Lesson 8: Older Adults and Mental Health

Attention

Who needs you when you are "old?"
Who wants you when you have limited resources and are older?
The gift of maturity could be earned wisdom and heritage.
Depression and despair can alternatively be experienced in maturity.
Declining health, transportation issues, housing, diet and nutrition, and finances all come into play.

Erik Erikson, and his wife, Joan, are/were widely published figures in the field of developmental psychology. Personality theory, therapeutic intervention, training and supervision for clinical practice.rik pre-deceased his wife by four years. His loss resulted in Joan re-thinking the final parts of Erikson's lifespan schematic. She concluded that there may well be a ninth stage, beyond the traditionl eight that everyone is trained to.
A kind of review and re-interpretation of all that hs come before can take place. It is not over until it is over. Final edit goes to the experiencing individual.

Final edit. The meaning is in the eye of the beholder!

Learning Outcomes

Upon completion of this lesson's material, students will be able to:

• Describe the different services for older adults.
  
• Describe the challenges associated with aging.
  
• Describe signs of elder abuse and how to respond.
• Learning about emotional and physical well-being and aging.

Teaching

Lecture

Story by Profession Joel Goodstat: "When I was writing this, I anticipate visiting with my friend "Edna," who lives just down the road. In a few days, it will her 89th birthday. As she says, she is a farm-girl by nature. This has determined her values and perspective. Edna and I become friends through her 35 years of working with senior citizens. Her mother before her, and her mother before her, did the same.

Edna has tough decisions EVERY day. She needs physical therapy. This will maintain her ability to care for herself including home cleaning and maintenance, shopping, and driving are physical-motor activities. Her sister, who is 91, chops her own wood, carts it into the house and helps neighbors with firewood. Edna by comparison is fragile but not frail. She needs to use her energy and time thoughtfully.

Actually, we all need to use our time and energy thoughtfully!! Acting as if we will live forever is disproven again and again. Painfully, my family was reminded back in October, 2014. A fatal automobile crash took a former relative of Edna's. We had planned on getting together later that day to have dinner together at my home. It was not to be. Edna now has some important decisions to make. She always has to budget her finances, they are fixed, and very limited. She is considering moving into senior housing. She wants more social activity than occurs when her son and daughter-in-law return at the end of day from work. She wants her OWN space! These are the issues that many older adults struggle with."

Erikson identified that individuals experienced eight different stages of development. Please review these stages to think about how they might apply to your work with older adults: Erikson's Eight Stages of Development

By the way, Erikson did talk about a stage beyond the eighth. It was what he called transcendence. Death is not necessarily the end of a life. The children you leave behind, the people whose life you touched, your ideas and life's wok all leave a heritage. Ideas can outlast earthly existence.

Services for Older Adults

As individuals age their need for community services changes. They will frequently use the medical services available in their communities including the doctor's offices, dentists, hospitals, acute care clinics, and mental health agencies. For individuals with mental health issues they may be accessing the community outpatient clinics for counseling and medication management and be receiving case management in their homes. If here is an acute mental health crisis they could access crisis services, crisis units and inpatient psychiatric hospitalizations.

Housing also becomes an issue for older adults. As a person's physical health changes his or her ability to maintain a home may diminish. There are a number of different types of living situations created for older adults.

Please read the Guide to Senior Housing

Now that you have an idea of the different types of housing for older adults we will review briefly some of the end of life care services that can be used for individuals when they are diagnosed with terminal illness. For individuals whose doctor indicates they have 6 months or less to live they can access hospice services. Hospice services assist individuals in living comfortably during their last months of life and helping them and their families prepare for what is ultimately coming, which is death. In our culture we find it very difficult to talk about death. We have to accept that we are only here on this earth for a specific amount of time but none of us want to really think about life here after we are gone.

According to the National Hospice and Palliative Care Organization: Hospice care is "considered to be the model for quality, compassionate care for people facing a life-limiting illness or injury, hospice care involves a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient's needs and wishes. Support is provided to the patient's loved ones as well. At the center of hospice and palliative care is the belief that each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow us to do so."

