The Experiences of Older Adults with Dual Diagnosis in an Inner Melbourne Community Mental Health Service

ABSTRACT

Less is known about the experiences of older adults (65+ years of age) with co-occurring mental health and alcohol and other drug use disorders (dual diagnosis) than is known about the experiences of their younger counterparts. This exploratory qualitative study sought to interview individuals receiving case management from an inner Melbourne community mental health service to determine their experiences of living with dual diagnosis and explore their interactions with mental health and addiction treatment, and general medical services alike. Six older adults with a dual mental health and substance disorder agreed to participate in a semi-structured interview process and provided their perspectives about living with complex mental illness and alcohol and other drug use.

Several key themes emerged throughout the interview process, mirroring the notion of dual diagnosis being a complex phenomenon involving a number of interrelated factors: these include medical complexity, poor service engagement and long-term use of alcohol and other drugs. Interviews also demonstrate the challenges inherent in providing care to this cohort, with the participants frequently describing their experiences with services as being fraught with difficulty. The increased understanding of the perspectives of older adults with dual diagnosis provides the foundation for further research into this population in addition to influencing future nursing care provided to this cohort.     

The macular degeneration and aging study: Design and research protocol of a randomized trial for a psychosocial intervention with macular degeneration patients

BackgroundAge-related Macular Degeneration (AMD) is the leading cause of irreversible and predictable blindness among older adults with serious physical and mental health consequences. Visual impairment is associated with negative future outlook and depression and has serious consequences for older adults' quality of life and, by way of depression, on long-term survival. Psychosocial interventions have the potential to alleviate and prevent depression symptoms among older AMD patients.MethodsWe describe the protocol of the Macular Degeneration and Aging Study, a randomized clinical trial of a psychosocial Preventive Problem-Solving Intervention. The intervention is aimed at enhancing well-being and future planning among older adults with macular degeneration by increasing preparation for future care.ResultsAdequate randomization and therapeutic fidelity were achieved. Current retention rates were acceptable, given the vulnerability of the population. Acceptability (adherence and satisfaction) was high.ConclusionGiven the high public health significance and impact on quality of life among older adults with vision loss, this protocol contributes a valid test of a promising intervention for maintaining mental and physical health in this population.     

Nurse-led brief psycho-education on self-stigma among clients with schizophrenia and affective disorders: - Solomon four-group design

BackgroundThe negative impact of self-stigma among clients with mental illness is well documented. Psychoeducation was found to be an effective measure for managing the treatment gap by reducing the stigma associated with the illness.PurposeThe present study investigated the effectiveness of a nurse-led brief psycho-education in reducing self-stigma among clients in the remittent stage of schizophrenia and affective disorders.MethodsThis study used Solomon- four-group design and was carried out at the Institute of mental health, Rohtak, India. A total of 80 participants were consecutively recruited using the block randomization method and as per the sampling criteria. A trained nurse delivered a 30-min individual-based brief psycho-education to the intervention group as per the standard module. The outcome measure was the reduction in the stigma based on a standardized stigma scale during a 1-month follow-up period.ResultsThe mean age of the participants was 40.48 years (SD = 3.55). Overall, the study observed a significant reduction of stigma scores in the intervention group in the alienation, stereotype endorsement, social withdrawal domain of ISMI during 1-month follow-up (p < 0.001). No interaction effect was found between intervention and pre-test except the social withdrawal domain (p = 0.034).ConclusionsThe nurse-led brief psycho-education has the potential to reduce stigma among clients with mental illness. Our findings open an area of discussion for placing greater attention on nurse-led brief psycho-education in this setting. The study provides pioneer research evidence regarding the involvement of nurses as brief psycho-education therapists among clients attending the tertiary mental health care unit of a lower-middle-income country. Considering the short-term effect of this study, more studies should be conducted in similar settings for an evidence base to advocate supportive nursing care practices in the routine mental health setting.     

