4. Older adults Flashcards
considerations with older adults
medication effects, cognitive changes
grief/loss/emotional issues
change in role
fear of dementia
attitudes to ageing- own, client, society
life experience
impact on decision making capacity
elder abuse
palliative care
cognition across lifespan
changes in performance on tests of general ability, but except for speeded tests (20+ years), declines occur relatively late (50s or 60s)
learning continues
age effects more apparent when facing novel tasks, especially 75+ years
little decline in complicated activities in everyday life
main cognitive changes in older adults
processing speed
forming associations
multi tasking/divided attention
biological explanations age-related memory decline
lose only about 2% of brain weight and volume each decade of life
loss in myelination and reduction in connection among neurons (slowing), decrease in certain neurotransmitters (dopamine), reduced blood flow
main effects on prefrontal region of cortex-attention and maintaining memories/thoughts in consciousness (WM)
social cognitive explanation age-related memory decline
negative age stereotypes
worry about underlying cause of memory slips (dementia?)
reduced routine and habit
increased overload of old memories
reinforcement of memory performance
positive reinforcement helps to increase future performance
how a negative stereotype affects memory
expectations of poorer memory
decreased use of active strategies
poorer recall
minimising memory changes
change expectations
adopt good learning strategies
positive and confident attitude about memory
in normal ageing
decline in episodic memory, source memory, working memory
NOT in semantic, implicit, procedural or naturalistic prospective memory
Neural changes: subtle changes in prefrontal cortex and hippocampus (memory decline)
in Alzheimer’s dementia
deficits in episodic memory are early features and severe, semantic memory also affected
Neural: neuropathology in entorhinal cortex and hippocampus (episodic memory) and then spreads to other cortical regions (semantic memory)
dementia syndrome
not a disease
pattern of symptoms that can be caused by many different illnesses
syndrome involving progressive decline in memory and other intellectual abilities
acquired, persistent, multiple impairments to cognition
dementia criteria
cognitive/behavioural impairments: new learning and memory, reasoning and handling of complex tasks, poor judgement, visuospatial abilities, language, changes in personality/behaviour
cognitive or behavioural symptoms that:
interfere with function at work or usual activities
represent a decline from previous levels
are not due to delirium or psychiatric disorder
dementia due to alzheimers
most common cause of dementia
insidious onset and gradual decline in cognition often beginning with memory lapses
other symptoms:
persistent and frequent memory difficulties, especially of recent events
vagueness in everyday conversation
apparent loss of enthusiasm for previously enjoyed activities
laking longer to do routine tasks
forgetting well known people or places
inability to process questions and instructions
deterioration of social skills
emotional unpredictability
anxiety and depression in older age
most significant reported symptom is cognitive changes
protective: greater perceived social support, regular physical exercise, higher level of education
risk factors for depression in later life
disability, newly diagnosed medical illness, poor health status, poor self-perceived health, prior depression and bereavement
risk factors for anxiety in later life
poor self rated general health status
physical or sexual abuse in childhood
more common than depression, similar risk factors
techniques to promote emotional wellbeing in older adults
physical activity
relaxation
sensory stimulation
music and arts
social
reflection
education and skills training
technology
quality of life approaches
carer interventions
interventions delivered by mental health professionals
CBT with older adults
structured, collaborative, creative- socratic dialogue, guided discovery, collaborative empiricism
more effective in older adults than working age adults
preferred compared to medication
CBT for depression
help person recognise any negative, self focused, self critical thinking and work with them to change these patterns to more realistic and problem solving thinking
behavioural- increase activities that are pleasurable/sense of achievement
CBT for anxiety
cognitive- help person recognise thoughts focused on threats and dangers, and change them to more realistic and problem solving
behavioural- relaxation, desensitisation, face up to things being avoided
biopsychosocial model
Impact of diagnosed and undiagnosed medical conditions
past trauma
past coping strategies
transitions
societal difficulties
chronicity
attitudes to mental health
leverage wisdom
modify questioning- rather than how mood is different to usual, can ask how would they like to feel
reminiscence therapy
thinking and talking about past experience in your life
thought to help by:
focusing on former successful coping experiences
reinforces sense of continuity
find meaning and coherence in one’s life
resolve unresolved conflicts
greater effects on community dwelling older adults compared to those in nursing homes/residential care
simple reminiscence
encourages social connections and shared memories
engage client in pleasurable discussion to develop connection/engagement
person talking to them would usually share some of their experiences or common memories too
topics might include growing up, schooling, marriage, children
life review
encourages an understanding of one’s life and identity
more structured
cover a different part of their life each session
childhood, adolescence, working life etc.
