Caring for older adults with bipolar disorder

Bipolar disorder is a recurrent, chronic mental illness that has a profound impact on the lives of patients and their families and may require extensive use of mental health services. Although bipolar disorder is often considered an illness of young people, the disorder is being recognized as more common in older adults than previously thought. Much more research needs to be done to understand the impact of aging on the course and treatment of bipolar disorder. Evidence-based interventions for treatment of this disorder in older adults must be developed. Mental health nurses can play a key role in enhancing medication adherence, implementing structured psychosocial interventions, and carrying out research to enhance diagnosis and treatment of older adults with bipolar disorder.     

Mental health disparities in the older Afro-Caribbean population living in the United States: cultural and practice perspectives for mental health professionals

Cultural characteristics play an important role in the lives of many older Afro-Caribbean as they continue to migrate, acculturate, and assimilate in the United States. Many among this unique cultural subgroup will develop mental illness; however, despite the availability of effective treatment, seeking appropriate care within the formal mental health system continues to be a challenge for this group as a consequence of their cultural heritage. This review describes how these cultural determinants often lead to mental health disparities among older Afro-Caribbean living in the United States. Suggestions are also included for how mental health nurses and other professionals can incorporate research and practice into the caring model of cultural humility as they continue to come in contact with this population in various clinical settings.     

Promoting self-management of urinary incontinence in a geropsychiatric day treatment program

As the number of older adults in the United States increases, the number of older adults with mental illnesses also will increase. There will be a corresponding increase in prevalence of UI and its associated problems--medical problems, loss of independence or need for institutionalized care, diminished quality of life, and increased costs. Psychiatric nurses are in a position to help older adults with mental illnesses improve their overall health and quality of life by preventing the problems associated with untreated UI. Within their practice, psychiatric nurses have the opportunity to ensure clients receive the comprehensive assessments needed to establish their functional, physical, behavioral, emotional, and social support status--information that forms the foundation for developing individualized treatment interventions. Psychiatric nurses have the expertise to integrate physical and mental health care for older adults with mental illnesses and co-occurring conditions, such as UI. Promoting self-management of UI among older adults with mental illnesses potentially will enable them to participate in psychiatric rehabilitation programs; improve their overall health and quality of life; prevent falls and fractures that often cause them to lose their independent community living status and to be admitted to long-term care facilities; and reduce the cost to mental health care providers of managing UI in the treatment setting.     

Subjectivity as “evidence”: an exploration of medication adherence in the treatment of schizophrenia using in-depth interviews

Anti-psychotic medication is considered one of the most efficaciousinterventions for the treatment of severe schizophrenia, yet ratesof adherence are notoriously and consistently low despite volumesof medical research. Scientific knowledge has failed to improvemedication adherence because it systematically rejects subjectiveexperience in conceptualizing mental illness. In this paper, thecontent of interviews with people diagnosed with schizophreniareceiving Assertive Community Treatment are interpreted from aFoucaldian perspective to illuminate how disciplinary assumptionsperpetuate power inequities and may be a barrier to adequateresearch generation and effective treatments. Implications for futureresearch methodology and clinical approaches are discussed.     

Exercises for mental wellness. Couldn't we all benefit?

For most of us, our cognitive functioning could be improved in many ways. Many of us struggle with our thinking skills at times, especially during times of stress and information overload. Some of the research that supports the use of prescribed cognitive exercises to slow cognitive decline in older adults may ultimately prove to be beneficial for all of us. Mental health nurses should encourage regular daily mental workouts, along with aerobic physical exercises, for everyone, not just older adults. Personal fitness training should focus not only on physical fitness, but also on mental fitness.     

