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BNKN601 > Older Persons Mental Health > Flashcards

Older Persons Mental Health Flashcards

1
Q

Why is OPMH important? (Older persons mental health)

A

Because New Zealand has an ageing population for example there are 2x more Maori over 80 years of age. Also MI is likely to increase alongside the presence of age related disabilities.

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2
Q

What factors do we need to consider when working with a OP wt MI?

A

Lifespan, Grief and loss, Comorbidities and physical health status, poly pharmacy and medication tolerance, ageist attitudes, and culture.

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3
Q

Global dementia is forecast to rise dramatically by what year?

A

2050.

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4
Q

What Is dementia?

A

A term used to describe symptoms that occur when there is a decline in brain function. This may include problems with memory, thinking, behaviour and the ability to perform daily tasks. This occurs as a result of damage to brain cells. The symptoms that develop are an indicator of the areas that have been damaged.

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5
Q

Dementia is what?

A

Progressive - meaning the symptoms gradually get worse over time (chronic brain failure)

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6
Q

What is the most common type of dementia?

A

Alzheimer’s disease

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7
Q

What does the treatment of dementia depend on?

A

The symptoms, diagnosis, and cause of their dementia.

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8
Q

Can medication cure dementia?

A

No. However it can improve symptoms or slow the disease down for a short period of time.

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9
Q

Who gets dementia?

A

The older you are, the greater your chance of getting dementia. Most people are over the age of 65 when diagnosed, although there can be a younger onset.

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10
Q

What are some groups of people who are known to have a higher risk of developing dementia?

A

Down syndrome, or other learning disabilities, Parkinson’s disease, those with risk factors for cardiovascular disease, history of drinking excess alcohol, history of dementia, history of head injury, mental health conditions, and low physical activity levels

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11
Q

What are the different stages of dementia?

A

Early, moderate, and advanced

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12
Q

How do we treat/manage dementia?

A

Lifestyle changes, cognitive stimulation therapy, treating heart risk factors, medication (donepezil), and mind/memory-based activities.

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13
Q

Care plans for patients with dementia should include the following:

A

Driving assessments, arranging an enduring power of attorney, updating the ‘will’, developing an advance care plan, assessing services that can keep the patient as independent for as long as possible, education around their condition, and completing the sunflower chart.

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14
Q

What is the sunflower chart?

A

A chart which asks the patient to write their “preferred name” and important information about themselves I.e place of birth, past occupation, pets, favourite music, hobbies ect.

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15
Q

What is delirium?

A

A confused mental state that causes disorientation (confusion). It starts suddenly and can come and go. It is common in older people and people with other health condition.

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16
Q

What are some symptoms of delirium?

A

Quickly changing mental state, problems with attention, awareness, thinking, memory, feelings, or sleep. They may also experience an unsteady walk or tremor, and loss of bladder or bowel control.

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17
Q

What are the risk factors for delirium?

A

Being over 65 years of age, having dementia, a hip fracture or severe illness, and being elderly in hospital.

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18
Q

Is delirium lethal?

A

It can be

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19
Q

Does it matter at what point you get help for delirium?

A

Yes, its better to get help early to limit its longer-term effects.

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20
Q

What are some hyperactive symptoms of delirium?

A

Agitated, hallucination, restless, and aggressive

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21
Q

What are some hypoactive symptoms of delirium?

A

Withdrawn, and mor drowsy

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22
Q

What are some causes of Delirium?

A

Infections (UTI), medications (especially when on multiple), surgery or serious injury, heavy alcohol use or withdrawal, strokes, diabetes (not controlled), heart/kidney/liver failure, dehydration, lack of sleep, constipation and unrelieved pain/stress

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23
Q

What makes delirium worse?

A

Constipation, dehydration, fatigue, noisy/busy environment, pain, poor eyesight or hearing, poor nutritional intake, unmet needs, urinary retention, and unfamiliar surroundings.

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24
Q

What is the most common MI in older people?

A

Depression

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25
Q

What is somatisation?

A

maladaptive functioning of an organ system, without underlying tissue or organ damage, or where the symptoms are disproportionate to the underlying structural cause.

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26
Q

What is diagnostic overshadowing?

A

when a health professional makes the assumption that the behaviour of a person with learning disabilities is part of their disability without exploring other factors such as biological determinants.

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27
Q

Why may depression may be missed? (Missed diagnostic)

A

Due to diagnostic overshadowing and somatisation

28
Q

What is Carer fatigue?

A

Where primary caregivers for a family member with dementia have experiences recent suicidal ideation or low mood due to fatigue of care. This is one of the main reasons people enter aged care facilities.

29
Q

What are some risk factors for older persons mental illness

A

Issues with retirement, loss of functioning, change in family/friends, deterioration in physical health, chronic pain, and bereavement.

30
Q

Why is depression less obvious in older people?

A

Because symptoms of depression can also be attributed to their physical condition.

31
Q

What are some assessment challenges when working with an OP and trying to assess depression

A

Difficult to distinguish between depression and dementia, diagnostic overshadowing, ageism, and cultural issues.

32
Q

What is the most effective treatment for depression in OP

A

Early intervention

33
Q

How do we treat depression in OP

A

Psychosocial support and pharmacological support

34
Q

Why are OP more susceptible to adverse affects from medications?

