Mental Health Care for the Aged

Introduction

Once a person advances in age, their immunity is likely to decrease, hence, become exposed to various health challenges. Mental health issues in the aged are not a new phenomenon in the health care sector as they suffer from issues such as anxiety, depression, and stress. Due to an increasing population of the elderly in Australia, there is a need to increase medical attention among them. The Royal Commission Final Report into the Aged Care Quality and Safety noted that mental health received the least attention, which calls for an improvement. The elderly lack adequate access to psychological care, as the service providers do not fully address the issue. There is also a remarkable gap in the management of mental health in the field. The ultimate solution to these gaps is performing adequately reform in the sector.

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There is a widespread of mental problems among the older population due to inadequate quality of care. A study conducted by Better Place Australia (n.d.) suggested that 30-50% of the aged suffer from depression. Moreover, research by Creighton et al. (2018) reveal the prevalence of threshold and subthreshold anxiety disorders in the older population was 19.4% and 11.7% respectively. The increase of depression levels among the elderly amidst the COVID-19 pandemic cannot be disregarded. The growth of anxiety and uncertainty increased the mental health problems among the aged. Conversely, this population posits that they are unable to disclose their mental health problems to their caregivers due to fear of stigmatization. These factors point out a gap in the sector, thus, the need to provide quality services to the older generation to uphold their mental health.

Purpose of the Study

Without a doubt, the elderly population needs quality mental health care for them to live a quality life. In this essence, the study aims at establishing the readiness of the healthcare providers of the aged sector in handling mental health issues. It focuses on determining how mental health issues among the elderly are addressed in the current healthcare system using PICO. The population (P) under study are the patients from the older generation (50 years and above). Intervention (I) will refer to the personnel’s professional equipment and training. Outcome (O) is caring for patients with mental illness, with nothing for comparison (C).

Significance of the study

The older population spends most of their time with their caregivers, hence, they have a major impact on their mental wellness. To improve and uphold the quality mental status of the elderly, caregivers need to know the factors that influence the patients’ experiences. Creighton et al. (2018) established that the prevalent factors affecting the mental status of the elderly include their family ties, physical illnesses, age, retirement, and social groups among others. Understanding the issue affecting each older patient would contribute significantly towards resolving the issue. Poor mental health results in poor quality of life, which, unfortunately, could result in death. Older patients dealing with physical or chronic diseases could have a delayed recovery period due to poor mental health status.

It is crucial to equip frontline elder caregivers with skills that enable them to handle mental issues in the older generation. The right education and training would help caregivers choose the most suitable interventions when faced with a mental health challenge of a patient. A study conducted by Searle (2021) reveals that the elderly caregivers are training most emphasis on providing physical assistance and dealing with other healthcare problems. However, insignificant attention was given to mental health problems, which makes them less confident in addressing psychological problems among the elderly.

Research Questions

To understand the gap in training and provision of quality mental care among the elderly, the following research questions were formulated:

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  1. Are staff and nurses within the aged care sector equipped and trained to care for mental health patients?
  2. What factors cause mental health issues among the elderly and what interventions are best suitable to address them.
  3. What are the challenges faced by caregivers when attending to the elderly suffering from mental health issues?

Objectives of the Study

This research paper aims at establishing the kind of training that the frontline staff and nurses within the aged care sector undergo. It also evaluates whether the attained training equips them with the required skills to address mental health issues among their patients. This paper will also establish the factors that lead to mental health problems in the older generation while determining which interventions are needed to address each challenge. At the same time, this study will determine the challenges that caregivers and nurses face when attending to elderly patients with mental problems.

Structure of the paper

This research paper contains five chapters. The first chapter is the introductory part, which consists of background information of the topic under research, the purpose of the study, the significance of the research, research questions formulated, and the objectives of the study. The second chapter is the literature review of supporting documents. The third chapter contains the methodology used in the study that is divided into the research design, sample, procedure, and method of analyzing the results. The fourth part is the results or important findings of the study. While the last chapter comprises the discussion and conclusions of the study.

