Mental Health Concerns and The Older Adult
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be prudent if given consent. Breaches of confidentiality would need to be reviewed if the older adult is a danger to self or oth- ers during an acutely psychotic episode. Many factors must be considered during the assessment of the older adult with schizophrenic symptoms or psychosis. The healthcare worker can present psy- chosocial intervention and treatment mo- dality options that fit the mental health needs of the older adult. The National Al- liance on Mental Illness (NAMI) has found four types of psychosocial intervention that greatly improve self-esteem and quality of life for an older adult living with schizophrenia: CBT, functional adaptation skills training (FAST), vocational rehabili- tation, and technology communication connection (e.g., it provides remind- ers for medications and appointments). FAST is a unique treatment approach for schizophrenia that seeks to build neces- sary life skills that can address social de- terminant barriers to mental healthcare (Cepla, 2014). For example, an older adult with schizophrenia who lacks per- sonal transportation can be taught how to navigate public transportation. En- hancing transportation for the older adult can address access to care issues and in- crease resource availability for items such as groceries, clothing, and medications. Psychosocial interventions strengthen the quality of care and life for an older adult living with schizophrenia. Schizophrenia is treated pharmaco- logically with antipsychotic medications. First- and second-generation antipsychot- ics are most frequently seen as front-line treatment options, although third-gener- ation antipsychotics are up and coming. Antipsychotic medications are used in patients with schizophrenia because they primarily block dopamine, a known cause
of psychotic symptoms, and can alter oth- er neurotransmitters (Sadock et al., 2015). Antipsychotic medications carry a difficult side effect risk profile. Sedation, postural hypotension, anticholinergic effects, ex- trapyramidal symptoms, and tardive dys- kinesia are some of the most concerning side effects of antipsychotic medications (Boyd, 2017). Definition of anticholinergic effects (APA, 2022a): Side effects are characteristic of anti- cholinergic drugs and are also associ- ated with other agents (e.g., tricyclic antidepressants, monoamine oxidase inhibitors) that exert antagonist effects at muscarinic receptors. They include dry mouth, blurred vision, urinary hes- itancy or retention, and constipation. Similar antagonistic effects may occur at nicotinic receptors as well. Depend- ing on the specific receptors involved, these effects may also be called anti- muscarinic effects or antinicotinic ef- fects. Definition of extrapyramidal symptoms (APA, 2022d): A group of adverse drug reactions at- tributable to dysfunction of the extra- pyramidal tract, such as rigidity of the limbs, tremors, and other Parkinson-like signs; dystonia (abnormal facial and body movements); and akathisia (rest- lessness). Extrapyramidal symptoms are among the most common side ef- fects of the high-potency antipsychot- ics and have also been reported with the use of other drugs (e.g., SSRIs). Also called extrapyramidal syndrome (EPS).
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