COMPS: PT Exam & Intervention of Psychosocial Issues Flashcards
It’s getting better all the time:
Happiness, Well-Being INC after 50yo
see pics
Stress
Worry
Anger
Sadness
Happiness
The Reality for Many
Story of Mr. Smith, an 83yo retired salesman in NYC…
Why should we care?
- What are the psychosocial issues experiencing?
- suggestions to help cope?
- How does PT fit into this HC schema??
Depression is NOT Normal Aging
What is it?
Primarily the result of loss of health, as well as cognitive impair, incontinence, chronic cond’s, and personal/emotional loss
Depression is NOT normal aging
Contributing Factors:
- social iso
- substance misuse
- financial insecurity
- depression
- elder abuse
- caregiver burden
- self-neglect
- housing issues
Depression is NOT Normal Aging
W/ contributing factors, and depression:
what happens?
- Pts LESS likely to take meds, obtain necessary tests and proc’s, and access routine and preventative med care
- The course of acute and chronic illnesses can be negatively effected
Depression
aka….
“The common cold of the elderly”
MOST common psychological problem in the elderly is_______
Depression
NIH stats on depression
Of the 35mil Am’s age >65yo→ about 2mil suffer from full blown depression→ nearly 20% of Am’s 65+
*another 5mil suffer from LESS severe forms of depression
Major Depressive Disorder (MDD)
5 or more sx’s present for @ least 2wks:
-
At least ONE of the following:
- Depressed or irritable mood OR loss of interest or pleasure
-
AND the rest from the following:
- Sig wt loss or Dec in appetite
- Insomnia or hypERsomnia
- Psychomotor agitation or retardation
- Fatigue or lack of energy
- Feelings of worthlessness or guilt
- Dec concentration or indecisiveness
- Recurrent thoughts of death or suicide
S/S Depression in Older Adults:
Older adults who deny feeling sad or depressed may still have major depression
Clues:
- Unexplained or aggravated aches and pains
- Hopelessness
- Helplessness
- Anxiety+worries
- Memory probs
- Loss of feelings of pleasure
- Slowed mvmt
- Irritability
- Lack of interest in personal care
- skip meals
- forget meds
- neglect personal hygiene
Depression and Physical Illness:
Factors INC’ing risk of depression in pts w/ phys illness
Biological:
- hormonal, nutritional, endocrine
- meds effects
- phys consequences of systemic or cerebral dis’s
- CVAs
- PD
- DM
- CA
- AD
- MI
Depression and Physical Illness:
Factors INC’ing risk of depression in pts w/ phys illness
Psychological
- Sense of loss assoc’d w/ serious illness
- Effects of body img, self-esteem
- Impaired capacity to work and maint relationships
Depression and Phys Illness
Somatic concerns found in 60% of men and women 60+
What does this entail?
- Exaggerated focus on self and sx magnification replace social interactions
- Can lead to w/draw+social iso.
- Loss of autonomy→ results in phys sx’s in an effort to get attn, signal for help, control others
Pain-Anxiety-Depression Connection
Explain…
People suffering from depression tend to experience more severe and long-lasting pain than other people
The Pain-Anxiety-Depression Connection is particularly evident in pain syndromes such as:
- fibromyalgia
- IBS
- LBP
- HAs
- Nerve pain
Pain-Anxiety-Depression Connection
*Researchers once thought the relationship bw pain, anxiety, and depression resulted mainly from psychological rather than biological factors:
- Chronic pain is depressing, and likewise major depression may feel phys painful
- BUT researchers have learned more about how brain works, how NS interacts w/ other parts of body→ discovered that pain shares bio. mech’s w/ anxiety and depression
Tx When Depression Overlaps Pain
5:
- Relaxation
- Exercise***
- Psychotherapy
- Hypnosis
- Pharmacologic
Tx When Depression Overlaps Pain
Relaxation Training
- Muscle relaxation
- yoga
- mindfulness
Tx When Depression Overlaps Pain
Exercise
- Strong evidence that exercise boosts mood and alleviates anxiety
- Less evidence on impact about pain
Tx When Depression Overlaps Pain
Psychotherapy
- Cognitive Behavior Therapy (CBT)
Tx When Depression Overlaps Pain
Hypnosis
******
Tx When Depression Overlaps Pain
Pharmacologic:
- Dr may prescribe anti-depressants or mood stabs to address BOTH depress and pain
- SNRI’s
- Tricyclic Antidepressants
Depression or Dementia?
see pics
Depression or Dementia?
Sx’s of Depression
*NOTE the key words highlighted
- Mental decline is relatively rapid
- Knows correct time, date, and where he/she is
- Diff concentrating
- Lang and motor skills are slow, but normal
- Notices or worries about memory probs
Depression or Dementia?
Sx’s of Dementia
NOTE key words highlighted
- Mental decline happens slowly
- Confused and disoriented; becomes lost in familiar loc’s
- Diff w/ STM
- Writing, speaking, motor skills are impaired
- Does NOT notice memory probs or seem to care
Depression Scales
Several used to examine depression:
GO TO LINKS PROVIDED!!!
- Geriatric Depression Scale short form:
- extensively used for older adult pop
- geriatrictoolkit.missouri.edu/cog/GDS_SHORT_FORM.PDF
- Beck Depression Scale
- BDI used for 35yrs to ID and assess depressive sx’s→ highly reliable regardless of pop.