Literature Review

This research paper reviews of tens articles that evaluate whether healthcare providers in the elderly sector are ready to address mental health issues among their patients. To begin with, the study by Amare et al. (2020) provides an idea of the prevalence of mental disorders in the Australian older generation – in the cohort studied, almost 58% had various conditions. Currently, access for the older generation to professional psychological care is insignificant (Dawson et al., 2017; Stargatt et al., 2017; Tabatabaei-Jafari et al., 2020). However, current technologies allow increasing access, as demonstrated by Christensen et al. (2020). There is considerable prejudice against both older people and people with mental problems, which reveals itself in discrimination, ageism and negatively affects the group’s quality of life (Benjenk et al., 2019; Lyons et al., 2017; Rush et al., 2017; Smith et al., 2019; Temple et al., 2021). Most studies indicate a lack of knowledge and training among professionals.

Discrimination and prejudice against the older generation and mental problems limit access to health care. Benjenk et al. (2019) and Rush et al. (2017) note significant negative beliefs in nursing students against both groups, affecting their choice of work direction. As a result, the area of psychological assistance for the older generation has a staff shortage, which is also noted in research by Dawson et al. (2017) and Stargatt et al. (2017). At the same time, studies reporting negative relationships focus mainly on nurses. Participants of Smith et al. (2019) survey also included psychologists, psychiatrists and social workers. Although these professionals were friendlier to the older population, particularly LGBT representatives, they also noted a lack of knowledge (Smith et al., 2019). These facts suggest gaps in the training of various professionals.

Methodology

Introduction

This chapter helps to highlight how the research will be conducted. It includes the research approach, research strategy and design, research timeframe, data collection techniques, ethical considerations, reliability and validity, and limitations. This research studies the relationship between two variables, the caregivers and nurses in the elderly sector training and the quality of mental care provided, which will give more insight into the gap between the two..

Research Approach

This study both the quantitative and qualitative research methods, mixed research method. A qualitative method is one that observations, textual or visual analysis (from books or videos), and interviews (individual or group) while a quantitative research method emphasizes objective measurements and the statistical, mathematical, or numerical analysis of data collected through polls, questionnaires, and surveys, or by manipulating pre-existing statistical data using computational techniques. Therefore, in this study, we conducted textual analysis on the records of the elderly patients suffering from mental problems and the interventions provided. The researchers also interviewed caregivers and nurses in a caregiver department through a survey to evaluate the contents of their training.

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Research Strategy and Design

A research strategy and design are required as guidance on how research shall be carried out. This research shall utilize a single case research strategy to investigate the interventions provided to the elderly suffering from mental health issues. The researcher will conduct a survey to investigate the contents of training given to frontline workers and nurses working in the older populations department. The research utilized a convenience sample based on the relevance, accessibility, and availability of the sample.

Y= a+bx1

Y= Quality of mental care

X1=Training and skills to address mental issues

Quality of mental care= Right interventions, medications, and psychological therapy

The researcher will use the survey as a method and questionnaires and interviews as actual data collection methods.

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Research Timeframe

This research shall take a total of ten weeks from planning, development, implementation and analysis of the results. The planning stage shall take two weeks to identify the various factors affecting mental health wellness in the elderly population. The development stage, which is creation of various data collection tools shall take three weeks. Thereafter, the research shall be conducted in two phases, a process that shall consume about two weeks. Lastly, analysis and evaluation of the data collected shall be done in three weeks’ time.

Data Collection Techniques

Questionnaires will be typed and printed, then administered to the relevant respondents, and then be collected later for analysis.

By the use of interviews, data collection should be done by asking questions to possibly the respondents, the nurses, frontline workers, and trainers in the elderly department. Questions are to be posed orally about their level of training and challenges encountered with mentally unstable patients. In addition, interviews shall involve contacting the respondent through email, in this case, a short script containing questions will be prepared. The questions will ensure that the researcher is within the scope of the study. Semi-structured interviews were also prepared separately for the trainers. The primary focus of the interview questions was to establish whether the staff and nurses within the aged care sector are equipped and trained to care for mental health patients.

Online survey

This technique involves contacting and interviewing caregivers within the elderly populations’ sector online in order to acquire data and facts. This technique shall be conducted via email or social media platform. The survey shall make use of open-ended questions technique to obtain optimal information. The answers to the survey shall then be used to pose further questions a technique referred to as behavioral event interviewing (BEI). Interviews shall be conducted in two categories, which include formal interview that is structured and informal interview, which is also semi-structured.

