Chapter 31: Caring for Older Adults in Psychiatry

The field of psychiatric nursing must adapt to the growing global phenomenon of an aging population, specifically focusing on the complex mental health challenges faced by older adults who often contend with multiple chronic physical diseases. Late-life mental illnesses are frequently misdiagnosed, ignored, or attributed to normal aging due to prevalent societal ageism, which negatively impacts care, public policy, and research participation. Nurses are crucial in addressing conditions such as major depressive disorder—which poses a significant suicide risk, particularly for older men—and various anxiety disorders, including the unique issue of Fear of Falling (FOF). Comprehensive geriatric assessment is mandatory and includes ruling out physiological causes for acute confusion (delirium) and slowly progressing neurocognitive disorders like Alzheimer's disease, which are characterized by functional decline, aphasia, apraxia, and agnosia. Alcohol use disorder is the most commonly misused substance in this age group, often stemming from late-life stressors such as loss of career or spouse. Care must be carefully managed in the context of polypharmacy—the use of multiple medications—which necessitates strict medication reconciliation to avoid adverse drug interactions and potentially dangerous prescribing cascades, where drug side effects are treated as new conditions. Nursing interventions prioritize safety, pain management (often using non-opioids like acetaminophen or pain modulators rather than high-risk opioids), and psychological therapies such as cognitive behavioral therapy and reminiscence to boost self-esteem and improve mood. Nurses operate across various settings—from specialized inpatient units to home healthcare and respite programs—while serving as educators and advocates regarding the financial burdens of care and the importance of patient autonomy via mechanisms like advance directives and the Patient Self-Determination Act (PSDA).