SERIOUS MENTAL ILLNESS (SMI)
The healthcare worker should be able to identify the older adult who suffers with serious mental illness so that the complexity of the accompanying intervention and treatment can be addressed. SMI is a significant functional impairment caused by one or more mental disorders (most commonly schizophrenia, bipolar, or MDD). Approximately 4.8% of older adults in the U.S. live with SMI (SAMHSA, 2022b). An older adult who suffers with SMI often needs greater medical and mental illness intervention than some- one without SMI. The healthcare worker will need to assist with a comprehensive treatment plan. Older adults with SMI are likely to have comorbidities that complicate their quality of life and in- crease their risk of mortality (SAMHSA, 2021). The most common medical conditions contributing to earlier death are cardiovascu- lar diseases, followed by diabetes, chronic obstructive pulmonary disease (COPD), obesity, and tobacco use (Bartels et al., 2020). Specific psychopharmacological interventions are individualized for the older adult with SMI and are chosen to best meet the spe- cifics of their medical and mental illnesses. Older adults with SMI have better physical and mental health outcomes with psycho- social interventions that focus on improving independent living, teaching social skills, enhancing social support with peer mentors, and education about physical and mental illness management for better self-management lifestyles (Bartels et al., 2020). The healthcare worker can refer to case management or community resources, along with support from friends, family, and caregivers. Treatment options will be offered in accordance with appropriate care settings and social determinants for the older adult with SMI. Psychosocial Interventions for the older adult with SMI include the following (Bartels et al., 2020): ● Helping Older People Experience Success (HOPES) : HOPES is a 12-month course that contains seven modules: Commu- nicating Effectively, Making and Keeping Friends, Making the Most of Leisure Time, Healthy Living, Using Medications Effec- tively, and Making the Most of a Healthcare Visit. The courses are designed to meet weekly and teach a new skill set at every session. Weekly sessions provide active engagement for the Recovery and healthy aging should be initiated at the first psy - chiatric interview, systematically evaluated at every subsequent meeting, and adjusted as needed for the older adult with mental illness. Recovery is defined as the ability to overcome and adapt with positivity to any health disorder in order to reach one’s po- tential and life goals (SAMHSA, 2022c). Striving toward prioritiz- ing recovery and healthy aging brings mental healthcare in the direction of biopsychosocial interventions and functioning toward maximizing the quality of care for the older adult. This is an impor- tant goal of every mental health interaction and will be unique to each older adult client. Healthy aging is defined as healthy choic - es, connections, and prevention and management of health con- ditions that contribute to quality of life (HHS, 2022). There is more than one path to healthy aging and recovery. Deciding which practices and treatments (medications, therapies, community re- sources, etc.) are best suited for the older adult with mental ill-
older adult with SMI, and a wide range of potential tool sets offers the opportunity to meet a greater number of needs. ● Cognitive Behavioral Social Skills Training (CBSST) : CBSST individualizes training framed around personal functioning in a group setting. There are three modules that target self- management, communication techniques, and interpersonal problem solving. Each module meets weekly for one month. Unique goals are set for the older adult with SMI based on their needs and capabilities. ● Health and Recovery Peer (HARP) : HARP is a mental health program with peer support inclusion for the older adult with SMI that evolved from the chronic disease self-management program. The six topics it covers are illness self-management, exercise and physical activity, pain and fatigue management, healthy and affordable eating, medication management, and the importance of continuity of physical and mental health- care. HARP helps older adults with SMI set short- and long- term goals for all topics covered. ● Targeted Training in Illness Management (TTIM) : TTIM is a combination focus for older adults with SMI and comorbid di- abetes. This approach contains two sections. The first section has a nurse educator and peer mentor running weekly ses- sions for three months that address medication management, nutrition, exercise, substance use, problem-solving skills, en- gaging social support systems, and setting personal goals. The second half of the training is offered through telephone consultation with the goal of self-sustainment. The healthcare worker meeting the mental health needs of the older adult will most likely be collaborating with a team to maxi- mize the quality of care. Older adults with SMI are more likely to need acute care and premature permanent nursing home place- ment when compared to older adults without SMI; therefore, it is important to place greater emphasis on intervention and treat- ment options to increase autonomy (Bartels et al., 2020). A team approach between medical and psychiatric care is necessary for the healthcare worker addressing the mental health needs of the older adult with SMI. ness will be a multifaceted assessment process, possibly including other healthcare disciplines. SAMHSA (2022c) classifies four ma - jor dimensions for recovery implementation, and HHS recognizes nine topics for healthy aging. Table 7 combines SAMSHA recov- ery dimensions and HHS healthy aging topics, and it highlights older adult considerations for the healthcare worker to address. The healthcare worker can use recovery dimensions as factors for assessing an older adult. A review of an older adult’s health, home, purpose, and community can signify protective factors or barriers to recovery, each able to alter the length of recovery. Recovery dimension barriers can be targets for intervention. In addition to recovery dimensions are recovery principles for the healthcare worker meeting mental health needs. The healthcare worker can view the 10 SAMSHA recovery principles and their ap- plicability to the older adult in Table 8.
RECOVERY PRINCIPLES AND HEALTHY AGING
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