Semi-structured Interviews

The qualitative part of this study involved conducting interviews with both the caregivers and trainers within the elderly department. The nurses and caregivers were interviewed due to their first-hand exposure to the older patients suffering from mental instability. On the other hand, the trainers were involved in the research due to their long-term experience, especially in developing training content for workers in the department. The interviews were conducted via zoom, recorded, and presented for analysis.

Data Analysis

The collected data shall be sorted into various groups according to their level of importance and nature. Thereafter, the data will be analyzed using Microsoft Excel and Statistical Package for Social Science SPSS. Microsoft Excel will assist in grouping the data to facilitate any comparison that may arise. SPSS on the other hand will be instrumental in establishing the data associations, which eventually will lead to conclusions on the objectives of the study.

Ethical Considerations

The researcher ensured to explain issues at hand to the various respondents, that is, the reasons for carrying out the research and why they would like them to participate in it. Moreover, the researcher used the principle of voluntary participation whereby they did not force people to provide them with information pertaining to the research.

Equally, the various questionnaires that will be administered will not require the respondent to disclose his/her identity. All the data collected through questionnaires and interview will not be disclosed by the researcher to the third party, but the data will only be used to help realize the identified objectives. All the participants were assured to receive a copy of the research results after the completion of the research.

Reliability and Validity

Reliability means that similar results shall be obtained at diverse instances of the research while validity means that the respondents answer the questions posed correctly. During the pilot study, the researcher will administer at least 10 questionnaires at random to respondents and then collect them after say one week and then repeat the same practice to different respondents. After collecting the filled questionnaires, the researcher will make a comparison of the data from the respondents and then do corrections on the questionnaires as from the respondent’s comments. The various questions that will be found unclear to the respondents will also be made clear accordingly.

Limitations

Despite the success of the study, it has some limitations. One of the major limitations is that the study does not evaluate the classification of interventions provided to older patients with relevance to their mental issues, rather it evaluates all interventions in general. In addition, the researcher was not able to collect data from the elderly patients to establish their opinion about the current interventions rather, the researcher only establish factors affecting their mental health. In addition, due to the limitation of resources, the research did not engage older population caregivers from numerous departments, rather, the researcher used a small sample size generalizing other institutions.

Conclusion

This section contains a clear outline of the research philosophy, research approach, research strategy and design, research timeframe, data collection techniques, ethical considerations, reliability and validity, and limitations. This research aims at establishing whether the staff and nurses within the aged care sector are equipped and trained to care for mental health patients.

Results

The researchers engaged a multi-ethnic population of 200 people where women (67%) participants were more than men (33%). Among the participants, 65% were care staff, 15% were trainers while 20% were the elderly population. Data from the three groups were collected and analysed independently. Table 1 below contains the personal data of the research participants.

Variable Number
Occupation
Nurses and Caregivers
Trainers
Patients
130
30
40
Age (yrs.)
Nurses, Caregivers and trainers
Patients
46.3 + 12.8
72 + 10.3
Gender
Men
Women
46
20
Education
Primary 1
1

The elderly patients were required to answer questions pertaining to stress factors and provide their opinion on the quality of interventions provided. The results of analysis of their responses were recorded in tables 2 and 3 below.

Mental Stress Factors Among Older Patients
Physical pain/illness
Chronic disease
Family Relationships
Social ties
Retirement
60%
42%
70%
37%
13%
Quality of Interventions Given Unsatisfied Slightly Unsatisfied Fully Satisfied Slightly Satisfied Rather not say
41% 23% 13% 14% 9%

In addition, the researchers aimed at evaluating whether the right training was offered to the caregivers to enable them to provide quality mental health interventions. To collect this data, interviews, and surveys were conducted to evaluate the level of confidence the staff had in handling various mental health problems. The results of the study are recorded in table 4 below.

Confidence in Addressing Mental Stress Factors Among Older Patients
Physical pain/illness
Chronic disease
Family Relationships
Social ties
Retirement
56%
42%
11%
9%
13%

In conclusion, the researchers engaged trainers of caregivers in the research. They wanted to determine the contents of training sessions that addressed various issues affecting the older population. Some of the major issues addressed were physical assistance, medical help, and mental health support. The trainers classified the training contents in three groups and recorded them in questionnaires. The results were analysed and recorded in table 4 below.