Fear of people with mental illnesses: the role of personal and impersonal contact and exposure to threat or harm

Vignette and laboratory experiments suggest that negative reactions to people with mental illness are a direct consequence of their symptomatic behavior, but because of their poor external validity, these studies cannot tell us whether widespread negative public reactions to people with mental illness actually result from observation of symptomatic behavior. Focusing on perceived danger, we use a large national survey to test the "behavior hypothesis" in the general population. We reason that, if this hypothesis is correct, contact with people with mental illnesses should be associated with more perceived danger, and exposure to threat or harm should mediate this association. On the contrary, respondents with more personal and impersonal contact perceive people with mental illness to be less dangerous. Exposure to threat is more common among people with more contact, but this exposure explains very little of the variance in perceived danger. These findings do not support the conclusion that public fear of people with mental illness is due to the observation of violent behavior.     

From dinner table to digital tablet: technology's potential for reducing loneliness in older adults

Statistics estimate that close to 35% of our nation's older individuals experience loneliness. Feelings of loneliness have been associated with physical and psychological illness in several research studies. As technology advances and connectivity through tablet devices becomes increasingly user friendly, the potential for tablets to reduce loneliness among older adults is substantial. This article discusses the issue of loneliness among older adults and suggests tablet technology as a tool to improve connectivity and reduce loneliness in the older adult population. As nurses, we have the opportunity to help enhance the quality of life for our clients. Tablet technology offers a new option that should be fully explored.     

Older Adults and Their Vulnerabilities to the Exposure of Violence

According to US Census Bureau projections, there will be an estimated 72 million people over the age of 65 in the USA by the year 2030. Exposure to violence and crime victimization has serious physical, emotional, mental, and economic consequences for the growing older population in the USA. It should thus come as no surprise that much sociological attention has focused more on examining the correlates of violence for the older American population. We intend to provide an overview of the typologies, empirical research, and the pertinent factors associated with older people and their exposure to violence. We then discuss necessity to further research and our understanding of the important social problem of the exposure of violence for older people in the USA. In conclusion, implications of research findings of how to address the vulnerabilities of older people in relationship to their exposure to violence are discussed.     

Chronic illness and social network bridging in later life

Chronic disease has profound impacts on the structural features of individuals’ interpersonal connections such as bridging — ties to people who are otherwise poorly connected to each other. Prior research has documented competing arguments regarding the benefits of network bridging, but less is known about how chronic illness influences bridging and its underlying mechanisms. Using data on 1555 older adults from the National Social Life, Health, and Aging Project (NSHAP), I find that older adults diagnosed with chronic illness tend to have lower bridging potential in their networks, particularly between kin and non-kin members. They also report more frequent interactions with close ties but fewer neighbors, friends, and colleagues in their networks, which mediates the association between chronic illness and social network bridging. These findings illuminate both direct and indirect pathways through which chronic illness affects network bridging and highlight the context-specific implications for social networks in later life.     

An education intervention for families of people with schizophrenia in China: development and evaluation

In China, nurses and physicians are the main care providers for people with schizophrenia. This care is provided primarily in institutions because community services are in their infancy, and families carry the burden of care. In the absence of published nursing research in the area, this article reports the rigorous development and evaluation of a culturally sensitive patient/family intervention, which was implemented in a large psychiatric hospital in Beijing, China. A random sample of 15 nurses responded to an open-ended questionnaire to explore what they believed people with schizophrenia and their family members should learn. A convenience sample of 51 family members who lived with a person with schizophrenia were also interviewed to explore what they understood and needed to know about schizophrenia. Common learning needs were integrated with the literature and presented as the Comprehensive Patient/Family Education Guide, which was implemented with an experimental group of 42 family members, while a control group of 45 received the usual hospital treatment. The effect of the intervention was evaluated by interviewing a random sample of 19 of the family members. The results revealed some useful information for the future planning and implementation of such programs, and although focused on a Chinese sample, do offer insights for nurses around the world.     

