Older People and Mental Health Nursing (eBook)

Rebecca Neno is Primary Care Development Lead & Senior Lecturer in Primary Care at Thames Valley University, London. She is also a Committee Member of the RCN Mental Health and Older People's Forum. Barry Aveyard is a Lecturer in the School of Nursing and Midwifery, Sheffield Hallam University, Sheffield. He is also a Committee Member of the RCN Mental Health and Older People's Forum. Hazel Heath is an Independent Consultant on Nursing and Older People and a Visiting Senior Research Fellow at City University, London.

Older People and Mental Health Nursing 1
Contents 7
Contributors 13
Foreword 15
Introduction 17
Part 1CONTEXT 19
1 Background and Influences 21
Introduction 21
Psychological perspectives on mental health 22
Older people's mental health 23
The development of mental health services for older people 24
The contribution of nursing 26
References 29
Part 2HELPING OLDER INDIVIDUALS 31
2 Older Individuals and Mental Health 33
Introduction 33
The mental health of older people 33
Experiences of ageing and mental illness 34
Discrimination 35
Participation in meaningful activity and mental health 36
Relationships and mental health 37
Physical health 38
Poverty 39
Transitions and the threat to mental health 39
The significance of continuity 41
Experiences of services 41
Community support: A model for the future 42
Conclusion 44
References 45
3 Normal Physiological Ageing 49
Introduction 49
The process of ageing 50
The ageing brain 50
Latent potential 54
Cognitive function 55
Conclusion 56
References 57
4 Values Underpinning Help, Support and Care 58
Introduction 58
Values and beliefs 58
Values are everywhere 59
Personal and professional values 60
Clarifying your values 62
Ageism 63
What does a values clarification exercise look like? 64
Values and evidence base 64
Having values and working with them 65
From values to action 66
Values enabling person-centredness 67
Conclusions 68
Resources 68
References 69
5 Approaches to Help, Support and Care 71
Introduction 71
Mrs Jane Gordon 72
Mr Raj Josephs 74
Mrs Rose Smith 78
Josie Lomax 80
Patrick O'Sullivan 82
Conclusion 83
Acknowledgements 83
Resources 83
References 84
6 Legal and Ethical Frameworks for Mental Health Nursing 85
Introduction 85
Contexts and circumstances 86
Groups at risk- complexities 87
The need for an ethical framework 87
Codes of conduct as ethical components 88
The politics of society vs. the individual 89
How do services enable clients? 89
The argument of best interest 90
Current ethical frameworks 91
Whose right and whose duty? 93
The use of advocacy 94
Moral or civil rights? 94
Advanced directives 95
The Mental Capacity Act, 2005 96
Consent 96
Conclusion 97
References 98
7 Dilemmas in Mental Health Nursing 99
Introduction 99
Rights, risks and responsibilities related to restraint 100
Avoiding the use of restraint, assessing the risks 100
Our responsibility in relation to restraint 101
Older people's rights 102
Dilemmas in caring for and supporting older peoplewith mental needs 102
Some therapeutic approaches 103
Safeguarding adults 108
Conclusions 110
References 111
8 Assessing Older People with Mental Health Issues 113
Introduction 113
Assessment revisited 114
The Single Assessment Process 115
Therapeutic relationship development 117
Structure of mental health assessments 121
What will be assessed? 122
How will it be assessed? 124
What will be done with the assessment? 126
Conclusion 126
References 127
Part 3NEGLECTED ASPECTS 131
9 Culture, Religion and Spirituality 133
Introduction 133
Spirituality 133
The importance of culture 135
Religion, spirituality and older people 137
Skills focus: Assessing for culturally sensitive care 138
Conclusion 139
References 139
10 Intimacy, Sex and Sexuality 142
Introduction 142
The backdrop to understanding relationships, intimacyand sexuality 143
What do we mean by intimacy and sexuality? 143
Effects of age changes on sexuality 146
Intimacy and sexuality-issues for older people with mental health needs 146
Problems associated with sexuality in people witha mental health illness 147
Skills and strategies for supporting intimacy and sexualityin older people with mental health problems 148
Staff support and awareness 150
Conclusion 151
Resources 151
References 152
11 Nutrition 153
Introduction 153
Nutrients and the brain 153
Assessment of nutrition and eating skills 154
Mental health status 157
Nutritional issues in the clinical management of dementia 157
Nutritional issues in the clinical managementof depression 158
Reflection 158
Conclusion 159
References 159
12 Palliative and End-of-Life Care 161
Introduction 161
Death and dying in today's society 162
The challenges for mental health nurses working withpeople at the end of their lives 162
Assessing the needs of older people with mental healthneeds at the end of their lives 163
Meeting the challenges and offering appropriate care at the end of a person's life 164
Conclusion 167
References 168
Part 4MENTAL HEALTH ISSUES FOROLDER PEOPLE 169
13 Acute Mental Health Issues 171
Introduction 171
How common is challenging behaviour in older people? 172
Why is it important to learn about challenging behaviour? 173
Understanding behavioural approaches andassessing behaviour 173
Causes of challenging behaviour 176
Example of a model in action 177
Interventions for older people with challenging behaviour 179
Caring for people who resist essential care 181
Caring for under-active or passive people 181
Caring for older people who may be aggressive 182
Caring for people with hallucinations 182
Caring for people with delusions 182
Caring for older people who 'wander' or 'pace' 183
Conclusion 183
References 184
14 Delirium 186
Introduction 186
Risk factors for developing delirium 188
The experience of delirium 189
Identifying delirium 192
Prevention and care 193
Conclusion 197
References 198
15 Enduring Mental Health Issues 200
Introduction 200
Schizophrenia 201
Homelessness 204
Bipolar disorder 205
Substance misuse 207
Conclusion 210
References 211
16 Depression in Later Life 213
Introduction 213
What is depression? 214
Depression and dementia 218
Depression and risk 220
Treatment of depression 222
Medical treatments 223
Conclusion 225
References 226
Chapter 17 Dementia in Later Life 229
Introduction 229
Exploring dementia 230
Alzheimer's disease 230
Vascular dementia 231
The development of dementia care nursing 231
Dementia care nursing skills 234
Conclusion 239
References 239
Part 5FUTURE DIRECTIONS 241
18 Mental Health and Well-Being for Older People in the Future: The Nursing Contribution 243
Introduction 243
Future populations of older people and nurses 243
The mental health and well-being of older peoplein the future 245
Developments in treatment and care 247
Developing services for the future 247
Nursing in the future 249
Conclusion 251
References 252
Index 254