block 33 week 3 Flashcards
dopamine’s effect on eating?
regulates the rewarding property of food
leptin?
leptin is a hormone produced primarily by the fat cells in the body; it has an inhibitory effect on appetite by inducing a feeling of satiety.
Cognitive theory of ED?
- variant of OCD?
- The obsession with body shape and weight- the hallmark of an eating disorder- is likely a driving factor in anorexia nervosa.
- Distorted thought patterns and an over-evaluation of body size likely contribute to this obsession and one’s desire for thinness
ghrelin?
- Ghrelin is an appetite-inducing hormone produced in the stomach and the upper portion of the small intestine.
sociocultural theory of ED?
- Eating disorders are overwhelmingly found in Western countries where there is a heavy emphasis on thinness- a core feature of eating disorders.
- It is also found in countries where food is in abundance as in places of deprivation, round figures are more desirable
SLT in development of EDs?
- During childhood, children encode the behaviour of their role models (e.g., celebrities or parents),imitatingit.
- They do not imitate all behaviour, but if it isreinforcedor is the generally accepted opinion of society, they are likely to replicate it.
- Society and the media perceive ‘skinnier’women and ‘muscular’ men as more attractive.
family in ED?
- one of the strongest external contributors to maintaning EDs
- often family members are praised for their thiness
- maintains maladaptive eating behaviours
- Families that emphasize thinness or place a large emphasis on physical appearance are more likely to have a child diagnosed with an eating disordeR
personality in ED - perfectionism?
- Perfectionism - especially for anorexia
- perfectionism magnifies normal body imperfections, leading an individual to go to excessive (i.e. restrictive) behaviors to remedy the imperfection
Personality in ED - self esteem?
Self esteem - Low self-esteem not only contributes to the development of an eating disorder, but is also likely involved in the maintenance of the disorde
transdiagnostic model of ED?
suggests that overall low self-esteem increases the risk for over-evaluation of body, which in turn, leads to negative eating behaviors that could lead to an eating disorder
Using the MH act and compulsory treatment ?
- If a person’s physical health is at serious risk due to their eating disorder, they do not consent to treatment, and they can only be treated safely in an inpatient setting
*
Child or young person without capacity?
if physical health is at serious risk and they do not consent to treatment, ask their parents or carers to consent on their behalf and if necessary, use an appropriate legal framework for compulsory treatment (such as the Mental Health Act1983/2007 or the Children Act1989).
what is dementia?
- chronic/ progressive syndrome
- Disturbance of multiple higher cortical functioning e.g memory, thinking, language, judgement etc
dementia involves a clear?
- conciousness
- but may be accompanied/preceded by deterioration in emotional control, social behaviour or motivation
DDs of dementia
*Ageing
*Mild Cognitive Impairment
*Delirium
*Depression (‘Depressive pseudo dementia’)
- Amnesic Syndrome
ageing related memory issues?
- reduced ability to encode new material into secondary (long term) memory e.g. registering people/ place
- reduced efficiency of retrieval - accessing the right info
- no loss of memories that have alr been laid down
reversible causes that can present like dementia
- Space Occupying Lesions (SOL)
- Alcohol abuse
- Medication effects
- Thyroid problems
- NPH
- Vitamin deficiencies (e.g. B12, folate etc)
what is mild cognitive impairment?
- not a diagnosis, intermediate stage between normal age related conditions and dementia
- more serious memory loss in absence of cognitive or ADL impairment - subtle impairments
risk of dementia in MCI?
- higher risk of dementia (10-15% per year) - 3-5x higher risk than someone w.o MCI
Causes of MCI?
- early dementia
- physical health problems like COPD
- medication side effects e.g. anti cholinergics or meds that cause drowsiness
- MH problems
Prevalence of MCI?
- between 5% and 25%
pseudo-dementia depression ?
- Shorter history, often with precipitant
- Previous history of depression
- Patient complains of memory problems
Pseudo-dementia depression is often worse in ?
a morning
dementia history which differentiates it from depressive pseudodementia?
- Longer history, insidious, no precipitant
- ppt less likely to complain of depression or memory issues
- often worse on an evening
depression MSE?
