Caring for Older Adults in Behavioral Health Settings

One thing is certain in this life — we all age. And older people face particular mental, physical, and behavioral health challenges that can be improved by working with behavioral health professionals.

Caring for older adults in behavioral health settings can be rewarding. However, working with this older population is more successful when clinicians become familiar with effective communication techniques, respond to vision and hearing challenges, and address the impact of COVID on their lives. 

In this Consortium training video created in partnership with the Department of Mental Health and Addiction Services, “Recognizing & Responding to the Needs of Older Adults,” Donna B. Fedus, MA, explores ways to connect with and address the needs of older adults.

It Gets Better

When working with older adults, it’s important to counteract a myth that seniors are living out their golden years in despair and unhappiness. Numerous studies have shown that chronic depression and suicide are more common among people in midlife than they are in older adults. The same goes for “deaths of despair” in the United States. Most studies show that happiness can be illustrated as a U-curve, with life satisfaction reaching a low in the mid-40s and slowly climbing upward. 

That’s good news when it comes to working with older folks in behavioral health settings. But it doesn’t mean they don’t seek and require mental and behavioral health interventions.  

Communicating with Older Adults

The natural progression of aging leads to some sensory decline. Senses of taste, smell, touch, vision, and hearing are diminished. All of this can lead to communication challenges. 

Vision and hearing can present particular difficulties if not addressed.

Vision Challenges

When someone’s vision changes, it changes their communication. Vision impairment is obvious when someone is wearing glasses, but squinting, rubbing the eyes, tearing up, blinking, moving closer to an object, or moving something back and forth to try to get it into focus are other signs to be aware of. If people wear hearing aids, they might be over-relying on vision for communication, which can cause eye strain. 

As our eyes age, they require more light to see things clearly — and that includes faces for nonverbal communication. If someone discloses that they have vision problems or appears to have vision problems, we can take the following actions to help them feel more comfortable:

• Be aware of placement in the room, and place light sources behind them.
• Move closer to them.
• Offer to increase the light in the room, or offer to move them closer to a light source.
• If you offer handouts, have them be high contrast (avoid colored paper) with readable type. Avoid text over pictures.
• Ask if they need assistance reading something, or offer to read aloud.
• Offer another way for them to take in the information — a large-print or audio version, for example.
• If there is something to be signed, clearly indicate where by marking it or pointing to it.
• Be sensitive to glare and safety issues.
• Learn about common eye problems such as glaucoma and macular degeneration.
• Ask when their next appointment is with the eye doctor.
• Express empathy and patience.

Hearing Impairment

Hearing is another important sense that can become less acute as we age. When clients can’t hear or understand clinicians, it can make communication difficult. People who wear hearing aids are generally aware that their hearing is impaired. Other indications of hearing impairment are staring at your lips as you talk, moving their lips as they listen to you, cocking their head to hear better, talking loudly, or having the volume turned up on devices.

When encountering someone with hearing challenges, clinicians can help by:

• Demonstrating patience by slowing down.
• Using hand gestures.
• Lowering the register of your voice. Older people tend to hear better in lower octaves.
• Asking if they can hear you well enough.
• Removing distractions like TV, music, or radio.
• Being aware of which ear is better, and moving to that side.
• Getting in front of them so they can see you better. Our field of vision shrinks as we age.
• Facing them if they are reading your lips.
• Smiling and using other nonverbal signals to indicate that you are committed to communicating with them.

It is important to check in with clients with hearing loss to make sure they aren’t experiencing frustration with communication.

Vision or hearing loss can have a big impact on people's lives and can contribute to dementia, depression, and other health issues. 

COVID and Dementia

One major communication challenge during the COVID-19 pandemic has been the impact of masking and distancing on communication. Ninety-three percent of communication is nonverbal, and when clinicians wear a mask, two-thirds of their face is cut off from the person’s vision. If a clinician is also staying six feet away to observe distancing protocols, a person with visual or hearing impairment might be further challenged to understand.

When working with people with dementia, it helps to simplify communication, says Fedus. Slow it down and check in along the way to make sure the conversation is tracking. Reinforce the important messages, and continue to use nonverbal strategies to get points across. 

Resources for Working with Older Adults

In the next 30 years, the population of adults 65 and older is predicted to nearly double. At the same time, the United States is facing a serious shortage of providers who are skilled at supporting older adults: geriatricians and gerontologists.

Podcasts

Even if you are not considering a career in one of these fields, a number of excellent podcasts have been released in recent years that can help clinicians learn more about the needs of aging people.   

• NPR’s Aging  was created by Kathy Ritchie after her mother was diagnosed with dementia.
• The Gerontologist Podcast features experts tackling topics like aging in prison, loneliness, transportation, and more.
• GeriPal features specialists in geriatrics and palliative care.

Substance Abuse Treatment for Older Adults

The Substance Abuse and Mental Health Services Administration (SAMHSA) has a comprehensive guide available, titled Treating Substance Use Disorder in Older Adults. It addresses principles of care, screening and identifying substance misuse, cognitive impairment, prescription medication misuse, and treatment and recovery strategies.

The Executive Summary of the Treatment Improvement Protocol (TIP) notes that substance misuse in older adults is often overlooked and undertreated because of false beliefs that older people do not develop or need treatment for drug and alcohol abuse disorders. Among other findings, SAMHSA notes that

• Screening, assessment, and treatment can and should be adapted for older adults.
• Substance misuse can worsen age-related changes in cognition.
• Alcohol is the most common substance misused by older adults.
• Older adults face an increased risk of potentially dangerous drug-drug interactions and drug-alcohol interactions.
• Social support is key to sustaining long-term recovery for everyone, including older people.

Aging with Dignity

Whether you are facing your own aging issues, treating seniors in behavioral health settings, or simply expanding your range of comfort with aging clients, approaching older adults with compassion and respect goes a long way. 

As Fedus puts it in the video, “Gerontology is your life; aging is your future.”