Schizophrenia among Homeless Elderly in Australia: Unique Needs and Nursing Care Plan Interventions

Schizophrenia among the homeless Aged 65 years and above ,Schizophrenia among the homeless Aged 65 years and above ,
in Australiain Australia
INTRODUCTION
Demographic characteristics of schizophrenia
CONCLUSIONS
TreatmentUnique Needs
REFERENCES
Figure 1. Estimated Mental health-related Gp encounter (AIHW,2018)
. .
Nursing care plan interventions
• The needs for homeless older schizophrenic persons include stable housing,
proper healthcare, and food Grenier (2013).
• There is very high risk for older persons who are homeless to develop
mental health problem as compared to the general population.
• Homeless older persons suffering from schizophrenia have high mortality
rates as compared to the general population(Marek ,2017). Therefore, the
government should provide housing for such individuals.
• There is an urgency in dealing with challenges posed by being homeless at
an advanced age such need for specialized medical care beyond what
shelters can provide((Marek, 2018).
• It has been established that this unique group of patient experiences
decimation and stigmatization whenever they seek healthcare
services(Petersen et al., 2014). Therefore, the mental healthcare service
providers including nurses should be adequately sensitized on the unique
needs of homeless older schizophrenic patients
• The homeless older schizophrenic patients face difficulties in accessing
housing and support services from the government due to bureaucratic
procedures within the government (Marek, 2018)
• This unique group of patient need a both clinical and psychiatric help on
dealing with effects of poor nutrition, exposure to communicable diseases
and drug abuse (Gaebel and Zielasek, 2015).
• First generation antipsychotics(FGAs), conventional neuroleptics such as
chlorpromazine have been oldest and common form of pharmacotherapy of
older patients with schizophrenia (Solmi et al.,2017)
• FGAs have undesired side effects such as extrapyramidal symptoms (EPS)
and tardive dyskinesia (TD), sedation, anticholinergic effects, and postural
hypotension, limiting their usage as the drug of choice for treating older
patients with schizophrenia (Solmi et al.,2017).
• The use of second generation antipsychotics (SGAs), such as quetiapine,
risperidone, olanzapine have provided relief for the treatment of
schizophrenia in older persons.
• The SGAs have high safety and tolerability compared with FGA. However,
there are noticeable side effects including weight gain and metabolic
disorders (Solmi et al.,2017).
• The use of non-pharmacologic therapy such integrated Cognitive
Behavioral, Social Skills Training (CBSST) has proved beneficial to
treatment of elderly schizophrenia(Petersen et al., 2014).
 In the year 2015, 4 million Australians suffered mental illness related
conditions including schizophrenia.
 According to Mental health services Overview - AIHW (2018), based on
the BEACH survey data individuals aged 65+ (1,198.2 per 1,000
population) had the highest rate of mental health-related estimated GP
encounters, compared to the general population (749.9).Figure 1.
 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.
Based on gender females are more prone to the risk of developing
schizophrenia as compared to their male counterparts in Australia (860.0
and 625.9 per 1,000 population respectively).
 Top reasons clients with a mental health issue sought SHS support were
housing crisis/inadequacy, domestic/family violence, and finance troubles.
 Of clients with a current mental health issue, 60% received support for
longer than 45 days.
 For clients with a current mental health issue, the most frequently recorded
source of referral to an SHS agency was a Specialist homelessness
agency/outreach worker (25.6%), followed by Other (government or non-
government) agency (18.7%) and Mental health service (8.6%)
Pharmacotherapy and psychosocial interventions offered by nurses directed
towards management of Schizophrenia contribute immensely to the reduction
of incidence of the disease. Nursing models and theories in the care of the
elderly homeless schizophrenia has proved important in management of this
disease. The use of Cognitive Behavioral, Social Skills has proved beneficial
hence should be encouraged. It is fundamental for the nurses to develop a good
rapport with elderly schizophrenic patient and their families. This is critical in
the patient’s recovery. The gap in theory-practice in the psychiatric nursing
care of homeless elderly persons suffering from schizophrenia is an area of
concern which should be addressed immediately.