TIC en actividad física y parámetros cardiovasculares en mayores: una revisión

IntroductionAgeing is a period of physical and psychological changes. Inactivity is one of the biggest problems among the older adult population increasing the risk of sarcopenia and chronic diseases. Physical activity is an effective intervention to improve health outcomes. In recent years, there has been an increase in the use of technology, with health technology tools (ICT) appearing as an intervention to increase physical activity and improve associated health problems.ObjectiveIn this review, we evaluated the effectiveness of health technology to increase physical activity and to improve cardiovascular parameters in older adults.MethodologyStudies with a great variety of health technology tools to increase physical activity levels, and that evaluated the effect of that increase on cardiovascular parameters were included by searching the main databases.ResultsEleven studies reporting the use of a variety of ICT tools were included in this review. Despite these differences, the effectiveness of health technology tool interventions has been demonstrated in increasing physical activity and reducing cardiovascular parameters.DiscussionThe lack of adherence of older adults to health technology would be a disadvantage, but it has been shown that younger older adults are more familiar with health technology tools and the number using them is increasing.ConclusionHealth technology tools show effectiveness in increasing physical activity in older adults and improving cardiovascular parameters.     

Social transformation and social isolation of older adults: Digital technologies,nursing, healthcare

BackgroundThe incidence of social isolation among older adults is on the rise in today's health care climate. Consequently, preventing or ameliorating social isolation through technology in this age group is now being discussed as a significant social and health issue.AimThe purpose of the opinion paper is to clarify social transformation through technology and shed light on a new reality for older adults in situations of social isolation. Our goal is to persuade the reader that our position on this topic is a valid one. We support our claims with practice-based evidence and published research studies.MethodsTo do so, we checked the most recent literature, most of which came from the last decade. Our literature survey focused primarily on what is known about technology and how technology can affect social transformation and perceptions of social isolation.FindingsTwo dominant transformative realities became the focal points: the precarious implications of loneliness for older adults and the emerging reality of social change through digital technology central to eHealth and mHealth.DiscussionTo benefit from new technologies and reduce the detrimental effects of social isolation, we must engage older adults in a meaningful way and adapt the system of smart devices to reflect the specific physiological and psychological characteristics of the ageing population.ConclusionOlder adults need to comprehend the meanings of their social experiences to preserve their active lifestyle. Human interactions may be desirable, but technological dominance may also minimize the adverse effects of social isolation.     

The Determinants and Effects of Chronic Pain Stigma: A Mixed Methods Study and the Development of a Model

People with chronic pain report experiencing stigma, but few studies have explored this in detail. This mixed-methods study aimed to investigate factors that contribute to chronic pain stigma, the effects of stigma, and to explore the stigma experiences of people with chronic pain. Participants were 215 adults with chronic pain who completed questionnaires assessing chronic pain stigma, opioid use, mental health conditions, pain, depression, disability and social support, and 179 also answered open-ended questions about stigma experiences. Linear regression and path analysis showed that greater stigma was experienced by those who used more opioids, had a mental health condition, viewed their pain as organic, and were unemployed. Stigma was associated with greater disability, depression and lower social support. Qualitative results supported quantitative findings, with 3 themes: 1. “Faking It”: Others disbelieve pain and attribute it to drug seeking, laziness, or mental health problems, 2. A spectrum of stigma: Experiences of stigma vary from none to widespread, and 3. “I hide it well”: Concealing pain and avoiding stigmatizing situations lead to isolation & disability. This study demonstrates the negative influence of stigma and presents a novel integrated model of chronic pain stigma which may be used to develop interventions.PerspectiveThis study demonstrates the contributors to, and negative effects of, stigma for people with chronic pain. It presents an integrated model which could guide strategies to reduce chronic pain stigma amongst health professionals and the public, and to reduce self-stigma amongst people with pain.     

