TOPIC. The nurse's role in providing mental health services to the elderly
SOURCE. The Mental Health Interventions Program
GOAL. To provide a viable model for providing these services.
CONCLUSION. Nurses have the skills necessary to ensure that the elderly are recipients of quality mental health care.
Key words: Elderly, home visits
The fastest growing segment of the population in America is composed of seniors over 75 years of age. By the year 2010, the total population of this age group is expected to be more than 18 million (U.S. Bureau of the Census, 1991). Approximately 86% of all older people suffer from one or more chronic illnesses. The majority of these people live in the community; only 5% of seniors over 75 reside in nursing homes (Harper, 1990). The stresses of aging will be felt not only by the aged but also by the people and society responsible for their care.
In general, older adults are more skeptical of psychiatric services, believing that a person should be able to "pull oneself up by the bootstraps." Ageism, which is pervasive in our society, has resulted in the tendency to view the elderly as poor candidates for mental health interventions. As a result, seniors are grossly underserved (Turner, 1992), although mental health experts estimate that 18% to 25% of older adults, at any given time, have some mental health symptoms (Cohen, 1990). Quality of life issues in the elderly are a concern that can and should be addressed by mental health nurses.
The Mental Health Interventions Program
In the late 1970s, nurses at the Newton Massachusetts Health Department staffed senior drop-in centers, which were designed to provide health promotion and educational services to older adults. As the nurses became acquainted with clients and a positive rapport developed, the clients discussed their medical and social problems with them. The nurses noted there was little time to assist seniors who had lost spouses or were devastated by a recent medical problem, and thought that a program was needed in which mental health nurses could devote their time exclusively to mental health concerns of senior citizens. To obtain funding for the program, the nurses successfully applied for a Federal Community Development Block Grant.
Two part-time nurses were hired to make home visits to low and moderate income residents over the age of 60 who had identified mental health needs. The number and frequency of visits were based on the nursing assessment, and no fee was charged to the client. Referrals came from the senior drop-in centers, local hospitals, social agencies, physicians, relatives, neighbors, and clients themselves. The program was titled "Mental Health Intervention for the Elderly."
As of this writing, there are well over 100 clients enrolled in the program. The average age of these clients is 80; grief and loss are the most common presenting symptoms. Depression, isolation and loneliness, loss of physical and mental functioning, and anxiety about the future also are prominent. These seniors are struggling to cope with changing life circumstances at a time when the major support systems of there lives are least available. Often spouses may be failing or have died, children and extended family may not be living in the proximate area, friends may be consumed by their own problems, and work no longer provides diversion or self-esteem. Whether loss is due to the death of a loved one, or not being able to tend to the much loved garden, it has a profound impact on the daily lives of many of these seniors.
As a mental health provider, the nurse has a unique opportunity to help these clients. Most seniors view nurses as helpful and nonthreatening care providers. While elders may perceive a stigma in seeking psychiatric help, it is relatively easy for them to allow the nurse into their confidence. The familiar routine of checking a blood pressure often serves as a gentle entry into the therapeutic nurse-client relationship. …