- during MSE mood can be labile, more constistent performance, attempt to answer questions
Delirium?
- Rapid onset, short history
- Fluctuating course of cognitive impairment and level of consciousness
- More prominent and complex, fleeting psychotic symptoms (e.g. vivid visual hallucinations)
what is altered in delirum?
- perception and affect altered - illusions, low mood, anxiety, fear, euphoria
- Abnormal motor activity (over or under activity)
- Emotional changes more prominent and variable
delirious patients tend to get worse as?
- tend to get worse as the day goes on - more confused at night
delirium - may have?
evidence of medical illness e.g. pyrexia
RF for delirium?
- older
- cerebral compromise - dementia e.g.
- chronic conditions
- renal impairment
- psychiatric history
RF for delirium - impairment?
- sensory impairment - visiual/ deafness
- immobile impatients
RF for delirium - drug and envir related?
- poly-pharmacy
- unfamiliar environment
most common cause of dementia?
- most common - alzheimer’s: 50-60
other types of dementia?
- vascular - 20-30%
- LBD: 10-15%
- FT dementia: upto 10
alcohol can contribute to up to ?% of dementias
10
other rarer causes of dementia?
parkinsons, huntingtons, MS, HIV etc
Ix of dementia?
- History
- MSE and cognitive assessment
- Physical Examination
- Blood tests– at a minimum, FBC, Biochemical screen, TFT’s, Blood glucose, B12 and folate levels
MSU in dementia?
- infection
- CKD
CT scan for dementia?
esp. for shorter duration (less than a year), younger onset, ‘atypical symptoms’ or examination findings
semantic memory =
meaning of concepts/ objects
what is alzheimers?
- progressive global decline of higher cognitive functions
- initially involves short term memory
alzheimer’s affects:
- memory- early episodic changes - events involving the person
- Language
- Motor Skills (praxis)
- Recognition Skills (gnosis)
- Personality e.g. apathy, irritability
alzheimer’s ppts can also develop?
psychotic symptoms, gait disturbances, seizures later on
vascular dementia (large and medium vessel disease)?
- Due to cerebral ischemia/Infarction
- sudden step wise deterioration
- Deficits dependent on damaged region - can be cognitive, motor, sensory
small vessel disease involves a ? progression
Insidious onset, gradual progression
small vs large vessel disease?
- small: gradual progression
- large: stepwise decline
SVD - symptoms?
- apathy
- slowness of thought
- problems with exec functioning
- reduced attention
- relative preservation of higher cortical functions like gnosis, praxis, visuospatial
- espec subcortical and periventricular white matter - Binswangers disease
- may be problems w mobility/ gait
LBD vs parkinsons dementia?
- Early cognitive symptoms = DLB
- Motor Symptoms > 1 year = PD
PD w dementia?
Motor symptoms, apathy, slowing of thought, executive functioning, forgetfulness
LDB?
- Rapid dementia,
- fluctuations,
- hallucinations,
- mild parkinsonian features
LBD - 2 of 3:
- Fluctuations in cognition/performance
- Persistent, well formed hallucinations
- Spontaneous parkinsonism
features supportive of LBD?
- Falls, syncope, neuroleptic sensitivity - sensitivity to AP , delusions, hallucinations, REM Sleep behaviour disorder - acting out dreams
- Early visuo-spatial difficulties, word finding, attention, judgement, mental flexibility, decision-making, and insight
LBD and AP?
- LBD patients are very sensitive to AP - can die from this
fronto-temporal dementia - language variant can involve?
- Primary Progressive aphasia and semantic dementia
Behavioural variant of FTD?
- Stereotypical, repetitive and compulsive behaviour
- Apathy, withdrawal, self neglect
- Dis-inhibition, impaired judgement e.g. overspending, socially inappropriate, criminal, sexualised behaviours
Behavioural variant of FTD - emotions?
*Emotional blunting, shallow affect - offensive comments to others
Behavioural variant of FTD - Eating?
*Abnormal eating, hyper-orality etc - cramming and bingeing
Behavioural variant of FTD - preservation of?
