Gero-Ch. 24 Mental Health

What are factors that influence the ability to manage stress?

Box 24.1 Health and fitness, sense of control over events, awareness of self and others, patience and tolerance, resilience, hardiness, resourcefulness, social support, and a strong sense of self

What are the goals for older adult mental health and disorders?

Box 24.2-Reduce suicide rate, major depressive episodes, increase primary care facilities giving mental health treatment on site or by paid referral, increase adults with mental disorders who receive treatment Increase persons with substance abuse and mental disorders receiving treatment for both disorders, screening by primary care provider, increase home with adults with mental health problems who receive mental health services

What are some of the medical disorders that cause anxiety?

Cardiac arrhythmias, delirium, dementia, COPD, heart failure, hypothyroidism, hypoglycemia, postural hypotension, pulmonary Adema, and pulmonary embolism

What contributes to the development of anxiety symptoms and disorders or reactivation of prior anxiety disorders in elderly?

Changes and challenges for elderly

What may contribute to anxiety?

Chronic illness, cognitive impairment, and emotional loss

What diagnostic and laboratory test may be ordered if cognitive impairment is suspected?

Cognitive assessment, brain imaging, and neuropsychological evaluation

Pharm approaches: What treatments may patients use w/ anxiety disorders in addition to pharmacotherapy?

Cognitive behavioral therapy (Pharmacotherapy-used alone as well)

In the elderly, what complicates mental health disorders' recognition and diagnosis?

Comorbid medical conditions + myth that elderly do NOT respond well to treatment

Box 24.3: Khyâl cap (wind attacks)

Concern that khyâl (wind like substance) may rise in the body and along with blood

Diagnostic and statistical manual of mental disorders (DSM-5)

Increased emphasis on culture and mental health including range of psychopathology worldwide; less ethnocentric

Box 24.3 What other related conditions are there to Ataque de Nervios?

"Blacking out" in southern United States and "falling out" in West Indies

What is resilience?

"Flourishing despite adversity"

Who is most likely to be resilient?

People who are able to use personal resources & see the world beyond their own concerns

Box 24.3: Khyâl cap (wind attacks)

A syndrome found among Cambodians in the United States and Cambodia

What settings do older people receive psychiatric services?

Acute and long-term inpatient psychiatric units, primary care, community and institutional settings

Box 24.3 What mental disorders is Ataque de Nervios' symptoms similar to?

Acute anxiety (panic disorder)

Where will nurses encounter elderly patients with mental health disorders in emergency departments or in general MedSurg units?

Acute care settings

What is an important and effective service in acute care settings?

Advanced practice psychiatric nursing consultation

Who uses mental health services at half the rate of non-Latino whites?

African Americans and Latinos

Regardless of age, what race/ethnicities receive lower mental health treatment initiation, receive low quality care and experience greater burden of unmet mental needs than non-Latino whites?

African-American, Latino, and Asian Americans

What complicates prescription and monitoring in elderly?

Age related changes in pharmacodynamics and polypharmacy i

What also affects identification and treatment of mental disorders in elderly?

Ageism

What are anxiety disorders' symptoms?

Agitation, irritability, pacing, crying, and repetitive verbalizations

What are other growing concerns among older adults?

Alcohol abuse and dependence

What is important to investigate for anxiety?

All possible causes of anxiety such as med conditions and depression

Box 24.4: What meds may cause anxiety symptoms?

Anti-cholinergics, digitalis, the off-line, antihypertensives, beta blockers, beta adrenergic stimulator's, corticosteroids, OTC meds, caffeine, nicotine, and withdrawal from alcohol sedated and hypnotics

What is the first line treatment?

Anti-depressants in the form of SSRIs (selective serotonin reuptake inhibitors)

What may make diagnosis difficult in older adults for anxiety?

Anxiety's general and pervasive nature. Elders tend to deny psych symptoms, attribute anxiety related symptoms to physical illness, and coexisting anxiety symptom-mimicking condition *Cognitive impairment makes diagnosis difficult as well (general population)

What are the most prevailant mental health problems in late life?

Anxiety, severe cognitive impairment, and mood disorders

Box 24.3 Susto: What are the symptoms?

Appetite, sleep disturbances, sadness, low self-worth, and lack of motivation

What are major signs of both anxiety and depression?

Avoiding previously enjoyed activities and increasing social isolation

What generation has experienced mental health consequences from military conflict and 20th century drug culture (may cause future psych illnesses)?

Baby boomers

What are we observing for and searching for when assessing for anxiety disorders?

