Mental Health Concerns and The Older Adult
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inappropriate and ineffective method for anxiety treatment (Boyd, 2017). Treatment can be tailored to the individual needs of each patient. The AGS (2019) provides a list of potentially inappropriate med- ications for older adults, and it includes the benzodiazepines alprazolam (Xanax), lorazepam (Ativan), and diazepam (Vali- um) and offers alternatives for medicating anxiety with buspirone (Buspar) and SS- RIs like citalopram (Celexa) and sertraline (Zoloft). Nonpharmacological approaches are plentiful for the treatment of anxiety in the older adult. The clinical practice guideline for geriatric anxiety recom- mends nonpharmacological methods of treatment: lifestyle modifications (sleep, diet, exercise, social support), behavioral therapy (relaxation), cognitive-behavioral therapy, mindfulness, yoga, art/dance/ music therapy, or alternative therapies (Subramanyam et al., 2018). Knowing how the older adult has coped in the past is helpful when establishing strengths and weaknesses for current treatment focus- es. The healthcare worker can assess for anxiety and offer treatment suggestions that are available and acceptable to the needs of the older adult. Bipolar Bipolar is a disease typically diagnosed earlier in life than older adulthood. The average age of onset is 25 years old and portends a short life expectancy (Sadock et al., 2015). Even though older adult on- set is rare, bipolar is a diagnosis for life. Therefore, a healthcare worker would need knowledge of common bipolarity symptoms that can be found in bipolar I and bipolar II: mood lability, agitated and cyclic depression, episodic sleep irregu- larities, possible impulsivity (often involv- ing high-stakes behavior like unsafe sex- ual activity, gambling, or substance use),
deep depressive crashes (can coincide with suicidal ideations), and historical fail- ure of antidepressant treatments (Sadock et al., 2015). Older adults with bipolar can still experience mania or hypomania, but the incidence decreases with age. Older adults with bipolar often suffer from mul- tiple comorbidities such as cardiovascular disease, cancer, lung diseases associated with smoking, hypertension, diabetes, and substance use and abuse (Sajatovic et al., 2013). The physical and mental health of the older adult can be quite compromised. More severe comorbidities are associ - ated with poorer outcomes. A thorough psychiatric history of symptoms and treat- ments should be assessed. The assess- ment priority for the older adult with bipo- lar having a manic or depressive episode is safety. Interviewing family, friends, and caregivers can be helpful for addressing potentially harmful activities for the old- er adult. Immediate intervention can be taken if needed, in accordance with work- place policy or state law. The healthcare worker meeting the mental health needs of the older adult with bipolar is likely to see psychiatric mood-stabilizing medica- tion. The most common pharmacological treatments for bipolar are lithium carbon- ate (Lithium), divalproex sodium (Depa- kote), and lamotrigine (Lamictal) (Boyd, 2017). Successful past pharmacological treat- ment can be reviewed and taken into consideration for current treatment op- tions. Since the older adult with bipolar is likely to have comorbidities, special considerations should be taken when prescribing or altering their medication regimen(s). Older adults metabolize, tol- erate, and respond to medications differ- ently than younger populations; there-
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