● Autonomy and independent living. ● Accountable basic needs covered (food, shelter, safety). ● Positive self-esteem and self-image. ● Access to medical care and medications. ● Sense of purpose and belonging. Person-centered care accounts for older age and lifestyle modifications, access to care, and quality of life considerations (SAMHSA, 2022d). The healthcare provider needs to consider the following for the older adult seeking treatment: physical disabilities to accommodate (mobility, hearing, vision), cognitive deficits that interfere (memory and attention), learning needs and preferences (slower pace and repeated information if needed), and respect for age and gender preferences for provider and group therapies. Spirituality The spiritual assessment of the older adult is documented in the social history section of the psychiatric evaluation. The healthcare worker is reminded that it is critical to maintain neutrality of stance while assessing the older adult’s spiritual beliefs. Spirituality is a broader topic than religion. It is estimated that 80% of Americans practice some type of religion (APA, 2013). All healthcare workers will interact with the spiritual aspects of an older adult’s beliefs, religion, or purpose of life while meeting their mental health needs. The inability to address spiritual involvement in an older adult’s life can limit a client’s recovery (Neathery et al., 2020). If the healthcare worker is reluctant or uncomfortable assessing an older adult’s spirituality, a self-assessment to identify the barriers can be beneficial. Cultural awareness and acceptance are key for impartiality of assessment. Spirituality is a component of mental healthcare that is often woven into an older adult’s lifestyle, guiding 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 assessment 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 ramifications that could hinder treatment. A history of problematic behavior 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 comorbidities, 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 decision 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 worker 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 something to cause harm to the health and well-being of an elderly person), 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) (National Research Council, 2003) The older adult is vulnerable to all generalized types of Older adults have lived through a multitude of challenges by the time the healthcare worker is assessing for intervention. Adaptation and change are inevitable. How the older adult has coped in the past is salient for how they will cope with present 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:
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 psychological abuse, includes “a caregiver saying hurtful words, yelling, 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 most at risk for abuse are female, those without support systems, those with disabilities, and those who are cognitively 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 financial 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 authorized 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 following EXCEPT: a. Disheveled appearance. b. Severed family ties.
c. Difficulty sleeping and easily agitated. d. Unexplained bruises and bed sores. CRISIS, LOSS, GRIEF, AND BEREAVEMENT IN THE OLDER ADULT
and future difficulties. The healthcare worker will see the older adult experience 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.
A time-limited event that triggers adaptive or non-adaptive responses to maturational, situational, or traumatic experiences.
EliteLearning.com/Psychology
Book Code: PYMA2024
Page 54
Powered by FlippingBook