Mental Health Care for the Elderly

This assignment delves into the critical issue of mental health in the elderly population. It analyzes the increasing prevalence of mental health cases among older adults and examines the associated challenges. The discussion focuses on cost-effective strategies to mitigate this issue, emphasizing early intervention through cognitive skill development and promoting integrated mental and physical healthcare. The assignment also explores potential system-wide changes, including a 7-day mental health service, to identify and address mental health needs in a timely manner.

Running head: NURSING FINANCE
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Name of the Student
Name of the University
Author Note

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Introduction and Assessment of Current Practice/Intervention
Current local health data to validate concern
The health of the elderly people of America is a serious national concern. As the number of the
elderly people increases, there are limited resources to meet the criteria required to provide
quality care to patients and their families. According to the World Health Organization, health
can be defined as a state of mental, physical and social well-being of an individual. Mental health
is imperative in order to maintain good overall health, particularly in the elderly populations
(Www.who.int, 2017). According to the Center for Disease Control and Prevention (CDC),
about 20% of people aged 55 years or above experience some form of mental disorders. The
common forms of mental illnesses among the elderly include anxiety, depression, major
cognitive impairment and mood disorders or bipolar disorders. Mental illnesses are also
associated with high risks of suicide among the elderly. Elderly males have a high rate of suicide
incidence. Men aged approximately 85 years or above show suicide rates of 45.23 per 100,000
individuals, while the overall rate for suicide of all ages is 11.01 per 100,000 individuals
(Www.cdc.gov, 2017).
Depression is the most prevalent health problem among the elderly population (Steptoe et al.,
2013). Due to the feeling of distress associated with it, it can lead to impairments in mental,
physical and social functioning. This in turn acts as a barrier to the treatment of chronic
diseases. The elderly population visit the doctors, use emergency services, consume more
medication, stay longer in hospitals and suffer large amounts of hospital charges. The rate at
which depressive symptoms increase with age in not a normal symptom and in about 80% of the

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cases it is treatable. However, such people do not get proper treatments or are undertreated
because mental health is an under-recognized topic (Www.cdc.gov, 2017).
Support services are needed to reduce the risk of mental and physical illness. However, 12.2% of
the elderly people, who are 65 years or above reported that they rarely or never got proper
emotional support. One in five of Hispanics and Non-Hispanics reported that they never got the
proper support they need when compared with the white elderly population (Www.sccgov.org,
2017). The healthcare system cannot meet the demands of increased mental health issues of the
elderly population. Estimates reveal that compared to the requirement of 5000 geriatric
psychiatrists, only 2400 geriatric psychiatrists were present in the United States of America
(USA). The elderly adults suffer from financial issues regarding resources and treatments. The
treatment gaps in developed countries is 44-70%, while it is 90% in the developing countries.
The common barriers to treatment gaps include limited availability of trained professionals like
doctors and nurses as well as medication, affordability of medications for mental disorders, lack
of mental health education and insufficient policies regarding mental health and stigma
associated with mental health (Bragg et al., 2012).
Analysis of Project Recommendation using Cost Benefit Analysis (CBA) and other data
By using Discount Cost and Benefit Flows at an appropriate rate if known state why the
current practice/situation is a problem
With the desire to increase mental healthcare facilities and resources, proposed
interventions need to meet both cost-effectiveness as well as efficacy. The increased utilization
of the Psychiatric Emergency Services (PES) is an increased concern with the growing

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population of elderly adults in USA. However, even after carrying out effective cost benefit
flows, the PES still suffer because of the increase in the population of elderly people with mental
illnesses. This results in an imminent crisis in association with the mental health resources. With
the increase in demand, the available resources cannot meet the demands. One factor is the
increase in the number of dementia related symptoms. The greater utilization of the Psychiatric
Emergency Departments in the hospitals by the elderly people were due mainly because of their
violent behaviors. This creates a problem for those who arrive by ambulance or caregivers
because of the lack of resources. The elderly population with violent behaviors uses up these
resources. The length of stay of the older adults in the emergency departments are also much
higher than the younger patients with mental illnesses. Because of mental health service
shortages, caregivers prefer to keep the elderly people in the emergency departments, thereby
giving rise to increase use of resources and medications.
Provide facts and decision analysis using a ratio of benefits to costs to support
recommendations
Multiple Criteria Decision Analysis (MCDA) methods for decision-making are widely
used in healthcare sectors. The healthcare decisions to which MCDA can be applied include
Benefit risk assessment, Health technology assessment, Commissioning decisions or priority
setting frameworks, and prioritizing the access of patients to healthcare. Recommendations that
can be given to psychiatric emergency departments keeping in mind the cost benefit analysis, are
developing a brief, acceptable and feasible screening program for mental health patients admitted
in the emergency departments. Examination of scalability and applicability is required with
respect to young, elderly and special need populations. Improvement of patient safety and skills
regarding self-management. The most cost-effective recommendations for depression could be