The evaluation of a short group programme to reduce self-stigma in people with serious and enduring mental health problems

The concept of stigma has been acknowledged as being an important factor in the way that people with mental health problems are viewed and treated. Some authors suggest that stigma should be viewed as a multifaceted rather than a single concept. One part of this multifaceted concept has been called self-stigma which has been defined as the reactions of stigmatized individuals towards themselves. This study examined the impact of a 6-week group programme designed to reduce self-stigma in a group of service users with serious and enduring mental health problems. Twenty participants were assessed prior to the commencement of the group and immediately following its cessation. In addition to self-stigma, assessments for self-esteem, self-acceptance and psychological health measures were also undertaken. The results record a significant reduction in the stigma following the group and also non-significant increases in the participants' levels of self-esteem, self-acceptance and overall psychological health. However, there was only a negligible correlation recorded between the reduction in self-stigma and the increase in self-esteem, self-acceptance and psychological health. The paper discusses the possible explanations for these findings.     

Older Adults with Schizophrenia Finding a Place to Belong

Older adults with schizophrenia experience a high prevalence of comorbid conditions. The perspective of older adults with schizophrenia about their physical health has not been considered as a contributing factor. This paper presents findings from a grounded theory study that explored this perspective among 28 older adults with schizophrenia. Analyses revealed that finding a sense of belonging supported feeling physically healthy. A sense of connection with others and a physical place were associated with supporting a sense of belonging. Awareness of the facilitators of and barriers to finding a place to belong is key to improving the physical health of this vulnerable population.     

Barriers and Facilitators of Hispanic Older Adult Mental Health Service Utilization in the USA

Mental health providers in the USA encounter the challenge and opportunity to engage the rapidly growing population of Hispanic older adults in evidence-based mental health treatments. This population underutilizes mental health services, despite comparable or slightly higher rates of mental illness compared with non-Hispanic White older adults. This review identified barriers and facilitators of mental health service use by Hispanic older adults in the USA to identify practice, policy, and research implications. Hispanic older adults face multiple compounding barriers to mental health service use. Issues related to identification of needs, availability of services, accessibility of services, and acceptability of mental healthcare treatment are discussed.     

Dual Diagnosis in Older Adults: A Review

Dual diagnosis is associated with frequent relapse, poor treatment engagement and overall unsatisfactory treatment outcomes. A comprehensive review of the contemporary literature examining this issue was conducted, finding a paucity of literature concerning dual diagnosis in older adults. Of the literature appraised for this review, a number of studies examined US Veteran's Affairs populations, which were largely male. Studies concerning older mental health populations were scarce. During the literature search, a number of background studies that influenced contemporary research regarding dual diagnosis in older adults were found; these studies were examined regarding their contribution to contemporary paradigms concerning older adults with co-occurring mental illness and substance use disorders. This review presents the results of the contemporary literature concerning dual diagnosis in older adults. Several recurring themes emerge from the literature, including the notion of a statistically small population that, in absolute terms, represents a sizeable number of individuals coming to the attention of aged mental health services in the future. Additionally, the potential for under-diagnosis in this cohort is highlighted, potentially creating a hidden population of older adults with dual diagnosis.     

Blood pressure and cognitive function among older adults in India

ObjectiveWe aimed to investigate the relationship between blood pressure and cognitive function among older adults in India.MethodsIn this study, we analyzed cross-sectional data of systolic and diastolic blood pressure (SBP and DBP, respectively) and cognitive testing from 3690 adults aged 60 years and older participating in the Longitudinal Aging Study in India—Diagnostic Assessment of Dementia from 14 states in India.ResultsAfter controlling for key sociodemographic, health, and geographic factors, higher SBP and lower DBP were each independently associated with worse cognitive function. Older age, female sex, lower education level, being widowed, residing in a rural area, being a member of a Scheduled Caste or Scheduled Tribe, having a low level of economic consumption, being underweight, and a history of stroke were all independently associated with worse cognitive function scores.ConclusionsBoth SBP and DBP were independently associated with cognitive function among older adults in India in diverging directions. Clinical interventions targeting high SBP and low DBP may benefit both cognitive health and cardiovascular health.     

