Biological considerations The APA lists medical components for psychiatric evaluation. The healthcare worker can gather the data for the older adult directly from the client, family, friends, or caregivers (with consent), as well as historical medical charts. The information can be accumulated over time and prioritized during each interview. For example, the healthcare provider needs a complete medication history that in- cludes all interventional trials (successes and failures), and most notably any side effects, prior to beginning or restarting psychi- atric medication. The APA recommends that the following bio- logical considerations be obtained by the healthcare worker: pri- mary care involvement; allergies or drug sensitives; an exhaustive medication review of past and current prescription drugs as well as over-the-counter nutrients, supplements, and vitamins; current or historical medical illnesses, including hospitalizations, past or present medical treatments, surgeries, procedures, and alterna- tive treatments; past or present neurological or neurocognitive disorders; physical trauma, especially head injuries and any se- quela; sexual and reproductive history; cardiopulmonary issues; endocrinology involvement; past or current infectious disease; and current or past pain levels and treatments (Sadock et al., 2015). Psychosocial considerations There are psychosocial considerations related to an older adult’s mental healthcare. Some overlap with biological considerations and can be assessed and targeted for treatment. For example, driving is a psychosocial aspect that can be affected by biology. Activities of daily living (ADLS) The healthcare worker needs to assess the older adult’s ability to be autonomous. The inability to perform ADLs may indicate an unsafe or poor quality of life (Edemekong et al., 2022). The healthcare worker can utilize standardized measurement tools for assessing ADLs (basic and instrumental) of the older adult and in- tervene with other services when safety or quality of life is at stake. The AGS defines basic and instrumental ADLs. Basic ADL are (AGS, 2022): ● Ambulating (ability to move and transfer independently, walk- ing). ● Feeding (ability to feed self independently). ● Dressing (ability to cover self with clothing). ● Grooming (ability to care for personal hygiene, bathing, hair and nail care). ● Continence (ability to maintain bowel and bladder function). ● Toileting (ability to make it to the toilet and clean self). Instrumental ADL are (AGS, 2022): ● Transportation and shopping (ability to buy groceries and ne- cessities). ● Financial management (ability to pay bills and manage financ - es). ● Cooking (ability to prepare meals and serve them). ● Household maintenance (ability to clean and live in a home). ● Communicate (ability to get in touch with others via phone or electronic means). ● Medicate (ability to manage medications as prescribed). Increasing age and health problems can cause increased difficulty with ADLs. Decreased physical functioning can be caused by bio- logical deficiencies in the musculoskeletal, neurological, circulato - ry, or sensory systems. Cognitive, auditory, or visual impairments can increase difficulty with ADLs (Edemekong, 2022). Dementia can limit the older adult’s capable and safe performance of ADLs like cooking and self-medicating. The healthcare provider can as- sess the strengths and weaknesses verbalized by the older adult as well as gather information from collateral sources. Interventions might include caregivers, family, other healthcare providers, or
There are a few notable biological considerations in neuropsy- chiatry for the healthcare worker to include when planning men- tal healthcare for the older adult. The healthcare worker under- stands the older adult can learn new information; however, the rate at which an older adult solidifies the material can take longer than for other age populations (Sadock et al., 2015). In addition, psychomotor speech and memorization are slower in older age, especially simple recall and encoding ability, but they are con- sidered normal for the older adult. In addition, the intelligence quotient (IQ) typically holds steady until age 80 (Sadock et al., 2015). These biological considerations can drive the approach and length of time the healthcare worker might allot for assess- ment, intervention, or treatment. The healthcare worker might also include the older adult’s family, friends, or caregiver(s) when new information is presented to the older adult. A historical base- line is an important piece of the assessment for the healthcare worker. The healthcare worker needs to know basic objective measures for physiological functioning such as vital signs (blood pressure, pulse rate, temperature, respiratory rate, and pain level) and nutritional status for older adult clients if psychopharmacol- ogy is involved. The healthcare worker adult can increase their understanding and provide a more thorough plan of care by cou- pling with the older adult’s primary care provider. healthcare worker should attempt to assess whether retirement was voluntary or involuntary. Involuntary retirement is associated with negative mental health effects and decreased self-image (Rhee et al., 2016). However, the Age Discrimination Employment Act (ADEA) of 1967 protects older adults in the workforce from forced retirement by making it unlawful (Sadock et al., 2015). If the older adult is retired, follow-up questioning about how the older adult feels about the loss of occupation can open an opportunity for exploration of other topics like finance and relationships. The healthcare provider can assess beyond formal employment for re- sponsibilities and time commitments acquired by the older adult. Housing The healthcare worker should assess the housing situation of the older adult. Housing is a basic need and typically must be met pri- or to the administration of interventions. It is estimated that about 5% of Americans live in nursing homes; however, approximately 35% of older adults will reside in a long-term care facility at some point during their lifetime (Sadock et al., 2015). The living situa- tion of an older adult can affect treatment options. For example, an older adult that lives near a bus stop has the necessary financial resources, and is capable of navigating will have greater options for meeting their needs like attending mental health treatment. Where an older adult resides must be assessed to understand available mental health intervention and treatment. Transportation—Driving safety One of the most difficult subjects for the healthcare worker to discuss with the older adult, yet an impactful topic for self and others is autonomous driving. Driving is the leading cause of injury-related deaths in the 65- to 74-year-old population and is the second leading cause (behind falls) in the 75- to 84-year-old population (Promidor, 2019). The cessation of driving privileges is inevitable for everyone. Each older adult interaction is an oppor- tunity for the healthcare worker to assess for prevention. Knowing when and how to approach the older adult about driving safety is imperative. Preventing driving disability with properly timed inter- ventions can impact lives. There are acute and chronic medical conditions that should be strong indicators of safety for the older adult client. Cessation of driving privileges should be reviewed when the conditions in Ta- bles 2 and 3 manifest or the medications in Table 4 are prescribed in the older adult and until they are medically evaluated by their primary care provider. The healthcare worker meeting mental health needs of the older adult will need to be in contact with the primary care provider about medical conditions and medications outside of their scope of practice.
case management. Employment status
The healthcare worker needs to assess the employment status and working habits of the older adult. Retirement is common in the older adult and can be a turbulent period of transition. The
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