Managing Cognitive and Mental Health With a Growing Older Adult Population

Providing person-centered care requires addressing the “whole person,” which includes mental health and cognition. Brain health may be affected by age-related changes in the brain, injuries such as stroke or traumatic brain injury, mood disorders such as depression, substance use disorder or addiction, and diseases such as Alzheimer disease. Some elements affecting brain health cannot be changed, but there are many lifestyle changes that might make a difference. Several barriers impede efforts to support older individuals’ cognitive and mental health, including stigma about acknowledging the need for help among residents or family members; lack of trained staff; less-than-ideal payment models; and organizational structures that make it difficult to provide adequate support.

In this ECRI Strategies column, Victor Lane Rose, MBA, NHA, FCPP, CPASRM, outlines a comprehensive approach that requires both broad measures to support the mental health of all residents and targeted strategies to meet the specific needs of individual residents. This piece could not be more timely, as the world struggles with the mental health effects from social distancing and lockdown orders. Mr Rose discusses the challenges related to addressing the mental health needs of older adults, takes a closer look at a few common mental health issues experienced by those in aging services settings, and describes evidence-based approaches to overcome barriers to mental health care.

Older adults may not present with the same signs of an infection as younger persons. Specifically, in the case of urinary tract infections (UTIs), determining whether nonspecific symptoms such as delirium are related to an infection along with identifying the origin of a possible infection is especially challenging, increasing the risk of diagnostic errors. Morgan C Johnson, DNP, FNP-BC, and colleagues conducted a retrospective review of 152 urinalyses in one long-term care facility (LTCF) to assess the management of UTIs in older women. Chi-square analysis was used to assess for associations between cognitive impairment, meeting symptoms criteria, and receiving empiric antibiotic treatment. Due to the growing population of older adults in LTCFs, these institutions can play a critical role in antimicrobial stewardship.

Addressing cognitive function and mental health can only be accomplished with an adequate workforce to initiate interventions in the rapidly growing older adult population. Physician assistants (PAs) were recognized as effective providers of quality care in geriatrics as early as 1979, yet PAs in geriatrics as a primary specialty remain few in number compared with other medical settings, despite the obvious need. In their Review article, Benjamin J Smith, DMSc, PA-C, and coauthors issue a call to action to increase the educational opportunities for PAs in geriatrics and LTC. PAs have the potential to positively impact the geriatrics workforce, in part due to their versatility and education in the medical model, they assert.

An organized and united approach can ensure the success of increasing the number of PAs serving older adults in ambulatory and LTC settings, filling worrisome gaps.