Nurses’ Perspectives on the Care of Adults with Mental Health Problems and Histories of Childhood Sexual Abuse

Despite growing awareness and evidence linking childhood sexual abuse (CSA) to numerous ongoing health problems in adulthood, the integration of this knowledge into nursing practice remains inconsistent. This article reports the results of a study that explored nurses’ perspectives on, and experiences with, providing care for adults with mental health problems who may also have histories of CSA. Nurses’ views underscore the challenges and complexities involved when providing care for this population. The themes of nurses’ knowledge and comfort levels, ethical practice, patient care considerations, and system issues are used to discuss nurses’ understandings, perspectives, and experiences.     

Experiences of primary care among young adults with mental illness – A systematic literature review

Background

Mental illness, such as depression, anxiety disorders, attention deficit hyperactivity disorder and different addictive diseases, has increased among young adults over the last decade. Mental illness is associated with distress and problems functioning in social activities. Healthcare centres, that is, primary care, serve as the first point of contact with healthcare professionals for those young adults and provide outpatient medical and nursing care covering both physical and mental illness.

Objective

To explore experiences of primary care among young adults with mental illness.

Methods

A systematic literature review was conducted that followed the method of Bettany–Saltikov and McSherry. A keyword search was performed in various databases, and after a quality assessment 23 articles were included in the review.

Results

Young adults' experiences from primary care are described in four categories – Facing difficulties to accept help, relational preconditions, structural and organisational hindrances and satisfaction with youth-focused mental health interventions. Young adults with mental illness experience many difficulties in accessing and receiving proper help from primary care. Further, they did not believe in recovery from mental illness, and they also expressed a lack of mental health literacy.

Conclusion

While being the first contact with healthcare professionals, primary care needs to adjust its services to address the growing group of young adults suffering from mental illness. It is necessary to provide tailored guidelines and interventions in primary care for young adults with mental illness, and the Tidal Model may improve the contacts with young adults in primary care.     

Perspective on advanced directives among older adults in Shanghai: A qualitative study

ObjectiveThis study aimed to explore the perception on advanced directives (ADs) among older adults in Shanghai.MethodsThrough purposive sampling, 15 older adults with rich life experiences who were willing to share perceptions and experiences of ADs participated in this study. Face-to-face semi-structured interviews were conducted to collect the qualitative data. Thematic content analysis was applied to analyze the data.ResultsFive themes have been identified: low awareness but high acceptance of ADs; pursuing natural and peaceful sunset life; ambiguous attitude on medical autonomy; being irrational facing patients’ dying and death issues; positive about implementing ADs in China.ConclusionIt is possible and feasible to implement ADs in older adults. Death education and compromised medical autonomy may be needed in the Chinese context as the foundation. The elder’s understanding, willingness and worries about ADs should be fully revealed. Diverse approaches should be applied to introduce and interpret ADs to older adults continuously.     

A Review of: “Losing a Parent to Death in the Early Years: Guidelines for the Treatment of Traumatic Bereavement in Infancy and Early Childhood by Alicia F. Lieberman,Nancy C. Compton,Patricia Van Horn,and Chandra Ghosh Ippen”

Abstract

This article addresses the need for improved clergy-mental health professional collaboration in the assessment and treatment of elderly suicide. Millions of older adults with personal problems seek the counsel of clergy. A recent Gallup survey found that elders are more willing to turn to their clergy than their medical doctor or a mental health specialist for help when a friend is contemplating suicide (Gallup Organization, 1992). Elder suicide prevention presents the mental health and religious communities with unique opportunities to work together in the best interests of those they serve.     

