189 Mental Health Concerns and The Older Adult
Definition of tardive dyskinesia (TD) (APA, 2022i): A movement disorder associated with the use of antipsychotics, particular- ly conventional antipsychotics that act primarily as dopamine- receptor antagonists. It is more common with prolonged use (months or years), and older patients, females, and patients with mood disorders are thought to be more susceptible. Symptoms include tremor; so-called choreoathetoid movements; and spasticity of muscle groups, particularly orofacial muscles and muscles in the extremities. Onset is insidious and may be masked by con- tinued use of the antipsychotic, only appearing when the drug is discontin- ued or the dose lowered. Its incidence is estimated at up to 40% of long-term users of conventional antipsychotics; the incidence is lower with atypical an- tipsychotics. No effective treatment is known. Older adults need special consider- ations for medications to treat schizo- phrenia. Older adults with schizophrenia often need adjustments to medication regimens with lower doses or divided doses throughout the day when possible (Sadock et al., 2015). The AGS releases and continually updates safety criteria to guide the treatment of the older adult population. The AGS (2019) recommends only patients with schizophrenia receive antipsychotic medication, which increas- es the risk of stroke, diminishes cognitive ability, and contributes to early death.
The healthcare worker should investi- gate all medications being taken by the older adult with acute notation of anti- psychotics drugs and their known side ef- fects. Table 6 is a snapshot of antipsychot- ic medication options and is presented to increase understanding of decreased dose ranges and the comparative difficul - ty of side effect risk profiles for antipsy - chotics in older adults. Neuroleptic malignant syndrome (NMS) is a life-threatening condition that can happen in response to antipsychotic medications. Early recognition and inter- vention are the most important things a healthcare worker can do for a patient ex- periencing NMS. The primary symptoms of NMS are mental status changes, severe muscle rigidity, and autonomic changes (historically presenting with high fever ranging between 101 and 103 degrees Fahrenheit, tachycardia, and fluctuating blood pressure) (Boyd, 2017). Emergen- cy intervention is needed for NMS. The healthcare worker should intervene as workplace policy dictates to get the pa- tient to appropriate medical care as soon as possible. A delicate balance is needed to lessen problematic schizophrenic symptoms and antipsychotic medication side effect pro- files, which can be dangerous to the old - er adult. The healthcare worker can help assess the older adult with schizophrenia and seek to find interventions and treat - ments that can be modified if needed. With an individualized plan of care and proactive planning, the healthcare worker can increase the quality of mental health services provided, in turn increasing the quality of life for the older adult living with schizophrenia.
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