In general, problems affecting the elderly are similar to those affecting persons of any age. This section highlights the differences from the viewpoint of etiology, frequency, and prognosis.

1. CONCEPTS AND PRINCIPLES RELATED TO MENTAL HEALTH PROBLEMS OF THE GERIATRIC CLIENT:
1. The elderly do have capacity for growth and change.
2. Human beings, regardless of age, need sense of future and hope for things to come.
3. An inalienable right of all individuals should be to make or participate in all decisions concerning themselves and their possessions as long as they can.
4. Physical disability due to the aging process may enforce dependency, which may be unacceptable to elderly clients and may evoke feelings of anger and ambivalence.
5. In an attempt to reduce feelings of loss, elderly clients may cling to concrete things that most represent, in a symbolic sense, all that has been significant to them.
6. As memory diminishes, familiar objects in environment and familiar routines are important in helping to keep clients oriented and in contact with reality.
7. Familiarity of environment brings security; routines bring a sense of security about what is to happen.
8. If individuals feel unwanted, they may tell stories about their earlier achievements.
9. Many of the traits in the elderly result from cumulative effect of past experiences of frustrations and present awareness of limitations rather than from any primary consequences of physiological deficit.
2. ASSESSMENT:
1. Psychological characteristics of the geriatric client:
1. Increasingly dependent on others, not only for physical needs but also for emotional security.
2. Concerns focus more and more inward, with narrowed outside interests.
1. Decreased emotional energy for concern with social problems unless these issues affect them.
2. Tendency to reminisce.
3. May appear selfish and unsympathetic.
3. Sources of pleasure and gratification are more childlike: food, warmth, and affection, for example.
1. Tangible and frequent evidence of affection is important (e.g., letters, cards, and visits).
2. May hoard articles.
4. Attention span and memory are short; may be forgetful and accuse others of stealing.
5. Deprivation of any kind is not tolerated:
1. Easily frustrated.
2. Change is poorly tolerated; need to have favorite chairs and established daily routine, for example.
6. Main fearsin the aged include fear of dependency, chronic illness, loneliness, boredom, fear of being unloved, forgotten, deserted by those close to them, fear of death; fear of loss of control of one's own life; a failing cognition; loss of purpose and productivity.
7. Nocturnal delirium may be due to problems with night vision and inability to perceive spatial location.
2. Psychiatric problems in aging:
1. Loneliness—related to loss of mate, diminishing circle of friends and family through death and geographic separation, decline in physical energy, loss of work (retirement), sharp loss of income, and loss of a lifelong lifestyle.
2. Insomnia—pattern of sleep changes in significant ways: disappearance of deep sleep, frequent awakening, daytime sleeping.
3. Hypochondriasis—anxiety may shift from concern with finances, job, or social prestige to concern about own bodily function.
4. Depression—common problem in the aging, with a high suicide rate; partly because of bodily changes that influence the self-concept, the older person may direct hostility toward self and therefore may be subject to feelings of depression and loneliness.
5. Senility—four early symptoms:
1. Change in attention span.
2. Memory loss for recent events and names.
3. Altered intellectual capacity.
4. Diminished ability to respond to others.
3. Successful aging:
1. Being able to perceive signs of aging and limitations resulting from the aging process.
2. Redefining life in terms of effects on social and physical aspects of living.
3. Seeking alternatives for meeting needs and finding sources of pleasure.
4. Adopting a different outlook about self-worth.
5. Reintegrating values with goals of life.
4. Causative factors of mental disorder in the aging client related to:
1. Nutritional problems and physical ill health related to acute and chronic illness:
1. Cardiovascular diseases (heart failure, stroke, hypertension).
2. Respiratory infection.
3. Cancer.
4. Alcohol dependence and abuse.
5. Dentition problems.
2. Faulty adaptation related to physical changes of aging (e.g., depression, hypochondriases).
3. Problems related to loss, grief, and bereavement.
4. Retirement shock related to loss of status and financial security.
5. Social isolation and loneliness related to inadequate sensory stimulation.
6. Environmental change (relocation within a community or from home to institution): loss of family, privacy.
7. Hopelessness, helplessness related to condition and circumstances.
8. Altered body image (negative) related to aging process.
9. Depression related to helplessness, inability to express anger.
3. ANALYSIS/NURSING DIAGNOSIS:
1. Self-esteem disturbance related to body image disturbance and altered family role.
2. Impaired social interaction related to social isolation and environmental changes.
3. Dysfunctional grieving related to loss and bereavement.
4. Altered feeling states and spiritual distress related to hopelessness, anxiety, fear, powerlessness.
5. Altered physical regulation processes related to physical ill health.
6. Sleep pattern disturbance related to insomnia and altered sleep/arousal patterns.
4. NURSING CARE PLAN/IMPLEMENTATION:
1. Long-term goal: to help reduce hopelessness and helplessness.
2. Short-term goal: to focus on ego assets.
3. Help elderly preserve what facet of life they can and regain that which has already been lost.
1. Help minimize regression as much as possible.
2. Help retain their adult status.
3. Help preserve their self-image as useful individuals.
4. Identify and preserve their abilities to perform, emphasizing what they can do.
4. Attempt to prevent loss of dignity and loss of worth—address them by titles, not "Gramps," "sweetie," or "honey."
5. Reduce feelings of alienation and loneliness. Provide sensory experiences for those with visual problems:
1. Let them touch objects of various textures and consistencies.
2. Encourage heightened use of remaining senses to make up for those that are diminished or lost.
6. Reduce depression and feelings of isolation.
1. Allow time to reminisce.
2. Avoid changes in surroundings or routine.
7. Protect from rush and excitement.
1. Use simple, unhurried conversation.
2. Allow extra time to organize thoughts.
8. Be sensitive to concrete things they may want to keep.
9. Health teaching:
1. How to keep track of time (e.g., by marking off days on a calendar), to promote orientation.
2. How to keep track of medications.
3. Exercises to promote blood flow.
4. Retirement counseling:
1. Obtaining satisfaction from leisure time.
2. Nurturing relationships with younger generations.
3. Adjusting to changes: physical health, retirement, loss of loved ones.
4. Developing connections with own age group.
5. Taking on new social roles.
6. Maintaining a satisfactory and appropriate living situation.
7. Coping with dependence on others, especially one's children.
5. EVALUATION/OUTCOME CRITERIA:
1. Less confusion and fewer mood swings.
2. Increased interest in activities of daily living and interaction with others.
3. Lessened preoccupation with death, dying, physical symptoms, feelings of sadness.
4. Reduced insomnia and anorexia.
5. Expresses feelings of belonging and being needed.