The professionalization of psychiatric nursing. From doctors' handmaidens to empowered professionals

The professionalization of psychiatric nursing in the United States has been subject to political, economic, and theoretical influences, and prominent individuals such as Florence Nightingale and Hildegard Peplau have caused changes over time. Throughout history, professional and societal beliefs about mental illness have affected the nature of psychiatric nursing. In colonial times, people with mental illnesses were considered to be either possessed by demons or inferior and treated as animals. Today, psychobiological causes of mental illness are better understood, and treatment is aimed at adjusting disordered physiology and implementing psychosocial interventions. Care of people with mental illnesses has echoed this shift with increasing professionalization of psychiatric nurses. Attention to the lessons of history can help psychiatric nurses identify current societal influences, act on them according to their own vision, and further increase their professionalism.     

Nursing home admissions and long-stay conversions among persons with and without serious mental illness

The appropriateness of nursing homes for individuals with serious mental illness remains a controversial issue in long-term care policy more than a decade since the landmark U.S. Supreme Court Olmstead decision in 1999 , which affirmed the rights of persons with disabilities to live in their communities. Using national nursing home Minimum Data Set assessments from 2005, the authors compared the demographic, clinical, and functional characteristics of persons with and without serious mental illness newly admitted to nursing homes. They found that newly admitted people with serious mental illness were younger and more likely to become long-stay residents than those admitted with other conditions, despite a higher proportion of residents with serious mental illness, including the elderly, classified as low-care status. The most substantial and clinically significant difference for rates of low-care status 90 days after initial admission are for persons younger than 65 with serious mental illness versus those younger than 65 without serious mental illness (33% vs. 8.5%, or 3.9 times greater). There is a notable difference in low-care status between persons aged 65 and older with serious mental illness and those aged 65 and older without serious mental illness (14% vs. 6.6%, or 2.1 times greater). These results suggest that a substantial number of adults with serious mental illness residing in nursing homes may have the functional capacity to live in less restrictive environments.     

Outcomes of parental mental illness on children: a qualitative study from Iran

Children of parents with mental illness are a substantial, yet marginalized group. This study, as part of a more extensive research project, used grounded theory to explore the outcomes of parental mental illness on their children. Seventeen informants were interviewed at a mental hospital in the city of Qazvin, Iran. The participants were selected using purposeful and theoretical sampling. Interviews were analyzed using Strauss and Corbin's method. It was revealed that parental mental illness leads to five major outcomes that involve communication, mental, educational, economic, and extra roles factors. As such, it is suggested that these children should be considered within health care plans and that policy makers, nurses, and other health care providers use these findings for preventive and educational purposes.     

Responsibility Inferences and Intergenerational Obligations to Parents and Stepparents: Are Step/Children Less Obligated When Older Adults Are at Fault for Their Problems?

Beliefs about intergenerational obligations to assist older adults are known to be influenced by contextual variables such as the type of kin relationship (i.e., stepparent, parent) between older and younger adults. One contextual variable that has not been studied is the degree to which older individuals are seen as culpable for their problems. If older kin are perceived to be at fault for their problems, are they seen as less deserving of help than if they are not to blame? Do judgments about being at fault for problems affect beliefs about helping parents differently than beliefs about helping stepparents? A random national sample of 229 men and 274 women responded to vignettes about an older parent or stepparent who needed help managing diabetes, which was presented as either the consequence of the older adult's actions or as an inherited illness. Respondents were asked about younger family members' obligations to help older adults, how much help younger adults and public agencies should provide, and how much older adults were responsible for themselves. The effects of older adults' marital status and sex of both adults also were examined. Obligations to stepparents were less than obligations to parents. The amount of help respondents thought should be provided was moderated by older adults' marital status. Obligations and aid to parents and stepparents generally were not affected by the older adults' culpability for the problems.     

