The older adult with depression is at a higher risk for suicide; therefore, anxiety symptoms coupled with depression need a critical safety assessment (Sadock et al., 2015). There are medical conditions that can mimic anxiety symptoms in the elderly. Further assessment is needed to rule out stroke, multiple sclerosis, cardiac dysfunction, irritable bowel syndrome, hypoglycemia, hyperthyroidism, hepatic failure, vitamin B deficiencies (1, 6, and 12), and decreased folic acid (Subramanyam et al., 2018). Laboratory studies can also confirm the presence of interference when considering the diagnosis of anxiety. If anxiety is found in the older adult, assessment for substance use and abuse is needed. Alcohol is often the drug of choice to self-medicate anxiety, but it is an inappropriate and ineffective method for anxiety treatment (Boyd, 2017). Treatment can be tailored to the individual needs of each patient. The AGS (2019) provides a list of potentially inappropriate medications Bipolar Bipolar is a disease typically diagnosed earlier in life than older adulthood. The average age of onset is 25 years old and portends a short life expectancy (Sadock et al., 2015). Even though older adult onset is rare, bipolar is a diagnosis for life. Therefore, a healthcare worker would need knowledge of common bipolarity symptoms that can be found in bipolar I and bipolar II: mood lability, agitated and cyclic depression, episodic sleep irregularities, possible impulsivity (often involving high-stakes behavior like unsafe sexual activity, gambling, or substance use), deep depressive crashes (can coincide with suicidal ideations), and historical failure of antidepressant treatments (Sadock et al., 2015). Older adults with bipolar can still experience mania or hypomania, but the incidence decreases with age. Older adults with bipolar often suffer from multiple comorbidities such as cardiovascular disease, cancer, lung diseases associated with smoking, hypertension, diabetes, and substance use and abuse (Sajatovic et al., 2013). The physical and mental health of the older adult can be quite compromised. More severe comorbidities are associated with poorer outcomes. A thorough psychiatric history of symptoms and treatments should be assessed. The assessment priority for the older adult with bipolar having a manic or depressive episode is safety. Interviewing family, friends, and caregivers can be helpful for addressing potentially harmful activities for the Schizophrenia Like bipolar, schizophrenia is a diagnosis expected to impact the remainder of life. Schizophrenia onset is typically in late adolescence to early adulthood, but an older adult diagnosis is possible (Boyd, 2017). Psychosis is classically associated with schizophrenia. Definition of psychosis (APA, 2022h): 1. An abnormal mental state involving significant problems with reality testing It is characterized by serious impairments or disruptions in the most fundamental higher brain functions—perception, cognition and cognitive processing, and emotions or affect—as manifested in behavioral phenomena, such as delusions, hallucinations, and significantly disorganized speech. 2. Historically, any severe mental disorder that significantly interferes with functioning and ability to perform activities essential to daily living. Psychosis requires immediate intervention and is handled according to workplace policy and state law for the healthcare worker. Older adults with schizophrenia usually have improved symptoms with age and experience fewer relapses (Boyd, 2017). The healthcare worker should be aware of common symptoms of schizophrenia. Schizophrenia symptoms are classified as positive, negative, and neurocognitive (Boyd, 2017): ● Positive symptoms happen in addition to regular functioning, most commonly as hallucinations (can involve any of the five sense) and delusions (unreasonable beliefs, involving thoughts only).
for older adults, and it includes the benzodiazepines alprazolam (Xanax), lorazepam (Ativan), and diazepam (Valium) and offers alternatives for medicating anxiety with buspirone (Buspar) and SSRIs like citalopram (Celexa) and sertraline (Zoloft). Nonpharmacological approaches are plentiful for the treatment of anxiety in the older adult. The clinical practice guideline for geriatric anxiety recommends nonpharmacological methods of treatment: lifestyle modifications (sleep, diet, exercise, social support), behavioral therapy (relaxation), cognitive-behavioral therapy, mindfulness, yoga, art/dance/music therapy, or alternative therapies (Subramanyam et al., 2018). Knowing how the older adult has coped in the past is helpful when establishing strengths and weaknesses for current treatment focuses. The healthcare worker can assess for anxiety and offer treatment suggestions that are available and acceptable to the needs of the older adult. older adult. Immediate intervention can be taken if needed, in accordance with workplace policy or state law. The healthcare worker meeting the mental health needs of the older adult with bipolar is likely to see psychiatric mood-stabilizing medication. The most common pharmacological treatments for bipolar are lithium carbonate (Lithium), divalproex sodium (Depakote), and lamotrigine (Lamictal) (Boyd, 2017). Successful past pharmacological treatment can be reviewed and taken into consideration for current treatment options. Since the older adult with bipolar is likely to have comorbidities, special considerations should be taken when prescribing or altering their medication regimen(s). Older adults metabolize, tolerate, and respond to medications differently than younger populations; therefore, lower doses of bipolar medications might be needed and are associated with good outcomes (Sajatovic et al., 2013). Lower rates of mood-stabilizing medication in elderly patients will also decrease side effects and possibly ease medication longevity. Recent findings for nonpharmacological approaches to bipolar treatment can be applied to the older adult population. A new treatment approach utilizes peer mentors who can provide support and hope (Sajatovic et al., 2013). The treatment settings and goals for the older adult with bipolar will depend on the current mental status of the patient. ● Negative symptoms are an absence of regular functioning such as flat affect and diminished emotional expression and activity. ● Neurocognitive impairment is expressed as disorganized speech, thought, or behavior. Prior to the diagnosis of schizophrenia, an assessment would include ruling out medical causes of schizophrenia symptoms, mainly psychosis. Underlying medical etiology can present as psychosis in the older adult. The top five psychosis-inducing medical conditions to check the older adult for are substance abuse, thyroid disorders, delirium cause by infection, dementia, and vitamin B12 deficiency (Gaddey & Holder, 2021). A thorough assessment of the older adult is prudent prior to an initial diagnosis of schizophrenia. If the older adult with a diagnosis of schizophrenia is exhibiting symptoms out of their ordinary, a sweep for known medical conditions that mimic psychosis is also warranted. A differential diagnosis of brief psychotic disorder, major depressive disorder (MDD), and posttraumatic stress disorder (PTSD) can also be considered for the older adult. Collateral information from family, friends, and caregivers would be prudent if given consent. Breaches of confidentiality would need to be reviewed if the older adult is a danger to self or others during an acutely psychotic episode. Many factors must be considered during the assessment of the older adult with schizophrenic symptoms or psychosis. The healthcare worker can present psychosocial intervention and treatment modality options that fit the mental health needs of the older adult. The National Alliance on Mental Illness (NAMI) has found four types of psychosocial intervention that greatly
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Book Code: PYMA2024
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