PSYCHOSOCIAL NEEDS AND CARE OF THE ELDERLY

 

PSYCHOSOCIAL NEEDS AND CARE OF THE ELDERLY

In Americas and European countries the number of elderly people is increasingly swelling mainly due to improved living standards. In America there are over 30 million elderly people above 65 years of age. By the year 2030, this number is likely to double, so that the elderly will represent more than 20% of the United States population.

The concern is not only the increase in the number of the elderly, but that those who have reached 85 years and above are also increasing and becoming more and more weak or frail, dependent, vulnerable to both chronic physical diseases and mental illnesses.   

Moreover, the proportion of old – old (over 85 years) will increase 3-4 times faster than the general population. By the year 2050, 50% of the population is projected to live over 85 years. The significance of these figures to the health care provider, policy makers and health care planners is the relationship between increased age and chronic mental and physical problems requiring long – term care.

Along with the rapid growth in the percentage of elderly, there is also increase in the number of long – term care facilities. In the USA the number of nursing homes increased by 140%, the nursing homes beds increased to 304% between 1960 and 1976. This is so because of Medicare and Medic aid policies and deinstitutionalisation of the mentally ill. If the current trends continue, the elder population in the nursing homes will double in 35 years from 1.3 million in 1985 to 2.8 million in 2020.  In the USA approximately 5% of the population over 65 years resides in long-term care facilities, and 20% of those over 85 years of age.  These trends therefore, give us a hint on the need to be ready to meet these challenges of looking after the aged psychosocially, environmentally and physically.

Over the past two decades the deinstitutionalisation movement has discharged many elderly people from mental facilities and put them in nursing homes. The most challenging problems faced by nurses is the management of emotional and behavioural problems and cognitive in the elderly people that they nurse. Although dementia strikes only 5% of all people over 65 of age, individuals with dementia account for between 50% to 75% of all people in nursing home beds.

It is estimated that between 70% and 80% of nursing home residents have some mental problem, yet most long-term care facilities do not adequate psychosocial care for their residents. It is argued that mental problems often are the critical difference between an elderly person’s ability to manage independently in the community and the need for institutionalization.  This then suggests the need for more and better educated Gerio–psychiatric nurses to look after the elderly.

It has been observed that traditionally elderly people have underserved in terms of psychiatric services all over the world, worse in the Sub Saharan countries which have failed to care even for young.  The neglect which occurs in both institutional and outpatient settings, can be traced back to the time of Freud, who emphasised the importance of early childhood experiences and believed that personality was less likely to change with advancing age.  For instance, he felt that the elderly were not suitable for psychoanalysis (a therapy that favours verbal facility).  

Other factors that have led to the negatively influenced provision of psychiatric services to the elderly include:

a)     Their inability to pay for the services

b)     Inaccessibility of services due to transport or mobility problems

c)     Devaluation of the potential benefits of psychotherapy by many elderly people.

d)     Perceived stigma associated with psychiatric help in the minds of the elderly and their relatives.

e)     Lack of geropsychiatric nurses, physicians, and other health care professionals trained in the mental health needs of the elderly.

f)      Ageist biases on the part of some mental health providers who see the elderly as not appealing/attractive or not worthy clients.

g)     Many health care professionals perceive mental illness as a necessary fact of life in old age, therefore, elderly people are not given comprehensive/holistic assessment and treatment they deserve.

 Psychological disturbances that in the elderly that may be secondary to physical problems frequently are misunderstood and mislabeled by many health care providers as “Senility”. The elderly are also called the “Normally confused, Unhappy, Isolated, Lonely, Too troublesome, argumentative, the unappreciating, and Too demandful”.   

The society does not expect the elderly to behave responsibly, but allowed to portray symptoms of mental illness, such as memory loss, poor interpersonal relationships, irritability, and social withdrawal.

Despite all the odds or barriers, evidence shows that the elderly do benefit from counseling and other therapies. 

 

 

 

ASSESSMENT

NEED FOR COMPREHENSIVE ASSESSMENT

Nursing assessment of the geriatric (elderly) mental health client is multifaceted and challenging partly because of the complex interplay among physical, mental, social, economic, spiritual, environmental, treatment – related factors in these types of people. In addition to standard psychiatric approaches, assessment of the geriatric clients should minimally include:

i)       Physical history which includes risks identification regarding drugs, alcohol, infections and falls.

ii)   Mental status

iii)  Previous illnesses and their treatments

iv)  Interpersonal relationships, role functioning, socialization and support systems.

 v)  Activities of daily living

vi)  Coping mechanisms and resources.

It is necessary that nurses caring for the geriatric clients with mental problems must be knowledgeable about the normal aging process in order to identify pathology accurately. For instance, the elderly suffer from some degree of decreased sensory acuity in all spheres. Therefore, knowledge of these sensory changes can help nurses and other health care givers to modify the environment appropriately. It is assumed that 40% of all people with delusional disorders (paranoid) have a hearing problem.

The database of the geriatric mental health nurse must be comprehensive and incorporate an understanding of:

a)      Altered medication response and tolerance

b)     Cognitive functions alterations

c)      Altered and diverse manifestations of physical and mental illnesses

d)     Decreased rebound potential following losses and stressors (both physical and Psychological factors).

e)     Increased risk potential

f)       Decreased stamina

g)      Increased sociocultural stressors

h)     Altered dietary needs and capabilities.

 

ASSESSMENT INSTRUMENTS

 

Instruments that are developed and used for the younger generations may not be applicable for the elderly. There are several tools used in assessing the geriatric clients with emotional problems.

 

Early identification and referral of elderly who are demented will facilitate accurate diagnosis and treatment that may slow down the progression this deterioration of the illness and delay nursing home placement. Early detection also is important in providing much needed help to family members, including, support groups, respite care, legal and financial counseling. Early is also valuable in protecting both the client with dementia and the community from adverse situations such as driving vehicle when one has impaired judgement.

 

MENTAL STATE EXAMINATION

 

This is one of the most reliable tools in assessing and evaluating the elderly or geriatric clients. It is more concerned in determining five areas of mental function and affective relationships:

 

1.      Patterns of speech

2.      Emotional reactions and mood

3.      Perception

4.      Thought content

5.      Cognition

 

Cognitive ability or disability is particularly relevant in the mental health assessments of elderly individuals. Cognitive impairment is the central feature of dementing illnesses that occur in later life. It is as well the primary cause of the self – care and behavioural problems associated with them. Decline in recognition, comprehension, memory, learning ability, problem solving and orientation often are manifested in behavioural changes that increasingly limit the individual’s ability to function independently.