Mental disorders of older age

Question 1

Why do older people have a higher risk of developing mental illnesses.

Answer 1

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

Question 2

The presentation of depression in older people is often less obvious, why?

Answer 2

Difficulty in distinguishing between dementia and depression, diagnostic overshadowing, different language, psychosomatic presentation.

Question 3

Should we assess older people for the risk of suicide?

Answer 3

the rate of suicide is high and tends to be more fatal, lethal, all talk about suicide is a must

Question 4

Dementia

Answer 4

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

Question 5

Delirium

Answer 5

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.

Question 6

Depression

Answer 6

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

Question 7

Delirium definition/ difference from dementia

Answer 7

• 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

Question 8

What are risk factors for delirium, why are older people more at risk ?

Answer 8

diagnostic overshadowing, physical causes goes untreated, agitation, restlessness, vulnerability, falls risk, older people are more at risk due to dehydration and developing UTI’s

Question 9

What is the primary goal in the nursing management of delirium?

Answer 9

treat the underlying cause, prevention measures, management; keep people safe, support therapy though reassurance, fluid and nutrition, memory cues, pharmacology

Question 10

Dementia; clinical features

Answer 10

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

Question 11

Aphasia

Answer 11

• impairment in transmission of ideas by language in any form

Question 12

Apraxia

Answer 12

• impaired motor activity

Question 13

Agnosia

Answer 13

• a failure to recognise objects

Question 14

Sun Downing

Answer 14

an increase in behaviour problems occurring late in the afternoon evening and night (possibly attribute to changes in hormones melatonin and light)

Question 15

stages of dementia

Answer 15

stage one: early/mid dementia
stage two: moderate dementia
stage three: severe dementia

Question 16

Stage one: early/mid dementia

Answer 16

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

Question 17

Stage two: moderate dementia

Answer 17

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

Question 18

stage three: severe dementia

Answer 18

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

Question 19

types of dementia

Answer 19

• Alzheimer’s disease - 20-60% (depression may be an early symptom
• Vascular dementia - 20-30%

Question 20

Other causes for dementia

Answer 20

• 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

Question 21

Delirium definition

Answer 21

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

Question 22

Delirium symptoms

Answer 22

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

Question 23

Ageism

Answer 23

• 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

Question 24

Confusion

Answer 24

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?