Mental Health in the Older Australian Person - Literature review Example

Mental Health in the Older Australian Person Name Instructor Institution Date Introduction According to AMA (2011), numerous Australians experience one or more mental illnesses within the course of their lives. As a result, mental health practitioners have a role of responding to the initial reactions to the illness. The medical practitioners are also expected to make clinical assessment and then make it their duty and follow through with other medical and health services. AMA (2011) reveals that the provision of mental health services in Australia had been faced with inadequacies and gaps in terms of mental health prevention, treatment and management and the articulation of the solutions needed to improve the patients’ and medical profession system. In this paper, the discussion focuses on the mental health in older Australian person. Condition Mental health includes human emotions, social and psychological well-being. Mental health has impacts on the way a person thinks acts or feels in the course of coping with life. Mental health is also beneficial in the fact that it determines stress handling, relations with others, and choice making. This importance of mental health is relevant at every stage of life starting with childhood to adulthood. When a person’s mental health is affected, the person is suffering from a mental disorder which affects the way they think, behave and the person’s mood. Mental illnesses are presented in persons with mental disorder genes and family history, stress experiences, and abuse history. Mental illnesses are common amongst persons of any age group. However, the most affected persons are the elderly. According to Inouye (2012), mental status alterations are one of the most commonly presented symptoms in elderly persons who are acutely ill. These changes account for about 30% of the emergency evaluations among older patients. In the elderly persons, the mental status acts like a barometer. It indicates the elderly person’s underlying health and is the sole symptom of an underlying serious disease. Australia has a population consisting mostly of colonial era settlers’ descendants, and immigrants of post-federation 90% of whom are descents of Europe. Of all the Australian population, only s2.2% represents the indigenous population of Torres Strait Islanders and Aborigines. Despite the Australian population being generally healthy, there are exceptions for the indigenous population who are more vulnerable to diseases. Background In 2003 (Khouzam, Battista, Ernes and Ahles, 2005) approximately 6 million adults over the age of 65 were suffering from mental illnesses and by 2050 the number is expected to get to 15 million. According to Khouszam, Battista, Ernes and Ahles (2005), increase in late-life psychosis by 2050 will be associated with the increased number of baby boomers moving into late life. In addition, the baby boomers also build up age associated cognitive conditions. These authors also reveal that Dementia will be the most common cause of the increased experiences of psychosis symptoms among older persons. IPA (2012) reveals that as the global population ages, this will be associated with increased ranges of age-associated mental disorders. This poses a challenge, as each nation will be required to train adequate amounts of skilled health workers. The mostly affected elderly persons are those that experience psychotic disorder at a younger age. The other challenge facing clinicians is how to diagnose the causes and treatment of mental disorders at late life more so where psychosis arises after the age of 60. The most common forms of psychotic disorders among the elderly are dementia-associated disorders and mood-associated disorders (Khouzam, Battista, Ernes and Ahles, 2005). Dementia related disorders include Lewy Body Dementia and Psychosis Dementia. Mood associated disorders are depression associated with psychotic features, late life delusional disorder and bipolar disorder. The most common mental disorders among older Australians are Dementia, depression and anxiety disorders. Older people affected are those living in rural and remote area, people of diverse culture, and among the aboriginal and Torres Strait Islanders (healthinsite.gov, 2012). With increasing number of older persons, Australia like most of the Western countries is experiencing workforce shortages. In addition, the health care system has been unable to meet present and future demands in workforce more so on the basis of ageing population and increasing prevalence of chronic disease (ipa-online.org, 2012). Treatment In Australia, the older person in need of specialist mental health care most commonly receives care in residential aged care settings. Such settings are characterized by limited resources and staffing (ipa-online.org, 2012). There is also an assumption that a large number of older people that require specialist mental health care may have received care in the community as part of aged care services. In residential or community contexts, there are numerous personal carers employed with or without vocational training. In order to ensure high quality care, the skills, attitudes and knowledge of the care provider play a significant role. Person centered care approach is critical in ensuring that patients receive quality care. In Australia, person centered care is hindered by the declined workforce capacity. According to ipa-online.org (2012) the quality of care is affected by poor mix of skills and shortage of skilled practitioners. Nurses have to engage in activities they are not qualified for and are forced to work as part of a production line. As a result, the culture of nursing care is no longer conducive or supportive of person