Schizophrenia in Elderly Homeless Individuals: Nursing Management and Interventions

Assignment 2: Justification
Introduction
Schizophrenia is a mental health problem associated with impairments in manifestation
of reality exhibiting as auditory hallucinations, paranoid illusions in the background of important
social or occupational dysfunction (Susanti et al., 2018; Verhaeghe, 2018). Diagnosis is
dependent on the patient's self-reported experiences and perceived behaviour. According to
Druss et al. (2018), Schizophrenia has been associated with an increased dopamine action in the
brain’s mesolimbic pathway. Globally, the management and treatment of elderly homeless
individuals suffering from mental health illness including schizophrenia is a huge challenge to
the health service providers (Rezansoff et al., 2016; Fazel et al., 2014). According to Gaebel and
Zielasek (2015), an individual experiencing a combination of homellesness and mental disorder
poses a major challenge to public health policy focus globally.
The demographic characteristics of Australian population paints a picture of ageing
population with findings from a survey conducted and released in the year 2017 revealed that 3.8
million representing 15% of the general population of Australian citizens were 65 years and
above (Australian Institute of Health and Welfare [AIHW], 2018). The research findings by
Rezansoff et al. (2016) revealed that 11% of persons with no home suffers from schizophrenia.
However, 5 in 100 persons suffers mental health problem in Australia (AIHW, 2018). At the
same time, 36% of the homeless individuals in Sydney Australia were suffering from
schizophrenia (Mental health services Overview - AIHW", 2018).
Homelessness and schizophrenia
Various studies have established a positive relationship between homeless and low
antipsychotic medication adherence leading to high risk of relapse, patient being in hospital for
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longer periods, and rise in suicide cases (Rezansoff et al., 2016; Coe et al., 2015). In Australia,
mental health related conditions including schizophrenia are considered a public health issue,
furthermore, it is anticipated that the ratio of mental healthcare service providers such as nurses
who are critical in supporting the homeless aged population will decrease significantly in the
coming years (Allison and Bastiampillai, 2015). At the same time, from economical perspective
the Australian government through treasury has recognized the fact that the aging and homeless
elderly population is a major factor for reduced economic growth due to reduced labor force
(Wilkins, 2017).
The national rate of specialized homeless services data established that there is an
increase elderly persons with mental health problems such as schizophrenia since the beginning
of the data collection and they represent the fastest increasing sub-group within the specialized
homelessness service (SHS) collection ("Mental health services Overview - AIHW", 2018). The
number increased from 23.5% in 2012-2013 to 32.3% in 2016-2017 this represent an average
annual increase of 10.7%. Housing crisis and inappropriate housing conditions have been cited
by the schizophrenic old persons to be the main reason for pursuing help from the SHS and other
community health facilities (AIHW, 2018; Allison and Bastiampillai, 2015).
The precise cause of schizophrenia is not known and the prediction of who will develop
the disease is quite difficult. However, it is believed that factors related to individual’s genetics
plays a major role in the disease development (Conn, 2018). It is believed that chromosome 13
and 6 are involved in predisposition to the development of schizophrenia (Howes et al., 2017).
The other factors include biological factors such excessive dopamine. Diagnosis of schizophrenic
cases may prove difficult, however, there are certain symptoms that can be noticed by the
patients relatives including loss of ability to communicate well coupled with mood fluctuations
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(Chang et al., 2018). Nurses working in the community home care plays a critical role in the
management of elderly homeless schizophrenic patients. According to ("Mental health services
Overview - AIHW", 2018), in the year 2016 employed specialized psychiatrists were 9.9% of the
all employed specialist medical practitioners, and 58.8% of all employed nurses were aged 45
years and above.
Nursing management and interventions
Nurses managing the schizophrenic patients should understand that early diagnosis and
identification of the risk factors related to the development of schizophrenia among the elderly
homeless results to reduced number of cases (Olfson, 2016). Nurses need to identify
schizophrenia and note the hallmark symptoms including poor social interactions, hallucinations,
thought distortion, and disorganized thinking (Conn, 2018). There are different nursing
intervention approaches nurses deploy to care for schizophrenic patients include the needs to
develop a good rapport and trust between nurses and the patients, assessing the patient’s ability
to carry out daily physical activities, hence, promoting patient’s independence (Carlbo et al.,
2018). At the same time, nurses should introduce themselves and highlight their responsibilities
to the patients and their families. According to Townsend and Morgan (2017), mental health
nurses should ensure that the patient’s family are well informed about the disease and the need
for medical adherence. Nurses should be able be able to recognize the positive symptoms of
schizophrenia including weakened physical movement associated with depression, marked
behavioral changes and suicidal thought due impulsiveness, and risk for injury related to
hallucinations and delusions. There is also risk of poor nutritional status among the homeless
elderly schizophrenic patients due to poor feeding practices relating to self-neglect (Farrer et al.,
2018).
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