Chapter 35: Older Adults in Psychiatric Nursing

As life expectancy increases, there is a heightened demand for specialized mental health services to address conditions that either emerge for the first time in late life or persist from younger years. The text identifies significant barriers to care, including patient-centered stigma, provider biases like ageism, and systemic economic limitations within Medicare and Medicaid. A central focus is placed on the continuum of care, emphasizing prevention through the maintenance of physical, social, and spiritual balance, and the identification of stressors such as relocation, isolation, and loss of independence. Depression is highlighted as a primary concern, often presenting with physical symptoms rather than traditional sadness, which can lead to misdiagnosis as dementia—a phenomenon known as pseudodementia. The chapter underscores the critical risk of suicide among elders, particularly older white males, noting the importance of recognizing subtle "silent suicide" behaviors like refusing food or medications. It also explores late-onset bipolar disorder, anxiety disorders frequently linked to medical conditions, and psychotic disorders like schizophrenia, where late-life symptoms often involve bizarre, persecutory delusions. Substance abuse, particularly involving alcohol and the misuse of prescription medications through polypharmacy, is presented as an underdetected but growing issue among the baby boom generation. Effective nursing management requires a comprehensive assessment of both activities of daily living (ADLs) and instrumental activities of daily living (IADLs), while involving caregivers in the process. Therapeutic strategies advocate for the "start low, go slow" pharmacological approach to account for pharmacokinetic changes in older bodies, such as decreased renal clearance and increased body fat. Non-pharmacological interventions include milieu management techniques such as reminiscence therapy, which helps patients find meaning in their life history, as well as pet and music therapy to enhance emotional well-being and social interaction. By normalizing the environment and fostering independence, healthcare providers can significantly improve the quality of life for older adults navigating mental health challenges.