Relative preservation of memory, visuo spatial functioning in early stages.
what are the 2 language variants of FTD?
- Primary progressive aphasia
- semantic dementia
primary progressive aphasia ?
- reduced speech fluency
- articulation problems
- phenological (organisation of sounds) and syntactical (sentence structure errors)
- preservation of comprehension
semantic dementia?
- preservation of fluency and phonology of speech
- difficulty with naming and comprehension
alcohol related dementia?
- spectrum ranging from amnesic syndrome (Korsakoff’s) to dementia
- may have other signs of chronic alcohol use e.g. peripheral neuropathy, cerebellar ataxia
- can be difficult to distinguish from AD
alcohol related dementia may stabilise with?
- may stabilise and improve with abstinence, good diet and thiamine supplementation especially early on
how is alcohol related dementia diagnosed?
absence of alcohol - 2 months at least
symptoms of alcohol related dementia
Psychosocial management of dementia?
- counselling, education
- Targeting interventions, social stimulation, management of mood etc
- Lifestyle changes
- cognitive stimulation therapy
support for dementia?
- care support and education
- social and home care services
Medical management of dementia ?
- Optimising physical health and medication- including stopping unnecessary medication, eyesight, hearing, mobility etc
- Modification of risk factorse.g. cardio/cerebrovascular
- Lifestyle advice
disease modifying drugs for dementia?
AChIs, memantine
symptomatic Tx in dementia?
antidepressants, anti-psychotics
history taking for dementia?
- Onset and course
- cognitive problems
- impact on daily life, function
- mood, anxiety, personality and behavioural issues
PMH for dementia history?
- Cadiovascular/ cerebro- vascular risk factors
- past head injuries
- falls, alterations in mobility, bladder problems
- Exacerbating factors (eg hypoxia, sleep apnoea etc)
fitness to be prescribed ACh inhibitors is influenced by?
cardiac rhythm, asthma, peptic ulcer, liver problems, bladder outflow problems etc)
amnesic syndrome?
- impairment of recent memory (anterograde amnesia) - loss of memory in new info
- difficulties in learning new material
- disturbance of time sense e.g. chronological sequences
in amnesic syndrome, what is preserved?
- preservation of new info - they can remember info you just give them, may not be able to recall this a few mins later
in amnesic syndrome, there may be?
- may be confabulation - falsification of memory
amnesic syndrome vs dementia?
- other cognitive functions usually well preserved - opposite of dementia
- may also have personality change e.g. apathy
most common cause of amnesic syndrome?
- alcohol -> acute B1 deficiency - Korsakoff’s psychosis is the most common cause
other causes of amnesic syndrome?
- long term heavy drug use
- toxins - lead, mercury, CO, insecticides
- head trauma
- tumours
- stroke and CV disease
- post infection
Delirium/ acute confusional state - clinical picture?
- disturbance of conciousness, cognitive function and perception
- develops over a short time period
- symptoms often fluctuate over time
What is delirium associated with?
- altered sleep wake cycle
- hallucinations, suspciousness or persecutory beliiefs
- motor slowing/ stupor
- withdrawn and quiet presentation
- agitation or restlessness
DSM criteria for delirum ?
- Acute onset and Fluctuating symptoms
- disturbance of consciousness (including inattention)
- at least one of the following:
–disorganized thinking,
–disorientation,
–memory impairment,
–perceptual disturbance, - evidence of a putative causal medical condition (only present in about 50% of cases)
ICD criteria for delirium?
- Impairment of consciousness and attention
- Global disturbance of Cognitive function
- Psychomotor disturbance (Hyper or Hypo-activity)
- Disturbance of sleep wake cycle
- Emotional disturbance
prevalence of delirium?
- most common acute disorder in hospitals
- higher rates in: the elderly, stroke, hip fracture, vascular surgery, critical care
Consequences of delirium?
- inc incidence of dementia
- increased hospital acquired complications - falls, pressure sores etc
- increased mortality - doubles death rates in 65+
ACOVE?
- 30-40% of cases preventable
- Assessing care of vulnerable elders project (ACOVE) - “in top 3 areas most needing improvement”
Who is delirium more likely in?
