By: SOPHIA F. DZIEGIELEWSKI
Growing old is often viewed negatively
in our society, including some health and mental health care professionals.
Victimized by societal attitudes that devalue old age, many individuals (young
and old) will do almost anything to avoid or deny old age. Such prejudices are
the result of both rational and irrational fears. Rational fears about declining
health and loss of income, loved ones, and social status can be exaggerated by negative
stereotypes, as are irrational fears such as changes in physical appearance,
loss of mobility, loss of masculinity or femininity, and perceived mental
incompetence. Older adults continue to be oppressed by myths and misinformation
and by real obstacles imposed by various biological, psychological, social, and
economic factors.
Practitioners need to examine their own
attitudes toward aging. They need to recognize older adults
as valuable resources in our society and provide services and advocacy to
assist them in maximizing their degree of life satisfaction and well-being. Many older adults
fear loss of activity and may deny the actual loss. Older adults may suffer from
chronic conditions where improvement is unlikely. They may also suffer from
continuous life stresses, such as widowhood, social and occupational losses,
and progressive and declining physical health problems. Lack of access and
transportation creates barriers for older adults with psychiatric problems who attend community mental health centers for checkups and
medication.
Knowledge of the problems that elderly individuals
face is critical. Practitioners need to know what is normal and what is not as far as changes in sexuality (Clay,
2012). Education can help to address problems that can occur, as well as the
perceptions and attitudes of ascribed asexuality in older adults by family,
friends, peers, and caregivers. Patronizing attitudes about elderly individuals
increase the tendency to deny terminal problems rather than help them develop
ways to cope. A diagnostic assessment should take into account the individual’s
health conditions and environmental factors, among other aspects of his or her
life.
Assessing lethality with a suicidal
older client is essential. Older adults may not openly discuss feelings of
hopelessness and helplessness, and these must be screened. If suicidal ideation
and a concrete plan (the way to carry out the suicidal act) are expressed,
steps to ensure hospitalization must be taken immediately, as for any client at
serious risk for suicide.
Many older adults may not be
forthcoming with situational criteria, and the practitioner may remain
uncertain of the seriousness of the client’s thoughts with respect to his or her actions.
Regardless of whether the client’s behavior is action focused, some type
of immediate protective measure needs to be employed.
Diagnostic Assessment with Older Adults
1.
Identify life
circumstances that can complicate the diagnostic assessment process.
2.
Retirement issues:
Identify problems with work role transition and retirement status.
3.
Chronic conditions:
Identify an individual’s chronic medical
conditions and how these conditions can affect his or her level of daily
functioning.
4.
Physical health
conditions: Identify physical health conditions, especially vision and hearing
problems that can complicate or magnify current problems.
5.
Mental health
complaints: Identify mental health problems, looking for signs such as feelings
of sadness, loneliness, guilt, boredom, marked decrease or increase in appetite,
change in sleep behavior, and a sense of worthlessness. Be aware that signs of
depression in elderly persons can be situational (the etiology of the
depression is related to life circumstances), and screen for problems related
to tragic life experiences, including the loss of loved ones, job, status, and
independence, as well as other personal disappointments.
6.
Screen for confusion that
may be a sign of dementia.
7.
Medication use and
misuse: Identify the use and misuse of prescription medication because commonly
prescribed medications can present such side effects as irritability, sexual dysfunction,
memory lapses, a general feeling of tiredness, or a combination of these.
8.
Sexual problems: Be
open to the identification of sexual
problems.
9.
Suicide: Identify the
probability of accumulated life losses and be cognizant of a client’s
abilities and/or problems in coping with grief.
References
SOPHIA F. DZIEGIELEWSK,
2015, DSM-5TM
in Action, by John Wiley & Sons, Inc.
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