Schizophrenia is a mental health problem associated by impairments in
manifestation of reality exhibiting as auditory hallucinations, paranoid illusions
in the background of important social or occupational dysfunction (Conn,
2018). It causes devastating to the patients and to most people who are
afflicted, and very costly for families and society. The precise cause of
schizophrenia is not known and the prediction of who will develop the disease
is quite difficult. However, some of the theories have been put forward to
explain the cause of schizophrenia include genetic predisposition together with
exposure to environmental factors or stress that trigger the disorder. More
genes believed to be causing this disorder have been identified include DISC1,
Dysbindin, Neuregulin and G72 genes (Conn, 2018). 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
Australian citizens were 65 years and above (AIHW, 2018). 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 their data collection and they represent the fastest increasing sub-
group within the 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%. 36% of the homeless
individuals in Sydney Australia were suffering from schizophrenia (Mental
health services Overview - AIHW", 2018).
Australian Institute of Health and Welfare. (2018). Retrieved from
https://www.aihw.gov.au/reports-statistics/health-welfare-services/mental-
health-services/overview
Conn, P. J. (2018). 43. Building on Genetics and Pathophysiology Of
Schizophrenia To Guide Discovery Of New Treatments. Schizophrenia
Bulletin, 44(Suppl 1), S70.
Gaebel, W., & Zielasek, J. (2015). Homeless and mentally ill–a mental
healthcare challenge for Europe. Acta Psychiatrica Scandinavica, 131(4),
236-238.
Marek, L. N. (2017). Does Homelessness Increase the Risk of Readmission in
Acute Care Patients Diagnosed with Schizophrenia.
Petersen, M., Parsell, C., Phillips, R., & White, G. (2014). Preventing first time
homelessness amongst older Australians. AHURI Final Report, Australian
Housing and Urban Research Institute, Melbourne.
Olfson, M. (2016). Building the mental health workforce capacity needed to
treat adults with serious mental illnesses. Health Affairs, 35(6), 983-990.
Solmi, M., Murru, A., Pacchiarotti, I., Undurraga, J., Veronese, N., Fornaro,
M., ... Carvalho, A. F. (2017). Safety, tolerability, and risks associated
with first- and second-generation antipsychotics: a state-of-the-art clinical
review. Therapeutics and Clinical Risk Management, 13, 757–777.
http://doi.org/10.2147/TCRM.S117321
 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. Nurses need to identify schizophrenia and note the hallmark
symptoms including poor social interactions, hallucinations, thought
distortion, and disorganized thinking (Olfson, 2016).
 Nurse should intervene by Acknowledging that the hallucinations and
delusions are real to the patient but make him/her understand that it is not
the same in real world. Such admission of the reality to the patient will
enable the patient become indeterminate of the validity of what he/she sees
or hears (Gaebel and Zielasek, 2015).
 The nurse should intervene by reducing environmental stimuli. This aimed
at lowering the level of anxiety which can trigger hallucinations enabling
the patient to calm down.
 The patient’s level of functioning should be maximized by promoting
independence and only offering help where necessary and rewarding
positive behaviour. Nurses should be able to monitor drug therapy by
administering prescribed medication and ensure drug adherence by the
patients in their custody. At the same time, anaphylactic reaction and
toxicity due to drugs are managed well (Olfson, 2016).
 The nurse need to guide the patient in identifying activities that help reduce
his/her anxiety. This will enable the patient lessen his/her anxiety, while
also helping the nurse to build rapport with the client.
 Check if the medications have reached therapeutic levels. This is due to the
fact that many symptoms of schizophrenia subside with medications. This
in turn helps facilitate interactions.
 Mental health nurses should ensure that the patient’s family are well
informed about the disease and the need for medical adherence.
 Accurate and well-timed diagnosis of schizophrenia among the elderly
homeless individual can positively impact on the treatment attainment,
nurses offering the much needed care should be able to pay special
attention to the early signs that might be expressed by the patients
(Petersen, 2014).
A portrait of a person with schizophrenia
representing that person’s distorted view of
reality