- increasing age
- dementia
- psych illness
- poly pharmacy
- immobile patients
- those moved to an unfamiliar environment
NICE - at risk groups for delirium?
- 65+
- prev history of cognitive impairment/ suspected cognitive impairment
- current hip fracture
- severe illness
Indicators of delirium - cognitive?
- cognitive function e.g. worsened concentration, slow responses, confusion
indicators of delirium - perception?
- Perception e.g. visual or auditory hallucinations
indicators of delirium - physical function?
- physical function e.g. reduced mobility, reduced movement, restlessness, agitation, changes in appetite, sleep disturbance
Indicators of delirium - social behaviour?
- social behaviour e.g. poor cooperation, withdrawal, or alterations in communication, mood and/or attitude.
clinical asssessment of delirium?
- DSM criteria
- Short Confusion Assessment Method (short CAM)
- Abbreviated mental test scores
Ix of delirium?
- O2 sats
- U+E’s Ca, glucose
- FBC
- ECG
- CXR
- B12/Folate and TFT’s only if chronic
- Additional: LFT’s CSF, EEG and CT head
Delirium vs dementia?
- Delirium – Acute (normally fluctuating) confusional state associated with underlying physical Illness
- Dementia – Progressive, irreversible decline in cognitive function
what can cause delirium - illnesses?
- any acute illness like infection, hypoxia, truama
- renal failure, dehydration, constipation
medications that can cause delirium?
- medications - antidepressants, sedatives, pain killers, antiparkinsons
withdrawl from ? can cause delirium
drugs, including alcohol
pathogenesis of delirium?
- cholinergic deficiency and dopamine excess suspected??
- Cytokines IL1, IL2, IL6, TNF, and interferon alter permeability of blood brain barrier + affect neurotransmission
Delirium - HPA axis
- Stress (2ndy to Illness/trauma) activates HPA axis ncreasing cytokine activity and leading to chronic hypercortisolism (effects hippocampal 5HT receptors)
Management of derlirium ?
- identify and treat underlying cause
- meds and referral to liason service if needed
addressing disorientation in delirium?
- consider use of a side room and avoid room changes
- avoid excessive noise
- provide, clock, calander, and soft lighting
delirium - promoting orientation?
- limiting contact to small group of familar staff
- Introduce cognitively stimulating activities (for example, structured reminiscence) and reorienting communication.
- repeated verbal reminders and facilitate vists from family
- avoid transfers between wards
preventing dehydration/ constipation in delirium?
- oral fluid intake
- offer IV fluids if necessary
preventing immobility in delirium?
- encourage people to walk around and
- mobilise early after surgery
derlium management - agitiation?
- Lorazepam
- Treats agitation but increased risk of confusion/disinhibition/sedation (falls)
AP for delirium?
- For short-term (for 1 week or less) treatment of psychotic symptoms (delusions and hallucinations)
- Atypical (e.g. Quetiapine) preferable to typical (e.g. Haloperidol) bc less side effects
? side effects of AP can increase confusion
Anti-cholinergic side effects
AP - ? side effects can increase risk of falls
- Extra-pyramidal side effects can increase distress and risk of falls
- Sedation can increase risk of falls
which AP should be avoided in suspected dementia/cerebro-vascular Disease delirium?
Olanzapine/Risperidone
restriction of liberty?
Liberty may be RESTRICTED in patients best interests but not DEPRIVED unless DoLS used
other causes of delirium?
- Alzheimer’s disease
- Subdural haematoma
- Metabolic (e.g. diabetic emergencies)
- Hypothermia
- TIA and stroke (e.g. dysphasia presentation)
- Transient global amnesia
delirium - fluctuating confusion?
*If confusion is fluctuating, consider subdural haematoma or dementia with Lewy bodies which may present with fluctuating confusion, hallucinations and extrapyramidal signs.
medications liked to delirium?
- opiates
- anti-arrhythmics like digoxin
- oxybutynin
- bronchodilators (e.g. theophylline)
withdrawal from ? can cause delirium?
