Mental Health Concerns and The Older Adult
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Drug Administration (FDA) has approved medication to treat symptoms and slow the progression of invasion. The life ex- pectancy with a diagnosis of Alzheimer’s disease varies from 3 to 10 years (NIA, 2022b). The mental healthcare provider can prepare the older adult and family members for the future and focus treat- ment options on quality of care that is uniquely important to the older adult. Sleep difficulties Sleep is a crucial component of phys- ical and mental health and warrants an assessment during every psychiatric men- tal health examination. Dementias, most notably Alzheimer’s disease, can be a perpetuating cycle of negative sleep and interference with cognition (Boyd, 2017). Sleep changes are a natural part of ad- vancing age but can contribute to wors- ening states of mental health if natural adaptations are not rendered or medica- tions are improperly prescribed. With ad- vancing age, restful sleep decreases and interruptions in the sleep pattern shorten, both of which contribute to a decreased quality of sleep. Rapid eye movement (REM) during sleep (the deepest and most restful part of sleep) becomes less fre- quent, as do circadian rhythms (Sadock et al., 2015). Falling asleep, staying asleep, and feeling rested become more difficult with advancing age. Sleep deficiencies can worsen cognitive functioning and can be magnified if the older adult has cognitive disorders. It’s necessary to rou- tinely assess the older adult’s quality and quantity of sleep. Interventions for sleep difficulties will vary for the older adult. The safest sleep intervention is nonphar- macological. The healthcare worker can encourage and educate the older adult on healthy sleeping habits.
Nonpharmacological sleep interventions for the older adult include the following (Boyd, 2017): ● Use awareness for when to go to bed and go to bed when feeling tired. ● Create a routine and stick to it (it can take time). ● Use your bed only for intimacy or sleep. ● Decrease or eliminate stimulating foods after lunch (caffeine). ● Avoid naps. ● Add or increase physical exercise. ● Include relaxation techniques (simple relaxation, guided imagery, or distraction). The use of pharmacological interven- tions needs further assessment and pos- sible referral. The AGS (2019) notes pos- sible dangers in prescribing medications that are potentially inappropriate for old- er adults: zolpidem (Ambien), zalepon (Sonata), eszopiclone (Lunesta), alpra- zolam (Xanax), lorazepam (Ativan), and diazepam (Valium). Sleep hygiene is the primary recommendation from the AGS (2019) for older adults. If the older adult is technologically savvy, the healthcare worker can suggest apps for healthy sleep regimen reminders, sleep logs, relaxation techniques, or medication reminders. Getting restful sleep is important for the health and well-being of the older adult. Depression The healthcare worker is likely to in- teract with an older adult experiencing depressive symptoms or suffering from a diagnostic depressive disorder. De- pression is more common in people who suffer from illness or decreased function- ing; 80% of older adults have at least one chronic health condition, and 50% have two or more (CDC, 2021b). Remembering ageism and bias is important as the health-
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