Late Adult I Flashcards
What are the three Ds?
delirium, dementia, depression
What is the condition of dementia defined as?
Development of multiple cognitive deficits manifest by both
1) memory impairment
2 one or more of aphasia, apraxia, agnosia, disturbance in executive functioning
must be severe enough to cause impairment in social or occupational functioning
What type of memory loss is affected first by dementia?
STM before LTM
Define aphasia.
Impaired ability to communicate through oral or written language
Define apraxia.
Impaired ability to execute motor functions despite motor abilities and sensory function
Define agnosia.
loss of ability to recognize persons or things
- may not associate objects with purpose
explain what executive functioning means.
planning, organizing, higher level functions and complex behaviours. Judgement
What are the 4 different types of dementia with there percentage of prevalence within dementia cases?
Alzheimer’s disease 60%
Vascular dementia 20%
- associated with a CVA
Lewy Body dementia 5-15%
- characterized by fluctuating cognition and vivid hallucinations
Frontotemporal dementia 2-5%
- personality changes, rapid onset, self-stimulating behaviours are common
What percentage of AD patients suffer from delusions, depression/anxiety, and hallucinations?
Delusions: 50%
Depression/anxiety: 40%
Hallucinations: 25%
What behavioural disturbances may be associated with dementia?
self-destructive behaviour
non-compliance
dependency
aggression
impulsiveness
hiding/hoarding
What are some tests that are done in order to help determine if someone suffers from dementia?
MMSE
CT/MRI
psychiatric/psychological evaluations
Medical hx
physical exam
lab tests
ruling out other causes
can be confirmed on autopsy
Describe the progression of dementia
EARLY STAGE (2-4 yrs) STML, denial, confusion, difficulty with ADLs, withdrawal. Stage where family becomes aware and seeks help
MIDDLE STAGE (several years)
- significant impairment of ADLs
- dec language skills, reasoning and planning
- disinhibition and aggression
- may be admitted to residential care
LATE STAGE (1-2 yrs)
- dec engagement with environment, motor skills, and speech
- dependent with ADLs
What are the aspects of care given to manage dementia?
- multidisciplinary
- psychological
- social
- medication
- care of primary caregiver (respite)
- psychosocial health promotion
Describe what Delirium is.
syndrome characterized by SUDDEN ONSET, altered behaviour and mental status
can be a transient state
symptoms often fluctuate
List some symptoms of delirium
- difficulty with attention
- disoriented
- sensory disturbances (hallucinations)
- sleep-wake disturbances
- changes in psychomotor activity
- anxiety, fear, irritability, euphoria, apathy
What are the three types of changes in consciousness in delirum?
HYPERACTIVE: agitation, constant motion, repetitive movements
HYPOACTIVE: inactive, withdrawn, dec motor and verbal responses
MIXED: fluctuation
What are the risk factors for delirium?
- dementia
- > 75 yrs old
- polypharmacy
- hx of delirium
- chronic illnesses
- recovery from surgery
What are some common causes of delirium?
- drug toxicity
- infection
- pain
- dehydration
- acute illness
- substance abuse
- psychosocial problems
What interventions may be taken to help care for delirium pts?
- interdisciplinary planning
- promoting comfort and familiar environment
- maintaining routine
- promote normal sleep schedule
- promote hydration
- AVOID restraints
- support/educate family
What conditions must be met to be diagnosed with depression?
- at least 2 wks of depressed mood or loss of interest/pleasure
- change in appetite, weight, sleep, activity
- feelings of worthlessness and guilt
- difficulty thinking
- recurrent thoughts of death, suicidal ideation
- dec in social, occupational functioning
describe the prevalence percentage of depression within the populations in the community, in acute care, and in residential care of those age >65 yrs.
Community 15-20%
acute care 21%
residential care 40%
list some risk factors for depression
> 60 yrs
previous depression
medical illness
chronic pain
substance abuse
lack of social support
stressful events
what interventions might be taken in cases of depression?
improve sleep patterns
encourage independence for personal care
encourage social activity
encourage verbalizing anxiety/sadness
find hope for the future
pet therapy
pharmacological support
What is important to do as a nurse when caring for cognitive impairments?
be comprehensive
- recognize signs of depression
- distinguish between dementia and delirium
- consider co-morbidities