Classification of Training Contents
Physical Care Medical Care Mental Health Care
65% 30% 5%

Conclusion

Mental health problems carry the risk of physical health problems for the older generation up to early death, which justifies the need to study the issue carefully. Politicians and representatives of medical services should pay attention to training and expand their programs with themes of care for older adults with mental health disorders. Given the nation’s aging and the increase in the number of older populations, there is the urgency of drawing attention to the problem.

The current review has limitations since a small amount of literature is devoted to preparing staff to work with older people with mental problems. Although the sources studied are relevant to the topic, future studies may concentrate on physicians as more focus has been shifted to nursing training. Attention should be paid to studying methods to make psychological services more accessible for the older generation and allow better education of employees of various specialties. Nevertheless, the significance of the review is in demonstrating gaps and drawing attention to the complexity of this issue.

References

Amare, A. T., Caughey, G. E., Whitehead, C., Lang, C. E., Bray, S. C., Corlis, M., Visvanathan, R., Wesselingh, S. & Inacio, M. C. (2020). The prevalence, trends and determinants of mental health disorders in older Australians living in permanent residential aged care: implications for policy and quality of aged care services. Australian & New Zealand Journal of Psychiatry, 54(12), 1200-1211. Web.

Benjenk, I., Buchongo, P., Amaize, A., Martinez, G. S., & Chen, J. (2019). Overcoming the dual stigma of mental illness and aging: Preparing new nurses to care for the mental health needs of older adults. The American Journal of Geriatric Psychiatry, 27(7), 664-674. Web.

Better Place Australia. (n.d.). Mental health interventions in aged care. The Centre for Better Relationships. Web.

Christensen, L. F., Moller, A. M., Hansen, J. P., Nielsen, C. T., & Gildberg, F. A. (2020). Patients’ and providers’ experiences with video consultations used in the treatment of older patients with unipolar depression: A systematic review. Journal of Psychiatric and Mental Health Nursing, 27(3), 258-271. Web.

Creighton, A. S., Davison, T. E., & Kissane, D. W. (2018). The prevalence, reporting, and treatment of anxiety among older adults in nursing homes and other residential aged care facilities. Journal of Affective Disorders, 227, 416-423. Web.

Dawson, S., Gerace, A., Muir-Cochrane, E., O’Kane, D., Henderson, J., Lawn, S., & Fuller, J. (2017). Carers’ experiences of accessing and navigating mental health care for older people in a rural area in Australia. Aging & Mental Health, 21(2), 216–223. Web.

Goh, A., & Dow, B. (2020). People in aged care sector need psychological as well as physical protection. The University of Melbourne. Web.

Lyons, A., Alba, B., Heywood, W., Fileborn, B., Minichiello, V., Barrett, C., Hinchliff, S., Malta, S., & Dow, B. (2018). Experiences of ageism and the mental health of older adults. Aging & Mental Health, 22(11), 1456-1464. Web.

Rush, K. L., Hickey, S., Epp, S., & Janke, R. (2017). Nurses’ attitudes towards older people care: An integrative review. Journal of Clinical Nursing, 26(23-24), 4105-4116. Web.

Searle, L. (2021). Mental health concerns among the most common in Aged Care Royal Commission. Mental Health Australia. Web.

Smith, R. W., Altman, J. K., Meeks, S., & Hinrichs, K. L. (2019). Mental health care for LGBT older adults in long-term care settings: Competency, training, and barriers for mental health providers. Clinical Gerontologist, 42(2), 198-203. Web.

Stargatt, J., Bhar, S. S., Davison, T. E., Pachana, N. A., Mitchell, L., Koder, D., Hunter, C., Doyle, C., Wells, Y., & Helmes, E. (2017). The availability of psychological services for aged care residents in Australia: A survey of facility staff. Australian Psychologist, 52(6), 406-413. Web.

Tabatabaei-Jafari, H., Salinas-Perez, J. A., Furst, M. A., Bagheri, N., Mendoza, J., Burke, D., McGeorge, P., & Salvador-Carulla, L. (2020). Patterns of service provision in older people’s mental health care in Australia. International Journal of Environmental Research and Public Health, 17(22), 8516. Web.

Temple, J. B., Brijnath, B., Enticott, J., Utomo, A., Williams, R., & Kelaher, M. (2021). Discrimination reported by older adults living with mental health conditions: Types, contexts and association with healthcare barriers. Social Psychiatry and Psychiatric Epidemiology, 56(6), 1003-1014. Web.

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