Older Persons Mental Health Flashcards
What cognitive assessments are used for dementia?
- Folstein Mini-Mental State Examination (MMSE)
- The Abbreviated Mental Test (AMT)
- The Addenbrooke’s Cognitive Examination (ACE)
- General Practitioner Assessment of Cognition (GPCOG)
- The Montreal Cognitive Assessment (MOCA)
What cognitive assessments are used for delirium?
- Abbreviated Mental Test (AMT)
- Confusion Assessment Method (CAM)
- Mini-Mental State Examination (MMSE)
Briefly differentiate between delirium and dementia
Note: sleep wake cycle, attention, arousal, autonomic features, duration, delusions, course, consciousness level, hallucinations, onset and psychomotor activity
Briefly describe the epidemiology of delirium
Delirium occurs in about 15– 20% of all general admissions to hospital.
Delirium is the most common complication of hospitalisation in the elderly population.
Up to two-thirds of delirium cases occur in inpatients with pre-existing dementia.
15% of >65 s are delirious on admission to hospital.
Briefly describe the epidemiology of dementia
There are currently 800 000 people with dementia in the UK and it is estimated that there will be over one million by 2021.
Dementia increases with age (rare if <55 years; 5– 10% if >65 years ; and 20% if >80 years ).
Overall prevalence is similar in ♂ and ♀, but AD is more common in ♀, whereas vascular and mixed dementias are more common in ♂.
What are the clinical features of delirium?
What are the clinical features of dementia?
Briefly describe the causes of delirium
Briefly describe the causes of dementia
What physical changes occur to the brain as age increases?
The following changes occur in brain as a part of normal ageing:
- The weight of the brain decreased by 5-20% between 70 and 90 years with a compensatory increase in ventricular size
- There is neuronal loss, especially in the hippocampus, cortex, substantia nigra and cerebellum
- Senile plaques are found in the neocortex, amygdala and hippocampus
- Tau proteins form neurofibrillary tangles, found normally only in the hippocampus
- Lewy bodies are seen in the substantia nigra
- Ischaemic lesions are seen in 50% of normal people over the age of 65
What psychological changes occur as age increases?
From mid life there is a decile in intellectual functions, as measursed with standard intelligence tests, together with deterioration of short-term memory and slowness. IQ peaks ar 25 years, remains stable until 60-70 years and then deciles. Problem solving reduces after about age 60.
There may be changes in personality and attitudes, such as increasing cautiousness, rigidity and ‘disengagement’ from the outside world.
What social changes occur as age increases?
Later life presents a serious of major changes. Many indiviudals retire, lose partners, lose their physical health and are forced to live on much lower incomes and in poorer-quality housing than younger people.
These are difficult transitions which may predispose to mental illness. The majority of older people remain living at home: 50% with a partner and 10% with other family members. Those who live alone may become isolated and lonely.
Briefly describe the epidemiology of psychiatric conditions as age increases
The greatest budern of diease is in 2 areas:
- Mood and anxiety disorders
- Cognitive impairment
What types of mental disorders are seen in older patients?
Many of the same disorders affect older people as affect younger people. They can be subdivided into 3 types:
- Pre-existing problems that continue to older age
- New diagnoses after the age of 65
- Mental health disorders associated with ageing
Common diagnoses include:
- Dementia
- Delirium
- Mood disorders
- Anxiety disorders
- Psychoses, schizophrenia and delusional disorder
- Suicide and deliberate self-harm (DSH)
- Alcohol and substance misuse
The assessment of older people presenting with a psychiatric problem is fundamentally the same as in the younger population. However, what factors need extra consideration?
- Is this an episode of a recurrent problem or a new diagnosis?
- Are the symptoms being caused by mentall illness or could it be organic pathology (e.g. brain tumour or dementia)?
- What physical illnesses does this patient have and do these complicate the situation?
- What is the patient’s living situation and what is their level of function in activities of daily living?
Who is involved in the MDT when assessing an older person’s mental health?
The assessment should be taken by a MDT team including psychiatrist, psychologist, occupational therapist, physiotherapist and social worker.
What parameters need to be included when assessing an older person’s mental health?
A full assessment will include:
- Full history from the patient, family and involved professionals
- Full physical and neurological examination
- Full cognitive assessment (including a MMSE)
- Functional assessment (activities of daily living and mobilisation)
- Social assessment (housing, finances and activities)
- Assessment of carers’ needs
What specific information needs to be obtained during the history/ assessment of an older person?
- Timing of onset of symptoms and their subsequent course
- Previous similar episodes
- A description of behaviour over a typical 24 hours
- Previous medical and psychiatric history (including intellectual ability and personality characteristics
- Accurate drug history
- Family history of psychiatric problems
- Living conditions
- Ability for self-care, shopping, cooking and laundry
- Ability to manage finances and deal with hazards e.g. fire
- Any behaviour that may cause difficulties for carers of neighbours
- The ability of family and friends to help
- Other services already involved in the patient’s care
Briefly recap the features of a mental state examination (MSE
Note: NOT mini mental state examination (MMSE)
- Appearance and behaviour
- Speech
- Mood
- Thoughts
- Perception
- Cognition
- Insight
Briefly describe the appearance and behaviour (MSE) of an older patient presenting with mental health problems
Observation of the patient’s clothin, personla cleanliness and home environment provides valuable information. Looks for signs that suggest these are chronic problems rather than acute illness.
Agitation and psychomotor retardation may be obvious.
Wandering, incontinence and disorientation may point to dementia.
Briefly describe the speech (MSE) of an older patient presenting with mental health problems
Dysphagia is frequently seen in moderate to advanced dementia, or after a stroke.
In delirium, dementia or alcohol excess, speech may be inappropriate.
Lack of speech may suggest depression and excessive quantities of rapid speech may suggest mania.
Briefly describe the mood (MSE) of an older patient presenting with mental health problems
Older people may not admit to low mood, sadness or depression. Anhedonia, fatigue, weight loss, anorexia and insomnia are common.
Suicidal ideation and passitve death with are more common in older than in younger adults.
Florid mania is rare, but present as in younger patients.
Briefly describe the thoughts (MSE) of an older patient presenting with mental health problems
There are no specific differences in older people.
Anxiety is very common.
Delusions are seen in depression, delusional disorder, delirium and dementia.
Briefly describe the perception (MSE) of an older patient presenting with mental health problems
Hallucinations are common in dementia and delirium, but also in pre-existing or late-onset psychoses.
Visual hallucinations are particularly associated with delirium and alcohol withdrawal.
