MH in the later years

Question 1

Delirium

Answer 1

sudden deterioration in mental functioning in response to an underlying medical cause

Question 2

restraints

Answer 2

Physical restraints have been used on older people with a dementing or mental illness who are considered to be in danger of falling or wandering.
Regardless of the age of the consumer, restraints should be used to manage physical behaviour only as a last resort

Question 3

HPs and older people

Answer 3

• the older person can be easily excluded from discussions about health care resource allocation, policy initiatives and even their own treatment regimes
• see and understand the older person in context. That is, the health professional is encouraged to view the person in terms of their emotional, psychological, physical, sexual and spiritual totality, rather than see them simply as an illness
- do not pathologise ageing, and treat MIs as an inevitable consequence of ageing

Question 4

ageism

Answer 4

discrimination based on a persons age

belief that older people are frail and a burden on economic resources

Question 5

cognitive assessments

Answer 5

Mini mental state exam
addenbrookes cognitive examination
mental state exam

Question 6

Mini mental state exam

Answer 6

 quick and effective pencil‐and‐paper test that provides a reliable instrument for dementia screening and identifying delirium in the older person). It includes asking the person to count backwards by 7s from 100, to identifying common objects (e.g. a pen, a watch), to spelling simple words backwards, to writing a sentence, and to demonstrate that they are oriented to day, month and year, as well as town and country

Question 7

Addenbrooke’s cognitive examination (ACE)

Answer 7

 early stages of dementia, and capable of differentiating subtypes of dementia including Alzheimer’s disease, frontotemporal dementia, progressive supranuclear palsy and other parkinsonian syndromes’
 used to identify frontotemporal dementia;
 may take up to half an hour to administer

Question 8

Mental state exam (MSE)

Answer 8

 subjective assessment of the person’s mental state and allows the skilled health professional to make judgements about a person’s appearance, behaviour, mood, affect, speech, cognitions, thought patterns and level of consciousness, largely through a face‐to‐face conversation with the person

Question 9

dementia

Answer 9

• a chronic and progressive cognitive decline that involves disturbances of brain function such as memory, thinking, comprehension, abstract thought, language and judgement

Question 10

assessment of dementia

Answer 10

o formal diagnosis of dementia is typically performed by a specialist such as a psychiatrist, geriatrician or psycho-geriatrician. But that does not mean that other health professionals have no role to play.
o when dementia is suspected, it is important for the person to be seen by a specialist to rule out other possible causes of the presentation
o formal process of diagnosing dementia may include the use of scans or pencil‐and‐paper tests such as the MMSE and ACE

Question 11

challenging behaviours and medication… why is it an issue?

Answer 11

Challenging behaviours tend to be responded to by giving the person anti-psychotic medications.
o This is an issue because:
 antipsychotics do not change the dementia‐related behaviours of the person in any meaningful way
 introduction of antipsychotics can result in a whole variety of new behaviours that emerge as part of adverse reactions and side effects

Question 12

why is depression difficult to identify in an older person?

Answer 12

may be because the older person has little understanding of depression, or may see it as a weakness or a moral failure rather than a treatable condition.

Question 13

symptoms of depression in older people

Answer 13

o somatic complaints, aches and pains, reports of feeling unwell
o difficulty with memory and concentration
o lack of energy, but may feel restless, anxious and irritable
o sleep disturbance
o loss of appetite
o a tendency to ruminate and worry

Question 14

Assessment of depression in older people

Answer 14

o Geriatric Depression Scale (GDS)

o Cornell scale for depression in dementia (CSDD)

Question 15

Geriatric Depression Scale

Answer 15

 requires only a ‘yes’ or ‘no’ response
 It can also begin a discussion between the health professional and the older person and in this way break down the barriers between both

Question 16

Cornell scale for depression in dementia (CSDD)

Answer 16

 designed for the assessment of depression in older people with dementia who are able to communicate their basic needs. The tool differentiates between the diagnostic categories and severity of depression

Question 17

delirium

Answer 17

o sudden deterioration in mental functioning in response to an underlying medical cause

Question 18

assessment of delirium

Answer 18

 formal diagnosis of a delirium is made by the medical specialist and is based on the results of a variety of assessments
 the most effective way of identifying a delirium is through observing a change in the person’s behaviour
 any change in the person’s usual behaviour must alert the health professional to the possibility that a delirium may be present
 there are also a number of practical tests the health professional can perform to make a reasonable judgement about the presence of delirium
 MMSE

Question 19

symptoms of delirium

Answer 19

 Acute onset and fluctuating presentation.
 Determine if there is a brief or severe change in mental status.
 Inattention.
 Assess whether the individual has trouble focusing and keeping track of the conversation.
 Disorganised thinking.
 Are they incoherent, unpredictable and struggling to form logical thoughts?
 Altered level of consciousness.
 Determine if the person is drowsy but easily aroused (lethargic), difficult to arouse (stuporous), unable to be aroused (comatose) or overly alert (hypervigilant).
 impaired attention
 increased distractibility
 thinking that is muddled, chaotic and confused

Question 20

types of delirium

Answer 20

hyperactive (agitated, over-active, aggressive, loud, chaotic)
Hypoactive (withdrawn, isolative, quiet, little motor activity)

Question 21

risk factors for delirium

Answer 21

	Infections
	Medications
	Trauma
	Disorders of heart and lungs
	Dehydration and constipation

Question 22

how to respond to delirium

Answer 22

hydration, reassure, support them be compassionate, ensure compliance with prescribed medical treatment as it may be life threatening