Mental Health in Care for the Elderly
Assoc. professor E. A. Lothe
Winter School, Maribor University
Maribor, Slovenia, Nov 2015
Goals for the lecture:
1. Acquire some insight into mental health issues for
the elderly patient
2. Acquire some insight into specific nursing
challenges regarding this group of patients
3. Be aware of the particular ethical issues at
stake when working with this group of patients
Normal aging process
• Biological – respiratory, cardiovascular
etc
• Psychological – memory function,
intellect learning abilities on decline
• Loss, grief, bereavement overload
• Attachment issues
• Dealing with death
• Psychiatiric disorders late in life
Awareness of
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Diagnoses – differential diagnoses
Care challenges
Need to counsel relatives and next-of-kin
Assessment of factors precipitating or
influencing elderly people´s life situation
• Organic – brain changes
• Environmental – family, friends
• Social - loss, bereavement, crises, violence
against elders (Elder abuse)
Common mental illnesses
• Depressions – suicide
• Schizofrenia – delusions, hallucinations
of persecutory nature
• Anxiety
• Confusion
• Development of dementia
• Biological factors
• Psychological aspects
• Social aspects
Late blooming – discover it
Depressed and dysphoric patients
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Sporadic attempts at twisting reality
Tendency to under-estimate one´s own
significance
Tendency to mis-interpret, brood, doubt
Slow thoughts, slow speech, latency
Delusions
Guilt feelings
Suicidal ideation
Loss of interests
Anxiety
Concentration issues
Existential needs
• Need to find meaning in life, suffering,
pain, death
• Existential needs often escalate during
crisis, serious illness, facing death
”Being there” for the patient –
nursing challenges
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Assisting the patient in being here and now
Understanding his/her impulses
Understanding possible social withdrawal
Particularly strong sensitivity
Communication
Interaction
Environmental work
Memory work
Nursing challenges
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Patience required!
User participation a key
Be generous with your time
Be generous with your attention
Focus on good moments
Build alliance
Strengthen the patient´s self esteem
Assist the patient in living through his existential
crisis
Nursing tools
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Give generously of your time
Motivate patiently
Be together with, stand by
Show empathy and listen
Respect
Show that you care
The one-to-one conversation
• Building relations
• Communication
–Open invitation
–Listen
–Listen to the silence
–Listen to the affective message
• Create an alliance for cooperation
• Utilize yourself as a tool!
Recommended literature
Denhov & Topor (2013). The components of helping relationships with
professionals in psychiatry: Users´ perspective. Intn´l J of Soc
Psychiatry.
Drageset, Eide & Ranhoff (2013). Anxiety and depression among
nursing home residents without cognitive impairment. Sc J Caring Sci,
27; 872-881.
Edlund, Lauerer & Drayton (2015). Recognizing depression in late life.
Nurse Pract, 40(2): 36-43.
Handsaker, Dempsey & Fabby (2012). Identifying and treating
depression at the end of life and among the bereaved. Int J Palliat Nurs,
18(2): 91-97.
Recommended literature, cont.
Jakobsen, R & Sørlie, V (2010). Dignity of older people in a nursing
home: Narratives of care providers. Nursing Ethics 17(3): 289-300.
Raue, Weinberger, Sirey, Meyers & Bruce (2011). Preferences for
depression treatment among elderly home health care patients.
Psychiatr Serv; 662(5): 532-537.
Townsend, MC (2015). Psychiatric Mental Health Nursing. Concepts of
Care in Evidence-Based Practice. Philadelphia, USA, F.A.Davis Co.
Tveito T; Bramness JG; Engedal K; Lorentzen B; Refsum H & Høiseth G
(2014). Psychotropic medication in geriatric psychiatric patients: use
and unreported use in relation to serum concentrations. Eur J Clin
Pharmacol 70: 1139-1145.