centered approach that needs time with the recipients of care and flexibility in work organization in order to promote tailored individual needs. In order to improve their condition, mentally sick elderlyseek information from health practitioners and remain under the care of trusted persons while at home. Available support One of the disadvantaged groups of persons in primary healthcare is people with mental health problems (Bywood, Katteri and Lunnary, 2011). Throughout the world, there is numerous associationsto deal with mental health conditions for the elderly. The main aim of these associations is toensure that the elderly have their mental health recognized as a key issue of health and wellness. In Australia, such institutions include Fight Alzheimer’s, Save Australia and Alzheimer’s Australia Dementia Research Foundation. Through the Fight dementia campaign, Australians are encouraged to support the existence of a world without dementia by signing up as a champion. Elderly persons in Australia are also provided with a Mental Health Research Institute. In this Institute, Australian researchers seek to understand the causes of psychiatric and neurodegenerative diseases. The research findings are then used to provide better diagnosis and treatment for mental illnesses. Principles of primary health care Accessibility and social justice The World Health Organization indicates that life expectancy in Australia is 79 year for males and 84 years for females. Healthcare funding is carried out through mixed federal, state and private contributions.(Australia, n.d )The Mental health policy changed the approach to mental health care from institutional based to community oriented service. (Australia, n.d). According to the Royal and New Zealand College of psychiatrists (2010), 13% of the population was over 65 years old by 2010. This population is expected to double by 2051. With such high life expectancy, people with mental health issues will live longer. Older persons with mental disorders are disadvantaged by their disease and their old age. These older persons also have reduced access to mental health services which are by far designed for the younger people. Mental health care is managed by general practitioners, residential aged care facilities, community health services among others. However, there is no consistent national system for delivery of mental health services delivery to the older Australian person. In addition, the quality and accessibility of these services varies enormously with rural areas being poorly served. In some parts of rural areas, health care services are nonexistent. Nurses can assist through the provision of seamless services that meet mental health needs specifically tailored to the needs of the older Australians. Nurses can also embrace a model through which older people with mental health problems are identified as early as possible by medical practitioners. After that, the identified elders can then be provided with appropriate well-coordinated evidence based treatment, rehabilitation and prevention of relapse. Appropriate technology In order to effectively apply technology in the prevention of mental health issues among the elderly, there is a need for nurses to provide information on the bio-psychosocial influences on ageing and their consequences(PMSEIC, n.d).?? With the right information, innovative tools can be developed to restore or prolong human function. Human functioning obtained using innovative tools on the elderly should handle the social, physical and cultural demands placed on the patients by their environment. In order to improve the body’s system performance, assistive technology can be developed. Assistive technology however, raises the question of affordability. The development of technologically innovative IT-based communication and decision support technologies designed to inform consumers would mean that the elderly and their care givers are informed on the best way to deal with mental health problems. Through the use of such technologies, consumers remain informed about the best measures to take, to prevent or cure mental health problems (PMSEIC n.d).Building designs that are innovative assist in overcoming cognitive, sensory, and physical impairments attributed to restricting patient’s functional capacities and social integration. Technological developments such as well-designed prosthesis and various aids can assist persons with sensory or cognitive losses (PMSEIC n.d). Health promotion In Australia, the provision of aged care services is characterized by mixed provision types. The types of provisions include a high degree of cooperation between the government, the community and the nongovernmental sector (NIHW, 2007). The non-government sector has long provided aged care especially in majority of residential services and community care services. High care residential services are associated with private sectors. The government of Australia has a major role in funding residential and community age care. The Australian government formulates policies under consultations with state and territory government. These tools are effective in promoting the health of the elderly with mental illnesses. Community aged care services are very effective especially to older persons with complex needs that do allow living at home thereby reducing hospital admissions (AMA, 2011). Conversely, residential aged care services provide housing and support for older people who are unable to live at home (NIHW, 2007). With reduced enrollment of nursing, nurses should be dynamically trained to handle different issues in aged care provision. Health Education Today, the capacity of nurse in Australia is failing. This has resulted in the shortage of skilled practitioners. As a result, the nurses only have