● Be aware of the language used (this goes for words you say or they say; humor is acceptable but in the proper context). ● Educate the client about the importance of mental illness (draw comparisons to how they would treat someone with a physical illness). ● Show empathy for those with mental illness. ● Be honest about treatment (normalize mental health treat- ment). The healthcare worker can educate family, friends, and caregivers about participating in normalizing mental healthcare for the older adult. Table 1 presents communication suggestions the health- care worker can pass on to family, friends, or caregivers of the older adult suffering from mental illness. Words are powerful, so encourage others to choose them wisely. Table 1: Anyone Can say This and Not That to Reduce Stigma Say This Not That “Thanks for sharing with me.” “That’s not that bad.” “Can I help you in any way?” “You can do it.” “That sounds really difficult.” “Life moves on.” “I’m here for you.” “That happens to everyone.” “That sounds heavy and sad.” “Everything happens for a reason.” “I can’t imagine. Tell me more.” “I know all about that.” “How are you feeling?” “You’ve got to think happy thoughts.” Homelessness falls into this social determinant and would require additional assessment and coordination of care. The depth a healthcare provider should reach will depend on the client and their individual living situation. Clarity of a client’s physical health and safety can also be obtained with client consent by interview- ing and family, friends, or caregivers. Health risks of loneliness include the following (CDC, 2021c): ● Higher risk for premature death from disease, especially re- lated to smoking, obesity, and sedentary lifestyle. ● Dementia risk increases by 50%. ● Heart disease risk increases by 32%, leading to higher rates of stroke. ● Coincides with higher rates of depression, anxiety, and sui- cide. ● Specific to heart failure: risk of death increases four times, risk of hospitalization increases by 68%, and emergency visits in- crease by 57%. and economic stability—can be used as a circular framework for the healthcare worker assessing older adult mental health needs (ODPHP, 2022). A deficiency in any of the determinants for the older adult can be a barrier to accessing mental health services and treatment. More than one social determinant can be miss- ing for a client. Assessing social determinants can lead to better understanding of the obstacles an older adult must overcome to seek mental healthcare. Insufficient coverage in social determi - nants might require additional assistance from case management, family, or peer interventions. Stigma can stand in the way of ac- cess to care and treatment. Breaking stigma is everyone’s job, but
To increase the potential benefits of telemedicine, the healthcare worker can interview the older adult as well as their family, friends, or caregivers when assessing the inclusion of telemedicine for mental healthcare. There are other technological gains for a will- ing and able client. Apps related to, for example, healthy coping techniques, exercise logs, medication reminders, and communi- cation can enhance the quality of life and safety of the older adult. Technology can strengthen mental healthcare for the older adult; however, the healthcare worker must prudently examine the initial and continued feasibility of its use. Stigma Mental healthcare access and quality can also be affected by stig- ma. Racial inequalities have been found in this social determinant of health. Research has found that African Americans experience greater amounts of stigma surrounding mental health treatment than other Americans (Conner et al., 2010). The basis and con- tinued existence of mental health stigma for African Americans is unclear; however, the rates of access to mental healthcare are un- deniable. Stigma is a mental healthcare barrier that the healthcare worker should not ignore. More than half of people suffering with mental illnesses do not get help (APA, 2020). Older adults can be unwilling to seek mental healthcare due to feelings of shame and guilt; these same patients, who are willing to receive treatment from their primary care provider, are often reluctant to seek men- tal health specialty care until their symptoms are severe (SAM- HSA, 2021). Stigma can trap the older adult and cause them to suffer silently. It can drive an older adult to feel the loss of dignity and reinforce isolation, which perpetuates loneliness (APA, 2020). The healthcare worker should be equipped to help reduce the feelings around stigmas. Suggestions to help reduce the stigma of mental illness include the following (APA, 2020): ● Encourage the client to talk openly about mental health (share with others). ● Empower the client to stand up to misconceptions (give them facts and data). Determinant 3: Neighborhood and built environment The physical place where someone resides contributes to their overall health and safety. Those at highest risk for unsafe or un- healthy environments in the U.S. are ethnic and racial minorities (CDC, 2022b). Examples of negative impacts on health and safety are neighborhoods with high crime rates or environments close to pollution sources. A client’s physical environment falls into the so- cial and developmental history of the mental health assessment. Determinant 4: Social and community context Relationships and social support play crucial roles for the older adult. Lack of social support and decreased or absent significant relationships negatively impact mental health in the older adult (Harandi et al., 2017). A healthcare worker can assess this social determinant in the social and developmental history of the mental health assessment. Older adults are at significant risk of experi - encing isolation and loneliness (CDC, 2021c). This can be due to the death of a spouse/significant other, estrangement from family, worsening disabilities, or perceived feelings of burden to others. Groups most at risk within the older adult population are immi- grants; those who are lesbian, gay, bisexual, and transgender; and those suffering abuse (CDC, 2021c). While there is not a clear measure for loneliness, there is evidence of related health risks that accompany it. Determinant 5: Economic stability Poverty contributes to clients not being able to meet their ba- sic needs. Approximately 9.3% of the older adult population in the U.S. lives below the poverty line (SAMHSA, 2019). Housing, healthcare, and nutritious food and drink are major concerns for older adults that could contribute to mental health conditions. Case managers are a prudent referral for the older adult lacking the financial means to meet their needs. The five Healthy People 2030 social determinants from the U.S. Department of Health and Human Services {ODPHP, 2022 #17}— education access and quality, healthcare access and quality, neigh- borhood and built environment, social and community context,
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