Look Beyond Your Older Patient's Medical Complaints

[Maureen Bonatch MSN, BSN, MSN, RN]

Many of us imagine getting older as a time when we're free from constraints of work and can enjoy traveling or spending more time with family and friends. Although some discover that those golden years don't turn out how they expected. Physical, social or financial losses may coincide with the later years of life. Dealing with these issues may result in feelings of depression or anxiety.

Although trips to the physician may become more frequent for a variety of medical ailments, many older adults neglect to mention mental health issues-often because they don't believe they are issues or realize they might benefit from treatment. According to the World Health Organization, the over 60-age population is expected to double from the years 2015-2050. Mental health or neurological disorders affect 20 percent of adults over age 55, although less than 3 percent seek help. The high rate of suicide is alarming, with men age 85 and older having the highest rate of any group. When older patients make light of feelings of unhappiness, dig a little deeper and educate caregivers, family, and friends to help increase awareness of mental health concerns.

Not So Golden Years

Some losses are expected with aging, but that doesn't make it easier to cope. It can be especially difficult when several losses coincide and the patient's support system or coping skills is lacking. There can be many challenges associated with growing older such as:

• Loss of spouse
• Loss of mobility and independence
• Declining physical and mental health
• Chronic illnesses
• Financial challenges
• Change in socioeconomic status
• Isolation and loneliness

Increase Awareness

We're aware that mental health is essential to overall health and well-being. Although detecting mental health issues in the older adult can often prove challenging and may present with barriers to seeking or receiving mental health care.

• Symptoms of mental health concerns may be overlooked if they're incorrectly attributed to aging.
• Prescribed medications can affect mood or mimic symptoms of depression and may be misdiagnosed.
• Many elderly are reluctant to seek help due to the stigma associated with mental health treatment, which was especially prevalent during earlier eras. Often older patients are more comfortable seeing their primary care physician and may be more receptive to discussing mental health concerns.
• A lack of access to mental health care may occur due to challenges with transportation, or available providers. Consider telemedicine for rural patients or those who have difficulty leaving their home due to physical challenges.
• Many older patients may deny mental health issues or don't perceive a need for treatment. Providing additional education to the patient, and their family may help increase awareness.

Mental Health Promotion

Common mental health concerns of older adults include depression, anxiety, and substance abuse, although elderly patients often have unique mental health needs. The same symptoms that might spur additional questions regarding mental health for a younger patient may be attributed as a normal part of the aging process. Neglecting to treat mental health can affect the patient's ability or desire to care for physical health.

Symptoms of depression may be overlooked or untreated because they coincide with other life events. Depressive symptoms with an older adult may present differently and not have overt signs such as sadness and instead be noted within other physical complaints. Exploring complaints, providing education to caregivers and offering resources may help increase the awareness that:

• Depression isn't normal for older people and is more than just a passing mood - Persistent sadness, withdrawal from family and friends, unexplained weight loss, and sleeping too much or too little are a few indicators of depression
• Living alone doesn't mean you're lonely - Encourage the development of a social support system and nurturing interests and hobbies
• The uncertainty of finances and healthcare expenses can be stressful - Discuss coping skills for dealing with stress
• Don't ignore vague threats - Elderly that attempt suicide are often more successful due to the use of methods with more deadly intent, having less chance of being discovered in time and frailty
• Patient expectations may not be realistic - Treatment for mental health issues is often a process of developing coping skills and social support in addition to therapy or medication and not a quick fix
• There is often a stigma surrounding mental health that is even more prevalent in the elderly - Fixed beliefs and discomfort may remain despite the strides made in acceptance of mental health treatment

Coping with Aging

There are many stressors that accompany aging that can contribute to feelings of depression and other mental health issues. In a world that is continuously speeding up, take some time to slow down to uncover mental health issues that may accompany your elderly patient's physical complaints. Providing education on the symptoms of mental health concerns, coping methods, and potential treatment might help improve your patient's quality of life and make those years a little more golden.

Share Your Tips On Increasing Mental Health Awareness.

[K+MgSO4, BSN]

Thanks for this. I care for over 65y/o with hip fractures. The fracture is often only a small part of their issues. All of these patients get a referral to occupational therapy and pastoral care (I assit the PC dept by facilitating their students so they love referrals).

OT and PC are a great resouce and because of the practical nature of OT work and investigating DADLs, CADLS etc can reveal a lot. I often tell grads and students that PC team is one of the few services in hospitals that do not have a "agenda" from a discharge planning perspective. Our PC team are great - we have a chaplin from the humanistic society for atheists! And they are just really nice.