- alc
- benzos
- SSRIs
- opiates
delirium - raised MCV can indicate?
may indicate hypothyroidism, vitamin B12/folate deficiency or alcohol misuse.
delirium - CXR to check for?
malignancy
delirium - ECG to check for?
arrhythmia or ischaemia
other Ix for delirium?
- urine culture
- CT/ MRI head
- drug screen and alcohol levels
delirium - ear examination?
Ensure there is no ear wax that may affect hearing. Reduced hearing may exacerbate an acute confusional state.
delirium - CNs?
Check vision and pupil responses. Look out for facial weakness. Check the fundi for papilloedema (raised intracranial pressure).
AD typical presentation?
- The presenting symptom is usually loss of recent memory first, and often difficulty with executive function and/or nominal dysphasia.
- There is also loss of episodic memory — this may include memory loss for recent events, repeated questioning, and difficulty learning new information.
cognitive deficits in AD?
aphasia, apraxia, and agnosia.
VD clinical presentation?
- Stepwise increases in the severity of symptoms — subcortical ischaemic vascular dementia may present insidiously with gait and attention problems and changes in personality.
what else may be present in VD?
- Focal neurological signs (such as hemiparesis or visual field defects) may be present.
Dementia w LB core clinical features?
- Core clinical features are fluctuating cognition; recurrent visual hallucinations; REM sleep behaviour disorder and one or more symptoms of parkinsonism: disorder; bradykinesia, rest tremor, or rigidity.
- Memory impairment may not be apparent in early stages.
FTD clinical picture?
- Personality change and behavioural disturbance (such as apathy or social/sexual disinhibition) may develop insidiously.
- Other cognitive functions (such as memory and perception) may be relatively preserved.
Cognitive problems and dementia assessment tools?
- informant questionnare on cognitive decline in the elderly (IQCODE) or FAQ
Red flags for dementia?
- Falls
- Head injury
- Bereavement
- History of cancer
- Rapidly progressing symptoms
- Severe disability and risk to independence
- Confusional state
- Systemic symptoms such as fever, night sweats or weight loss
features of underlying disease - acute illness?
- Check for symptoms of infection (e.g. chest, urinary tract or gastrointestinal symptoms).
- Chest pain and shortness of breath may be due to cardiac ischaemia.
Features of underlying disease - depression?
- Depression in the elderly may present as memory loss.
- Ask about other symptoms of depression such as tearfulness, irritability, appetite, sleep and diurnal variation of symptoms.
- Assess risk of suicide.
features of underlying disease - alcohol?
recent change in drinking pattern
features of underlying disease - thyroid?
Ask about cold intolerance, tiredness and loss of energy
when are cholinesterase inhibitors CI?
- Vascular problems
- prostatic symptoms
- active peptic ulceration
low levels of what can cause cognitive impairment ?
low sodium and high calcium
what does papilloedema indicate?
raised ICP
what are the dementia screening tools?
- 10 point cognitive screener
- 6 item cognitive impairment test
- 6 item screener
- mini cog
10 point cognitive screener scores?
- 6–7 indicates possible cognitive impairment,
- and 0–5 indicates probable cognitive impairment.
what is ageing assoc w ?
- ageing is associated with geriatric syndromes such as frailty, urinary incontinence, falls, delirium and pressure ulcers.
- As people age, they may experience certain life changes that impact their mental health, such ascoping with a serious illness or losing a loved one.
- this can lead to social isolation
what contributes to MH conditions later in life?
loneliness and social isolation
what else can impact MH of the elderly?
- elder abuse
- many older people care for relatives with chronic health conditions -> affects their mental health
- poor physical health -> stress
impact of physical illness on mental health?
- chronic physical illness leads to stress, worry or anxiety
- low self esteem or stigma
- social isolation or loneliness
- sleep problems e.g. from pain or side effects of medications
impact of disease on family?
- Longer life expectancies, coupled with extended ageing-related illness or disability, can significantly prolong the care phase.
- This, in turn, places significant mental, physical and financial burdens on older people, caregivers and extended family member
? decisions can strain family relationships
end of life
family consequences of illness?
- psychological distress from feelings of helplessness and lack of control
- additional stress and burden of caring for the person
- anxiety about the future
- changes to the family dynamic
non pharm treatments of dementia?