time to spend on the provision of services they are trained to offer, thereby failing to offer theperson centered approach type of support to mental health patients (ipa-online.org, 2012). The provision of quality care is dependent on the skills, attitudes and knowledge of the care providers. Education and training are relevant in knowledge and skills improvement for high quality aged care. However, this training is insufficient in changing the attitudes of nurses. Owing to low enrollment of student nurse, existing registered nurses have increased responsibilities some of which fall outside the practice they have learnt. In Australia, aged care and mental care sectors share numerous issues regarding workforce. These sectors compete for the reducing pool of qualified nurses with acute and primary health care sectors (ipa-online.org, 2012). In order to handle the problem, the Australian government, professional bodies and industries in the health and aged care sector are called to promote specialist mental health nurses for older persons. These bodies are also required to put measures in place that provide clear delineation of practice scope, appropriate workload and skill mix. Culture sensitivity/cultural safety In Australia, the decreased enrollment of student nurses is associated with negative status perception. For aged care staff, both internalized and external negative status perceptions are common. Internalized perceptions are associated with the aged care sector. The baby boomers tend to rate aged care facilities poorly owing to their independence and autonomy (AIHW, 2007). Externally, aged care’s negative perceptions tend to affect nursing students who feel that their peers do not value aged care thereby abandon it. In order to address the issue, nurses should encourage enrollment in aged care by nursing students through campaigns, sponsorships, and mentorship programs. (AIHW, 2007) Intersectoral collaboration (collaboration between sectors) Government, non-government and private sectors participate in the provision of mental healthcare services. In Australia, Primary care is funded through Medicare. Medicare is a government funded system for funding health (Australia, n.d). Through this system, eligible persons receive free access services to a general practitioner. The choices of Medicare eligible persons are enhanced through private health insurance tailored to their needs. In Australia, Medicare offers mental health patients with the opportunity for recognition, and management of their ailments. In addition, Medicare facilitates referral to specialist mental health services. The most disadvantaged populations are the most disadvantaged owing to their non-English speaking background, such as the Aboriginal and Torres Strait Islander. Nurses can engage in the establishment of programs aimed at identifying older people with mental health problems especially in areas associated with the disadvantaged. This identification should be carried out as early as possible to ensure that appropriate and well-coordinated evidence based treatment is provided the as fast as possible. Public participation The Australian public has participated in creating awareness about mental health through participation in campaigns, participation in training workshop where well reputed public speakers in Australia offer training and comments on situations regarding mental health. The public also educates each other on issues regarding Mental health (Yates and Root 2010). The public can also participate in funding of care and support through individual or consolidated funding. Amongst them, people can educate each other and promote awareness. With the right information, the public can provide information or receive basic mental health information from mental health experts (Yates and Root 2010). Depression, delirium and dementia Depression According to Khouzam, Battista, Emes and Ahles (2005), depression among the elderly is a mood related disorder. The common form of depression is depression with psychotic features. Psychotic depression is common among depressed patients with depressive episodes occurring later in life unlike those whose episodes occur earlier in life. The symptoms are usually mood congruent this implies that the mood expressed by the patient is congruent and consistent with the content of their thoughts. When occurring new in old age, depression is expressed in range of conditions including major depression, bipolar disorder occurring as depression, chronic depression, complicated bereavement and others (NSW, 2001) The conclusion states that any psychotic disorder occurring in late life and in conjunction with delirium and dementia requires appropriate psychosocial history and medical workup before initiation of any form of treatment. I agree with the fact that depression should not be treated without careful diagnosis and appropriate psychosocial history. This is because depression is a disease that accompanies many medical and neurological disorders. In addition, depression increases the risk of death if not disability. Currently, most part of the literature on depression emphasizes on treatment. However, I believe that preventing depression is an effective way especially for persons with complicated medical conditions like stroke (Rovner, Casten, Hegel, Leiby and Tasman, 2007). Delirium According to Alogiakrishnan and Wiens (2004), the development of delirium in the elderly is linked to the use of drugs. The best and most effective way to treat delirium is through identification of the easiest trigger. Delirium induced by drugs is common in hospital settings. The risk of anti-cholinergic toxicity is higher among the elderly and the risk of inducing delirium medications. In addition, polypharmacy altered pharmacokinetics and