Complicated grief can happen when a person cannot move beyond the loss and a degradation of functioning occurs; however, it is only experienced by about 10% to 20% of people (Boyd, 2017). If the older adult cannot move past the loss and is overwhelmed by the change, the healthcare worker needs to intervene. Complicated grief occurs after six months of intense mourning; there is a feeling of being “stuck,” deep yearning is expressed, trust toward other people is apparent, and life become meaningless (Boyd, 2017). The healthcare worker will assess safety and the social support network to help the older adult overcome complicated grief. Grief that does not follow a normal response in the timing of symptoms can be documented as delayed grief. In delayed grief, there is a lack of initial symptoms of grief but they surface later (Sadock et al., 2015). The healthcare worker can explore the Kübler-Ross cycle of grief to assess for extended denial when the older adult appears stoic in presentation to acute loss. Cultural norms and awareness are cautioned as the healthcare provider works with the client to determine their definition of normal and what an appropriate response to loss and death are. Another form of grief is prolonged grief, which is sometimes called traumatic grief because the loss was unforeseen. It is similar to persistent complex bereavement disorder. Persistent complex bereavement disorder is a clinical diagnosis that requires the deceased to have a significant connection to the mourner. In addition, there are intense feelings of yearning/ sorrow/constant thoughts of the deceased/constant thoughts of the nature of death (one of those), and these difficulties interfere with functioning for more than a year after the death (APA, 2013). Traumatic grief is more difficult to cope with, thus leading to a longer recovery time. It often includes external circumstances such as violence, abruptness, and unanticipated or preventable death (Boyd, 2017). Traumatic grief is often termed Case study: Ms. P Ms. P. is a 68-year-old Caucasian female being seen by you in the mental health clinic. She recently lost her husband of 48 years. She barely talked at her appointment last week and has mostly been looking down at the floor avoiding eye contact. She reluctantly tells you that she overheard her children talking about housing options for her. She does not want to leave her home. Her husband drove her to all of her appointments and took care of all of her needs (groceries, medications, etc.). She has two married children who both live out of state. Her oldest daughter brought her to the visit today and is sitting in the lobby. Ms. P has a history of colon cancer (currently in remission), diabetes, hypertension, and depression. She takes oral medication for her elevated blood pressure, diabetes, and depression. Today she tells you that she feels empty, alone, and hopeless. Neurocognitive disorders Changes in cognition are statistically significant for the older adult population (Boyd, 2017). The healthcare worker must understand the differences in neurocognitive disorders for assessment, intervention, treatment, and when to refer to other disciplines and community resources. According to the APA (2013), the DSM-5 diagnosis of a neurocognitive disorder is a deficiency in the following: attention (distractibility with multiple stimuli), executive functioning (decision making, planning, Delirium Delirium is a neurocognitive disorder that a healthcare worker will come across in the older adult population. Delirium is an acute cognitive impairment caused by an underlying medical culprit (Boyd, 2017). The healthcare worker needs sharp attention of its presence; however, treatment is often administered in the acute care setting by medical professionals. There are a multitude of risk factors and known causes for delirium in the older adult population. Delirium risk factors for the older adult include the following (Boyd, 2017):
prolonged grief due to extenuating forces and an anticipated loss. Therefore, the person experiencing the loss faces a longer period of change and adaptation. Symptoms of traumatic grief/prolonged grief include the following (APA, 2013): ● Last all day (nearly every day) for at least one month. ● Disruption of self (feeling loss of self). ● Extended denial about the death. ● Inability to confront reminders of the deceased person (avoidance). ● Intense outward feelings (emotions such as anger). ● Constant struggle with moving forward with daily activities and social engagements. ● Empty feelings about life. ● Loneliness (feeling isolated and distant from others). While considering the cycle of grief and the various types of grief an older adult may experience, the healthcare worker should consider the symptoms of grief and their interference with functioning and relationships, the risk of self-harm or harm to others, and the symptoms of clinical depression when presenting appropriate intervention. Most grief will resolve on its own accord without psychiatric intervention; however, a healthcare provider might be consulted for acute medical intervention. Sleep deficits can be addressed with short- term psychopharmacological agents; however, anxiolytics, antidepressants, and narcotics are not recommended for normal grief (Sadock et al., 2015). If therapy is warranted, the healthcare worker can provide options for treatment. Grief therapy (one-on- one or group sessions) and self-help groups have been found to be most beneficial for those mourning and unable to overcome grief, loss, or bereavement (Sadock et al., 2015). The healthcare worker can work with the client, family, and community to assess the availability of resources to support the older adult. Question: What stage of grief is Ms. P in and what assessment criteria supports this? Discussion: Ms. P is displaying signs that support the depression stage (Kübler-Ross & Kessler, 2005). She is stating that she feels empty, alone, and hopeless after the loss of her husband and loss of access to groceries, medications, and medical appointments. She is expressing concern that she might even be moved from her home. Depression is also a clinical diagnosis. Further assessment would be warranted to determine her safety risk and the need to intervene or treat. Ms. P’s daughter is in the waiting area and can possibly provide clarity and insight into Ms. P’s current and future mental health needs. and working memory), learning and memory (recollection and recognition), language (expressive, fluency, grammar, receptive), perceptual-motor (visual and motor perception), and social cognition deficits (emotion recognition, ability to relate to another). Differentiating cognitive regression and disruption can be difficult, especially when a baseline of functioning or collateral information is not available. The healthcare worker who assesses and/or treats older adults will encounter older adults with neurocognitive disorders. ● Advanced age (65 years and older). ● Male. ● History of falls. ● Preexisting dementia. ● Functional dependence (long-term care facility residents). ● Endocrine and metabolic disorders. ● Fractures in bones. ● Medications (consider AGS 2019 BEERS criteria for potentially inappropriate medications in older adults). ● Vital sign changes (hypotension, hypo- or hyperthermic).
MENTAL HEALTH DIAGNOSES FOR THE OLDER ADULT
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Book Code: PYMA2024
EliteLearning.com/Psychology
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