Mental Health Needs of Older Adults
The mental health needs of older adults encompass a wide range of presentations. Frequently these get pushed aside as addenda to the other complexities of care when they need to be prioritized to better optimize care of older adults. This teaching strategy looks at the most frequent mental health issues seen in older adults and creative ways to help students better grasp and address these issues. Application of mental health concerns using evolving case studies, as well as brief scenarios can set the stage for beginning the discussion on what students saw, how they would prioritize what they saw, and what interventions might be appropriate. This teaching strategy can help educators start this process. The strategies presented can be used in lecture, seminar, and clinical settings.
Mental Health Needs of Older Adults
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Learning Objectives
Students will:
- Develop a better understanding of the targeted mental health needs of older adults.
- Use tools to assess mental health concerns of older adults.
- Understand the atypical presentations of mental health issues in older adults.
- Identify the impact of mental health issues in addressing the complexities in caring for older adults.
- Recognize the need to assess functioning related to mental health issues in the older adult experiencing life transitions.
Learner Pre-Work
Suggested Learning Activities
1. Use the unfolding case study of Henry and Ertha and play the audio file. Henry and Ertha are an elderly couple experiencing issues of transition, depression (Henry), and cognitive impairment (Ertha). Use the Instructor’s Toolkit to guide questions and ask the students the following discussion questions, which are specifically targeted for the mental health concerns of Henry and Ertha.
- How is Ertha demonstrating that she may have a cognitive impairment?
- How would you assess this concern?
- What medications are generally indicated for cognitive issues?
- What symptoms of depression do you see in Henry?
- How are symptoms of depression differentiated from the symptoms of Henry’s medical issues?
- What medications are generally indicated to treat depression?
- How are these medications monitored? What are the side effects specific to older adults? How is a response measured?
2. Using this teaching strategy:
- The activities in this teaching strategy can be used individually or in its entirety. For example, the mini scenarios can be used in lecture to illustrate a point or engage students in a discussion. They can also be used to prepare students caring for older adults, to increase their knowledge regarding what they may encounter. In addition, they can be used in an online forum discussion to have students identify their own assessments and prioritizations of the situation. The strategy can be used in its entirety in lecture, clinical or even as a clinical alternative.
- Assign students to older adults they can interview and access. Introduce students to the Try This: series and have them access the assigned older adults using tools that are appropriate for the clients.
- The Try This:® Series from the Hartford Institute for Geriatric Nursing (HIGN) at the NYU Rory Meyers College of Nursing contains many evidence-based assessment tools. The students can watch videos, print out tools, or read articles directly related to the tools used. The tools specific to mental health issues include:
- Mental Status Assessment of Older Adults: The Mini-Cog
- Geriatric Depression Scale (GDS)
- Confusion Assessment Method (CAM)
- Confusion Assessment Method for the ICU (CAM-ICU)
- Modified Caregiver Strain Index (CSI)
- Elder Mistreatment Assessment
- The 2019 American Geriatrics Society Updated Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults
- Alcohol Use Screening and Assessment for Older Adults
- Brief Evaluation of Executive Dysfunction: An Essential Refinement in the Assessment of Cognitive Impairment
- Recognition of Dementia in Hospitalized Older Adults
- Assessing and Managing Delirium in Persons with Dementia
- Decision Making in Older Adults with Dementia
3. Either in writing or in discussion in a clinical conference, have students prioritize mental health issues based on the assessment of their clients and the coordinating tool they used as part of the assessment process. Then have students identify individualized interventions to address these issues. The following are considerations for students as they formulate their thoughts on the assessments of their clients:
- Are the client’s issues related to a cognitive issue, a mood issue, or anxiety?
- How is functioning affected by the client’s issue?
- How might medications play a role in the symptomatology?
- How is the client’s family affected by the issue?
- What type of a response can be expected with medication? How will the response be measured? What side effects of medication are of particular concern with older adults?
- What path and prognosis can be expected with the client’s specific issues?
- How would the nurse consider risks and benefits of treatment options in terms of quality of life with this client?
4. Have the students write a reflection of the impact they felt while both assessing their older adult clients and considering the interventions that would best fit the clients’ needs.
Suggested Reading
National Institute of Mental Health: Older Adults and Mental Health:
www.nimh.nih.gov/health/topics/older-adults-and-mental-health/index.shtml
Mental Health Treatment Seeking Among Older Adults with Depression: The Impact of Stigma and Race - www.ncbi.nlm.nih.gov/pmc/articles/PMC2875324/?tool=pubmed
Recognizing Dementia, Delirium and Depression in Older Adults
Nursing Management of Delirium - http://currentnursing.com/pn/nursing_management_delirium.html
Author Information
Community College of Philadelphia
Philadelphia, PA