Learning opportunities through camping for mental health nursing

1. To equip nurses with the skills necessary for working with disturbed people, nurse educators need to be mindful of not watering down the essential skills necessary for nurses to deal with difficult behaviour in all branches of nursing. 2. These components of a mental health clinical experience should equip the graduate to deal with the pressures of dealing with disturbed people in any environment, as the skills learned generalize to any branch of nursing. 3. Universities can combine with traditional hospital services and community mental health services to provide services to clients with mental illness. An additional benefit is in providing students with an intensive clinical learning experience that reinforces the theory taught in the classroom.     

Moving toward recovery within clients' personal narratives: directions for a recovery-focused therapy

Recent literature emphasizes that recovery from schizophrenia involves recovery within one's own narrative of an integral sense of identity, agency, social connection, and worth. While this is intuitively appealing and consistent with a wide range of literature, it raises the issue of how to best help people do this in individual psychotherapy. In this article, we explore how psychotherapy might help people construct new narratives or storied understandings of their lives and thereby promote recovery from schizophrenia. Exemplified with two individual examples, we first discuss the barriers that challenge and the techniques that help psychotherapists seeking to enter into dialogue with people with severe mental illness. We also offer a theoretical model of how the revitalization of dialogues within therapy can be conceptualized as a process that promotes recovery and discuss the objective measurement of such outcomes.     

Schizophrenia Fellowship of Australia,Inc.

One of the most stigmatized health areas is mental health, so the feasibility of a self-help organization to assist those with the common mental illness, schizophrenia, was contemplated with some misgivings by the Victorian Mental Health Authority in 1977. However, as it was departmental policy to encourage community involvement in alleviating mental illness and its associated problems, a number of relatives of people with schizophrenia were contacted to assess their reaction to the proposition. The response was positive and eight relatives agreed to become a steering committee to organize a public meeting to put forward the idea of forming a self-help organization centred on schizophrenia.     

Commentary: the forgotten older adult with serious mental illness: the final challenge in achieving the promise of Olmstead?

Older adults with serious mental illness disproportionately reside in nursing homes despite the U.S. Supreme Court Olmstead decision supporting the rights of persons with disabilities to benefit from integrated services in the community. This commentary addresses the neglected policy debate on implementing Olmstead for this rapidly growing, older population with special needs. First, the author describes research findings on older adults with serious mental illness living in nursing homes who might more appropriately reside and receive services in the community. Second, the author summarizes the evidence base for effective psychosocial rehabilitation interventions and services facilitating independent living in community settings for this subgroup. Finally, he concludes with seven policy recommendations aimed at advancing the promise of the Olmstead decision with respect to older adults with serious mental illness.     

Normal life crises and insanity—mental illness contextualised

According to a 2005 survey, the people of Rosengård, a culturally heterogeneous borough of Malmö, Sweden, utilise considerably less mental health services in relation to their estimated needs than the rest of the city's population. A study based on interviews with people living or working in the area revealed several possible reasons. Most important was their perception of what constitutes mental illness. If the cause of one's disturbed mental state is viewed as a normal life crises rather than an illness, one does not seek medical treatment. The aim of this article is to illustrate how under-utilisation of mental health services by an immigrant population can be explained by their different perceptions of what constitutes mental illness. Interventions should add concerns regarding a client's socio-economic and psychosocial needs, rather than solely follow a medical model.     

On 'False, Collusive Objectification': Becoming Attuned to Self-Censorship, Performance and Interviewer Biases in Qualitative Interviewing

In this paper, we discuss a problem in qualitative interviewing labeled by Bourdieu as 'false, collusive objectification'. As described by Bourdieu, interviews where this occurs appear authentic because they often echo social science concepts and terminology and therefore may please the interviewer; however, they are actually unusable. We evaluate Bourdieu's claim for the existence of 'false' interviews in light of the predominant postmodern position in qualitative research, offer examples from our own research on people diagnosed with mental illness and raise the issue of whether, when and how qualitative researchers should concern themselves with the shortcomings of interviews. We conclude with suggestions derived from Bourdieu's view on how to address the problem he described.