Are Nurses Within the Aged Care Sector Equipped and Trained to Care for Mental Health Patients?

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Table of Contents

Background and Aim
Method
Results
Discussion
Conclusion
References

Background and Aim

There is an increase in the elderly population in Australia, and they require significant medical care. At the same time, according to the Royal Commission’s Final Report into Aged Care Quality and Safety, mental health care is of the lowest quality, which signals the need for change (Searle, 2021). Access to psychological care, the role and responsibilities of service providers, and the management of mental health care are among the gaps and challenges in the field (Searle, 2021). Reform of the existing care system for the aged population can solve these problems.

Inadequate quality of care is associated with widespread mental health problems in the older population. According to a review by Better Place Australia (n.d.), 30-50% of people in this age group suffer from depression. At the same time, studies by Creighton et al. (2018) indicate that the prevalence of “threshold and subthreshold anxiety disorders was 19.4% and 11.7% respectively” (as cited in Better Place Australia, n.d., para. 7). The pandemic COVID-19 suggests growth in anxiety levels and increased risks of mental health problems in the older generation (Goh & Dow, 2020). An essential factor is that it is difficult for more aged people to discuss mental issues with health care providers due to the stigma of the mental problems. These facts point to the importance of providing quality services to the older generation in maintaining their mental health.

Based on the presented background, the study aims to determine healthcare providers’ readiness to work with mental problems in the older generation. Thus, population (P) is patients of the aged care sector, intervention (I) is personnel’s equipment and training, and outcome (O) is caring for patients with mental health problems, with nothing for comparison (C). Therefore, the PICO question: ‘for patients of the aged care sector, is current personnel’s equipment and training enough to care for people with mental health problems?’.

Method

The study begins with the search for the literature necessary to achieve the goal and reveal the topic. Databases such as PubMed and PubMed Central (PMC) were the primary sites for searching for literature on the issue. Additional sources for the search were Google and Google Scholar search engines, and publications dates were limited to 2017-2021 years. Search terms included: aged care sector patients, mental health problem, mental health, Australian aged care sector, staff and nurses training, staff and nurses’ equipment, care for elderly patients’ mental health. The total number of literature for selection also included sources found through other articles and references in them.

Initially, 67 records were found from all sources using key terms, of which 63 were left after duplicates removal. Screening of 63 articles allowed an additional 42 papers to be excluded, which meant that 21 sources remained for thorough verification with the Critical Appraisal Skills Program (CASP). CASP checklists (n.d.) provide tools for evaluating different types of research, such as qualitative, review, cohort study, and other papers. Through the questions, checklists helped select the most reliable and suitable sources, and the final result includes ten articles.

The main inclusion criteria are:

publication in a peer-reviewed journal;
English language;
be published within the last five years;
the appropriate age of the groups studied – the older generation;
the studying patients with mental health conditions or the desire to contact mental health specialists;
the disclosure of the topic of quality of health services;
having significant implications for practice.

Sources that focused on the treatment process (rather than quality) or described only factors causing the condition or complications were excluded.

