How to Treat Elders With Mental Illness

Sad senior woman in counselling session
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How can we tell if an elder is suffering from a mental illness, symptoms of cognitive impairment, or both? What can we do to help them? What can we do if they are not willing to accept our help?

Aside from assessment and medication-based treatment, we can apply behavioral approaches that all family members can learn to help these elders find relief. Much of it has to do with getting past the stigma of mental illness and into symptom treatment as it occurs to keep our elders calm and at peace. It requires training caregivers how to approach these elders in a way that is best for the elder. We also need to teach elders how to calm themselves down and to call us when they are distressed.

Below are some tips for how to treat elders with mental illness:

Make a Doctor’s Appointment

If you notice that an elder exhibits psychiatric symptoms such as depression, anxiety, confusion, or paranoia, make an immediate appointment with his or her primary care physician (PCP). A decision-maker without memory loss who knows the patient’s medical history should attend with the patient. Most elders need coaching from family to accept a referral to see a psychiatrist or psychologist for a psychiatric or psychological evaluation. A PCP can help here as well.

See a Specialist

If an elder presents with psychiatric symptoms and memory loss that are both undiagnosed, a good PCP or geriatrician should give him or her a Mini-Mental Status Exam, as well as some pen and paper memory tests to quickly check memory and psychiatric symptoms as they relate to orientation to time and place. Then, the PCP should refer your loved one to a neuropsychologist for comprehensive memory testing, and to a psychiatrist and neurologist to diagnose and treat psychiatric symptoms and memory loss. Treatment can include everything from medications to out-patient memory support groups to at-home exercises with a caregiver.

Memory and Psychological Testing

There are home-visiting neuropsychologists that do memory and psychological testing for home-bound elders. Otherwise, it should be done as an outpatient. These results can be used to help manage a psychiatric medication or establish a declaration of capacity if the results show a patient is not capable of making their medical or financial decisions. There’s a lot to this piece, especially as it relates to the use of psychiatric medications in elders who are conserved.

Track Symptoms

It’s important to enlist the caregiver and family in tracking side effects of a new medication and its effects, as well as reporting that information to doctors. Call a doctor’s office right away with new symptoms between appointments, as mental health medications are generally quite strong and elders react quickly to them. It’s best that a geriatric care manager handle this data and consult with a doctor’s office directly about it to ensure accuracy in administration.

Monitor Meds

Say your elder starts a new psychiatric medication and it does not seem to have an effect on them, or their behavior is getting worse. Besides reporting this too and being seen by a doctor as soon as possible, a caregiver needs to monitor the elder closely for other symptoms that often occur with psychiatric medications in older individuals, including shortness of breath, sweating, increased depression, and decreased gait/increased fall risk. All family members should take note of and report such changes.

Speak Their Language

Behavioral approaches are often the most accessible tools for elders with mental illness who do not want to take psychiatric medications. These are best prescribed by geropsychologists or psychiatrists. It’s best to describe symptoms rather than medical diseases (i.e. “when you feel sad” versus “your chronic depression”). Caregivers and family members can learn this approach. It revolves around speaking to an elder in a way that is most agreeable to them to increase cooperation.

Discuss Outcomes Wisely

Set reasonable expectations for elders with mental illness to prevent agitation and disappointment. Let their doctors discuss potential outcomes of treatment with patients and just repeat their recommendations so an elder does not get false hope that an antidepressant is going to eradicate their depression. Provide elders with doctor’s visit summaries, as long as it does not agitate them. Give all doctors a copy of the patient’s current medication list you maintain so every doctor knows what the others have prescribed.

Improve Home Care

There are many things you can do to make life more conducive to these patients at home. Make sure elders with sundowner’s and mental illness are home and settled in before nightfall. Paint rooms in light colors for elders with depression. Make sure elders with mental illness always spend time outside every day (as able) to help with all symptoms and improve quality of life. Avoid high salt or sugar diets. Make their diets as rich in fresh fruits and veggies as possible. Avoid caffeine and stimulants, especially alcohol which can result in detrimental side effects with medications and dehydration.

Talk With Them

Allow elders with mental illness enough time and space to talk as frequently as they desire. This allows for an outlet—a place for difficult emotions to be released and work themselves out. The best thing you can do for anyone with a mental illness is to give them someone they can trust when everything else is slipping away. Ask caregivers and facilities to give elders space when they are agitated to allow them to calm down and allow the episode to pass. We make it much worse when we crowd them. Only one person should speak to them at a time. Stay calm.

Set Boundaries

It’s important to be patient with an elder, give them as much choice as possible, and help them calm down when they are upset. Many times elders with mental illness just need boundaries and a container for their emotions, which otherwise make them feel out of control. That can be a heartfelt conversation, a hug, an ear, or letting them know how much you care about them.

It turns out there is more that we can do to help the elders in our life that are suffering from a mental illness. It is a complicated and difficult process that cannot be understated. With help from professionals and good self-care, including support groups or individual therapy, we can be there for our loved ones in their darkest hours to ease their burden and assure them we are not going anywhere.

This article was provided by Kindly Care, an online service that allows you to find an in-home care provider near you.

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