As Americas millions of baby boomers born from 1945 through 1965 continue to age, nurses can expect to care for more patients with heart disease, arthritis, cancer the traditional diseases of older adulthood. But two recent reports indicate healthcare professionals also will be caring for patients in this age group with mental health and substance use issues and hepatitis C.
Mental health concerns
The Institute of Medicine estimates in its new report The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? that between 14% and 20% of the nations elderly population, up to 8 million older adults, have one or more mental health conditions or substance misuse or abuse problems.
Marlene Nadler-Moodie, APRN, MSN, PMHCNS-BC, president of the American Psychiatric Nurses Association in Arlington, Va., said the estimates did not surprise her. We will be flooded with more people needing mental health [services], and we dont have a big enough workforce, she said. Mental illness is not sexy and terribly stigmatized, and its on peoples back burner.
However, as the IOM report points out, mental health issues can lead to poorer overall health outcomes; for instance, depressed patients are less likely to take cardiac and other medications as directed. Most prevalent, according to the IOM report, are depressive disorders and dementia-related behavioral and psychiatric symptoms. Treatment is available, and it can be very beneficial, Nadler-Moodie said.
Older adults can benefit from talk therapy, not just pharmaceutical treatments, said Joan Calandra, RN, PhD, CNS, clinical psychologist in Los Angeles, a psychiatric clinical nurse specialist and author of Nurse.coms Mental Health & Older Adults courses. She encourages nurses to listen and be empathetic with older patients, adding that even those with dementia will appreciate the attention.
Boomers and older adults suffer many losses and often deal with chronic health issues and physical limitations. Such events may worsen depression and result in severe symptoms, the IOM report said. As we get older, we lose our ability to do things we used to be able to do and mourn that, Calandra said. Differentiating between grief and depression is difficult. Older adults also may drink more to cope with losses or loneliness, Nadler-Moodie said.
The IOM authors also indicate an increase in the rates of accidental and intentional misuse of prescription medications and report that age alters drug and alcohol metabolism, which can worsen health problems and increase the risk of overdose. However, the general public doesnt think about older adults abusing prescription drugs or drinking alcohol, Calandra said.
Patients may hide their substance use or not think about it, and if admitted to the hospital, they may experience alcohol withdrawal. Nurses can screen patients for substance use and watch for depression and other mental health issues and intervene, Nadler-Moodie said. The aging population has a serious drinking problem, and baby boomers comfortable using illicit drugs years ago still may be doing that, she said.
That illicit injection drug use and other behaviors during their youth, such as obtaining a tattoo in an unlicensed facility or sexual contact, also may put baby boomers at risk for hepatitis C. Transmission also can occur with blood transfusions and other healthcare procedures in which proper injection techniques were not followed. Yet, the Centers for Disease Control and Prevention report that baby boomers do not perceive themselves at risk and are not being tested.
What happened earlier in life, you dont think about, because you feel fine now, said Barbara OConnor, RN, MSN, CIC, infection control manager at Howard County General Hospital in Columbia, Md. She said hepatitis C is extremely common and the most frequent disease her hospital reports to the health department.
The CDC is changing its recommendation from testing at-risk people to screening all U.S. baby boomers with a one-time test for hepatitis C, because one in 30 baby boomers more than 2 million Americans has been infected with the virus, but most dont know it. [Testing] is a great idea, because hepatitis C is one of those diseases that can sneak up on you, OConnor said. You can have it for years doing damage. Many people are diagnosed incidentally.
The CDC estimates one-time testing of all boomers could identify more than 800,000 additional people with hepatitis C and save more than 120,000 lives. Treatment includes combination therapy with pegylated interferon and ribavirin and generally lasts six months or longer. Hepatitis C can cause serious liver diseases, including liver cancer, and more than 15,000 Americans die from hepatitis C-related conditions annually.
Identifying Hepatitis C-positive baby boomers would allow infected individuals to receive earlier care and newly available treatments that potentially could reduce their risk of developing life-threatening liver disease, said Elizabeth Monsees, RN, MSN, CIC, infection preventionist at Childrens Mercy Hospitals and Clinics in Kansas City, Mo., and a member of Association for Professionals in Infection Control and Epidemiologys national Communications Committee.
Monsees said nurses also should be cognizant that individuals with Hepatitis C can be asymptomatic and can transmit the virus to others. Nurses should be aware of the risks and follow sharps safety and proper injection and infusion practices.
Testing for hepatitis C requires a blood sample to check for antibodies to the virus. If reactive, an additional test is needed to assess whether the virus currently is circulating and the patient is chronically infected. Some people can clear the virus without treatment, but the antibodies will remain present. OConnor said screening could take place during patients annual exams and a positive result would allow treatment to start before significant damage is done. She expects patients will have questions about screening and why its recommended and reminded nurses that as with any bloodborne pathogen, a stigma exists. Nurses are in a good position to provide that education about hepatitis C and how it can be insidious and damaging for years before you know its there, OConnor said.