185 Mental Health Concerns and The Older Adult
Anxiety Anxiety is commonly found in early or middle adulthood but can be seen after 60 years of age, although initial panic dis- orders are very rare (Sadock et al., 2015). The symptom profile for older adults ex - periencing anxiety is different than young- er populations. Older adults tend to be less symptomatic, yet they are equally as troubled. The decreased symptoms have been attributed to a decreased autonom- ic nervous system (Sadock et al., 2015). Older adults have a vast life experience that can include change, transition, loss, and death. Upon assessment, loss, grief, and bereavement can look like anxiety. When assessing anxiety, it’s necessary to establish the underlying etiology, length of symptom interference, and cultural considerations. A thorough psychiatric history is needed for clarity of diagnosis. Degrees of clinical anxiety are mild, mod- erate, severe, and panic (Boyd, 2017). Anxiety often accompanies depression. The older adult with depression is at a higher risk for suicide; therefore, anxiety symptoms coupled with depression need a critical safety assessment (Sadock et al., 2015). There are medical conditions that can mimic anxiety symptoms in the elderly. Further assessment is needed to rule out stroke, multiple sclerosis, cardiac dys- function, irritable bowel syndrome, hypo- glycemia, hyperthyroidism, hepatic fail- ure, vitamin B deficiencies (1, 6, and 12), and decreased folic acid (Subramanyam et al., 2018). Laboratory studies can also confirm the presence of interference when considering the diagnosis of anxi- ety. If anxiety is found in the older adult, assessment for substance use and abuse is needed. Alcohol is often the drug of choice to self-medicate anxiety, but it is an
to stress/loss/bereavement (APA, 2010). Assessment can be completed during the psychiatric interview. The health- care worker can use an informal format or systematic questioning to elicit safety responses. No formal training is needed to administer the brief suicide screen- er called the Columbia Suicide Severity Rating Scale (C-SSRS) (SAMHSA, 2022a). All healthcare workers can administer the C-SSRS. The tool probes the older adult about their intent, plan, and preparation for death. If the questions are answered honestly, it can indicate older adults who are at high risk of suicide completion (The Columbia Lighthouse Project, 2016). To garner the greatest gains, the healthcare worker must utilize empathy to nurture an environment of trust with- in the therapeutic alliance with the older adult during this part of the assessment. The APA (2010) recognizes the use of a suicide contract commonly called a no harm contract between a mental health- care provider and a patient. There is no evidence to prove its effectiveness in pre- vention and it is cautioned against as a replacement for a thorough suicide risk assessment. But it can be a useful meth- od for discussing protective factors and a safety plan of action. The healthcare worker has decisions to make based on the level of risk verbalized by the older adult. The approach for intervention will depend on the severity of risk, workplace policy, and state legalities—especially related to breaching confidentiality. The healthcare worker will abide by the indi- vidualized plan of action for suicide pre- vention according to protocol and treat- ment setting.
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