pharmacodynamics are seen with aging. The most common causative of delirium are deliriants which are high dose narcotics, benzodiazepines, and anticholinergic medications. I agree with the fact that deliriantsare causative factors for delirium. However, this does not mean that every patient under deliriants medication will suffer from delirium. There are other factors that increase the susceptibility of an individual to drug induced delirium. These factors include physiological aging changes, medical co-morbidities, contribution of pharmacokinetic and pharmacodynamic changes to delirium.For all cases, the clinician is required to order standard, relevant investigations to eliminate non-drug causes. In particular, the clinician must pay attention to serum creatinine in order to calculate creatinine clearance and adjust renally eliminated medicated appropriately(Alogiakrishnan and Wiens2004). Dementia Dementia is a cognitive impairment. The measure of cognitive function is carried out using Mini Mental State Examination (MMSE) (Burns, Lawlor and Craig 2002). In late life, the most common form of dementia is Alzheimer’s disease or AD. For patients with AD, psychosis results to institutionalization while the caregiver experiences stress. Approximately 50% of AD patients in America suffer from Dementia with psychotic patients. According to Fick and Mion (2007), delirium superimposed on dementia causes life threatening complications. The complication intensifies with lack of recognition and lack of treatment. For patients with dementia, delirium has 4-5 times occurrence and the delirium superimposed on dementia is less likely to be recognized. The difficulty of recognizing delirium in dementia results from overlapping features. In order to assess delirium, I agree with the use of CAM or Confusion Assessment Method. Conclusion Among older persons, the emotional, social and psychological wellbeing deteriorates. This affects the mental health of the older person causing them to experience conditions such as depression, dementia and delirium. Under deteriorated mental conditions,elderly person’s experience stress handling, relations with others and decision making abilities is affected. In Australia, aging is a common problem resulting in a decreased workforce. This is also associated with an increased number of baby boomers moving to late life. Common psychotic disorders among elderly persons in Australia are Dementia associated with psychosis and depression. The most common form of mental health treatment in Australia arethe use of residential aged care and community aged care. There are numerous organizations that are available to promote public support and participation in mental health. In Australia, it is clear that the life expectancy is high, probably the highest in the world. Through the use of appropriate technology to manage mental health issues in the elderly, the life expectancy could be higher because it will result in innovative tools to prolong or restore human function. In addition, technological tools could promote building designs that could overcome physical or cognitive impairments resulting to increased mobility among the elderly. Promotion of health calls for elimination of the negative status that surrounds aged care nurses profession to promote enrollment of more student nurses. Bibliography Alagiakrishnan, K and Wiens, C 2004, an approach to drug induced delirium in the elderly, Post graduate medical Journal, Volume, 80, P. 388-393. Australia n.d, Integrated mental health care for older people in general practices of inner city Sydney, p. 69-76. .< www.who.int/mental_health/policy/services/Australia.pdf> Australian Medical Association or AMA 2011, Mental Health 2011, viewed December 18 2012, Australian Institute of Health and Welfare or AIHW 2007, Older Australia at a glance, Australian Institute of Health and Welfare, viewed December 18 2012, < http://www.aihw.gov.au/publication-detail/?id=6442468045 > Burns, Alistair, Lawlor, Brain and Craig, Sarah 2002, Rating Scales in old age psychiatry, the British Journal of Psychiatry, p. 97-98. Bywood, Petra, Katteri, Reacheal and Lunnay, Belinda 2011, summary disparities in primary health care utilization, Primary Health Care Research & Information Service. Fick, Donna and Mion, Lorraine 2007, Assessing and managing Delirium in Older Adults with Dementia, Alzheimer’s Association, Issue D8. Healthinsite 2012, mental health for older people, viewed 18 December, < http://www.healthinsite.gov.au/topics/Mental_Health_of_Older_People> Inouye, Sharon, K 2012, Chapter 26: Delirium and other mental status problems in the older patient, Elsevier, Inc., Viewed 18 December 2012, Ipa-online.org 2012, better mental health for older people, National psychogeriatrc Association, viewed 18 December 2012, < http://www.ipa-online.org/ipaonlinev4/main/healthcare/healthcare_workforce_issues.html> Khouzam, Hanl, Battista, Matthew, Ernes, Robert, and Ahles, Scott, 2005, Psychosis in late life: Evaluation and management of disorders seen in primary care, Geriatrics Journal, volume 60, Issue 3, p. 26-33. NSW health Department 2001, Consensus Guidelines for Assessment and Management of Depression in the Elderly, Faculty of Psychiatry of Old Age, Sydney. Rovner, Barry, Casten, Robin, Hegel, Mark, Leiby (2007), Preventing depression in age-related macular Degeneration, Arch gen Psychiatry, Volume 64, issue 8, p. 886-892 The Royal Australian & New Zealand College of Psychiarists 2010, older Australians Deserve a better deal in mental health, P. 1-4. PMSEIC or Prime Minister’s Science n.d, Engineering and Innovation council, promoting healthy Ageing in Australia, Yates, Ian and Root, Jo 2010, Submission to the productivity commission inquiry into aged care: Caring for older Australians. Read More