From the Guidelines
Comprehensive geriatric assessments are crucial for addressing psychosocial support among older adults, as they guide the development of a coordinated care plan to manage complexities of health conditions and optimize overall well-being. The Geriatric 5Ms framework is a practical approach to evaluating older adults, consisting of managing the patient's mind, mobility, medications, what matters most to the patient, and multicomplexity 1. This framework highlights the importance of considering the cognitive and psychological domains of a patient's health, as well as the intersection of multiple chronic conditions and social determinants of health.
When conducting a comprehensive geriatric assessment, healthcare providers should screen for depression using tools like the Geriatric Depression Scale, assess cognitive function with instruments such as the Mini-Mental State Examination, evaluate social isolation risk factors, and identify elder abuse or neglect. The assessment should also incorporate a review of the older adult's social network, living situation, financial resources, and access to community services.
Key components of the assessment include:
- Evaluating mobility and fall risk to prevent injuries and maintain functional status
- Reviewing and reconciling medications to minimize polypharmacy issues and optimize medication management
- Asking what matters most to the patient to prioritize their values and preferences in care planning
- Assessing multicomplexity to address the intersection of multiple chronic conditions and social determinants of health
Healthcare providers should implement a multidisciplinary approach involving social workers, psychologists, and community resources to address identified needs. Interventions may include referrals to senior centers, support groups, or home health services. Medication management is crucial, with careful consideration of polypharmacy issues; specific medications like SSRIs may be prescribed for depression with lower starting doses for older adults. Regular follow-up appointments should be scheduled to monitor psychosocial well-being and medication effectiveness, as comprehensive geriatric assessments have been shown to reduce disability, hospitalization, and institutionalization and improve quality of life 1.
From the Research
Psychosocial Support Among Older Adults
- Older adults often experience anxiety disorders, such as generalized anxiety disorder, panic disorder, agoraphobia, or social phobia, which can be treated with cognitive-behavioral therapy (CBT) or selective serotonin reuptake inhibitors (SSRIs) 2.
- The mental health care of older adults is labor-intensive due to multimorbidities, and ageism is a significant problem for this population, highlighting the need for a broader concept of geriatric psychiatry that encompasses health as well as illness 3.
- Social isolation and loneliness are serious public health issues among older adults, associated with negative physical, mental, and cognitive health outcomes, and increased risk for mortality, emphasizing the importance of social connectivity to wellbeing 4.
Health Assessment Role
- Comprehensive assessment, clinical management, intensive outreach, and coordination of mental, physical, and social health services are essential for the optimal care of older adults with mental disorders 3.
- The association between social isolation and health is mediated by loneliness, and individuals in the older cohorts (80+) may be particularly vulnerable to being socially isolated and lonely due to smaller social networks and greater physical and functional impairments 4.
- Purposeful activity interventions, particularly those that involve taking on a functional role, can improve well-being and quality-of-life outcomes in older adults aged 80 years and older, highlighting the importance of supporting older adults to access more purposeful social roles and create opportunities for helping and reciprocation 5.
Mental Health and Aging
- The COVID-19 pandemic has exacerbated the mental health needs of older adults, and the number of older adults in the United States will continue to grow, with the potential for expanded demand and contracted service options 6.
- Ageism, inequitable access, and financial and policy constraints may limit healthcare access for older adults, emphasizing the need for education, research, and practice to address these trends in aging 6.
- Enhancing older adults' well-being and quality of life through purposeful activity is crucial, and interventions that support participants to develop a new skill or take on a functional role can be effective in improving well-being outcomes 5.