10 - Older Person's Mental Health Flashcards
What is the difference between implied and expressed consent?
- Expressed is written or oral
- Implied is ambiguous e.g nodding, turning up for surgery on time, rolling up sleeve for blood test
What is the definition of mental capacity?
One’s own ability to make decisions e.g personal welfare, healthcare, financial
It is time specific and decision specific
What are the 5 principles of the MCA 2005?
- Assume everyone has capacity until proven otherwise
- Provide information in all sources to help aid capacity
- Unwise decision doesn’t mean somebody lacks capacity
- Best interests
- Least restrictive
What are some scenarios where someone may lack capacity?
- Stroke or brain injury
- Mental health problem
- Dementia
- Learning disability
- Confusion, drowsiness or unconsciousness
- Substance misuse
Always reassess as time and decision specific
What is the two stage capacity test?
Stage 1 - Is the person unable to make a particular decision? (Diagnostic)
Stage 2 - Is the inability to make a decision caused by an impairment of, or disturbance in the functioning of, a person’s mind or brain? e.g mental illness, dementia, or learning disability, or more temporary states such as confusion, unconsciousness, or the effects of drugs or alcohol. 4 test!!!!(Functional)
What is the definition of the following:
- LPA
- Deputies appointed by the Court of Protection
- Public Guardian
- IMCA
- LPA: Person appointed by pt when they have capacity to make decisions for them when they no longer have capacity
- Deputies appointed by the Court of Protection: Person appointed once the person has already lost capacity so cannot nominate a LPA. Could be friend, family or solicitor. Can have one deputy for finances/property and one about personal welfare. Not able to make healthcare decisions like LPA can
- Public Guardian: A person who polices LPAs and Deputies to stop them from financially abusing the person who lacks mental capacity
- IMCA: When somebody lacks capacity so needs a best interest decision but there is no family/friends for doctors to consult with about the best interest
What is a IMHA?
Independent Mental Health Advocate
Statutory right for people detained under most sections of the Mental Health Act, subject to Guardianship or on a community treatment order (CTO)
IMHAs help the patient get their opinions heard and help them to know their rights as per the law
What is DoLS being replaced by?
Deprivation of Liberty Safeguard is going to be replaced by Liberty Protection Safeguards (LPS) in 2022
What settings can DOLS be used in?
- Hospitals
- Care homes
Can only use restraints and restrictions when this is in place and should only be used when in somebody’s best interest
Should not place anybody under this if they can be held under the MHA
How is a DoLS applied for?
Must request standard authorisation from local authority
What is the definition of a mental disorder?
A behavioral or mental pattern that causes significant distress or impairment of personal functioning
What is the purpose of the following sections in the Mental Health Act 1983/2007, who can enforce it and how long does the section last for:
Section 2
Purpose: Allow a person to be detained in hospital for assessment, ADMISSION FOR ASSESSMENT, cannot be extended
Who can enforce it: AMHP + 2 Doctors (one of them being section 12 approved)
Duration: 28 days
What is the purpose of the following sections in the Mental Health Act 1983/2007, who can enforce it and how long does the section last for:
Section 3
Purpose: Admission for treatment, can be extended
Who can enforce: AHMP + 2 Doctors (one is section 12 approved and has experience with treatment of condition)
Duration: 6 months but can be extended
What is the purpose of the following sections in the Mental Health Act 1983/2007, who can enforce it and how long does the section last for:
CTO
Purpose: Supervised treatment in the community following being detained under a section in hospital. Can return you to hospital immediately for treatment if need be
Who can enforce: Responsible Clinician
How long: 6 months, can be extended
What is the purpose of the following sections in the Mental Health Act 1983/2007, who can enforce it and how long does the section last for:
Section 5 (4)
Purpose: Nurse’s holding power to hold you there until you can be assessed by a doctor, the doctor can then decide to end your section or start another
Who can enforce: Nurse
How long: 6 hours
What is the purpose of the following sections in the Mental Health Act 1983/2007, who can enforce it and how long does the section last for:
Section 5 (2)
Purpose: Doctor’s holding power, gives enough time for 2 doctors to review to be able to place them on a section 2 or 3
Who can enforce: Doctor
How long: 72 hours
What is the purpose of the following sections in the Mental Health Act 1983/2007, who can enforce it and how long does the section last for:
Section 136
Purpose: Police can detain someone from a public place if they believe them to be mentally disordered and bring them to a place of safety in the hospital. Allows them to be reviewed by 2 doctors to see if they need a section
Who: Police
How long: 24 hours
What is the purpose of the following sections in the Mental Health Act 1983/2007, who can enforce it and how long does the section last for:
Section 135
Purpose: Police can go into your home/private place and bring you to a place of safety e.g in the hospital/police station if they believe you to be mentally unwell
Who can enforce: Police or Other healthcare professionals
How long: 36 hours
What is the purpose of the following sections in the Mental Health Act 1983/2007, who can enforce it and how long does the section last for:
Section 117
Purpose: Aftercare provided to a patient after they leave hospital and have been on certain sections e.g Section 3. May get a CPA and specialist housing, help to meet other people, help with work or education, or free prescriptions for mental health medication
Who can enforce: Anyone on certain sections
How long: when patient no longer needs it and is well
What is the difference between a DNACPR and an Advance Decision to Refuse Treatment?
Advanced decision to refuse treatment could relate to numerous things e.g no pain relief, no ventilation but DNACPR is just refusing CPR
Both decisions can only be made by patient themselves if they have capacity
What are ReSPECT forms for?
Recommended Summary Plan for Emergency Care and Treatment
Promotes advanced care planning, good communication, shared decision making and DNACPR
How can you distinguish between dementia and delirium:
- Sleep-wake cycle
- Attention
- Arousal
- Autonomic Features
- Duration
- Delusions
Collateral history is key!!
What is Wilkinson’s theory?
It is not individual income that is a main determining factor of health but rather the degree of income inequality within a society
Income distribution determines health
What drug can be given to help soothe the hallucinations in Lewy Body dementia?
Cholinesterase inhibitors e.g Donepezil, Rivastigmine
What is this lady’s clinical frailty score:
86 year old lady with Alzheimer’s who is dependent on family for personal care and feeding.
8
What is the most likely answer?
Cortical Spreading Depression
wave of sustained depolarizationmoving through intact brain tissue and associated with brain ischemia, migraine aura, and seizures.
What is the most common ECG abnormality with Donepezil?
- Decreased heart rate
- Increased PR interval
