Mental disorders of older age Flashcards
Why do older people have a higher risk of developing mental illnesses.
depression is commonly associated with later life, medical complication such as stroke, cancer IM ect.psychological factors such as bereavement, retirement, loss, decrease in activity also increases the risk
The presentation of depression in older people is often less obvious, why?
Difficulty in distinguishing between dementia and depression, diagnostic overshadowing, different language, psychosomatic presentation.
Should we assess older people for the risk of suicide?
the rate of suicide is high and tends to be more fatal, lethal, all talk about suicide is a must
Dementia
Onset- Chronic
Course- slow, progressive, cognitive decline, may be worse in evening
Duration- months to years
signs and symptoms- conscious, sleep disturbance is not usually a feature, but sleep wake cycle may be set at the wrong time frame, behaviour tend to be worse in evening, aimless wandering or searching, hallucinations are rare, mood maybe flat or labile
Delirium
Onset- rapid, hours or days
Course- short, active during the day, fluctuating
Duration- hours to days
Signs and symptoms- clouding of consciousness, sleep disturbance, fluctuation thought the day, restless and uneasy, visual hallucination that are disturbing, emotional lability and distress.
Depression
Onset- often abrupt and coincides with stress/loss
Course- function worse in morning
Duration- six weeks to year
Signs and symptoms- conscious, sleep-wake disturbances, selective disorientation, slowed up, delusions/ hallucination rare, sad and feeling hopeless and worthlessness
Delirium definition/ difference from dementia
- delirium is defined as an acutely disturbed state of mind characterised by restlessness, illusions, incoherence, intoxication, fever and other disorders.
- transient, usually reversible, a syndrome that constitutes a characteristic pattern, signs and symptoms, causes rapid damage to brain
What are risk factors for delirium, why are older people more at risk ?
diagnostic overshadowing, physical causes goes untreated, agitation, restlessness, vulnerability, falls risk, older people are more at risk due to dehydration and developing UTI’s
What is the primary goal in the nursing management of delirium?
treat the underlying cause, prevention measures, management; keep people safe, support therapy though reassurance, fluid and nutrition, memory cues, pharmacology
Dementia; clinical features
significant and progressive, changes in cognition domains, complex attention, executive function, learning and memory, language, perception, motor function, social cognition, these must have a significant impact upon ability to perform ADL’s
Aphasia
- impairment in transmission of ideas by language in any form
Apraxia
- impaired motor activity
Agnosia
- a failure to recognise objects
Sun Downing
an increase in behaviour problems occurring late in the afternoon evening and night (possibly attribute to changes in hormones melatonin and light)
stages of dementia
stage one: early/mid dementia
stage two: moderate dementia
stage three: severe dementia
Stage one: early/mid dementia
the start of dementia is very gradual and often this stage of dementia is only apparent when looking back. At time it may be missed or put down to “old age” or work pressure
Symptoms:
- an unwillingness to try new things/ unable to adapt to change
- taking longer to do a routine job
- losing interest in hobbies and activities
- being irritable and easily upset
- showing poor judgement and making poor decisions
- repeating oneself
Stage two: moderate dementia
when the dementia is moderate independent living can be risky and some supervision is usually required
symptoms:
- forgetting to eat/ and or neglect personal hygiene
- seeing or hearing things which are not there
- becoming easily lost if away from familiar environments
- forgetting about recent events or the names of family and friends
- becoming very easily upset
stage three: severe dementia
by the time a person reaches the severe stage of dementia they need continual supervision, and will often need the specialist care of a dementia unit. The person will need help to shower and get to the toilet and their speech may deteriorate to the point where they can no longer be understood
symptoms:
- an inability to recognise family and friends or even everyday objects
- an inability to locate their own room or bed
- forgetting about what happened in the last few minutes
- incontinence of urine and later feaces
- disturbance at night and restless at sundown
types of dementia
- Alzheimer’s disease - 20-60% (depression may be an early symptom
- Vascular dementia - 20-30%
Other causes for dementia
- parkinsons
- frontal lobe dementia
- lewy body type
- physical or toxic damage
- genetic disorders (huntingtons)
- infections (HIV/ AIDS)
- vitamin deficiencies
- endocrine disorders
IS NOT A NORMAL PART OF AGING
Delirium definition
is a sudden, severe confusion, rapid changes in brain function that occurs with physical or mental illness
- most often caused by physical or mental illness and is usually temporary and reversible. Many disorders cause delirium, including, conditions that deprive the brain of oxygen or other substances
Delirium symptoms
delirium involves quick changes between mental state
- disrupted or wandering attention
- disorganised thinking
- emotional or personality changes
- incontinence
- movement triggered by changes in the nervous system
Ageism
- relationship to cultural safety
- people can be misdiagnosed because an assumption is made that the person is dementing simply because they are 72
- delirium could be misdiagnosed for dementia
- cultural safety tells us to never assume. get a history from the family. Was the change rapid or slow. could there be a UTI? how were they functioning last week
Confusion
care for the confused client/ service user
- describing the behaviour
- it is important to describe what you are seeing that suggests that the person is confused
- vague statements such as “appears confused today” are of no use to the IDT
- what was the indication that they were confused/ what did the person say? what do the family think?