Prevalence,Factors, and Health Impacts of Chronic Pain Among Community-Dwelling Older Adults in China

BackgroundChronic pain (CP) is prevalent among older adults in many Western countries and its prevalence, factors, and self-reported or objective measured health impacts have been well documented. However, there is limited information on these aspects among Chinese community-dwelling older adults.AimsOur aim was to assess the prevalence of CP and identify its associated factors as well as health impacts among older adults in China.DesignCross-sectional design.SettingsCommunity settings.Participants/SubjectsA total of 1219 community-dwelling adults aged 60 years or older.MethodsData on CP, sociodemographic characteristics, comorbidity, cognitive function, and physical activity, as well as self-reported outcomes (functional disability, depression, quality of sleep, and undernutrition) and objective measured physical function, were obtained.ResultsAmong 1,219 participants, 41.1% reported CP, of whom 16.6% experienced moderate to severe pain. The risk of CP was higher among older women with comorbidity and with depression and lower among older adults with higher educational level as well as with adequate physical activity. CP had significant associations with inadequate physical activity, functional disability, depression, poorer quality of sleep, and undernutrition, as well as worsening physical performance, poorer standing balance, and chair stands.ConclusionsCP is a common problem among Chinese community-dwelling older adults, particularly among the most vulnerable subgroups, and has substantial impacts on self-reported functional disability, depression, poor quality of sleep, and undernutrition, as well as objective measured physical function. Therefore it is relevant for older adults to develop effective CP management programs.     

The Factors Influencing Meal Satisfaction in Older Adults: A Systematic Review and Meta-analysis

PurposeThe aim of this study was to identify factors influencing meal satisfaction in older adults.MethodsAuthors searched four databases Ovid MEDLINE, Ovid EMBASE, the Cochrane Library, and KoreaMed using the following key search terms: “(elderly-mp. OR aged), AND (meal OR food OR eating OR feeding), AND satisfaction.” Only articles published between January 1946 and May 2018 were considered. The preferred reporting items for systematic reviews and meta-analyses guidelines were adopted for quality assessment. The authors ultimately selected 7 of 1,695 references for review and meta-analysis.ResultsA meta-analysis was conducted to determine the factors influencing meal satisfaction in older adults aged more than 60 years. The results showed that meal satisfaction was low when age increased and the individual was served frozen meals. Satisfaction with meals was high when food choices were available and individuals were served high-quality food and when the food smelled and tasted good or was personally tailored. Satisfaction was also high when individuals ate with their families. Moreover, meal satisfaction seemed to be influenced by physical health, whereas it did not show a significant correlation with mental health.ConclusionIntending to improve the quality of life of older adults by increasing their meal satisfaction, the authors pointed out factors that institutions should attend to when providing meals to older adults. To contribute to the lack of any existing conceptual and theoretical framework in this field, further steps to be taken by the authors shall involve concept analysis that would assist in building a conceptual framework.     

The roles of community health nurses for older adults during the COVID-19 pandemic in Northeastern Thailand: A qualitative study

ObjectiveCommunity health nurses play an important role in primary health care service, especially during the spread of COVID-19. This study aimed to describe the work and activities of community health nurses focusing on the care of older adults during the COVID-19 pandemic in Northeastern Thailand.MethodThis was a qualitative research study. The methods, including observation, in-depth interview, secondary data, and focus group discussion, were employed to obtain data from 46 key informants. The process started from February to August 2022 in northeastern Thailand. Data were analyzed using content analysis.ResultsThe results of this study were organized into 3 main themes focusing on 1) Community health nurses’ role for older adults during the COVID-19 pandemic, which consists of 12 sub-themes; 2) Barriers of community health nurses in caring for older adults during the pandemic consisted of 2 sub-themes; and 3) Factors contributing to the success of community health nurses in managing health and providing care for older adults during the pandemic consisted of 4 sub-themes.ConclusionsThe findings showed that community health nurses had played important roles, such as educating and advocating health, providing care, promoting and empowering people in the community toward health, and giving emotional and nutritional support to older adults during the COVID-19 pandemic. This study can be used as a guideline for policymakers and health-related agencies to develop healthcare strategies and to optimize the management of community health nurses in caring for older adults during the pandemic. COVID-19 is a major public health challenge; therefore, understanding the roles and activities of community health nurses helps improve primary care cluster development, strengthens healthcare services in community, and for everyone in the community to be ready for possible challenge of future global pandemics.