Results

Author, Year, Country	Methodology and Participants	CASP Scores	Key Findings
Amare et al., 2020, Australia	This retrospective cross-sectional study included 430,862 older Australians over 65 years old living in permanent residential aged care (PRAC). To determine the causes and factors affecting the appearance of mental disorders in a given sample, the authors applied stepwise multivariate logistic regression modeling.	11/12	Of the sample studied, more than half of older Australians, namely 57.8%, had at least one mental disorder, the most frequent of which was depression. This finding indicates a high prevalence of the problem in the country. At the same time, people with disorders were younger than other participants. Important factors affecting the emergence of the issues were limited physical activity, physical diseases, in particular, their comorbidities.
Benjenk et al., 2019, USA	The qualitative study includes 14 semi-structured, in-depth interviews with undergraduate psychiatric nursing instructors and professors who train nursing students. The participants for the interview were selected by convenience and snowball sampling. The authors elucidated students’ attitudes toward patients with mental disorders and older patients. The researchers encoded transcripts of the interview using the thematic analysis approach.	9/10	Educators have identified biases towards geropsychiatric as a significant issue in the training of future nurses. Most students are negative and biased about both psychiatric and geriatric specialties. This attitude affects the choice of future work, creating a shortage of personnel in the areas under discussion. Moreover, other problems were discovered: little time in the program for psychiatric-mental health nursing and stigma maintained among all nurses against patients with mental disorders.
Christensen et al., 2020, Denmark	The paper’s authors conducted a review of articles focusing on the effectiveness of using videoconferences in the treatment of depression in older people. After searching eight databases, out of 3537 pieces, 21 sources were selected. The authors divided the results obtained in the articles for analysis into quantitative and qualitative. Among them, “The quantitative data included gender, age, diagnosis, satisfaction, usability and acceptability” (Christensen et al., 2020, p. 260). For qualitative studies, the authors applied thematic analysis and an inductive approach.	8/10	The use of videoconferencing in treating depression in the older generation is effective when face-to-face appointments are not available. Participants’ concerns and biases quickly disappeared after several videoconferencing sessions.
Dawson et al., 2017, Australia	With the help of purposive sampling, 11 participants were selected. They were carers for the elderly, 67-94 years old, with mental problems in rural areas of South Australia. Pathways Interview Schedule and broad questions were used to gather information about the availability of medical, psychological services for older adults. Later, for analysis, interview transcripts were encoded and divided into themes.	10/10	The interviews were divided into six main topics describing obstacles and difficulties in accessing professional psychological care for older people with mental problems. Among the factors of influence are the knowledge of caregivers and the ability of employees to involve them in the planning of psychological interventions. The main barriers to accessing psychological services were lack of knowledge among carers, unwillingness to use these services, and difficulties for employees to inform about confidentiality.
Lyons et al., 2017, Australia	2,119 Australians aged from 60 to 94 years were surveyed across the country using various recruitment strategies. The authors analyzed the data with “a hierarchical multiple regression for each of the dependent variables: depression, anxiety, stress, and positive mental health” (Lyons et al., 2017, p. 1458). The analysis purpose was to identify the influence of the experience of ageism on these variables and their dependence on socio-demographic indicators.	10/10	The experience of ageism is closely related to the deterioration of the mental states of the older generation. At the same time, there is not only an increase in depression and stress but also a decrease in the likelihood of a positive experience. The high negative impact is more noticeable for younger women than other survey participants. Differences in influence depended on the sexual orientation of participants. Among heterosexuals, the adverse effects of ageism manifested themselves more strongly, probably because non-heterosexual participants experience constant stress due to the stigma of their orientation.
Rush et al., 2017, Canada	The paper’s authors applied a systematic integral review process to examine the sources researching nurses’ attitudes towards older generation care. Of the 1,690 articles over 12 years, eight were selected for review.	7/10	Seven of the eight articles studied identified negative attitudes towards aged care as prevailing among nurses. Factors of influence on attitudes were education, experience, demography, and the working environment. Nurses prepared for work in the geriatric direction expressed more benevolence than nurses in other specialties.
Smith et al., 2019, USA	57 long-term care (LTC) resident service providers completed online surveys to identify their experience and willingness to work with LGBT individuals among the older generation. Providers included “63% psychologists, 16% social workers, 14% psychiatrists, and 5% nurses” (Smith et al., 2019, p. 198). For analysis, specialist responses were encoded, and topics were distributed according to the frequency.	8/10	Most of the providers participating in the survey had experience working with at least one LGBT representative. They noted that they did not have proper preparation for such work but were ready to study. Among the obstacles to improving work processes, they also note the lack of evidence-based practices for LTC and the existing stigma directed at the LGBT community. At the same time, the last obstacle forces part of the older generation not to report their LGBT affiliation.
Stargatt et al., 2017, Australia	The researchers conducted a questionnaire for 90 employees of Australian residential aged care facilities (RACFs) to seek their views on the availability of psychological services to residents. The institutions where the survey invitations were sent were randomly selected. The questionnaire was divided into several parts to elucidate the presence of symptoms of mental conditions in residents, the availability of treatment, and barriers to it.	10/10	While all participants responded affirmatively about the presence of symptoms of mental disorders, only 14% indicated that the facility hired a professional psychologist. Overall, access to psychological treatment for RACFs residents was assessed as insufficient. For example, few people received referrals to specialists. The barriers were lack of funding, staff unprepared for symptoms identification, and inaccessibility of specialists.
Tabatabaei-Jafari et al., 2020, Australia	The study uses the healthcare ecosystem approach for descriptive assessment of the provision of psychological care in various areas of Australia. The analysis included 11 regions, 9 of which are urban and 2 are rural. The authors used The Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) to describe the processes of providing psychological care to the older generation. The assessment included the availability of care, the possibility of placement for treatment, the diversity of care, and balance.	8/10	The authors found significant differences between urban and rural areas and between care availability to the older population and children and adolescents. Psychological care for the elderly is less accessible and diverse. In rural areas, these rates are even lower than in urban areas.
Temple et al., 2021, Australia	The article analyzed the secondary data of the earlier General Social Survey (GSS). The analysis did not include all respondents, but only over 55 years old – a total of 4,967 out of 18,574. The authors sought associations of discrimination against people with mental health conditions and barriers to healthcare through multivariable logistic regression.	10/12	Compared to 10% of people without mental disorders, about 25% with mental disorders reported discrimination. A significant part of the older generation with conditions associated discrimination with their health. Discrimination was manifested in critical social circumstances such as a working environment or health care, limiting the group’s access to care.