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Free Mental
health
programs
Elderly adults
with mental
illness
Psychosocial
interventions
Benefit to
cost ratio low
Benefit to
cost ratio
high
the use of older antidepressants along with psychotherapy and proactive management. This is
much more cost-effective keeping in mind the benefit to cost ratio as compared to the new
antidepressants, whose costs are much higher.
Recommendations for future practice based on analysis
Discuss potential effect on APN roles
Mental health programs will require increased participation from the Advanced Practice
Nurses specialized in psychiatric disorder handling and management. One of the barriers to
providing mental health services in the hospitals is the lack of trained APNs regarding mental
health. The Advanced Practice Psychiatric Nurses (APRN) are professionals licensed to carry out
specialized nursing practices regarding mental illnesses. The APNs have to work in long-term
care units like the dementia care units, hospitals, community settings and home healthcare
services (Stuart, 2014).

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Summarize results of the CBA and conclusions you drew as a result related to intervention
A cost benefit analysis was carried out to estimate the cost incurred by the Psychiatric
emergency services because of increase in the number of older adult encounters associated with
mental health. The number of encounters were very high approximately 3.5 per week. The cost
per encounter excluding medication and meals was 1500 dollars, thereby resulting in a total cost
of 126,000 dollars.
The interventions associated with mental health like free mental health services in
association with education programs regarding diabetes and falls prevention will incur serious
costs on the healthcare facilities.
Research and local data to support recommendations
Psychosocial interventions are effective in promoting mental health and preventing
depression among the older people. The psychosocial interventions include physical exercises,
skill or educational training and social support. These interventions help to improve the quality
of life of the elderly and provide them the skill and the knowledge to carry out daily life
activities by development of cognitive skills (Josefsson, Lindwall & Archer, 2014). These
interventions are much more cost effective as compared to free healthcare programs including
health checkups and medications.
Recommendations for outcomes or trends
If no improvements are seen in the number of mental health cases in the elderly, the
recommendations that can be made for carrying out a system wide change may involve
promotion of good mental health, delivering integrated mental and physical healthcare, providing

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effective care at the right time without delay. A 7 day mental health service can be carried out to
identify the number of elderly individuals suffering from mental illnesses and carrying out
appropriate measures to prevent the worsening of the symptoms.
Thus, it is necessary to carry out effective strategies to reduce the number of mental
health cases among the elderly population keeping in mind the cost effectiveness of such
strategies. Thus, proper care to the elderly at the right time will thereby reduce the length of their
stay and also will not significantly affect hospital resources.

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Reference List
Bragg, E. J., Warshaw, G. A., Cheong, J., Meganathan, K., & Brewer, D. E. (2012). National survey of
geriatric psychiatry fellowship programs: comparing findings in 2006/07 and 2001/02 from the
American Geriatrics Society and Association of Directors of Geriatric Academic Programs'
Geriatrics Workforce Policy Studies Center. The American Journal of Geriatric
Psychiatry, 20(2), 169-178.
Josefsson, T., Lindwall, M., & Archer, T. (2014). Physical exercise intervention in depressive disorders:
Meta‐analysis and systematic review. Scandinavian journal of medicine & science in
sports, 24(2), 259-272.
Steptoe, A., Shankar, A., Demakakos, P., & Wardle, J. (2013). Social isolation, loneliness, and all-cause
mortality in older men and women. Proceedings of the National Academy of Sciences, 110(15),
5797-5801.
Stuart, G. W. (2014). Principles and Practice of Psychiatric Nursing-E-Book. Elsevier Health Sciences.
Www.cdc.gov. (2017). Cite a Website - Cite This For Me. Cdc.gov. Retrieved 14 November 2017, from
https://www.cdc.gov/aging/pdf/mental_health.pdf
Www.cdc.gov. (2017). Depression is Not a Normal Part of Growing Older | Healthy Aging |
CDC. Cdc.gov. Retrieved 14 November 2017, from
https://www.cdc.gov/aging/mentalhealth/depression.htm

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Www.sccgov.org. (2017). Cite a Website - Cite This For Me. Sccgov.org. Retrieved 14 November 2017,
from https://www.sccgov.org/sites/bhd/info/MentalHealthBoard/OAC/Documents/2015/OAC-
Oct-handouts/BHB%20OA%20Committee%20Question%20report%20Sept%2014%202015.pdf
Www.who.int. (2017). WHO | Mental health: a state of well-being. Who.int. Retrieved 14 November
2017, from http://www.who.int/features/factfiles/mental_health/en/