Please watch the video about hospice care (2:46 min): Understanding Hospice Care (https://www.youtube.com/watch?v=cK3tpXwfuhE)

Palliative care (pronounced pal-lee-uh-tiv) is specialized medical care for people with serious illness. It focuses on providing relief from the symptoms and stress of a serious illness, many times through the use of medications and other therapies. The goal is to improve quality of life for both the patient and the family.

Elder Abuse

Information for this section from: Elder Abuse Prevention Network (elderabuseprevention.info)

Elder abuse, and/or neglect are now being screened by medical and mental health personnel more frequently than in the past. It may present as missed doctor appointments, failure to renew prescriptions, delays or interception of personal mail, or financial control. There are different types of elder abuse. The types include:

Neglect

Neglect is a form of abuse that can be hard to identify, but it is the most common type of elder abuse. As an outsider looking in, you may notice things that suggest that the elder is not getting the care that they need. An elder who is being neglected may look dirty, can smell or have signs of physical deterioration (sores or bruises), or may be dressed inappropriately for the weather. The elder’s home can also show signs that he or she is being neglected if it is overly dirty or otherwise is an unsafe environment, this can be interpreted as a red flag for neglect. In some cases of neglect, the elder is not allowed to leave their home, have visitors, or use the telephone. This may also be an aspect of a domestic abuse relationship if the primary caregiver is a spouse or child of the elder.

Physical abuse

Signs of physical abuse are often explained away by the frailty that comes with old age. As in any situation of abuse, an elderly victim may be reluctant to report physical abuse out of fear of the abuser. The combination of these two factors creates an increasingly dangerous situation for a victim who cannot defend him or herself and who does not have someone to intervene on their behalf. If an elderly person is suffering from physical injury (bruises, welts, scars), has experienced either a drug overdose or a failure to be properly medicated, or is not allowed to be without their caregiver, they might be suffering from physical abuse. Abuse is often perpetrated by a caregiver who is also the spouse or adult child of the elderly person. These domestic violence situations can be incredibly difficult for an elderly person to report due to the complex underlying relationships.

Emotional and psychological abuse

Elder emotional abuse can be an incredibly difficult type of abuse to uncover. Since the abuse often occurs within the confines of the home or behind closed doors, it can be very difficult to see the signs. In many cases, the victim is too afraid or too ashamed of the abuse to tell someone. However, someone close to the victim might notice that the elder has withdrawn from normal activities or has suddenly become much less alert. In cases of severe emotional abuse, you might see the abuser, who is often the caregiver, humiliate or intimidate the elder. This may also be an aspect of a domestic abuse relationship if the primary caregiver is a spouse or child of the elder.

Sexual abuse and domestic violence

As with many other victims of sexual and domestic abuse, elders often do not report sexual or domestic violence. Their reasons, however, are often much more complex: sometimes the abuse is at the hands of a caregiver; they are afraid they won’t be believed or there will be retaliation for telling; or they do not know where to seek services.

Financial exploitation

Financial exploitation includes taking someone's belongings or money without their knowledge or consent. Financial exploitation of elders is a common type of abuse. Because many elderly people have savings accounts, fixed income through social security, or own their homes, they become the perfect target for exploitation. Sadly, many elders who are financially exploited experience this abuse at the hands of trusted caregivers or family members. This can make the victim feel heartbroken, embarrassed and ashamed and they may choose not to report the abuse for fear that their loved one will get in trouble. For elders who are financially exploited by strangers, it can be very hard for them to believe that abuse happened to them, or they can feel so embarrassed that they “let” this happen that they don’t report the abuse. Financial exploitation can have devastating impacts on the victim; not only through loss of money, but the victim may experience physical and emotional reactions as well.