Discussion

This review includes ten studies to understand better how modern health care providers are ready to work with older adults with mental problems. The study by Amare et al. (2020) provides an idea of the prevalence of mental disorders in the Australian older generation – in the cohort studied, almost 58% had various conditions. Currently, access for the older generation to professional psychological care is insignificant (Dawson et al., 2017; Stargatt et al., 2017; Tabatabaei-Jafari et al., 2020). However, current technologies allow increasing access, as demonstrated by Christensen et al. (2020). There is considerable prejudice against both older people and people with mental problems, which manifests itself in discrimination, ageism and negatively affects the group’s quality of life (Benjenk et al., 2019; Lyons et al., 2017; Rush et al., 2017; Smith et al., 2019; Temple et al., 2021). Thus, most studies indicate a lack of knowledge and training among professionals.

Discrimination and prejudice against the older generation and mental problems limit access to health care. Benjenk et al. (2019) and Rush et al. (2017) note significant negative beliefs in nursing students against both groups, affecting their choice of work direction. As a result, the area of psychological assistance for the older generation has a staff shortage, which is also noted in research by Dawson et al. (2017) and Stargatt et al. (2017). At the same time, studies reporting negative relationships focus mainly on nurses. Participants of Smith et al. (2019) survey, in turn, also included psychologists, psychiatrists, and social workers. Although these professionals were more friendly to the older population, particularly LGBT representatives, they also noted a lack of knowledge (Smith et al., 2019). These facts suggest gaps in the training of various professionals.

Conclusion

Mental health problems carry the risk of physical health problems for the older generation up to early death, which justifies the need to study the issue carefully. This survey points to significant problems in providing professional psychological assistance to the elderly. Politicians and representatives of medical services should pay attention to training and expand their programs with themes of care for older adults with mental health disorders. Given the nation’s aging and the increase in the number of older populations, there is the urgency of drawing attention to the problem.

