Mental Health Nursing: Aging Population

Learning Outcomes

  • Discuss Concepts of Aging
  • Define Ageism
  • Discuss Social Trends in the Aging Population
  • Identify Five Mental Challenges of the Older Adult
  • Identify Medical Treatment for the Older Adult
  • Identify Nursing Actions for General Care of Older Patients

Aging

  • Aging is a continuous process that begins at birth.
  • It encompasses the process of getting older, which is a natural progression.

Aging Population

  • By the year 2030, it is anticipated that all Baby Boomers will have reached the age of 65.
  • According to the Pew Report, this demographic shift will significantly influence society.
  • As reported by the Department of Health and Human Services, the population of individuals aged 65 and older is expected to rise from 35 million in 2000 to 55 million in 2020.
  • It is important to note that a significant majority of individuals aged 65 and over remain intellectually intact and mentally healthy.

Challenges Involved With Aging

  • Prevalent Illnesses: Certain illnesses become more common with age.
  • Diminishing Senses: There is a noted decline in visual and hearing acuity as one ages.
  • Safety Issues: Aging brings various safety concerns that need addressing.
  • Losses: Common losses experienced by older adults include:
    • Employment
    • Income
    • Lifestyle changes
    • Disruption in social groups
    • Loss of spouse or family

Ageism

  • Defined as discrimination based on age, specifically the assumption that most people over the age of 65 are unable to function or contribute to society.

Intimacy in Aging

  • The need for intimacy does not diminish with age; however, there is a social stigma regarding intimacy among older adults.
  • Older adults face a dichotomy where the need for intimacy persists even as their social support systems may diminish or members may fall ill.

Elder Abuse

  • Older adults may suffer from various forms of abuse, including:
    • Physical Abuse: Bodily harm or physical intimidation.
    • Emotional Abuse: Inflicting mental pain or distress.
  • Elder abuse often occurs at the hands of family members or healthcare providers.
  • The Omnibus Budget Reconciliation Act (OBRA) is a federal act that provides standards for the care and protection of the older population.

Mental Health Challenges

  • Common mental health issues experienced by the older population include:
    • Alzheimer’s Disease: A debilitating illness characterized by alterations in cognitive function and irreversible effects. The presence of plagues and tangles in the brain is notable.
    • Depression: A significant and often underreported mental health issue.
    • Cerebrovascular Accident (CVA): Commonly referred to as a stroke; it can have lasting cognitive and physical impacts.
    • Aphasia: A condition affecting speech and language skills.
    • Insomnia: Sleep disturbances are prevalent.
    • Paranoid Thinking: Some older adults may exhibit heightened paranoid thoughts.
    • Medication Concerns:
    • Affordability and Availability: Older adults may struggle with accessing necessary medications.
    • Side Effects: Older adults often experience adverse effects due to polypharmacy.

Medication Concerns

  • Pharmacokinetics: Drug absorption and metabolism may slow with age, leading to different pharmacological needs.
  • Issues surrounding patient compliance while taking medications are prevalent among older adults.
  • Risks of medication toxicity and the potential for severe side effects must be considered, emphasizing the need for careful monitoring.

Medication Screening Tools

  • American Geriatrics Society (AGS) Beers Criteria: Helps identify potentially inappropriate medications for older adults.
  • STOPP: Screening Tool of Older Persons' Prescriptions.
  • START: Screening Tool to Alert to Right Treatment.
  • These tools are critical in assessing medication appropriateness for the older population.

Common Medication Side Effects

  • Older adults may experience various side effects, including:
    • Dry Mouth: Common with many medications.
    • Constipation: Often overlooked but requires attention.
    • Orthostatic Hypotension: Dizziness upon standing due to blood pressure changes.
    • Urinary Complications: Issues with bladder control.
    • Confusion/Disorientation: Medications can impact mental clarity.
    • Fatigue: A common complaint following medication side effects.
    • Mood Swings: Emotional responses can be altered by medications.

Nursing Interventions

  • Effective nursing care for older adults should include:
    • Respect: Treating all patients with dignity.
    • Goal Setting: Collaborating with patients to set achievable care goals.
    • Patience and Understanding: Essential qualities when caring for older patients.
    • Appropriate Use of Humor: Can alleviate tension and enhance communication.
    • Safety Assurance: Ensuring the safety of the patient in all aspects of care.
    • Promoting Independence: Supporting the patient's ability to maintain control and act independently.
    • Effective Communication: Tailoring communication to meet the needs of older patients.

Restorative Nursing

  • Defined as part of rehabilitation, focusing on:
    • Dignity Maintenance: Ensuring the patient's dignity is upheld.
    • Achieving Maximum Function: Helping patients attain their highest level of functioning.
    • Goals include: Independence, self-esteem enhancement, and allowing control over life activities.

Restorative Nursing (continued)

  • Facilities are often required to have at least one designated nursing assistant and one nurse trained in restorative care.
  • Essential for facility documentation and reimbursement requirements.
  • Effective restorative programs are evaluated through state and federal surveys.

Palliative Care

  • Specialized care focusing on managing the symptoms and stress of serious illness rather than curing the illness.
  • Involves helping individuals receive end-of-life care, ensuring comfort and quality of life during advanced illness stages.

Palliative Care (continued)

  • Primary issues that require attention include:
    • Pain Management: Addressing and alleviating pain effectively.
    • Symptom Management: Managing other discomforting symptoms.
    • Sedation and Opioid Medication: Addressing severe pain while maintaining ethical considerations for the patient.
    • Artificial Nutrition and Hydration: Decisions regarding nutritional support should be made with sensitivity to patient wishes.
    • Assisted Suicide Considerations: Navigating legal and ethical complexities.
    • Complementary Therapies: Offering additional support and alternative treatments may be beneficial.
  • Nurses must develop strong communication skills and be aware of religious, cultural, ethical, and legal implications, especially regarding medications and assisted suicide.

Medical Treatment for the Aging Population

  • Medical care for older adults should be tailored to specific symptoms and diagnoses presented by the patient.
  • Monitoring Medications: Ensuring correct dosages and side effects management while considering patient compliance is critical.
  • Therapeutic Approaches: Group or individual therapy may be necessary in managing mental health.
  • Socialization Activities: Engaging older adults in social activities is vital for emotional well-being and mental health support.