ing their adherence to medications and therapies (Rodgers et al., 2018). Proper understanding of an older adult’s belief system, spirituality, and feeling of belonging is essential during assess- ment for relevant intervention and treatment. Legal involvement Legal history can be notable for the older adult client. The mental healthcare worker will assess for legal involvement or ramifica - tions that could hinder treatment. A history of problematic behav- ior related to disregard for rules and remorse can be diagnostic for antisocial personality disorder (ASPD). ASPD is associated with younger populations; however, the presence of it historically must be taken into consideration, as it carries high rates of comorbidi- ties, most commonly substance use disorders (Holzer et al., 2022). The healthcare worker can also assess for caregivers, friends, or family members who have any legal stake in the older adult’s deci- sion making. Elder abuse (physical/emotional/sexual/financial) According to statistics, abuse is reported for around 10% of those age 65 years and older (Sadock et al., 2015). The healthcare work- er must understand definitions and classifications of abuse and assess for mistreatment in all older adults. The American Medical Association has three general definitions for elderly mistreatment: abuse (something that causes harm or the withholding of some- thing to cause harm to the health and well-being of an elderly per- son), neglect (the inability to do good or provide needed services or basic needs [food, shelter, medical care] to an older adult), and exploitation (using an older adult’s money for self-purposes) (Na- tional Research Council, 2003) The older adult is vulnerable to all generalized types of abuse: physical, emotional, sexual, and financial. Physical abuse is defined as “bodily harm by hitting, pushing, or slapping. This may also include restraining an older adult against his/her will, such as locking them in a room or tying them to furniture” (NIA, 2020). Emotional abuse, also called psy- chological abuse, includes “a caregiver saying hurtful words, yell- ing, threatening, or repeatedly ignoring the older adult. Keeping that person from seeing close friends and relatives is another form of emotional abuse” (NIA, 2020). Sexual abuse involves unwanted sexual acts or being forced to watch sexual acts (NIA, 2020). Financial abuse happens when money or belongings are stolen from an older adult. It can include forging checks, taking someone else’s retirement or Social Security benefits, or using a person’s credit cards and bank accounts without their permission. It also includes changing names on a will, bank account, life insurance policy, or title to a house without permission (NIA, 2020). Older adults have lived through a multitude of challenges by the time the healthcare worker is assessing for intervention. Adapta- tion and change are inevitable. How the older adult has coped in the past is salient for how they will cope with present and future Crisis Prior to discussing loss, grief, and bereavement, it is prudent for the healthcare worker to understand crisis and its presentation to differentiate the state of being and possible intervention needed for the older adult. The definition of crisis is: A time-limited event that triggers adaptive or non-adaptive responses to maturational, situational, or traumatic experi- ences. A crisis results from stressful events for which coping mechanisms fail to provide adequate adaptive skills to ad- dress the perceived challenge or threat. (Boyd, 2017, p. 211) Crisis is a crossroad. The direction taken in the context of crisis determines the positive or negative consequences of the out- come. If the older adult chooses to grow and strengthen from the crisis, positive outcomes are expected. However, if the reverse is apparent or the client is incapable of coping, a negative and possible destructive outcome can occur such as self-harm or sui- cide. If an older adult in crisis has historically had difficulty coping, caution should be taken when assessing their safety. Depression and suicide are risks for clients who are unable to overcome a crisis (Boyd, 2017). Assessment for self-harm is paramount for the older adult in a crisis, regardless of past psychiatric history. A cri- sis should mitigate within four to six weeks (Boyd, 2017). When
Older adults most at risk for abuse are female, those without support systems, those with disabilities, and those who are cog- nitively inhibited or have dementia (NIA, 2020). The healthcare provider must assess for physical and verbal signs of abuse when interacting with the older adult. Signs of abuse in the older adult include the following (NIA, 2020): ● Cessation of enjoyed activity. ● Unkempt appearance. ● Difficulty sleeping. ● Unexplained weight loss. ● Easily agitated or violent outbursts. ● Outward signs of trauma and regression (e.g., rocking back and forth). ● Unexplained bruises, burns, cuts, scars. ● Signs of physical altercation (such as broken eyeglasses). ● Bed sores or other preventable disorder or disease. ● Lack of medical aids needed for functioning (glasses, hearing aids, dentures, medications, etc.). ● Financial warnings (eviction notices, unpaid bills despite finan - cial means). ● Report of unsafe living conditions (hazardous, unsanitary, or unsafe). Long-term effects of elder abuse can lead to declining physical and psychological health, severed social support, financial loss, and early death (NIA, 2020). Elder abuse requires intervention. The healthcare worker must comply with state laws and autho- rized means of reporting elder abuse according to facility policy. Local, state, and national resources exist to report and/or stop elder abuse. Self-Assessment Quiz Question #4 Abuse, a biopsychosocial consideration, in the older adult can lead to negative long-term effects; therefore, the healthcare worker recognizes the signs of elder abuse as all of the follow- ing EXCEPT: a. Disheveled appearance. b. Severed family ties. difficulties. The healthcare worker will see the older adult experi - ence crisis, loss, grief, or bereavement; therefore, it is imperative to know the difference in presentation as well as the course of typical action and line of intervention. chronic crisis is not acknowledged, however, constant unrest is classified as chaos. The healthcare worker can note varying types of and reasons a client might be experiencing a crisis. The healthcare worker assessing the older adult for mental health needs must be able to define crisis and understand the circum - stances around the situations causing disequilibrium to psycho- logical well-being. A crisis can cause feelings of being out of con- trol, desperation, and/or fear (Boyd, 2017). There are three types of crises that an older adult can experience: developmental (a remarkable maturational event in life), situational (a specific event in a person’s life that upsets the biopsychosocial equilibrium), and traumatic (due to an unknown incident) (Boyd, 2017). The older adult might experience a developmental crisis when their living situation changes dramatically, such as moving into a long-term care facility. A situational crisis can be an internal or external event for an older adult, such as disease progression or a new diagnosis. A natural disaster or a pandemic could affect the older adult and cause a traumatic crisis. c. Difficulty sleeping and easily agitated. d. Unexplained bruises and bed sores. Differentiating a temporary crisis from acute stress disorder de- pends on the severity of distress and how it impairs social func- tioning. It will also depend on diagnostic criteria in the Diagnostic
CRISIS, LOSS, GRIEF, AND BEREAVEMENT IN THE OLDER ADULT
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Book Code: RPTX3024
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