B700 Adult Nursing

Introduction

The health of the elderly people of America is a serious national concern. As the number of the elderly people increases, there are limited resources to meet the criteria required to provide quality care to patients and their families. According to the World Health Organization, health can be defined as a state of mental, physical and social well-being of an individual. Mental health is imperative in order to maintain good overall health, particularly in the elderly populations (Www.who.int, 2017). According to the Center for Disease Control and Prevention (CDC), about 20% of people aged 55 years or above experience some form of mental disorders. The common forms of mental illnesses among the elderly include anxiety, depression, major cognitive impairment and mood disorders or bipolar disorders. Mental illnesses are also associated with high risks of suicide among the elderly. Elderly males have a high rate of suicide incidence. Men aged approximately 85 years or above show suicide rates of 45.23 per 100,000 individuals, while the overall rate for suicide of all ages is 11.01 per 100,000 individuals (Www.cdc.gov, 2017).

Depression is the most prevalent health problem among the elderly population (Steptoe et al., 2013). Due to the feeling of distress associated with it, it can lead to impairments in mental, physical and social functioning.  This in turn acts as a barrier to the treatment of chronic diseases. The elderly population visit the doctors, use emergency services, consume more medication, stay longer in hospitals and suffer large amounts of hospital charges. The rate at which depressive symptoms increase with age in not a normal symptom and in about 80% of the cases it is treatable. However, such people do not get proper treatments or are undertreated because mental health is an under-recognized topic (Www.cdc.gov, 2017).

Support services are needed to reduce the risk of mental and physical illness. However, 12.2% of the elderly people, who are 65 years or above reported that they rarely or never got proper emotional support. One in five of Hispanics and Non-Hispanics reported that they never got the proper support they need when compared with the white elderly population (Www.sccgov.org, 2017). The healthcare system cannot meet the demands of increased mental health issues of the elderly population. Estimates reveal that compared to the requirement of 5000 geriatric psychiatrists, only 2400 geriatric psychiatrists were present in the United States of America (USA). The elderly adults suffer from financial issues regarding resources and treatments. The treatment gaps in developed countries is 44-70%, while it is 90% in the developing countries. The common barriers to treatment gaps include limited availability of trained professionals like doctors and nurses as well as medication, affordability of medications for mental disorders, lack of mental health education and insufficient policies regarding mental health and stigma associated with mental health (Bragg et al., 2012).

Analysis of Project Recommendation using Cost Benefit Analysis (CBA) and other data

With the desire to increase mental healthcare facilities and resources, proposed interventions need to meet both cost-effectiveness as well as efficacy. The increased utilization of the Psychiatric Emergency Services (PES) is an increased concern with the growing population of elderly adults in USA. However, even after carrying out effective cost benefit flows, the PES still suffer because of the increase in the population of elderly people with mental illnesses. This results in an imminent crisis in association with the mental health resources. With the increase in demand, the available resources cannot meet the demands. One factor is the increase in the number of dementia related symptoms. The greater utilization of the Psychiatric Emergency Departments in the hospitals by the elderly people were due mainly because of their violent behaviors. This creates a problem for those who arrive by ambulance or caregivers because of the lack of resources. The elderly population with violent behaviors uses up these resources. The length of stay of the older adults in the emergency departments are also much higher than the younger patients with mental illnesses. Because of mental health service shortages, caregivers prefer to keep the elderly people in the emergency departments, thereby giving rise to increase use of resources and medications.

Provide facts and decision analysis using a ratio of benefits to costs to support recommendations

Multiple Criteria Decision Analysis (MCDA) methods for decision-making are widely used in healthcare sectors. The healthcare decisions to which MCDA can be applied include Benefit risk assessment, Health technology assessment, Commissioning decisions or priority setting frameworks, and prioritizing the access of patients to healthcare. Recommendations that can be given to psychiatric emergency departments keeping in mind the cost benefit analysis, are developing a brief, acceptable and feasible screening program for mental health patients admitted in the emergency departments. Examination of scalability and applicability is required with respect to young, elderly and special need populations. Improvement of patient safety and skills regarding self-management. The most cost-effective recommendations for depression could be the use of older antidepressants along with psychotherapy and proactive management. This is much more cost-effective keeping in mind the benefit to cost ratio as compared to the new antidepressants, whose costs are much higher. 