- southlakepsych.org/index.htm/Patient_Forms_files/BeckDepressInv.jpg
Whooley Questions for Depression Screening
- A positive test (~95% Sn) IDs pts who may benefit from further eval
- A negative test essentially rules OUT depression
- SnNOUT
- Sn→ great Screening test
- The Whooley Questions (~65% Sp) cannot be used to dx or measure severity of depression
Mgmt of Depression
Create a _________ and provide the pt w/ a sense of _______
Trusting therapeutic relationship; autonomy
- Lessens feelings of despair and helplessness
- Be an active listener, unbiased listener→ allowing for pts to reveal concerns/issues that may affect tx
Mgmt of Depression
INVOLVE THE Pt**
in the exam process, setting goals, creating POC
Mgmt of Depression
Clear and concise explanations of…
Explanations of interventions, proc’s and expected outcomes
Mgmt of Depression
Depressed pts often become ______ in their communication abilities and req assist w/ ______
immobilized; motivation
- Diffs making decisions
- Become overwhelmed
- Extra time given to help them make decisions about their care
Mgmt of Depression
W/ LOW motivation, how can PTs assist?
Assist by providing encouragement, emphasizing pts strengths, offering positive feedback and promoting perceptions of self-worth
Mgmt of Depression
Info about the good prognosis of depression w/ pharmaco. intervention
VERY VALUABLE****
*depends on person
Mgmt of Depression
*Drug tx remains most common approach
5 Categories:
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Hetercyclic Antidepress’s
- Tricyclic Antidepress’s
- Serotonin/NE Reuptake Inhibitors
- Monoamine Oxidase Inhibitors (MAO inhibitors)
Mgmt of Depression
Drug Tx SE’s:
- balance dysf
- OH
- blurred vision
- constipation***
- Urinary retention
- mild tremor***
Mgmt of Depression
This is NOT used as freq’ly as pharmacotherapy and older adults are LESS LIKELY to access it….
Psychotherapy***
Mgmt of Depression
*Pyschotherapy (less accessed by older adults)
What is it?
- Involves counseling that helps people cope w/ depression and reinforces + outlook
3 Professions that can provide psychotherapy
- Psychologist
- Psychiatrist
- Social Worker
Mgmt of Depression
EXERCISE***
- Effective tx for depression
- Bastone and Filho (2004)→ report that ex program produces bennies w/ regard to reduction of deprssive sx’s and prevention of decline in mental status in institutionalized elderly
- Research shows clear relationship bw phys act and Dec lvls of depression******* USE IT!!!!
Ways to assist in prevention of depression:
ALL GIVE PURPOSE***
- Getting out into world
- Connecting to others
- Participating in acts.
- Volunteering
- Caring for a pet
- Learning a new skill
- Enjoying jokes and stories
- Maintaining healthy diet
- Exercising/phys activity****
Bipolar Older Adults
Dx of Mania req’s…..
- Dx of mania req’s a distinct pd of persistently elevated mood lasting for 1 or more weeks
-
Three add. sx’s may include:
- inflated self-esteem or grandiosity
- hyper-sexuality
- incd act.
- dec’d need for sleep
- pressured speech
- racing thoughts or flight of ideas
- distractibility
- Grandiose or paranoid delusions may be present
-
Three add. sx’s may include:
Bipolar Older Adults
Criteria for Dx’ing
- Identical to those for younger adults**
- pds of unusual elevation or irritability in mood that are coupled with inc’s in energy, sleeplessness, fast thinking or speech
Bipolar in Older Adults may also be a __________
Reoccurence or undx’d from younger days
Bipolar in Older Adults may be ______ that presents as ______
Depression that may present as irritability
Stress and the Older Adult
What is Stress?
- Stress response is like an airplane readying for take-off
- All systems are primed all the time
- Heart and blood vessels
- Immune system
- Lungs
- GI
- Sensory organs
- Brain
- ALL modified to meet perceived danger (stuck in fight or flight)
-
Systems effected by stressful situations
- Dec’s efficiency
- Acute (over time) + Long term (chronic)
- Dec’s efficiency
Ability to achieve a _________ after a stressful event becomes more difficult
Relaxation response
*can’t let it go even just “for now”
*talk to them about things but stay productive
What reduces the efficiency of the brains response to stress?
Aging
Older adults are often exposed to major stressors such as:
- med probs
- loss of spouse or friends
- change in living situation
- retirement or financial worries
Determining these in an older adult patient’s life during Hx taking can provide you w/ info that can help you with your _____, ______, ______
Stressors;
Dx, Prognosis, creating POC
Stress and Older Adult
Ex’s of Stressors
- Caregiving
- Loss and grief
- Changing roles as we age
- Ex. move in w/ son/daughter
- Change in social status
Stress and Older Adult
Caregiver Issues:
- Health of caregivers overlooked
- Research has demo’d that over 23% of family caregivers met the req’s for home health services for themselves and that 50% report their own health to be fair or poor
-
Most common self-reported health problem of caregivers:
- depression- 66%
- HTN- 34%
- arthritis- 30%
Stress and Older Adult
Caregiver Issues Stats
- ¼ Am households provide some degree of caregiving
- 7.3mil older adults (65+) need care
- 61% of “intense” family caregivers (providing @least 21hrs care/week) suffer from depression
- some studies say caregiver stress inhibits healing
Stress Scale
- Holmes and Rahe Life Events Scale → widely used tool for eval’ing stress
- purported as an indicator to determine chance of serious illness if high score is rendered
- en.wikipedia.org/wiki/Holmes_and_Rahe_stress_scale
Coping Strategies for Stress and Older Adult
- thinking confidently and optimistically in the face of bad news
- more time doing a few selected activities→ get the most out of them
- participating in family and community activities→ personal satisfaction
- social networks→ emo/phys support
- spiritual or religious involve.
- Positive healthy behaviors
Add. Tx Strategies for Stress and Older Adult
-
Relaxation
- meditate
- progress. relaxation
- guided imager, hypno.
- biofeedback
- breathing tech’s
-
Phys act/exercise
- aerobic
- dancing
- Prioritize stressors
