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 missing 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 determinants might require additional assistance from case management, family, or peer interventions. Stigma can stand in the way of access to care and treatment. Breaking stigma is everyone’s job, but it can start with one healthcare worker. The healthcare worker capable of fostering a therapeutic alliance built on trust and rooted in empathy will enhance the possibility for healthy communication and connection, naturally decreasing stigma. Friends, family, and caregivers can also be educated in empathetic communication with the older adult to normalize mental illness and treatment. Addressing mental health needs in the older adult will depend on the assessment recorded or provided to the healthcare worker. Assessment is not a single interaction; rather, it is a calculated and continuous process that evolves throughout the care for the older adult client (Boyd, 2017). The first interview can set the tone. Preparation prior to meeting the client is encouraged. The healthcare worker can review common developmental tasks of the older adult at any point while providing mental healthcare. Developmental tasks of the older adult are to maintain body image and physical integrity, to conduct a life review, to maintain sexual interests and activities, to deal with the death of significant loved ones, to accept the implications of retirement, to accept the genetically programmed failure of organ systems, to divest oneself of the attachment to possessions, and to accept changes in relationships with grandchildren (Sadock et al., 2015). Any of these tasks can be explored in more depth to establish known protective factors or barriers to the mental health of the older adult. An assessment is a deliberate and systematic gathering of information with the goal of formulating a plan. A mental health assessment includes biopsychosocial data to show current and previous health, functional ability, and problems/diseases/ illnesses both present and future (Boyd, 2017). The mental health assessment includes the biological domain, that is, the physical status of the client. This assessment is often carried out in conjunction with the client’s primary care provider. Biological data is important to the mental healthcare worker; however, a team approach to the older adult can serve the client best by allowing multiple disciplines to focus on their specialty area of practice. The medical record for the older adult can be quite involved. However, a records review and collaboration with the older adult client’s primary care provider can benefit the holistic picture of the mental health needs to be addressed. Physical problems or disorders can be exacerbated or accounted for by addressing the underlying psychiatric disturbance. The overlap of biological problems and psychosocial problems can be complicated. The American Geriatric Society (AGS) organizes geriatric health via alliteration for ease of remembrance. The five M’s of older age are multicomplexity, Healthcare directives Advanced care planning can be completed for clients of any age; however, it is responsible to offer the option to all older adults prior to medical crises or the end of life. The mental healthcare provider can support the older adult in these legal and ethical plans according to policy. Advanced care planning decisions include measures that can be taken in an emergency: cardiopulmonary resuscitation, use of a ventilator, artificial nutrition such as tube feedings or intravenous fluids, and comfort care measures (NIA, 2018). Older adults need to be aware of the risks and benefits of these differing emergency measures. Older adults with multiple comorbidities are less likely to recover from cardiopulmonary resuscitation and might need extended
Self-Assessment Quiz Question #3 Social determinants of health can enhance or inhibit care for the older adult. When the healthcare worker assesses Internet access and connectivity along with the technological capabilities of the older adult for telemental health follow-ups, the healthcare worker is exploring which social determinant of health?
a. Healthcare access and quality. b. Education access and quality. c. Social and community context. d. Stigma.
ASSESSMENT CONSIDERATIONS FOR THE OLDER ADULT
mind, mobility, medication, and what matters most (AGS, 2020). Multicomplexity is the description of the older adult as a client with comorbid biopsychosocial needs that can challenge the healthcare worker. Mobility refers to the level of autonomous or diminished functionality of the older adult, especially the ability to ambulate and care for themselves. Medication is typically remarkable for the older adult; polypharmacy can be common and problematic and often results in undesirable side effects that signal a strict need for regular consolidation evaluation. The final ideal, mattering most, encompasses the notion of aging and decision making to include the older adult as an advocate for health decisions and goals. This depiction can aid the mental healthcare worker to conceptualize the older adult’s biopsychosocial needs. Assessing the older adult as they present in their current level of functioning is paramount and requires establishing trust and building rapport. The psychiatric interview is the most important part of the mental health assessment. It provides an opportunity to positively impact older adults suffering from mental health issues and illnesses. Approaches that can enhance the therapeutic alliance include the following aspects (Boyd, 2017): ● Establishing a relationship rooted in cultural competence and cultural humility. ● Availability to assist in times of crisis. ● Awareness of acute safety issues related to the patient. ● Ability to provide education and manage expectations. ● Review and modification of treatment to individual preferences. ● Realistic intervention and goal setting. ● Support for patient to maintain safe autonomy. Every interaction provides the opportunity to strengthen or weaken this bond and to obtain facts, feelings, and thoughts that can be targeted for treatment. The psychiatric interview can be administered in any setting (e.g., hospital, clinic, nursing home, residential facility). The length of time allotted or needed will vary by client and setting. Consult your facility for the proper organization of psychiatric assessment documentation. ventilator care (NIA, 2018). The healthcare provider seeing the older adult for mental health needs can prompt the discussion with the inclusion of quality of life. Several options exist for an older adult in terms of an advanced directive: living will, durable power of attorney, and other specific medical measures such as a do not resuscitate order or a tissue or organ donation request (NIA, 2018). The mental healthcare worker can assist the older adult and family with advance care planning needs to increase the likelihood of receiving desired treatment during crises or the end of life.
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Book Code: PYMA2024
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