Mental Health Issues in Long-Term Care - Research Paper Example

? Running head: MENTAL HEALTH ISSUES Mental Health Issues in Long Term Care First Middle initial and of Course Name April 22, 2011 The United States of America is facing the largest change in demographics and related health care issues in the history of mankind. Nearly 24% of the country’s population is made up of people who are over 55 years (U.S. Census Bureau, 2009) and 20% of this population suffers from some form of mental health issues (U.S. Department of Health and Human Services, 2001). Currently, thirty five million Americans are over 65 years and it is predicted that by the year 2030, that number will reach 85 million (U.S. Census Bureau, 2009). There are two main reasons responsible for this trend: 1. The baby-boomer generation is growing old with most of the people in this group being in their 50s currently. 2. The life expectancy has moved from 47.3 years in 1900s to 77 years in 2000 (Federal Interagency Forum on Aging Related Statistics, 2010). This has been achieved largely due to improved sanitation, nutrition and rapid advancement in medical technologies. These factors have contributed to the dramatic rise in lifespan and proportionate increase in health care issues - especially mental health issues among the older American population. Statistics reveal that over 14 million people live in long term care facilities of which nearly 90% are over 65 years (Federal Interagency Forum on Aging Related Statistics, 2010). These long term care facilities vary in scope from institutions and homes for the mentally challenged to nursing homes and assisted-living facilities. According to the U.S. Department of Health and Human Services (2001), 67% of nursing home residents exhibit some form of mental or behavioral problems. The elderly patients living in long term care facilities experience various stress factors related to growing old like loss of spouse, loss of mobility and independence, declining physical and cognitive abilities, admittance into a long-term care facility and therefore being away from home. Due to these stress factors in life and lack of social support available to the older Americans, there is immense need for mental health care among this segment of the population. The incidence of mental health problems in long term care residents is therefore extremely high (American Health Care Association, 2003): Mental Retardation 2.82% Depression 42.79% Psychiatric diagnosis 18.76% Dementia 45.35% Behavioral problems 30.62% Mental Health Issues in Long Term Care Facilities Following are some of the common mental health issues faced by residents in long term care facilities: 1. Depression: Depression is the most common mental health issue among residents in long term care facilities. Older people often experience loneliness, helplessness, hopelessness, frustration and anger towards the later phase of their life. Symptoms of depression include feeling ‘low’ and not enjoying things that once used to be very interesting to them, difficulty falling asleep or sleeping all the time, loss or increase in appetite, crying or acting out emotionally, anger, irritability, suicidal behavior, restlessness or slowed movements. According to the National Institute of Mental Health (2000), although older Americans, over the age of 65 years, make up only 13% of the population, they account for 20% of the people who commit suicide. In fact older Americans have the highest suicide rate of any age group (National Institute of Mental Health, 2000). The most important factor that helps address depression in residents of long term care facilities has been found to be human interaction especially with their loved ones. 2. Delirium: Delirium is mostly caused by acute illness or drug toxicity. It may also be caused by fever, acute infection mostly urinary tract infection, medical conditions such as diabetes or as a reaction to leaving familiar people and places. Delirium always involves periods of diminished consciousness. A person suffering from delirium may act agitated without warning and then fall into a trance or may know exactly where he is at the beginning of a conversation but forget it by the end of the conversation. Sometimes the individual may also experience mild hallucinations. Delirium has been found to be treatable most of the time, but in some cases, it seems to linger around. Therapy has been found to be an effective tool to help individuals cope with and at times overcome this condition. 3. Dementia: Delirium involves irreversible deterioration of intellectual abilities and is often accompanied by emotional disturbances like depression, paranoia and anxiety. Alzheimer’s is the most common cause of dementia and affects 2.6 to 4.5 million Americans who are above 65 years (American Bar Association Commission on Law and Aging, 2005). Dementia can also be caused by brain injury such as mild strokes or even as a result of long term damage from alcohol. The symptoms of dementia are similar to that of delirium; therefore it is very important for older people to be evaluated by a medical doctor. Dementia is known to affect nearly 7% of Americans over the age or 65 and about 30% of Americans above the age of 85 (American Psychological Association, 1998). 4. Generalized Anxiety: Anxiety is yet another common emotional problem in later life and can appear in many different forms. A person suffering from anxiety may complain of feeling nervous, jittery or uncomfortable. They may worry about things that they cannot even name or may feel like something bad is going to happen. Sometimes they may complain about physical distress which does not have a medical or physical cause. For e.g., they may say that their heart is beating very fast therefore they are having a heart attack or that they are feeling dizzy or that they are feeling too hot or too cold. 5. Paranoia: Residents of long term care facilities may also experience paranoia wherein they become very suspicious and ‘on guard’. They are consumed by the thought that someone or something is ‘out to get them’. In this state, they may suspect their own son or daughter, the facility administrator, the FBI, CIA or even the Russians! This fear of being ‘picked on’ or ‘put down’ may come out in the individual’s behavior when they express fear or anger against that person. They may even accuse someone of stealing things or of trying to harm them. Paranoid behaviors may cause the residents to isolate themselves in their room so as to protect their belongings. Sometimes, residents may also become physically aggressive if they think that something or someone is threatening them. Other mental health issues common in residents of long term care facilities are bipolar disorder, schizophrenia and obsessive compulsive disorder. Although these illnesses may be pre-existing, living