Recommendations for future practice based on analysis

Mental health programs will require increased participation from the Advanced Practice Nurses specialized in psychiatric disorder handling and management. One of the barriers to providing mental health services in the hospitals is the lack of trained APNs regarding mental health. The Advanced Practice Psychiatric Nurses (APRN) are professionals licensed to carry out specialized nursing practices regarding mental illnesses. The APNs have to work in long-term care units like the dementia care units, hospitals, community settings and home healthcare services (Stuart, 2014).

Summarize results of the CBA and conclusions you drew as a result related to intervention

A cost benefit analysis was carried out to estimate the cost incurred by the Psychiatric emergency services because of increase in the number of older adult encounters associated with mental health. The number of encounters were very high approximately 3.5 per week. The cost per encounter excluding medication and meals was 1500 dollars, thereby resulting in a total cost of 126,000 dollars.

The interventions associated with mental health like free mental health services in association with education programs regarding diabetes and falls prevention will incur serious costs on the healthcare facilities.

Research and local data to support recommendations

Psychosocial interventions are effective in promoting mental health and preventing depression among the older people. The psychosocial interventions include physical exercises, skill or educational training and social support. These interventions help to improve the quality of life of the elderly and provide them the skill and the knowledge to carry out daily life activities by development of cognitive skills (Josefsson, Lindwall & Archer, 2014). These interventions are much more cost effective as compared to free healthcare programs including health checkups and medications.

Recommendations

If no improvements are seen in the number of mental health cases in the elderly, the recommendations that can be made for carrying out a system wide change may involve promotion of good mental health, delivering integrated mental and physical healthcare, providing effective care at the right time without delay. A 7 day mental health service can be carried out to identify the number of elderly individuals suffering from mental illnesses and carrying out appropriate measures to prevent the worsening of the symptoms.

Thus, it is necessary to carry out effective strategies to reduce the number of mental health cases among the elderly population keeping in mind the cost effectiveness of such strategies. Thus, proper care to the elderly at the right time will thereby reduce the length of their stay and also will not significantly affect hospital resources.

Reference List

Bragg, E. J., Warshaw, G. A., Cheong, J., Meganathan, K., & Brewer, D. E. (2012). National survey of geriatric psychiatry fellowship programs: comparing findings in 2006/07 and 2001/02 from the American Geriatrics Society and Association of Directors of Geriatric Academic Programs’ Geriatrics Workforce Policy Studies Center. The American Journal of Geriatric Psychiatry, 20(2), 169-178.

Josefsson, T., Lindwall, M., & Archer, T. (2014). Physical exercise intervention in depressive disorders: Meta?analysis and systematic review. Scandinavian journal of medicine & science in sports, 24(2), 259-272.

Steptoe, A., Shankar, A., Demakakos, P., & Wardle, J. (2013). Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the National Academy of Sciences, 110(15), 5797-5801.

Stuart, G. W. (2014). Principles and Practice of Psychiatric Nursing-E-Book. Elsevier Health Sciences.

Www.cdc.gov. (2017). Cite a Website – Cite This For Me. Cdc.gov. Retrieved 14 November 2017, from https://www.cdc.gov/aging/pdf/mental_health.pdf

Www.cdc.gov. (2017). Depression is Not a Normal Part of Growing Older | Healthy Aging | CDC. Cdc.gov. Retrieved 14 November 2017, from https://www.cdc.gov/aging/mentalhealth/depression.htm

Www.sccgov.org. (2017). Cite a Website – Cite This For Me. Sccgov.org. Retrieved 14 November 2017, from https://www.sccgov.org/sites/bhd/info/MentalHealthBoard/OAC/Documents/2015/OAC-Oct-handouts/BHB%20OA%20Committee%20Question%20report%20Sept%2014%202015.pdf

Www.who.int. (2017). WHO | Mental health: a state of well-being. Who.int. Retrieved 14 November 2017, from https://www.who.int/features/factfiles/mental_health/en/