Behavior and possible reason for behavioral changes or patterns

What does second line treatment methods include for anxiety disorder?

Benzodiazepines (alprazolam, lorazepam, mirtazapine)

What are some factors that may interfere with an older adults mental health? SATA A. developmental transitions B. divorce C. life events D. lack of socialization with others E. health status/surgical outcome F. situation calling for psychic energy

Correct: a, c, f They are some factors that affect elder's mental health. The others may contribute possibly to elder mental health, but are not the main factors. Others incl. physical illness and cognitive impairment

Box 24.3 Susto (fright)

Cultural expression for distressing misfortune prevalent among some Latinos in the US in people in Mexico Central America and South America

What determines the standards of "normal" behavior for any culture?

Culture (itself)

What are we looking for when assessing anxiety reactions in individuals in long-term care?

Daily disturbances such as staff/caregiver changes, room changes, or events which individual feels lack of control/influence

What are anxiety disorders often the presenting symptom of?

Depression

What is another significant change in the DSM-5?

Developmental approach and disorder exam across lifespan

What results from cultural variation and beliefs about mental illness causes, treatment effects, past discrimination, and lack of mental health treatments along with preferences, values, and beliefs?

Disparities

Box 24.3: Khyâl cap (wind attacks): What are the symptoms?

Dizziness, palpitations, shortness of breath, and cold extremities

What are the risk factors for anxiety disorders?

Early onset anxiety disorder, frailty, lack of social support, poor self rated health, vision impairment, medication, high stress life events: losses, traumatic events, having another psychiatric illness, substance abuse, cognitive decline, and dementia

In what population, is anxiety most common in?

Elderly

Who reports more somatic complaints rather than cognitive symptoms such as excessive worrying?

Elderly

What assist in structuring more culturally appropriate services, improving treatment outcomes and decreasing disparities?

Enhancing cultural proficiency of healthcare professionals

What makes chronic use of benzodiazepines cause?

Falls, cognitive impairment, and other serious side effects

Box 24.3 Susto: What is illness attributed to?

Frightening event that causes the soul to leave the body resulting in unhappiness, sickness, and difficulty functioning in social roles

What are the types of anxiety disorders?

Generalized anxiety disorder (gad), phobic disorder, ocd, panic disorder, and ptsd

What type of anxiety is associated with more primary care provider visits and increased average visit length?

Geriatric anxiety

How do most older People face life's challenges?

Good humor, equanimity, and courage

Do men or women have higher prevalence rates of anxiety symptoms and coexisting depression anxiety?

Higher in women > men

What ethnicity/race are slightly more likely to report a lifetime diagnosis of anxiety disorder compared with white non-Hispanics and African-Americans?

Hispanic older adults

What should nurses do to enhance timely recovery for patients with mental health problems?

Identify mental health problems early, seek consultation and treatment

Gero-psychiatric nursing collaborative

Improve current knowledge and skills for nurses in mental health care for older adults

What negative consequences may anxiety symptoms and disorders be associated with?

Increased hospitalizations, decreased physical activity, decreased functional status, increased sleep disturbances, increase healthcare service use, substance abuse, decreased life satisfaction, and increased mortality

What facilitates more accurate assessment of mental health, wellness, illness, and lead to less misdiagnosis?

Increased understanding of importance of cultural perspectives for individuals across the lifespan

Box 24.3: Khyâl cap (wind attacks): What serious effects are caused by khyâl?

Kyhâl entering lungs to cause shortness of breath/asphyxia or entering the brain to cause dizziness, tinnitus, and a fatal syncope

What characteristics may those who are unsuccessful in managing stressful situations have?

Lack of social support, accumulated stressors, unresolved grief, pre-existing psychiatric illness, cognitive impairment, and in adequate coping resources

Who is most at risk for mental health illnesses?

Life transitions and loss of social support

Why should use of older drugs, such as diazepam or chlordiazepoxide be avoided?

Long half-lives, increase accumulation and toxicity risk in elderly

What facilities are providing the majority of care to older adults with psychiatric conditions?

Long term care facilities and increasingly residential care/assisted living facilities (RC/ALFs)

What is late life anxiety often comorbid with?

Major depressive disorder, cognitive decline, dementia, and substance abuse

In what subspecialty is geropsychiatric nursing in within their adult psychiatric mental health nursing field?

Masters level

Why is developmental approach and disorder examination across life span relative to elderly?

Mental distress symptoms present differently from presentation and younger people

What are baby boomers more aware of and more comfortable doing?

Mental health concerns & seeking treatment (May add to the challenges to the mental health care system)

Who is successful when caring for pts. with mental health disorders?

