Mental Health Concerns and The Older Adult
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(NIA, 2021b). These recommendations can be individualized to fit the needs of the older adult and their circumstances. Case management and community en- gagement can be useful additions for support. The APA has published treatment rec- ommendations specific to age ranges. For initial treatment of the older adult with MDD, the APA (2019) recommends group-based cognitive-behavioral thera- py (CBT) or interpersonal psychotherapy (IPT) in combination with pharmacother- apy. The APA recognizes that treatment options are dependent on social determi- nants. The following are recommended treatments for MDD if group CBT or IPT are unavailable for initial treatment: indi- vidual CBT with or without pharmacother- apy and problem-solving group therapy (APA, 2019). If the healthcare provider is considering psychopharmacological in- terventions, a review of the AGS list of potentially unsafe medications for the older adults is needed. The AGS (2019) lists two tricyclic antidepressants, amitrip- tyline (Elavil) and imipramine (Tofranil), as potentially inappropriate and encourages considering prescribing selective sero- tonin reuptake inhibitors (SSRIs) citalo- pram (Celexa) and sertraline (Zoloft) as well as bupropion (Wellbutrin) if possible. Treating depressive symptoms of MDD with medication can be accomplished but must be reviewed for the safest option that meets the needs of the older adult. Suicidal risk The older adult population has a par- ticularly high rate of suicide. White men over the age of 65 have a risk that is five times higher than the general pop - ulation, and older adult men account for 60% of all completed suicides (Sadock et al., 2015). The safety of the older adult
is paramount for all healthcare workers in all settings. The recognition of risk factors coupled with appropriate intervention can save lives. Risk factors can be modi- fiable or nonmodifiable. The APA clinical practice guideline (2010) notes genetics, family history, and demographics as non- modifiable risk factors. Knowing the older adult’s risk factors can aid the healthcare worker in risk calculation but does not precisely predict attempts. The Nation- al Council on Aging (NCA) (2021) notes loneliness as the top reason for suicid- al ideations, followed by suicidal intent caused by feelings of deep grief over a loved one, mourning the loss of autono- my and self-sufficiency, chronic illness and pain that decrease the quality of life, cog- nitive impairment and dementias, and fi - nancial stress that causes an inability to pay bills. The older adult’s increased sui- cide risk is also consistent with a mental health diagnosis of depression, schizo- phrenia, posttraumatic stress disorder, substance use disorders, an inclusion of trauma, an experience of discrimination based on sexual identity, access to lethal means, and sleep disturbances (LeFevre & Force, 2014). The suicidal older adult with access to lethal means should trigger the health- care worker to immediately assess for safety. Statistics show that older adults plan more thoroughly for suicidal com- pletion and are most likely to use lethal means (firearms) than younger popula - tions (NCA, 2021). Reasons stopping or preventing the older adult from follow- ing through on suicidal thoughts, intent, and plans are called protective factors. Protective factors that apply to the old- er adult are cultural views, spiritual be- liefs, coping skills, personality traits, so- cial support systems, and past responses
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