state whether you agree with your peers. Read and respond in a scholarly fashion, commenting on how they incorporated theory with evidence-based practice. At a minimum, your response should be three to four paragraphs of three to four sentences each. Also give an example of how a PMHNP use this in practice.
According to Gielkens et al. (2018), the prevalence of PTSD in older adult’s ranges from 1.5% – 4%. However, symptoms in older adults may present in different ways, perhaps due to a lifetime of adaptive coping experiences and wisdom accumulation that may decrease the effects of trauma. Older adults may have adapted their lives to their complaints (Gielkens et al., 2018). It is also possible that older adults may have delayed onset of PTSD symptoms due to a neurological disorder affecting cognition, such as a cerebrovascular accident, Parkinson’s disease, or dementia, for example (Gielkens et al., 2018). Older adults receive less mental health care than middle-aged and younger adults, and psychological complaints are not commonly reported over physical ones. One factor may be PTSD or trauma not being introduced to the diagnostic nomenclature until 1980 (Gielkens et al., 2018). PTSD in older adults is associated with significantly elevated odds of a lifetime of mood, drug abuse, anxiety, and borderline/narcissistic personality disorders (Gielkens et al., 2018).
Psychological treatment of the older adult presents challenges, including removing the application of the bias and assessment of possible cognitive/physical adjustments needed, including compensating for potential physical limitations, including fatigue, mobility, and diminished hearing or vision (Gielken et al., 2018). Older adults and EMDR application is missing in research studies, with only a few conducted that demonstrate possible efficacy in older adults (Gielken et al., 2018). One study that showed EMDR on inpatient elderly women aged 70-85 (n=26) with mild to moderate cognitive impairment reports that EMDR was highly effective (Gielken et al., 2018). Adjustments in Phase 1 may include sorting through many memories, engaging in possible taboo subjects such as sexuality and death, and sorting through likely episodic memory decline (Gielken et al., 2018). In phase 2, the older adult may require information assimilation from loved ones (Gielken et al., 2018). In Phase 3, the therapist may need to navigate through some of the cognitive recall, such as using target-related cognitions (Gielken et al., 2018). During Phase 4, it may be the therapist’s interpretations of assigning subjective units of disturbance (SUD) if the client cannot provide feedback scales in the form of objective assessment, such as monitoring signs of tension and relaxation (Gielken et al., 2018). Additional alterations may be required for older adults including adjustments of the speed and duration of stimulation, replacing eye movements with taps or irregular tones, and possible visual or perceptual changes to accommodate (Gielken et al., 2018). Additional assessment during EMDR may be required by applying EMDR in the older adult through each phase, including possible monitoring of clenched fists, furrowed forehead, and tremors (Gielken et al., 2018).
Conclusion
As you can see, as evidenced by the research provided above that EMDR is an effective treatment for children, adolescents, adults, and older adults with not only PTSD but numerous mental health and psychiatric disorders. As future PMHNPs, we should always prioritize screening for adverse childhood experiences or a history of trauma to ensure early intervention occurs to increase their chances of recovery in the future. EMDR targets nervous systems that are now wired differently, desensitizing the uncomfortable dysregulated responses that no longer need to affect their future.
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