-harm or suicide. If an older adult in crisis has historically had difficulty coping, caution should be taken when assessing their safety. Depression and suicide are risks for clients who are unable to over- come a crisis (Boyd, 2017). Assessment for self-harm is paramount for the older adult in a crisis, regardless of past psychi- atric history. A crisis should mitigate with- in four to six weeks (Boyd, 2017). When chronic crisis is not acknowledged, how- ever, constant unrest is classified as cha - os. The healthcare worker can note vary- ing types of and reasons a client might be experiencing a crisis. The healthcare worker assessing the older adult for mental health needs must be able to define crisis and understand the circumstances around the situations
● Easily agitated or violent outbursts. ● Outward signs of trauma and regression (e.g., rocking back and forth). ● Unexplained bruises, burns, cuts, scars. ● Signs of physical altercation (such as broken eyeglasses). ● Bed sores or other preventable disorder or disease. ● Lack of medical aids needed for functioning (glasses, hearing aids, dentures, medications, etc.). ● Financial warnings (eviction notices, unpaid bills despite financial means). ● Report of unsafe living conditions (hazardous, unsanitary, or unsafe). Long-term effects of elder abuse can lead to declining physical and psycho- logical health, severed social support, fi - nancial loss, and early death (NIA, 2020). Elder abuse requires intervention. The healthcare worker must comply with state laws and authorized means of reporting elder abuse according to facility policy. Local, state, and national resources exist to report and/or stop elder abuse. CRISIS, LOSS, GRIEF, AND BEREAVEMENT IN THE OLDER ADULT Older adults have lived through a multi- tude of challenges by the time the health- care worker is assessing for intervention. Adaptation and change are inevitable. How the older adult has coped in the past is salient for how they will cope with pres- ent and future difficulties. The healthcare worker will see the older adult experience crisis, loss, grief, or bereavement; there- fore, it is imperative to know the differ- ence in presentation as well as the course of typical action and line of intervention.
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