Mental health for older adults and benzodiazpine use

Benzodiazepine (BZD) drug use among community-dwelling seniors is a significant health issue. Although long-term use of BZDs by seniors is a recognized problem, little is known about the mental health of the consumers. Better knowledge of their mental health would help nurses in identifying the psychological needs of this population. The goals of this longitudinal study1 (n = 138) were to describe the mental health status of long-term users of BZDs and to compare it with the mental health of seniors who have either begun or stopped consuming BZDs over a 1-year period (from Phase 1 to Phase 2). Results showed that one third of long-term users of BZDs do not present any mental health problem. Furthermore, no differences were observed between the mental health statuses of new users of BZDs, individuals who stopped using BZDs, and long-term users of BZDs. In conclusion, at least one third of long-term users of BZDs should stop using these drugs, and nurses should play a leading role in helping these seniors withdraw from BZD consumption.     

Access to mental health care among older adults

Many older adults experience common mental health problems that can have a negative impact on physiological health, functional status, and quality of life. Lack of access to mental health care for community-dwelling older adults is a significant problem. Busy primary care practices, few mental health professionals, inadequate problem recognition, and flaws in the health care system all contribute to restricted access to mental health care. As the population of adults 65 and older continues to grow, the need for mental health care for this group will increase. Strategies to improve access to mental health care must be targeted at the individual level, the provider level, and the system level.     

Health literacy and functional health status in Korean older adults

Aims and objectives. The aim of the study was to investigate the relationships of health literacy to chronic medical conditions and the functional health status among community‐dwelling Korean older adults. Background. In the literature, limited health literacy has been reported to have adverse effect on health outcomes. However, the link between health literacy to health status among Korean older adults needs to be clarified. Design. A cross‐sectional survey. Methods. A cross‐sectional survey of 103 community‐dwelling Korean older adults was conducted from June 2007–September 2007. Health literacy was measured using the Korean Functional Health Literacy test and functional health status was measured using the subscales of the Medical Outcomes Study 12‐item Short‐Form Health Survey. Results. Individuals with a low health literacy had significantly higher rates of arthritis and hypertension. After adjusting for age, education and income, older individuals with low health literacy had higher limitations in activity and lower subjective health. In a model adjusting for age and income only, older individuals with low health literacy were more likely to report lower levels of physical function and subjective health and higher levels of limitations in activity and pain. Conclusions. Among community‐dwelling Korean older adults, limited health literacy is associated independently with higher rates of chronic medical conditions and lower subjective health status. Relevance to clinical practice. Nurses are key to providing health education to older adults. The understanding of the relationship of health literacy to health status is essential to develop communication and health education efforts for older adults in nursing practice.     

Mental health professionals' attitudes towards people who have experienced a mental health disorder

The aim of this study was to gain information about the attitudes of mental health professionals towards people who have experienced a mental illness. The study involved a survey of 266 mental health professionals employed in a range of mental health treatment settings. Respondents were administered a questionnaire based on one of two vignettes describing a person with schizophrenia or depression. Attitudes were represented as beliefs about prognosis and long-term outcomes in relation to the two vignettes. Professional groups were found to be less optimistic about prognosis, and less positive about likely long-term outcomes, when compared with the general public. Medical staff were less optimistic about outcomes than other professional groups, with mental health nurses generally most optimistic. Most professionals based their attitudes on their experiences of working with people with mental health problems.     

Cognitive health in older adults

This article addresses both the theoretical and practical issues associated with cognitive aging, including the implications of neurophysiological changes in the brain as well as practical ways of screening for changes that may be problematic or may actually enhance healthy cognitive adaptations.     

The Neuman System Model applied to mental health nursing of older adults

As we move into the 21st century, nurses are facing the challenge of contributing to the health care of a society with an increasing proportion of ageing persons. This group of people become more heterogeneous as they age, bringing with them an extended life history of experiences of wellness and illness. They have been faced with numerous stressors and losses and have made successful or unsuccessful adaptation to those life experiences. One of the disconcerting stressors of the elderly is the promotion and maintenance of mental health. In this paper we will examine the application of the Neuman System Model to the mental health nursing of older adults.     