Statistics & Data

• Abuse can happen to anyone. Elder abuse affects both men and women, all cultures, races, and socio-economic groups.
• Elder abuse can happen anywhere; in a person’s own home, in hospitals and nursing homes, in assisted living facilities, and other institutional settings.
• Women and “older” elders (80 years old and older) are the most common victims of elder abuse.
• Elder abuse is most often perpetrated by the victim’s own family members. 90% of abusers are family members; most often adult children, spouses/partners, and others.
• Elder abuse is largely unreported. The National Center on Elder Abuse suggests that only 1 in 14 cases of abuse is actually reported to the authorities.
• A 2010 study reported that approximately 11% of the elderly population in the United States had experienced abuse or neglect in the year prior. However, this study did not include those elders who suffer from dementia or those living long-term care facilities. This is especially notable because it is believed that those elders who suffer from dementia are at an increased risk of being abused.
• Major financial exploitation is self-reported at a higher rate than self-reported rates of emotional, physical, and sexual abuse or neglect. According to a 2011 study, older Americans lose a minimum of $2.9 billion annually due to elder financial abuse and exploitation.
• Elders who experience abuse, neglect, or self-neglect face considerably higher risk of premature death than elders who have not been mistreated. Older adults who are abused or mistreated are three times more likely to die within the next decade than the same age adults who are not mistreated. (From http://elderabuseprevention.info/statistics-data)

Where can you go to get help? This link provides a list of services that are available to help individuals who may be in an abusive situation: Get Help - http://elderabuseprevention.info/get-help

Emotional Health

Loneliness is also very high on the list of non-abuse, non-neglect mental health risks. Companionship can be a very important component of caring relationships. No matter one's age feelings are real. They are governed by the brain, the nervous system, and endocrine glands. A healthy lifestyle can maintain a healthy brain. Physical exercise, while good for the body, is even better for the brain and one's emotional health. The brain creates and receives "feel-good" neurotransmitters and hormones secretions.

Physical Activity and Psychological Well-being in Aging

There is now considerable evidence that regular physical activity is associated with significant improvements in overall psychological health and well-being. Both higher physical fitness and participation in physical activity are associated with a decreased risk for clinical depression or anxiety. Exercise and physical activity have been proposed to impact psychological well-being through their moderating and mediating effects on constructs such as self-concept and self-esteem. ... In addition, for many seniors, aging is associated with a loss of perceived control. Because perceptions of control over one's own life are known to be related to psychological health and well-being, exercise scientists have begun to focus on the relationship between activity and various indices of psychosocial control, self-efficacy, and perceived competency. McAuley and Katula reviewed the literature examining the relationship between physical activity and self-efficacy in older adults. They conclude that most well-controlled exercise training studies result in significant improvements in both physical fitness and self-efficacy for physical activity in older adults. Several studies suggest that moderate-intensity physical activity may be more effective than either low- or high-intensity training regimens. There is growing recognition that physical activity self-efficacy is not only an important outcome measure as a result of participation in activity, it may also be an important predictor of sustained behavioral change in sedentary populations. Both cross-sectional and prospective cohort studies have linked participation in regular physical activity with a reduced risk for dementia or cognitive decline in older adults. It also seems that decreases in physical mobility are linked to cognitive decline (Chodzko-Zajko, W. J., Proctor, D. N., Fiatarone Singh, M. A., Minson, C. T., Nigg, C. R., Salem, G. J., Skinner, J. S. (2010). Exercise and Physical Activity for Older Adults. http://www.medscape.com/viewarticle/717050_7 )

Assessment

Lesson 8 Quiz

1. Describe when you would access hospice services and the types of services hospice provides to the individuals who receive the service. Research on the internet what hospice agency provides that service where you live and share the agency name, services, phone number, and website.
2. What are the signs of elder abuse you should be looking for when working with older adults? What should you do if you suspect elder abuse?

Lesson 8 Discussion (Online Class only)

Review the content of the Guide for Elder Abuse Response. How do feel this information helped you learn about this subject? Would you recommend that I include this app in this course in the future? Why will be important for you to understand about elder abuse when working in the field of community mental health?