Caring of mental health for older people
Dr Md Anawar Hossain
Mental disorders in older people
The number of older/aged people are gradually increasing, especially in the developed and middle-income countries due to their low birth rates. Poor mental health and mental disorders in older adults are causing suffering and disability for them all over the world. The four types of disorders cause disability in the older people: neurocognitive disorders, major depression, schizophrenia, and substance use disorders (Reynolds 3rd et al., 2022). The mental disturbances isolate them from social functioning and reduce economic productivity and adherence to co-prescribed medical treatments. They have multimorbidities. Therefore, the mental health care of the older people and their family caregivers is labor-intensive. Thus, the older people are losing their independence and suffering from early mortality from suicide and physical illness. Prevention, timely recognition and treatment are global public health and moral priorities in order to protect these older people (Reynolds 3rd et al., 2022).
Positive psychiatry against ageism and stigma
The older people, with and without mental disorders, are discriminated due to ageism and suffer from stigma (Reynolds 3rd et al., 2022). Aging has some positive characteristics, such as resilience, wisdom and prosocial behaviors, which should be promoted and implemented to combat ageism and stigma and to help protect and improve mental health in older adults. The positive psychiatry of aging and promotion of wellness within illness, can enhance well-being, resilience, optimism, and self-efficacy/personal mastery, which can fight against ageism and stigma.
Interventions in social determinants
Some social determinants, especially loneliness and social isolation cause mental illness in older adults. Therefore, it is essential to apply interventions that provide positive solutions to these issues in individual patients and the family caregivers.
Interventions in mental illness and unhealthy lifestyles
The older adults with mental illness often do not follow healthy lifestyles, especially lack of physical activity. Therefore, we need to identify and implement appropriate interventions that can improve both mental and physical health. Interventions can also improve brain and cognitive fitness, offered in individual and in group formats, that provide rewards and reinforcement for adopting healthier behaviors in physical activity, diet and sleep (Reynolds 3rd et al., 2022).
Use of technology
Interventions such as the use of smartphones for computer-initiated text-messaging or live telephone interactions can promote and enhance self-management of illness. Besides this, the use and investigation of digital phenotyping at the levels of sensors, data science and health care may be helpful in relapse prevention in old age (Reynolds 3rd et al., 2022).
Multidisciplinary and team-based care
It is essential to implement multidisciplinary team care with comprehensive assessment, clinical management, intensive outreach, and coordination of mental, physical and social health services (Reynolds 3rd et al., 2022). Future practice and research should establish and evaluate collaborative care and behavioral health homes. These models are based on comprehensive approaches consisting of novel use of telehealth, mobile health technology, and peer support. Team-based care should be measurement-based and interdisciplinary using a range of clinical, rehabilitative, preventive and supportive services. The mental disorders in older adults are complex and heterogenous at various levels. Therefore, team-based collaborative care models can provide an evidence-based and scalable pathway to implement prevention and personalized care, which are also the great solutions to the barriers posed by fear and stigma.
Focus on older people and family caregivers
Providing optimal care to the older adults with mental disorders should be both patient-focused and family-centered (Reynolds 3rd et al., 2022). Therefore, further research is needed how we can enhance the well-being of family caregivers as well. The family caregivers of older persons, who are under stress and burden, need help of information and support. The family caregivers must be included in the caregiving team, which will benefit both patients and caregivers alike and also help in accurate clinical assessment and targeted interventions for promoting wellness and preventing serious adverse incidents, such as suicide.
Pharmacotherapy
The safety and efficacy of pharmacotherapy can be optimized by paying more attention and care to metabolic, cardiovascular and neurological tolerability. In addition, further development and testing of medications is needed, which can reduce the risk for suicide, but can ameliorate cognitive impairment and slow down its progression (Reynolds 3rd et al., 2022).
Response variability to medications
The older adults respond variably to medications and other psychosocial and psychotherapeutic interventions. Therefore, the factors behind this response variability need to be investigated during acute, continuation and maintenance treatment which will allow clinicians to better personalize treatment depending on different individual’s needs. Anti-inflammatory medications should be further investigated to slow down accelerated aging, which is highly relevant to advances in clinical care (Reynolds 3rd et al., 2022).
Adaptation and innovation in treatment strategy
Researchers and clinicians learnt a lot of lessons from the treatment experiences for cardiovascular diseases and oncology. Based on that knowledge, detecting and diagnosing mental disorders in early state is greatly significant to prevent their complicated conditions, such as treatment resistance, cognitive impairment, and mortality (Reynolds 3rd et al., 2022).
Rights and needs
The older people with mental disorders have the legal rights to live with dignity, respect, wellness and independence. Therefore, it is a global public health responsibility to address the rights and needs of older people and their families living with mental disorders.
Reference
Reynolds 3rd C. F., Jeste D. V., Sachdev P. S., Blaze D. G., 2022. Mental health care for older adults: recent advances and new directions in clinical practice and research. World Psychiatry, Vol. 21 (3), Pages 336-363.