- mild to moderate dementia
- cognitive stumulation therapy
- group reminiscence therapy
- cognitive rehab/ occupational therapy
cognitive stimulation therapy?
range of activities and discussions (usually in a group) that are aimed at general improvement of cognitive and social functioning.
group reminiscence therapy?
thisuses objects from daily life to stimulate memory and enable people to value their experiences
cognitive rehabilitation/ occipational therapy?
the aim is to addresses the disability resulting from the impact of cognitive impairment on everyday functioning and activity by identifying goals that are relevant to the person
drug treatment options for dementia?
- AChE inhibitors
- memantine
AChE examples?
- donepezil
- galantamine
- rivastigmine
AChE inhibitors can be used as a monotherapy for?
managing mild to moderate Alzheimer’s disease.
Memantine?
- NMDA receptor antagonist
Mematine can be used as a monotherapy for managing?
Alzheimer’s disease for people with moderate Alzheimer’s disease who are intolerant of, or have a contraindication to, AChE inhibitors,or for people withsevere Alzheimer’s disease.
Mematine can be used in addition to
AChE in severe alzheimers
first line for mild to moderate dementia w Lewy Bodies?
- Donepezil or rivastigmine are recommended first line.
- Galantamine is an option if donepezil and rivastigmine are not tolerated.
Severe dementia with Lewy bodies - drug Tx?
- Donepezil or rivastigmine are recommended.
Vascular dementia drug treatment?
- AChE inhibitors or memantine are options if the person has suspected comorbid Alzheimer’s disease, Parkinson’s disease dementia, or dementia with Lewy bodies.
management of FTD?
People with frontotemporal dementia should NOT be offered AChE inhibitors or memantine.
AP for dementia?
- for psychotic features
- Risperidone and haloperidol
effects of aging on presentation of mental illness?
- masked by co-morbidities degenerative conditions like dementia may mean that the mental illness may be harder to pick up on as the person won’t be able to report their symptoms
- confusion
FPM in older adults?
- FPM is affected by ageing - oral doses of drugs can have higher circulating drug concentrations
drugs w higher risk of toxic effects bc of age related reductions in FPM?
nitrates,propranolol,phenobarbital, andnifedipine.
deline in renal function in the elderly means?
- renal elimination - GFR decreases
- impacts drugs like diazepam, risperidone, digoxin
the elderly excrete drugs ?
slowly, so are susceptible to nephrotoxic drugs
STOPP criteria
- STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions) aims to reduce the incidence of medicines-related adverse events from potentially inappropriate prescribing and polypharmacy.
START criteria?
- START (Screening Tool to Alert to Right Treatment) can be used to prevent omissions of indicated, appropriate medicines in older patients with specific conditions.
drugs the elderly are more sensitive to?
- the elderly are more sensitive to opiods, benzodiazepines, antipsychotics and antiparkinsonians
- anti-hypertensives and NSAIDs
what are somatisation disorders?
- form of mental illness that causes one or more bodily symptoms, including pain
- causes disproportionate distress
- unexplained symptoms
examples of symptoms seen in somatisation disorders?
- Persistent abdominal pain, headaches, joins pains, etc.
- Poor concentration, dizziness and moodiness
- Continual worry over decreasing physical health
- Onset of an acute flu-like illness or glandular fever
- Complete loss of bodily sensation or movements
- Loss or disturbance of motor function and pseudo-seizures (seizures that do not have the typical features of an epileptic fit and are not accompanied by an abnormal EEG)
symptoms of somatisation disorders usually occur after?
- Symptoms usually occur after a traumatic event and last for a few weeks or months
- Generally occurs more commonly in females than males
- Symptoms usually start in childhood or early adolescence
consider a somatform disorder if:
- there is a time relationship between psycosocial stressors and phsyical symptoms
- nature and severity of the symptom is causing disproportionate handicap
- there is a concurrent psychiatric condition
symptoms common to both depression and dementia
- Apathy
- Loss of interest in activities and hobbies
- Social withdrawal
- Isolation
- Trouble concentrating
- Impaired thinking
depression in alzheimers?
