Optimizing Nursing Home and Geriatric Patient Mental Health Care With Brooke Kempf, PMHNP-BC

In this video from on-site at Psych Congress Elevate 2024 in Las Vegas, Nevada, Brooke Kempf, MSN, PMHNP-BC, psychiatric mental health nurse practitioner and adjunct faculty member for Indiana University, shares her expertise on conducting psychiatric evaluations in the geriatric population. Kempf emphasizes the importance of distinguishing between normal aging and disease, highlights the need for comprehensive assessments using tools like the geriatric depression scale, advocates for involving family members in the evaluation process, and covers strategies for balancing efficacy and safety in pharmacologic treatments, considering the potential for comorbidities and polypharmacy in elderly patients. 

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Read the Transcript: 

Hello, my name is Brooke Kempf. I'm a psychiatric mental health nurse practitioner out of Terre Haute, Indiana, where I've spent my entire career working in the Community Mental Health Center. I’m also adjunct faculty for the Indiana University of Indianapolis.

Psych Congress Network: What are some key considerations and tips for conducting psychiatric evaluations in the geriatric population? 

Nurse Kempf: To give you some key tips when it comes to evaluating and treating patients that are older in our geriatric settings or maybe just in your primary care settings, we have to take some things into consideration. During assessments, first and foremost, we do not want to mistake normal sides of aging as disease, but we also don't want to overlook disease and think that this is just normal aging. So there are some tips as far as geriatric screening tools—you can use a geriatric depression scale to catch things that you're not overlooking. But you have to be sure to ask the questions. Be sure that individuals are not suffering more than they should be.

And if you can, involve other individuals in the family so that they can give you further information. 

Psych Congress Network: What are the most common mental health issues faced by this population and how can clinicians best address these issues pharmacologically? 

Nurse Kempf: Some of the most common mental health issues that our older population deal with are depression, anxiety, dementia. And it's not hard for us to understand because as these individuals get older, they do go through lifestyle changes.

They have a lot of loss that they experience. Sometimes they're placed into different facilities outside of their comfort zone of their home. So when it comes to treating these patients, first and foremost, get down to the source of the problem.

Is it just a situational event? Can we wrap them around with social supports or individual therapies that can assist them with the symptoms that they're dealing with. But when it comes time to pharmacological management, for depression and anxiety, we generally use what we would refer to as second-generation antidepressants, first and foremost, avoiding things like tricyclics if we could, just due to some of the side effect profiles associated with the older medications. But generally we're using SSRIs and SNRIs, to address these symptoms. And when it comes to dementia, using cholinesterase inhibitors.

Psych Congress Network: How can clinicians balance the efficacy and safety of pharmacologic treatments for mental health conditions in elderly patients, considering the potential for comorbidities? 

Nurse Kempf: When it comes to treating our older population, we have to take a lot into consideration. These individuals generally are on a multitude of different medications. They have a multitude of different illnesses that are all being treated at once. So first and foremost, we have to get a good assessment.

We have to be sure that we know about our patient's other diagnosis and what other medications that they are taking so that we can ensure that we are not attributing to further problems. We want to be sure that there are no drug-to-drug interactions and we want to monitor closely for side effects. So we have a big job, we have to weigh risk and benefits to our medications.

What I like to do is I try to find 1 medication that could help with a multitude of different problems, such as 1 medication that might help with sleep, anxiety, and depression, all in 1, rather than prescribing 3 different pills. Trying to reduce that pill burden for our patients as much as possible, and collaborating with their other providers to make sure that they're getting appropriate medications, de-prescribing sometimes when we have to, but again, doing that in collaboration with their other providers in a safe and effective manner. 

Psych Congress Network: How important is it to involve family members and caregivers in the mental health care of elderly patients? How can this be done effectively? 

Nurse Kempf: It is very important to involve other family members or just other individuals that may know your patient well when treating the elderly population. A lot of our patients have been through a multitude of different medications. Maybe they've had previous diagnosis, but as they're getting older, they may not recall or be able to give you a good history. Involving other family members or caregivers, with their permission, is very beneficial because they're able to give you maybe a more thorough history. They also can pick up on changes that maybe the patient hasn't even noticed.

Maybe the patient hasn't noticed some of their sleep habit changes. Maybe they haven't noticed their social decline. But family members are picking up on it sooner, sometimes than our patients, so they're able to give us insight to what we may overlook.

Thank you so much for joining us today to talk about this topic that I feel is often overlooked so I appreciate you wanting to learn more about this and please check back in for more information.

Brooke Kempf, MSN, PMHNP-BC, has worked as a psychiatric nurse at Hamilton Center in Terre Haute, Indiana, since she graduated from Indiana State University with an associate degree in 1994. Her passion for mental health was sparked as she worked as a charge nurse on the Inpatient Unit and continued to grow as she served in their outpatient setting while obtaining her Bachelor’s degree from ISU in 1996. Nurse Kempf was then able to obtain her Master’s degree from the State University at Stony Brook of New York and is board-certified by the ANCC as a Psychiatric Mental Health Nurse Practitioner. She currently practices as the Hospitalist for the Inpatient Psychiatric Unit of Hamilton Center Community Mental Health Center in Terre Haute, Indiana.