The purpose of this study was to use grounded theory to explore the subjective living experiences of elderly people with mental illness in Taiwan community. In Taiwan, there has been a significant increase in the number of elderly people with mental illness. A comparison between the past ten years reveals that 68% increase in the number of patients with schizophrenia, and 164% increase in patients with dementia (Ministry of the Interior, Taiwan, 2015). Dementia and affective disorders are reported in Taiwanese older adults at an annual rate of 8% and 25 % respectively (Ministry of the Interior, Taiwan, 2015). The prevalence of comorbid physical and mental illness increases with age and the incidence of mental illness increase when physical illness becomes more pronounced (Barnett et al., 2012; Satorious, 2013). The major mental health problems of the elderly people are depression, cognitive impairment, suicide risk, and chronic psychosis. Mental health problems have profound harmful health and psychosocial consequences, including increased risk for dementia (Saczynski, et al, 2010), functional decline (Ell, 2006; Lenze, et al, 2001), poor quality of life, and death (Ell, 2006, Cuijpers, Beekman, Reynolds, 2012). Even mild to moderate symptoms, if not successfully treated, are associated with poor health outcomes, erode quality of life, and increase health care utilization and costs (Glaser, 2003; Lenze, et al, 2001). Most elderly people will seek medical treatment for their physical diseases, but rarely seek mental health treatment or care assistance. Mental illness of the elderly people often untreated due to misunderstand, including the cognitive impairment and depression are the normal responses of aging, the natural reactions to chronic illness, the responses of loss of family members, and the responses of social role transition (Nair, Hiremath, Ramesh, Pooja, Nair, 2013). Most Taiwanese elderly people live in the community. People with aging will increase the risk of mental illness and mental health problems; however, there is a lack of adequate research and coverage on the daily life and care needs of elderly people with mental illness in Taiwan. More recent qualitative reports have highlighted that poor understanding of mental illness as barriers to health care for elderly psychotic patients. In this study, qualitative study and semi-structured interviews was use to explore the life experiences of elderly people with mental illness in Taiwan community.
Methods:
Ethical evaluated and approved for this study was obtained from the Institutional Review Board (IRB) of two psychiatric hospitals. A qualitative study and semi-structured interviews was used with psychotic elderly patients, who were recruited via the services of day care center of psychiatric mental health care and home care of psychiatric hospital. During the interviews, all participants continued to receive mental health care and their psychiatric symptoms were partially or fully relieved. Participants were willingness to share their life experiences, emotional and thought processes of aging and psychiatric illness in community. Every participant was interview 2 times at their home or day care center. The requirements for participation in this study were as follows: the participants were able to maintain 20-30 minutes mentally alert at least. The participants have no actively psychotic symptoms, were able to accept Individual semi-structure interview by Taiwanese dialect or Mandarin.
Results:
The 17 participants included 3 men and 14 women ages 61 to 94 (mean age = 73.47, SD = 10.18 years). Participants have major problems of schizophrenia (n=3), depressive disorder (n=7), or mild dementia (n=7). The continuation enhances strength to survive for coping with the aging and mental health problem was identified as the core category of the life experiences in the older adults in this study. The older adults struggled between survival in stress of aging and mental health problems, their life experiences categorized as bear the bitterness of life, adhere to psychiatric treatment and using resources out of the disease shackle, and persistence coping with stress of life and mental health problems. The major themes of the bitterness of life referred to participants experiencing negative emotions such as lack of care, family deconstruction, suffering for physical and mental health problems, feeling of helpless and hopeless. The themes of adhere to psychiatric treatment and using resources out of the disease shackle referred to accept the problem of illness, adhere to disease treatment and therapy, seek help (medical and social support), reflect on the value of their own existence and construct the sense of being, and accept the fate and life situation. Moreover, the themes identified of persistence coping with stress of life and mental health problems referred to control illness, maintain the driving force of life, experience the value of life, and relink with family and community.
Conclusion:
It is important to assess the life experiences of the elderly people with mental illness for providing nursing care for resolving the aging and mental illness problems. Understanding the specific issues confronting these individuals elderly would inform the development of more appropriate models of community‑based mental health and aged care. The major findings of this study were surrounding the continuation enhances strength to survive for coping with the aging and mental health problem. The nursing care need to reinforce elderly coping skills and to help elderly people find new strategies in their living situation, move and enhance the older person's ability for coping stress and maintain their mental health and community living functioning.