A

Degenerative changes that occur in aging affect absorption, metabolism and excretion of medications, co-morbid physical conditions can impact, the blood/brain barrier is more easily penetrated, and there is a change in receptor sensitivity in OP

35
Q

How do we address psychopharmacology with OP due to higher chances of adverse effects?

A

Collecting comprehensive drug history, careful screening prior to commencing medications, start low go slow, careful monitoring.

36
Q

What are some signs of early dementia?

A

Unwillingness to try new things/unable to adapt to change.
Taking longer to do usual activities,
Losing interest in hobbies/activities
Being irritable or easily upset,
Poor judgement, and making poor decisions
Repeating one’s self

37
Q

What are some signs and symptoms of moderate dementia?

A

Forgetting to eat
Poor ADLs
Delusions
Easily lost
Forgetting recent events or names of family members
Easily upset or distressed through frustration

38
Q

What are some signs and symptoms of severe dementia?

A

Inability to recognise family/friends/everyday objects
Inability to locate room and bed
Forgetting last few minutes
Incontinence of urine and later on faeces
Disturbance at night and restlessness at sundown

39
Q

Delirium is an acute what?

A

An acute confusional state

40
Q

What is acute confusion?

A

An abrupt change in mental state and ADL function

41
Q

What do we mean by inattention in delirium?

A

Difficulty focusing, sustaining, or shifting attention

42
Q

What is disorganised thinking?

A

Rambling, incoherent or illogical speech, delusions

43
Q

What are some psychomotor changes?

A

Agitation or retardation

44
Q

What are some emotional changes?

A

Anxiety, tearfulness, anger, blunting

45
Q

What impact does the diagnosis of Delirium have?

A 
Increased mortality rate. 
Prolonged hospital stay
Increased care needed
Increased caregiver burden 
Increase risk of developing permanent cognitive change
46
Q

Is confusion in old age normal?

A

NO

47
Q

What are 3 key questions to ask regarding confusion in old age?

A

When did it start? How were they functioning before the current illness? And how did the current illness progress?

48
Q

What strategies can help manage carer stress/fatigue?

A

Participation in well-being I.e stretching and relaxing, meditating, taking time for self, recognising symptoms, consider own needs carefully.

49
Q

What are some symptoms of carer stress/fatigue

A

Disrupted sleep/eating, increased consumption of sugar, alcohol/drug use, increased smoking, back pain, irritability, fear or anxiety, Im patients, inability to handle problem or emergency, overreacting to criticism, overreacting with anger, feeling hopeless, feeling trapped, lack of compassion, emotional withdrawn ect.

50
Q

What are some common medical conditions associated with depression?

A

Parkinson’s disease, stroke, heart disease, cancer, diabetes, thyroid disorders, Vitamin B12 deficiency, dementia, and multiple sclerosis.

51
Q

What are some psychological risk factors for depression in OP

A

Grief/loss, isolation, and stigma

52
Q

What are some assessment tools used for delirium

A

Delirium rating scale, confusion assessment methods for the ICU, mini-mental state examination

53
Q

What are some management ideas for delirium?

A

Prevent complications, normalise sleep patterns, relaxation techniques, education, encourage mobility, antipsychotic medications, vision/hearing aids, good communication, involving family and carer in care, good hydration, ensure pain relief ect.

54
Q

What is the pathophysiology of Alzheimer’s disease.

A

Neurofibrillary tangles and senile plaques.

55
Q

What is Aphasia?

A

Aphasia is a condition that affects your ability to communicate. It can affect your speech, as well as the way you write and understand both spoken and written language.

56
Q

What is Apraxia?

A

Apraxia of speech (AOS) is a neurological disorder that affects the brain pathways involved in producing speech.

57
Q

What is agnosia?

A

Loss of the ability to identify objects or people.

58
Q

What is sundowning?

A

What is sundowning? People with dementia may become more confused, restless or insecure late in the afternoon or early evening

59
Q

What Is the onset and duration for Dementia?

A

Slow deterioration over time - months to years

60
Q

What is the onset and duration of delirium?

A

Sudden onset - hours or days

61
Q

What is the onset and duration for depression?

A

Mood changes over 2 weeks, that may coincide with a life event or change

62
Q

What is the course of dementia?

A

Slow and progressive cognitive decline that is non-reversible

63
Q

What is the course of delirium?

A

Sudden, short, fluctuation reversible with underlying cause

64
Q

What is the course of depression?

A

Diurnal - fluctuations that can be worse of a morning or evening reversible with treatment.

65
Q

What are the signs and symptoms of dementia?

A

Wandering, agitation, sleep disturbance, fluctuations in behaviour during the day, generally alert, depression may present, difficulty with word recall.

66
Q

What are the signs and symptoms of delirium?

A

Restless and uneasy with fluctuations in agitation, restlessness and hallucinations, impaired attention, mood changes from anger, tearful outbursts, fear, disorganised thinking

67
Q

What are the signs and symptoms of depression?

A

Withdrawal, apathetic feelings of hopelessness. Persistent feelings of sadness, Loss of interest, irritable mood.

BNKN601 (31 decks)

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