Chapter 9 Pt 2 Flashcards
what is the most common psychiatric disorder in the elderly
major depressive disorder
who has the highest rate of completed suicide
white elderly males
what kind of symptoms are common inpatients with major neurocognitive disorder, as well as often the source of many psychosocial problems surrounding their care
behavioral symptoms
agitaiton and aggression can be distressing and dangerous for caregivers
describe mood disorders in major neurocognitive diserder
difficult to diagnose
patients may display symptoms of depression that are merely natural manifestation of their disease
mood and affect are often poor diagnostic indicators in patients with moderate-to-severe cognitive impairment
describe aggression in major neurocognitive disorders
may be provoked by the patients confusion in the setting of cognitive, memory, and language defects
may be provoked by hallucinations
describe psychosis in major neurocongitive disorders
delusions reported in up to 50% of Alzheimers
hallucinations (auditory and visual mostly) in lat least 25% of patients with major neurocognitive
if hallucinations not bothersome, pharmacotherapy unnecessary
how are the psychiatric manifestations of major neurocongitive disorders treated
behavior and environmental treatments for behavioral symptoms preferred
what are non-pharmacological treatments for the psychiatric manifestations of major neurocongitive disorders
music, art, exercise, and pet therapy
strict daily schedules to minimize changes in routine
continual reorientation of patient
reduce stimuli (quiet living environment)
surround patient with familiar objects (family photos, a favorite quilt)
what are pharmacological treatments for the psychiatric manifestations of major neurocongitive disorders
antipsychotics
- limited efficacy and increase mortality
- try olanzapine or quietiapine
- short term halloo of Risperdal work too
anxiolytics:
- SSRIs treat anxiety due to unrecognized depression well
- benzos should only be used very short-term, acute episodes
what happens to incidence of sleep disturbance with age
increases
reported as: difficulty sleeping, daytime drowsiness, and daytime napping
what are some normal age related changes in sleep
decreased REM latency and total REM
increase in stage 1 and 2 sleep, decrease stages 3 and 4 (deep sleep)
frequent nocturnal waking (decreased sleep efficiency)
decrease in total amount of sleep
sleep cycle advances (earlier to bed, earlier to rise)
what are some causes of sleep disturbances outside of normal aging
other medical conditions
drug/alcohol use
social stressors
medications
what is sleep like in patients with movement disorders
shallow
may be more restless at night because of trouble turning in bed
RLS moments in sleep are likely due to what and called what
called Periodic Leg Movement s(PMLs)
likely due to dopamine imbalance
sedative-hypnotic drugs are more likely to do what in elderly
side effects (memory impairment, ataxia, paradoxical excitement, rebound insomnia)
what medication is safer in elderly for sedation than benzos
trazodone (watch for orthostasis)
how should restraints be used in the elderly
used as last resort
reassessed at regular intervals
patient safety, health, and well-being should be most important concern
why do elderly suffer from more side effects of medications
less lean body mass and impaired liver and kidney function
when confronted with a new symptom in elderly patient on many medications what should one try and do
remove a medication before adding one
what are the types of elder abuse
physical psychological (treats, insults) neglect (withholding of care) exploitation (misuse of finances) sexual, rarely
elder abuse occurs in approximately what percentage of those over 65
10%
perpetrator of elder abuse is usually whom
caregiver (spouse or adult child) who lives with victim
nursing homes provide care and rehabilitation for whom
chronically ill and impaired patients as well as patients who are in need of short-term care before returning to their prior living arrangement
major of patients stay permanently, and fewer than half are discharged after only a short period of time
