A crisis results from stressful events for which coping mechanisms fail to provide adequate adaptive skills to address 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 outcome. 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 suicide. 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 crisis should mitigate within four to six weeks (Boyd, 2017). When 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 circumstances around the situations causing disequilibrium to psychological well-being. A crisis can cause feelings of being out of control, 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 Loss, grief, and bereavement Loss, grief, and bereavement are an expected part of life and will be seen in various presentations by the healthcare worker assessing the older adult. Statistical analysis suggests that 51% of women and 14% of men older than age 65 years will be widowed at least once in their lifetime (Sadock et al., 2015). The healthcare worker will assess the older adult suffering from loss, grief, and bereavement. Knowing the differences in terminology, the cycle of grief, and the risks to older adults unable to cope are crucial for the healthcare worker. The definition of loss according to the Merriam-Webster dictionary (2022) is “the act or fact of being unable to keep or maintain something or someone.” Loss is synonymous with more than death. For example, the older adult can feel the loss of identity, loss of autonomy, or loss of functioning. The definition of bereavement is “the process of mourning and coping with the loss of a loved one” (Boyd, 2017, p. 213) This is synonymous with death. The definition of grief is: The anguish experienced after significant loss, usually the death of a beloved person. Grief is often distinguished from bereavement and mourning. Not all bereavements result in a strong grief response, and not all grief is given public expression. Grief often includes physiological distress, separation anxiety, confusion, yearning, obsessive dwelling on the past, and apprehension about the future. Intense grief can become life-threatening through disruption of the immune system, self-neglect, and suicidal thoughts. Grief may also take the form of regret for something lost, remorse for something done, or sorrow for a mishap to oneself. (APA, 2022e). For the older adult, loss, grief, and bereavement are topics that are encountered over a lifetime. Loss can be felt over animate and inanimate objects. Older adults can experience loss over loved ones, driving privileges, jobs, and autonomy on many levels of health, home, and happiness. Cultures and societies have determined an acceptable amount of time to grieve loss. Typical American culture expects people to return to work or school after a few weeks of loss, find a new balance
disaster or a pandemic could affect the older adult and cause a traumatic crisis. Differentiating a temporary crisis from acute stress disorder depends on the severity of distress and how it impairs social functioning. It will also depend on diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorder ( DSM-5 ). Diagnostic inclusion for acute stress disorder requires “exposure to actual or threatened death, serious injury, or sexual violation” (not experienced through electronic media unless work related) (APA, 2013, p. 280). The healthcare worker must gather sufficient detail about the stressors and their causes in the older adult’s life to offer appropriate intervention. A healthcare worker often intercedes in times of crisis. Assessment for self-harm or harm to others is needed when an older adult is in crisis and will drive the immediate interventions. If harm is not a factor, the healthcare worker should focus their initial intervention on active listening (Corey & California State University, 2013). Allow the older adult the space to verbalize their feelings and experiences. The healthcare worker can meet these expressions with openness driving for acceptance. Feeling heard can help an older adult in crisis feel grounded (Corey & California State University, 2013). Stability in the midst of a crisis can help deescalate the extremes of emotions such as anger or sadness. Positive mental health support during a crisis opens the door for future intervention. Not all older adults who experience a crisis need mental healthcare. The necessity of crisis intervention will be determined by the ability or inability of the older adult to self-soothe and cope. It is worth understanding that the older adult may value feeling understood and supported during a crisis more than a healthcare worker’s ability to solve the problem (Corey & California State University, 2013). Assessment of coping skills and previous crisis coping will provide the healthcare worker with a plan for present needs and intervention. in a few months, and be adept in their coping to establish new relationships 6 to 12 months after the loss of a loved one (Sadock et al., 2015). The healthcare worker should assess and recognize that grief is an individual process each time it occurs. One notable framework for understanding grief in marked stages is by Kübler-Ross. However, the stages are not meant to be linear as they are written (Kübler-Ross & Kessler, 2005). Grief is felt uniquely by everyone but is often encountered with proportionally greater impact by the older adult than younger generations. The Kübler-Ross and Kessler (2005) framework allows common terminology and an expression of information with the hopes of a better understanding of the psychological process occurring individually over loss. The stages are written sequentially but are not always experienced linearly. The stages can last minutes or hours, weeks or months. The stages are a response to loss that is seen and felt by many. There is no normal response to loss; all loss is different. Kübler-Ross and Kessler (2005) hoped by creating the stages it would create a space for grief to resolve, enabling a person to cope with the loss and carry on with their life. Another view of grief comes from the dual process model. It provides the healthcare worker with a way of conceptualizing how an older adult can cope with loss over time. The exploration of this model can enable a healthcare worker to identify the coping mechanisms the older adult is utilizing in their journey of healing. The model has two processes working, sometimes simultaneously and other times not, and it focuses on the switch between loss-oriented coping and restoration-oriented coping as oscillation (Boyd, 2017). Both processes may take large amounts of time and effort, or one may take more or less. They are not mutually exclusive, but awareness of both is necessary for processing grief and loss. Loss-oriented coping is focused on the loss itself—the relationship—and restoration-oriented coping is focused on the burden felt from the responsibility from the loss (Boyd, 2017).
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Book Code: PYMA2024
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