Mental Health Concerns and The Older Adult
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causing disequilibrium to psychological well-being. A crisis can cause feelings of being out of control, desperation, and/or fear (Boyd, 2017). There are three types of crises that an older adult can experi- ence: developmental (a remarkable mat- urational event in life), situational (a spe- cific event in a person’s life that upsets the biopsychosocial equilibrium), and traumatic (due to an unknown incident) (Boyd, 2017). The older adult might expe- rience a developmental crisis when their living situation changes dramatically, such as moving into a long-term care facility. A situational crisis can be an internal or external event for an older adult, such as disease progression or a new diagnosis. A natural disaster or a pandemic could af- fect the older adult and cause a traumatic crisis. Differentiating a temporary crisis from acute stress disorder depends on the se- verity of distress and how it impairs social functioning. It will also depend on diag- nostic criteria in the Diagnostic and Sta- tistical Manual of Mental Disorder ( DSM- 5 ). Diagnostic inclusion for acute stress disorder requires “exposure to actual or threatened death, serious injury, or sexual violation” (not experienced through elec- tronic media unless work related) (APA, 2013, p. 280). The healthcare worker must gather sufficient detail about the stressors and their causes in the older adult’s life to offer appropriate intervention. A healthcare worker often intercedes in times of crisis. Assessment for self-harm or harm to others is needed when an older adult is in crisis and will drive the immediate interventions. If harm is not a factor, the healthcare worker should focus their initial intervention on active listen- ing (Corey & California State University, 2013). Allow the older adult the space to
verbalize their feelings and experiences. The healthcare worker can meet these expressions with openness driving for ac- ceptance. Feeling heard can help an old- er adult in crisis feel grounded (Corey & California State University, 2013). Stability in the midst of a crisis can help deescalate the extremes of emotions such as anger or sadness. Positive mental health sup- port during a crisis opens the door for fu- ture intervention. Not all older adults who experience a crisis need mental health- care. The necessity of crisis intervention will be determined by the ability or inabil- ity of the older adult to self-soothe and cope. It is worth understanding that the older adult may value feeling understood and supported during a crisis more than a healthcare worker’s ability to solve the problem (Corey & California State Uni - versity, 2013). Assessment of coping skills and previous crisis coping will provide the healthcare worker with a plan for present needs and intervention. Loss, grief, and bereavement Loss, grief, and bereavement are an expected part of life and will be seen in various presentations by the healthcare worker assessing the older adult. Statisti- cal analysis suggests that 51% of women and 14% of men older than age 65 years will be widowed at least once in their life- time (Sadock et al., 2015). The healthcare worker will assess the older adult suffer- ing from loss, grief, and bereavement. Knowing the differences in terminology, the cycle of grief, and the risks to older adults unable to cope are crucial for the healthcare worker. The definition of loss according to the Merriam-Webster dic - tionary (2022) is “the act or fact of being unable to keep or maintain something or someone.” Loss is synonymous with more than death. For example, the old-
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