The current review has limitations since a small amount of literature is devoted to preparing staff to work with older people with mental problems. Although the sources studied are relevant to the topic, future studies may concentrate on physicians as more focus has been shifted to nursing training. Moreover, attention should be paid to studying methods to make psychological services more accessible for the older generation and allow better education of employees of various specialties. Nevertheless, the significance of the review is in demonstrating gaps and drawing attention to the complexity and multilateralism of the issue.

References

Amare, A. T., Caughey, G. E., Whitehead, C., Lang, C. E., Bray, S. C., Corlis, M., Visvanathan, R., Wesselingh, S. & Inacio, M. C. (2020). The prevalence, trends and determinants of mental health disorders in older Australians living in permanent residential aged care: implications for policy and quality of aged care services.Australian & New Zealand Journal of Psychiatry, 54(12), 1200-1211.

Benjenk, I., Buchongo, P., Amaize, A., Martinez, G. S., & Chen, J. (2019). Overcoming the dual stigma of mental illness and aging: Preparing new nurses to care for the mental health needs of older adults.The American Journal of Geriatric Psychiatry, 27(7), 664-674.

Better Place Australia. (n.d.). Mental health interventions in aged care. The Centre for Better Relationships.

CASP checklists. (n.d.). Critical Appraisal Skills Programme CASP.

Christensen, L. F., Moller, A. M., Hansen, J. P., Nielsen, C. T., & Gildberg, F. A. (2020). Patients’ and providers’ experiences with video consultations used in the treatment of older patients with unipolar depression: A systematic review.Journal of Psychiatric and Mental Health Nursing, 27(3), 258-271.

Creighton, A. S., Davison, T. E., & Kissane, D. W. (2018). The prevalence, reporting, and treatment of anxiety among older adults in nursing homes and other residential aged care facilities. Journal of Affective Disorders, 227, 416-423.

Dawson, S., Gerace, A., Muir-Cochrane, E., O’Kane, D., Henderson, J., Lawn, S., & Fuller, J. (2017). Carers’ experiences of accessing and navigating mental health care for older people in a rural area in Australia. Aging & Mental Health, 21(2), 216–223.

Goh, A., & Dow, B. (2020). People in aged care sector need psychological as well as physical protection. The University of Melbourne.

Lyons, A., Alba, B., Heywood, W., Fileborn, B., Minichiello, V., Barrett, C., Hinchliff, S., Malta, S., & Dow, B. (2018). Experiences of ageism and the mental health of older adults.Aging & Mental Health, 22(11), 1456-1464.

Rush, K. L., Hickey, S., Epp, S., & Janke, R. (2017). Nurses’ attitudes towards older people care: An integrative review. Journal of Clinical Nursing, 26(23-24), 4105-4116.

Searle, L. (2021). Mental health concerns among the most common in Aged Care Royal Commission. Mental Health Australia. Web.

Smith, R. W., Altman, J. K., Meeks, S., & Hinrichs, K. L. (2019). Mental health care for LGBT older adults in long-term care settings: Competency, training, and barriers for mental health providers.Clinical Gerontologist, 42(2), 198-203.

Stargatt, J., Bhar, S. S., Davison, T. E., Pachana, N. A., Mitchell, L., Koder, D., Hunter, C., Doyle, C., Wells, Y., & Helmes, E. (2017). The availability of psychological services for aged care residents in Australia: A survey of facility staff.Australian Psychologist, 52(6), 406-413.

Tabatabaei-Jafari, H., Salinas-Perez, J. A., Furst, M. A., Bagheri, N., Mendoza, J., Burke, D., McGeorge, P., & Salvador-Carulla, L. (2020). Patterns of service provision in older people’s mental health care in Australia.International Journal of Environmental Research and Public Health, 17(22), 8516.

Temple, J. B., Brijnath, B., Enticott, J., Utomo, A., Williams, R., & Kelaher, M. (2021). Discrimination reported by older adults living with mental health conditions: Types, contexts and association with healthcare barriers.Social Psychiatry and Psychiatric Epidemiology, 56(6), 1003-1014.

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