help client appreciate common themes in life, sense of who they are
life book or digital story
life review therapy
encourages a recollection of problem solving success
ask specific questions to prime positive representation of self
self efficacy
greater effects than simple reminiscence, especially on depression
addressing hearing loss
minimise background noise
look at client when speaking
speak slowly and distinctly
don’t shout or over articulate
lower pitch of voice
sit close
written summaries for follow up material
auditory amplifiers
addressing vision loss
increase lighting, reduce glare, do not use glossy print materials
large print
time to refocus
reading glasses available
arrange furiture so pathways are clear
addressing mobility changes
office accessibility and toiler accessibility
sit at same level
do not assume they need help- ask first
dementia not preventable
can reduce risk factors (delay, prevent onset)
risk factors for one form of dementia may be same as another, prevention can target more than one type
modifiable risk factors for dementia
40% modifiable
early life (<45): les education
midlife (45-65): hearing loss, TBI, hypertenson, alcohhol >21 units per week, obesity
Later life (>65): smoking, depression, social isolation, physical inactivity, air pollution, diabetes
cognitive stimulation
typically group: reality orientation, reminiscence, music/art, validation
greater benefit when sessions occur mroe than weekly and for mild dementia
improve ADLs, quality of life, mood, comm, soc interaction, decrease in challenging behaviours
cognitive rehabilitation
goal attainment- 3 goals developed (e.g. learning to use mobile phone)
cognitive training
no adverse effects
methods that work in dementia
procedural memory training
dual cognitive support
spaced retrieval
errorless learning important
spaced retrieval
errorless learning approach
small amount of important information for very long periods
repeated at progressively lengthened intervals, active retrieval of important information
error made, feedback provided, interval shortened
minimal congitive effort, spontaneously used
preclinical/prodromal alzheimer’s disease
disease modifying treatments and cognitive interventions most effect early as possible in disease process
MCI
Subjective cognitive concerns and objective impairment on tests
still functionally independent, no dementia
common, increases with age
15% develop dementia within 2 years, triple risk of developing within 2-5 years
LATCH
group cognitive interventions for MCI and healthy older adults
6 week 2H group, 3M booster
middle-older aged participants
6-12 px
psychoed + therapy (CBT), info about memory and memory strategies, skills in everyday use of strategies
understanding memory
prepare for remembering: identifying, reducing risk factors, promote self confidence, concentration
reduce memory load: do tasks imemediately, external aids
internal strategies: spaced retrieval, association, implementation intentions
practice
group therapy
modelling acceptance, courage and optimism
group dynamic reinforces learning
peer credibility
expectancy-modification important for some participants
LATCH behaviour change technqiues
BCTs
85 active agent of intervention which work via 26 different mechanisms of actions (MoAs)
BCTs linked to MoA beliefs about capabilities
demonstration of the behaviour
instruction on how to perform behaviour
behavioural practice/rehearsal
graded tasks
problem solving
BCTs linked to MoA behavioural regulation (skills for changing behaviour)
self monitoring
facilitate performance of behaviour
BCTs linked or MoA goals- individuals want to achieve
Goal setting
review behaviour goals
review outcome goals
process for prospective memory
quick brainstorm highlighting the different types of prospective memory tasks (things that can be done straight away, things that need to be done in a little while, date attached, can be done anytime)
framework that illustrates the problems in the context of a memory model
this guides best type of strategy required for each problem
helping people choose optimal strategy for success
prospective memory model
formation
retention
reinstantiation
execution
difficulties at any step may mean we don’t remember our delayed intention at the right time
tasks often ‘forgotten’ because absorbed in another activity, hard to recognise cues to shift
propsective memory complex as it requires
deciding what need or want to do (forming an intention)
holding onto your intention while doing something else
recalling what you wanted to do, when the right moment arrives (recognising the cues that it is the right moment)
actually doing the task you planned
strategies for prospective memory
notes
diaries, calendars
do it now
alarms
implementation intention
implementation intention
make a specific and detailed plan about when, where and how your intention will happen, and visualise what is happening before, during and after you do the task
1. helps create stronger intention to begin with
2. helps create more cues
OPTIMISE
Online learning 6 modules
8 week period
booster at 3MO
Compensatory strategies rather than restorative (brain training) approach
psychoeducation (models of memory, age-related changes in memory)
practical skill building
opportunity to share experiences of memory changes amongst peers
personalised
most significantly increased strategy use, daily improvements, reduced memory concerns, confidence/self efficacy, sharing and shame-busting
