Older persons Flashcards
Risk factors of OPMH
Issues of retirement – drop in status and finances
Loss of functional capacity
Change in family and friend networks
Deterioration in physical health
Chronic pain
bereavement
Depression in older adults
Depression is the most common mental illness of old age and can have vascular brain changes associated with it. Older people may see the classic signs of depression as part of their physical condition rather that psychological state.
Often less obvious in the older adult. Why is this?
Attribute symptoms of depression to their physical condition (Somatic)
Focus on cognitive impairments i.e. memory loss and concentration difficulties
What are some assessment challenges?
What are some of the assessment challenges when assessing an older adult for depression?
Difficult to distinguish between depression and dementia
Diagnostic overshadowing
Ageism
Cultural issues
What is the most effective treatment of depression?
The most effective treatment is early intervention.
Psychosocial support
Pharmacological support
Suicide in OPMH
Suicide rates for older people are higher than or as high as suicide rates in younger people (Lapierre et al. 2011)
Effective lethal means of suicide increase with age
Never assume that because the older person is hospitalised that they don’t have access to means, it is easy to hoard medication and there is easy access to other objects that the person could use to harm themselves.
Psychopharmacology and Older people
Older adults may be more susceptible to adverse affects
Why?
Degenerative changes that occur in aging affecting absorption, metabolism and excretion of medications
Co-morbid physical conditions
Poly-pharmacy
Blood/brain barrier more easily penetrated
Changes in receptor sensitivity resulting in a greater or lesser than normal drug effect
How can this be addressed?
Collecting a comprehensive drug history
Careful screening prior to commencing medications
Low doses of medication – start low, go slow
Careful monitoring for adverse effects
Early dementia
an unwillingness to try new things/unable to adapt to change,
taking longer to do routine jobs
losing interest in hobbies and activities
being irritable and easily upset
showing poor judgment and making poor decisions
repeating oneself
How might you (as a nurse) support the person and their family at this stage?
Moderate dementia
forgetting to eat and/or neglecting 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 and distressed through frustration
How might you (as a nurse) support the person and their family at each of this stage?
Severe Dementia
an inability to recognise family and friends or even everyday objects
an inability to locate their own room and bed
forgetting about what happened in the last few minutes
incontinence of urine, and later faeces
disturbance at night and restlessness at sundown
How might you (as a nurse) support the person and their family at each of this stage?
Delirium
Delirium is an acute confused state
Delirium results from an underlying physical illness or toxin that causes a disturbance in brain physiology
What are the stages of Dementia?
Early/mild dementia
Moderate dementia
Severe dementia
What are the types of dementia?
Alzheimer’s disease -50-60 %(Depression may be an early symptom)
Vascular dementia -20-30%
What are some causes of dementia?
Parkinson’s
Frontal lobe dementia
Lewy body type
Physical or toxic damage
Genetic disorders (Huntingtons)
Infections (HIV/AIDS)
Vitamin deficiencies
Endocrine disorders
Living with dementia
People gradually loose their ability to solve problems
May get lost and or wander or try to leave the ward
Show poor judgement
Have poor emotional control
Experience personality changes
Show slower responses
Delirium
Delirium is sudden, severe confusion , rapid changes in brain function that occur with physical or mental illness
Delirium is 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.
Sundowning
The term “sundowning” refers to a state of confusion at the end of the day and into the night. Sundowning isn’t a disease, but a symptom that often occurs in people with dementia, such as Alzheimer’s disease. The cause isn’t known. But factors that may aggravate late-day confusion include:
Fatigue
Low lighting
Increased shadows
What are the other types of dementia?
Alcohol related dementia
Korsakoff’s syndrome
Consideration when working with OPMH
Lifespan
Grief and loss
Co morbidities and physical health status
Polypharmacy and medication tolerance
Ageist attitudes
Culture (including increase in Maori and migrant populations)
Dementia treatment
Treatment depends on the symptoms, diagnosis and cause of the dementia. Medication cannot cure dementia or repair brain damage. However, it may improve symptoms or slow down the disease for a short period of time.
Who gets dementia?
The older you are, the greater your chance of getting dementia (though dementia is not a normal part of ageing). Most people are over 65 when diagnosed, although some younger people have early onset dementia.
There are some groups of people who are known to have a higher risk of developing dementia.
Down syndrome or other learning disabilities
Parkinson’s disease
Risk factors for cardiovascular disease (such as angina, heart attack, stroke and peripheral arterial disease)
a history of drinking excess alcohol
a family history of dementia
a history of a head injury
mental health conditions such as schizophrenia or severe depression
low physical activity levels
Dementia management and person centred care
Although there is no cure for dementia, there are a number of treatments, including:
lifestyle changes
cognitive stimulation therapy
treating heart risk factors
Medication (e.g. donepezil)
Mind and memory-based activities.
Person centred care OPMH
Care plans should include information and support for the following:
a driving assessment
arranging enduring power of attorney
writing or updating your will
developing an advance care plan
accessing services to help you stay independent for as long as possible
learning about your condition
Sunflower chart
Wellbeing and contribution/ occupation
Reminiscence and prompts to remind
Environment
Delirium symptoms
Sudden and new symptoms of:
not being aware of the correct time and place
poor concentration and short-term memory
a disturbed sleep-wake cycle, including sleeping in the day
hallucinations (seeing or hearing things that aren’t there) or delusions (false beliefs)
being upset, confused or anxious
being withdrawn and drowsy
an unsteady walk or a tremor
loss of bowel or bladder control.
Delirium causes
*infections, especially, of the bladder (UTI), chest or skin
*medication, especially if several types are being used
*surgery or serious injury, including broken bones
*heavy alcohol use or withdrawal
*strokes
*diabetes that is not well controlled
*heart, kidney or liver failure
*dehydration, lack of sleep or constipation
*unrelieved pain or stress.
What makes delirium worse?
Constipation
Dehydration
Fatigue
Noisy, busy environment
Pain
Poor eyesight or hearing
Poor nutrition intake
Unfamiliar surroundings
Unmet needs
Urinary retention
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
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
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
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
Aphasia
- impairment in transmission of ideas by language in any form
Apraxia
- impaired motor activity
Agnosia
- a failure to recognise objects
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)