Mental health professionals in primary care offices, care managers, community-based multidisciplinary geriatric mental health treatment teams, and advanced practice nurses

What do cultural beliefs influence?

Mental illness exhibition + explanation, who makes healthcare decisions, help seeking behavior, preferences for type of treatment, and provider characteristics

Who has higher prevalence of anxiety?

People with physical illnesses, those in need of home health care or live in residential settings (ex. Long term care and assisted living facilities)

What is another med that can be used for anxiety disorder?

Non-benzodiazepine anxiolytic agents (buspirone) *Has fewer side effects but takes 4 wks longer of administration for effectiveness

What treatment/intervention is preferred for anxiety disorder?

Nonpharmacological interventions

What is a general definition for anxiety?

Normal human reaction and part of the response; rational and reasonable

Box 24.3 Susto: What mental disorders are these symptoms similar to?

PTSD, depression, and anxiety

Box 24.3: Khyâl cap (wind attacks): What mental disorders are khyâl cap's symptoms similar to?

Panic attacks, generalized anxiety disorder, and PTSD

In what individuals may treatment be complicated?

Patient having multiple anxiety disorders, suffers from comorbid depression, substance abuse, or medical problems

What population may have unmet needs for services?

People over age 65 with recognize mental or substance use disorder (Nearly half of them)

What are we assessing for anxiety?

Physical, social, and environmental factors, past life history, long-standing personality, coping skills, and recent events, coexisting medical conditions mimicking anxiety symptoms, elders denying psych symptoms, and thorough med review

What do the characteristics associated with resilience include?

Positive interpersonal relationships, willing to extend self to others, optimistic/positive affect, keeping things in perspective, setting goals + taking steps to achieve these goals, high self-esteem, self efficacy, determination, purpose in life, creativity, humor, & curiosity

Why would other people be reluctant to seek help?

Pride of independence, stoic acceptance of difficulty, unaware of resources, lack of geriatric mental health professionals and services, lack of insurance coverage for mental health problems and stigma of having a mental health disorder

What other health care services is it critical to integrate mental health and substance abuse with?

Primary care, specialty care, home health care, and residential community based care

Who is not a full-time staff member, are in adequate to meet needs of residents and staff?

Psychiatric consultants in nursing homes

What are the reasons that elders over 65 have unmet needs from services?

Reluctance to seek help

What is a factor that may explain the ability for some individuals to withstand stress?

Resilience

How do you most older adults manage transitioning stressors?

Resilience, hardiness, and resourcefulness

What is essential with elimination of OTC meds and herbs that cause anxiety if possible?

Review meds including OTC meds, herbs or home remedies

What med properties are preferred in SSRIs?

Sedating (Sedating > stimulating)

What may symptoms of mental health problems be overlooked as?

Seen as a normal consequence of aging or blamed on dementia (From both HC professionals + elderly)

Box 24.3: What other symptoms may Ataque de Nervios include?

Seizure like or fainting episodes, suicidal gestures

What are some of the obstacles to mental health care?

Shortage of train personnel, limited availability and access for psychiatric services, lack of staff training related to mental health and mental illness, and in adequate Medicaid and Medicare reimbursement for mental health services

What can facilitate resilience?

Social support from community, family, and professionals, access to care, and availability of resources

Box 24.3: What may attacks frequently occur as a result of?

Stressful event relating to the family

What do treatment choices depend on for anxiety disorders?

Symptoms, specific anxiety diagnosis, comorbidities, and any current med regimen

Box 24.3: Ataque de Nervios (attack of nerves)

Syndrome of individuals of Latin dissent characterized by symptoms of intense emotional upset including acute anxiety, anger, grief, screaming, and shouting uncontrollably, attacks and crying, trembling, heat rising from the chest ➡️ head, verbal and physical aggression

What do resilient people do during stressful situations?

They "bend rather than break" during stressful times and are able to return to adequate (and sometimes better) functioning after stress "bounce back"

Why might the prevalence of mental illnesses be higher than reported statistics?

They are not always reported and not well researched especially among non-white populations

What is essential to meet the needs of residents and staff for mental health care?

Training and education of frontline mental health care staff as well as new models for mental healthcare and services

True/false: anxiety disorders are not part of normal aging

True

In what individuals are anxiety symptoms common in?

Visually impaired older adults

When may anxiety become problematic?

When is prolonged, exaggerative, and interferes with function

Box 24.3: Khyâl cap (wind attacks): What causes these attacks frequently?

Worrisome thoughts