Relocating care: negotiating nursing skillmix in a mental health unit for older adults

Mental health care in Australia in the last 20 years has moved from stand-alone psychiatric hospitals to general hospitals and the community. This paper reports an action research project exploring the experiences of nurses on an acute mental health unit for older adults staffed with a skillmix of mental health and general nurses, which recently transitioned from a psychiatric to a general hospital. The new service provides comprehensive health care, including the management of physical co-morbidity and a recovery orientation. Recovery acknowledges the role and rights of consumers and carers in planning and management of care, choice and individual strengths (Shepherd). The new ward received additional resources to establish the model of care, including a broader skillmix. The paper explores the dynamics of development of a new model of care and of bringing together staff with different professional orientations, cultures and priorities. Focus groups and interviews were conducted with 18 staff. Analysis resulted in three themes relating to the impact of competing goals and foci of care upon professional boundaries; competing organisational cultures and the impact of service change upon work practices. The findings are explored in relation to ideas about health care delivery associated with neoliberalism.     

A new service in the intermediate care of older adults with mental health problems

This article describes the a new multidisciplinary, nurse-led service for older adults with mental health problems, the Home Treatment Team (HTT) which has just begun in the Older Adults Directorate of Central and North West London Mental Health Trust (CNWL). The team aims to provide mental health care and treatment in the home for adults aged over 65, offering an alternative to hospital admission and facilitating early discharge. These functions place the service in the intermediate care category (Department of Health (DH) 2001), an area which is not well documented in the care of older people with mental health needs.     

Self-transcendence and mental health in oldest-old adults

Patterns of self-transcendence that older adults report as being important to their emotional well-being are described in this study, and the relationship between self-transcendence and mental health symptomatology in oldest-old adults is investigated. The sample consisted of 55 independent-living older adults, 80 to 97 years old. Methodological trianglulation was used whereby qualitative data together with quantitative findings were examined. Four patterns of self-transcendence, congruent with the investigator's definition, were identified by the participants as being important to their sense of well-being: Generativity, Introjectivity, Temporal Integration, and Body-Transcendence. Results of Pearson correlation analysis and matrix analysis of data supported a relationship between self-transcendence and mental health found in previous research, thus demonstrating the importance of the expansion of self boundaries in older adults.     

Personality disorder and public mental health

The diagnosis of personality disorder often appears to tell as much about the diagnoser as the diagnosed. For many it describes those who are deemed personally offensive, and as such it is not so much a diagnosis as a value judgment, the product of a negative interaction between two people that is given spurious respectability by a medical label. It is argued that these attitudes constitute a disastrous misperception of the truth, as personality disturbance (diathesis) in its many forms, including the unsatisfactory term 'disorder', is a highly significant contributor to human misery and handicap and a major cost to public mental health. It achieves this sorry record largely through stealth, because the current categorical system fails to embrace the breadth and heterogeneity of abnormal personality and the notion of offensive immutability makes the diagnosis a stigmatic one. This can be avoided by recoding personality in terms of severity. New treatments are now beginning to show evidence of efficacy and it is not unreasonable to hope that a condition that has been muttered about for years in parentheses will now be better recognised and defined, exposed without misunderstanding, and managed appropriately and well.     

Monitoring functional status in hospitalized older adults

The Katz Index of Independence in Activities of Daily Living can help nurses detect subtle changes in health and prevent functional decline. OVERVIEW: Created 45 years ago, the Katz Index of Independence in Activities of Daily Living has shown itself to be an important tool in measuring an older adult's capacity to care for her- or himself. When a nurse using the tool notes a diminishment in the patient's ability to perform any of six activities-bathing, dressing, toileting, eating, transferring, or remaining continent-further assessment may uncover a reversible cause, such as a chronic or acute condition requiring treatment. A video demonstrating the use of the Katz index is available for free online at http://links.lww.com/A241.