in institutionalized care setting can add to the stress and aggravate these issues in the residents. Therefore, continued medical and psychological care for this group of the population is very important. Current Challenges in Long Term Care Facilities One of the main challenges that health care professionals are facing today is to address the increasing mental health care demand of people living in long-term care facilities. This need is expected to quadruple in the next twenty-five years (Matteson, 2008). Neither the long-term care industry nor the health care professionals who serve their clients are currently equipped to meet this challenge. In the current scenario, mental health problems of those living in long term care facilities are routinely ignored, medicated or tolerated and seldom treated effectively (Matteson, 2008). This is due to broad diversity in quality of various long term care facilities. While the best facilities are dedicated to maximizing the quality of life of their residents, the worst facilities focus on maximizing their profits and avoid litigation. Although many people living in the community have the same degree of physical disability as those living in long term care facilities, the decision to place an individual in these facilities is based on the amount of family and social support and the presence of a psychiatric disorder. In most states across the United States, the majority of the elderly who are mentally ill are placed in long term care (Matteson, 2008). This is so because they have no where else to go. However, many long term care facilities are not equipped to deal with the challenges presented by their residents. Most of the staff in long term care facilities have little or no training in mental health care, they often feel overwhelmed with the tasks given and are not adequately compensated. Mental health issues in elderly people, unlike those in younger people, are often accompanied by concurrent medical problems. Therefore, psychological problems in this population are often indicators of physical illnesses. In fact, more than 50% of the elderly psychiatric patients have been found to have an undetected physical illness (Backman et. al., 2003). Studies have revealed that medical illnesses resulting in hospital admission was the strongest predictor of accelerated decline in mental status of elderly Americans (Backman et. al., 2003). Another major concern in geriatric mental health assessment is that psychiatrists miss nearly 80% of physical illnesses during the initial assessment (Matteson, 2008). This may be primarily because mental health practitioners are trained to look at symptoms as signs of psychopathology and not medical illness. Secondly, only about 10% of psychiatrists specialize in geriatrics (Matteson, 2008). Since medical problems can cause serious behavioral and emotional disorders, it is important to consider the medical aspect before any diagnosis or behavioral intervention is attempted. Another major aspect that is often overlooked while assessing behavioral and emotional problems of elderly Americans is nutritional deficiencies. Elderly people often become deficient in certain vitamins and minerals because of improper nutrition and poor quality of food. They may consume less protein and increase the consumption of refined carbohydrates because of financial difficulties. This can result in destabilization of blood sugar which can significantly increase the risk of dementia (De Castro, 1993). Studies have found that long term care residents suffering from depression and anxiety have low folic acid and vitamin B12 levels (Bjelland et. al., 2003). These deficits have also been known to result in symptoms of disorientation, depression dementia, and psychosis. Vitamin B5 deficiency has been found to result in restlessness, irritability, and depression. Similarly excessive calcium taken through supplements etc has been found to cause hyper-calcemia, which may result in expression of symptoms like fatigue, depression, anxiety, panic attacks, headaches, paranoia, memory deficits, and insomnia (Frizel, et. al., 1969). Another startling fact is that people over age 65 represent only 13% of the population but consume 30% of all prescribed medications (Graeden, 1996). On an average, 15 drugs are prescribed to elderly people over the age of 60 every year. 37% of this population takes at least five drugs, while another 20% take seven or more medications at once (Wilford et. al., 1994). A large percentage of this population also takes herbs, vitamins and supplements. The toxic effects of overmedication have been suspected to cause thousands of cases of confusion, mood disorders and memory problems in the elderly population (Graeden, 1996). In fact, it is estimated that over 200,000 people in America suffer from medication-induced mental problems. Every year, adverse reactions to prescription drugs, drug misuse and medication abuse account for thousands of illnesses and deaths in the elderly (Graeden, 1996). In conclusion, there is immense need to provide adequate mental health services in long term care facilities. This need is going to drastically increase in the years to come because of the growing elderly population in America. However, addressing this need requires staff that is trained in geriatric mental health issues. Mental health care providers in long term care facilities need to be aware of the physical illnesses, medications, nutrition and all other aspects related to the resident so that they get a comprehensive view of their health status. Lack of this knowledge can lead to consequences like over medication, undetected physical illnesses and prescribing wrong or unnecessary medications. Above all, the most important requirement of this industry is recruiting personnel that are passionate about working in geriatric care. This would ensure that proper medical and mental health care services are provided to the elderly, who often feel the lack of support from friends and family during the later phase of their life. Reference American Bar Association Commission on Law and Aging. (2005). Assessment of older adults with diminished capacity: A handbook for lawyers. 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Journal of Women’s Health and Gender-based Medicine. 9(3), 289-297. U.S. Census Bureau. (2009). Current population Survey. Retrieved from http://www.census.gov/ population/socdemo/age/ppl-167/tab01.pdf U.S. Department of Health and Human Services. (2001). Older Adults and Mental Health: Issues and Opportunities. Retrieved from http://www.globalaging.org/health/us/mental.pdf Wilford, B.B, Finch, J., Czechowicz, D.J., & Warren, D. (1994). An overview of prescription drug misuse and abuse: Defining the problem and seeking solutions. Journal of Law, Medicine, & Ethics. 22(3), 197-203. Read More