May is Mental Health Awareness Month and Older Americans Month
by Kathleen Heren, Rhode Island's Long Term Care Ombudsman
May is Mental Health awareness month. It is also Older Americans Month. What better time than to talk about the behavioral needs of older Americans? The one thing that still holds true is labeling older adults with a diagnosis because they show symptoms of a mental health disease. The most recent example is an elder being diagnosed as schizophrenic by a physician in an emergency room. The elder has never had that diagnosis, and now they suddenly develop it?
Schizophrenia starts early in a person's life, usually in their teens. It doesn’t just appear at 80 years old. So, what happens then is the elder is placed on psychotropic medication that they don’t need. The federal government (CMS) recognized this dangerous practice and now enforces stricter guidelines for making that diagnosis.
As people age, they experience life changes that affect their mental health. A particular illness or spouse loss may result in isolation, grief, and depression. Effective treatment options are available to elderly people, which does not mean drugging them. Many times, I have heard a resident will be sent to the emergency room for an evaluation because of aggressive behaviors, and when asked what may have changed in their life, I am told their spouse of 50 years has recently passed away.
My response has been to ask the staff if they sought grief counseling for the resident. The reply is that they didn’t think of that. How often does a resident experience behavioral changes due to an infection like a urinary tract infection? This is quite common. Behavioral changes can also come with medications that are not at a therapeutic level.
The World Health Organization has found that elders with heart disease also suffer from depression and hearing and vision impairments, which can lead to social isolation because the elder is ashamed. Physical changes to the brain in the aging process can also cause behavioral changes. We all experience these changes as we age. Individuals who have not had much contact with others during their lives can develop these changes faster.
More than 34 million U.S. adults suffer from depression. This country has just gone through Covid. Younger people who were not allowed to socialize or go to places like school, church, or just out with their friends showed signs of mental illness - never mind what the elderly have been through.
Another problem is the lack of mental health services for elderly people. Most nursing home residents are on Medicaid. The psychiatric services they receive are usually from some fly-by-night agency that covers the nursing home's responsibility for providing mental health services.
Telehealth is excellent if the person they speak to does not have dementia. There are ways to treat mental illness in older adults; it does not always come from a bottle. I always remember an old saying my nursing instructor told us when we would label a patient with a mental health diagnosis, it goes like this; A Yorkshire man once said to his friend, everyone in the world is crazy except for me, and you, and sometimes I have my doubts about you.
Be an advocate for your family member. Rule out other causes before medication is ordered.
Rhode Island State Long Term Care Ombudsman
Office of the RI State Long Term Care Ombudsman Program
Alliance for Better Long Term Care Inc
422 Post Road Suite 204
Warwick, RI 02888
Ms. Heren provides a monthly guest blog to Connelly Law Offices, Ltd., where she discusses issues and topics that come across her desk as the Rhode Island State Long Term Care Ombudsman. The opinions expressed in our guest blogs are only those of the author(s). They do not purport to reflect the opinions or views of Attorney RJ Connelly III or Connelly Law Offices Ltd. employees.