- may be less severe
- may not last as long and symptoms may come and go
- The person with Alzheimer’s may be less likely to talk about or attempt suicide
confidential information must be protected unless?
- unless there is a sig risk to the individual, public or children
- When a significant risk to safety is imminent and not sharing information appears likely to result in death or serious injury, then relevant information can and should be shared with those people for whom consent has been given to share
consent =
- this refers to seeking consent to involve another person (not necessarily a family member unless aged under 18) to share appropriate information about the patient’s general care and ris
- explain to the patient that information sharing deos not ened to take the form of total disclosure
MHA states that (capacity?
- MHA states that a person must be assumed to have capacity unless it’s established that they lack capacity
- However, if a person is at imminent risk of suicide there may well be sufficient doubts about their mental capacity at that time.
- practitioners need to act in the patients best interests - this may involve sharing critical information
Mental capacity act 2005 ?
- a person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain.
MCA - a person is unable to make decisions for himself if he is unable to:
- (a)to understand the information relevant to the decision,
- (b)to retain that information,
- (c)to use or weigh that information as part of the process of making the decision, or
- (d)to communicate his decision (whether by talking, using sign language or any other means).
Effects of dementia on carers?
- guilt - losing temper, not wanting the responsibility, feelimg embarassed about the person’s off behaviour
- grief and loss - loss of the future they planned together
- anger - at the person, having to be a carer, angry at lack of support
- exhaustion
support for carers - carers assessment?
- needs assessment used by the LA to decide which support their eligible to receive
- works out your abilities and how they affect your caring role
- and your needs and which level of support is needed
support for dementia on medical issues?
- GP, social services, occupational therapists to support and advise on medical issues
local support groups for dementia carers?
- local support groups - local Alzheimer’s Society office, Age UK and Carers UK.
online discussion forums for carers?
- online discussion forums - practical suggestions and letting of steam - e.g. Talking Point
therapy for carers?
- talking therapies such as CBT
booklets for carers?
- booklets such as Caring for a person with dementia from alzheimer’s.org.uk for practical support
support that the LA can offer a carer?
- homecare visits
- adaptations to the home
- respite care
- support from professionals, such as a dementia specialist nurse
- support groups
residential homes provide accomodation and personal care such as help w:
- washing
- dressing
- taking medicines
- going to the toilet
nursing homes?
- These also provide personal care but there will always be 1 or more qualified nurses on duty to provide nursing care.
- Some nursing homes offer services for people that may need more care and support.
who are nursing homes for?
- severelearning disabilities, severe physical disabilities or both
- a complex medical condition that needs help from a qualified nurse
NHS LTP for older ppl?
- the NHS long term plan will ensure consistent access to mental health care for older adults with functional needs (i.e. depression, anxiety and severe mental illnesses).
- NHS talking therapies for anxiety and depression which need to meet the needs of older patients
NHS LTP - community based teams
- Community-based mental health crisis response teams will work closely with ‘physical health’/Ageing Well Urgent Community Response services to provide coordinated rapid response, assessment, admission avoidance, and discharge support functions for older people
what are community MH teams?
- support people w mental health problems but also their carers
community MH teams involve?
- a community psychiatric nurse (CPN), a psychologist, an occupational therapist, a counsellor and a community support worker, as well as a social worker.
- one member is appointed as a care coordinator and keeps in contact to help plan care
social/ community care?
- social care is support to carry out day to day tasks
- e.g. managing money or improving relationships
- can be referred or contacted directly
supported housing?
- if the person is finding it difficult to manage in their own home and needs more support
- can be:
- support in their own home
- supported housing and group homes
- short stay supported housing
support in ur own home
floating support?
- benefits
- budgeting
- accessing care, local activities, education, training or advocacy.
- often run by charities
community care or home help?
- social services offer them a home
- care workers might help with things like household tasks, preparing meals and taking medication.
- social services do an assessment on how much help you need
short stay supported houses - crises houses?
- They offer short-term housing and are an alternative to going into hospital
short stay supported houses - hostels?
- short stay hostels offer hosuing for a short time
- usually for people who are homeless with certain needs.
