Geriatric considerations - Mental health: Nursing

Stress is a normal response to internal and external threats to homeostasis or the body's stable equilibrium caused by a real or perceived threat.

The two types of stress are you stress and distress, you stress or positive stress results from beneficial and motivational stressors like starting a new job.

Whereas distress or negative stress occurs in response to a negative stressor like the death of a loved one. Regardless of the source of stress, the body responds by undergoing a series of physiologic changes.

In the short term, the body can adapt and return to homeostasis. But if sustained stress can be detrimental to physical and even mental health leading to problems with cognition, memory, depression and anxiety, especially in those who aren't able to cope or effectively manage stress.

As the nurse caring for an older adult patient, youll identify common stressors recognize signs and symptoms of ineffective coping and implement patient centered care strategies to promote effective coping.

Now, stress happens across the lifespan, but some stressors are more likely to impact older adults such as major life changes, involving loss and health conditions, loss can be social like losing independent driving privileges, emotional such as the death of a partner financial like reduced income due to retirement and physical such as losing eyesight from a chronic condition like macular degeneration.

Remember, older adults may use coping strategies that are both effective and ineffective to deal with stress. For example, ineffective coping strategy is sublimation when negative energy is channeled into a positive activity like exercise.

Whereas an ineffective coping mechanism is suppression when an individual avoids thinking about a stressor altogether. All right, sustained stress over time can deplete the energy reserves required for effective coping, resulting in signs and symptoms of ineffective coping.

That can be categorized as physical cognitive or behavioral physical manifestations initially result from triggering the fight or flight response where hormones are released in response to stress to protect the body and maintain homeostasis.

Specifically norepinephrine and epinephrine released by the adrenal medulla, increase the heart rate, BP and respiratory rate.

While cortisol released from the adrenal cortex results in increased glucose supply if stress is dealt with effectively body functions return to normal.

However, when stress continues, exhaustion occurs, which can lead to muscle tension typically in the head, neck and back, altered bowel and bladder function like constipation or diarrhea as well as decreased appetite, sleep disturbances and even diabetes, mellitus and decreased immunity.

Likewise, temporary, mild stress can lead to greater cognitive alertness. However, when sustained, it can lead to mental exhaustion, difficulty solving problems, impaired concentration and problems with memory.

Other cognitive symptoms include irrational or impulsive choices or an inability to make decisions. Sustained stress can also cause irritability, anger and anxiety, potentially leading to depression and even suicidal ideation.

Lastly, behavioral manifestations may include taking on more responsibilities to avoid dealing with stressors. Whereas others may avoid their responsibilities altogether.

They might make errors when performing tasks become disorganized or be quick to yell or even have an emotional outburst without warning.

They may also develop ritualistic behaviors like finger drumming or toe tapping. Concerning some may self medicate with alcohol or recreational drugs to deal with stress.

As the nurse caring for an older adult patient, you'll implement patient centered care strategies to promote effective coping.

Begin by identifying your patients perceived stressors and how the stressors impact their daily life. And ask about the use of coping strategies and the ability of social support.

Determine if your patient is depressed or suicidal and promptly seek out emergency resources as indicated. Then implement non pharmacologic and pharmacologic interventions.

Encourage your patient to verbalize their feelings while offering nonjudgmental support, then assist them to identify personal strengths and effective coping strategies they've used in other stressful situations and discuss how they could apply these strategies to their present situation.

You can also explore how they could use relaxation techniques like music, imagery and meditation or suggest engaging in diversional activities like attending an exercise class or developing a hobby to take their mind off stress.

Also assist your patient to identify community resources such as support groups and refer them to a social worker as needed.

Other patients may also benefit from seeking spiritual or religious support. Finally, when indicated, administer the prescribed anxiolytics and mood altering medications and collaborate with a mental health practitioner and gerontologist as needed.

All right, as a quick recap, stress is a normal response to internal and external threats to homeostasis caused by real or perceived stressors.

Common stressors in older adults are often linked to major life changes involving loss and physical health. And patients may deal with stress using effective or ineffective coping strategies.

Signs and symptoms of ineffective coping can be physical cognitive or behavioral. As the nurse caring for an older adult patient, youll identify common stressors recognize signs and symptoms of ineffective coping and implement patient centered care strategies to promote effective coping.