By | August 6, 2019

Because the health, behavioral, and social parts of life overlap more as one ages, those caring for or serving older adults can make a difference by providing support that considers the whole person.

Although many older adults remain mentally healthy, the World Health Organization says about 15% of adults over 60 have a mental disorder. Older adults in healthcare settings and long-term care facilities are more likely to have a behavioral health disorder than those who live in the community, according to the Substance Abuse and Mental Health Services Administration. Both of these statistics are concerning, as the American Psychological Association says the number of older adults is expected to reach about 15 million by the year 2030.

Yet many older adults may go undiagnosed and untreated because of misinformation, false beliefs about aging, and the stigma associated with mental health issues, as Daniel D. Sewell, MD, notes. As a caregiver for older adults, you must pay close attention to all symptoms and intervene appropriately, as mental health issues in older adults are just as treatable as they are for younger adults.

Also, keep in mind the circular relationship between pain, illness, and mental health issues. Behavioral symptoms can be caused by physical pain or illness and vice versa.

Identifying Disorders

“Behavioral health” is often used to refer to mental health, psychiatric care, counseling, and substance use disorders treatment. In older adults, the common behavioral health disorders are depression, anxiety disorders, substance use disorders, and bipolar disorder, according to Caring People. Dementia, Alzheimer’s disease, and eating disorders also play a role in the lives of many older adults.

Until a better understanding of the underlying causes of these disorders is reached, clinicians must diagnose based on the symptoms a person is experiencing. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5™) is currently the most common tool used for that purpose.

The formal service system requires the identification and documentation of clinically defined symptoms and problems. It can be easy to get caught up in the problem identification and work aspects involved in accessing services for older adults, including referrals, paperwork, and utilization. Although these factors are important and necessary to manage, the keys to successful outcomes involve efforts beyond the formal requirements.

The ways in which you engage older adults throughout that process should include a focus on recovery, hope, and well-being. Challenge yourself to identify how you can translate best practices for wellness into your work with older adults, if you are not already doing so.

Supporting, Not Directing

Strive to involve older adults in their own behavioral health services. Negative beliefs that older adults are dependent, vulnerable, and require the expertise of healthcare professionals may cause you to take over and “do what is best” for the person. While possibly well-intentioned, this attitude can be extremely harmful. Your responsibility is to make sure that no harm comes from your care efforts, however unintentional that outcome might be.

You should never deny individuals the opportunity to make decisions for themselves when they are able to do so. Even people with cognitive difficulties from disorders such as early to moderate stages of Alzheimer’s or schizophrenia often have some decision-making abilities.

Your responsibility is to make sure that no harm comes from your care efforts, however unintentional that outcome might be.

People should be encouraged to make decisions where they are capable. If competency is a concern, you should make every effort to support the decisions the person would have made when they were competent, or to question them about such things if there are periods of greater lucidity or clarity and document their desires.

You may occasionally find yourself in the middle of family disagreements, where decisions about what supports and services are needed create conflict. In these situations, your role is to be an advocate for the older adult.

In situations where people are unable to come to an agreement, you may need the services of a trained mediator. If you suspect abuse or neglect is occurring, you are required to report the situation to your local investigating agency according to local, state, and national guidelines.

Believing in Recovery

Recognizing the ability to change can help when you are promoting resilience in older adults who have behavioral health challenges. Resilience is the ability to adapt and recover from adversity or difficulty.

Although resilience is an internal characteristic, you can promote it externally. When working with older adults, you can acknowledge their strengths and teach them coping skills. You can also encourage them to identify their sense of purpose, eliminate or reduce stressors, develop social networks, and gain some control over their lives.

Although resilience is an internal characteristic, you can promote it externally.

What makes believing in recovery difficult for some professionals may be that they usually see only those people who are struggling, not the ones who have recovered and no longer need intensive services. These experiences may make it seem like no older adult with a behavioral health disorder lives well.

In your work, it is important to focus on the person’s recovery and remind yourself of the great ability each person has to grow and change, even later in life. “Recovered” does not have to mean cured, although many people can become symptom-free. Mental health is about living a life of quality, dignity, and choice.

Examining Your Views

Professionals may carry their own attitudes and beliefs about how behavioral disorders might prohibit older adults from living well. Some professionals focus their efforts on stabilization or maintenance, rather than offering supports that can help truly improve the situation. Studies do show that it is possible to recover when behavioral health disorders are present, even at an older age.

Mark Ragins, MD, a prominent psychiatrist, advocate, and writer in the recovery movement, is a founding member of the Village, a behavioral services program in California. He suggests that the Village finds success because the staff there treat people like people and not patients.

If you will take a few moments to examine your own beliefs, think through the following questions.

  1. What are your beliefs about recovery for people with behavioral health conditions?
  2. In what ways are you demonstrating these beliefs in your current work?
  3. What might it take to create even more of an internal upheaval and transformation within yourself to make appropriate changes?

You may be in the unique position to assess and refer people with behavioral health needs who might not otherwise get help. Appropriate community service referrals can be made based on levels of care, and you should promote services that support behavioral health functioning.

When addressing behavioral health disorders, it might be tempting to focus on the problem and intervene because you are trying to fix things for the person. However, this approach is not most helpful in the end.

Being a collaborative, supportive advocate for older adults’ independence, recovery, resiliency, and pursuit of living well with a behavioral health disorder is paramount.

Jennifer Burks, RN, MSN

Jennifer W. Burks, R.N., M.S.N. earned her Bachelor of Science in Nursing from The University of Virginia in 1993, and her Master of Science in Nursing from The University of North Carolina, Greensboro in 1996. She has over 20 years of clinical and teaching experience, and her areas of expertise are critical care and home health. Her professional practice in education is guided by a philosophy borrowed from Florence Nightingale’s Notes on Nursing, “I do not pretend to teach her how, I ask her to teach herself, and for this purpose, I venture to give her some hints.”

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