Older Persons Mental Health Flashcards
How would you take a history from someone with cognitive impairment?
Presenting Complaint
-Tell me about whats been going on?
-Use NOTEPAD:
-Nature
-Onset
-Triggers
-Exacerbating/relieving factors
-Progression
-Associated symptoms
-Disability
-Impairment in memory? Long or short?
-Change in personality or mood?
-Any hallucinations? Do you ever hear or see things that you know aren’t there?
-Do you have any repetitive thoughts?
-Any change in vision?
-How would you describe your mood? Enjoyment in things?
-Any thoughts of self harm or harming others?
Past Medical History
-Any current medical conditions?
-Any history of mental health e.g. anxiety depression
-Any previous surgeries?
Drug History
-What current medications do you take?
-Any herbal remedies?
-Any over the counter?
-Any allergies?
Social History
-Sleep history?
-Sleep/wake cycle
-ADLs?
-Appetite?
-Changes in concentration?
-Smoke? drink alcohol? recreational drugs?
Family History
-Any family history of mental health disorders?
-Any medical conditions which run in the family?
Suggest 3 ways you communicate effectively with patients presenting with cognitive impairment
1. Simplify and Clarify Language: Use clear, simple language and short sentences. Avoid medical jargon and complex explanations.
2. Be Patient and Provide Reassurance: Cognitive impairment can affect a patient’s ability to process information quickly. Speak slowly and give them time to respond.
3.Use Visual Aids and Written Instructions:Visual aids such as pictures, diagrams, or written instructions can help reinforce verbal communication.
What is a mental state examination?
The mental state examination (MSE) is a structured way of assessing a patient’s current state of mind.
Explain the different sections of a mental state examination?
Appearance and behaviour; Observe the patient’s general appearance e.g. clothing, hygeine, posture,weight, physical stigmata. Note the patients behaviour .e.g engaged, eye contact, body language, facial expression,abnormal movements.
Speech; rate of speech, quantity of speech, tone of speech, volume of speech.
Mood and affect; mood is how the patient tells you they feel , affect is how you think the patient feels based on expressions and body language.
Thoughts; form (speed, fluency, flight of ideas, gibberish, thought blocking.,) and content ( delusions, obsessions,compulsions)
Perception; any hallucinations e.g Do you ever hear whispers or talking when no ones there?
Cognition; a formal assessment of cognition through ;Mini-mental state exam (MMSE), Abbreviated mental test score (AMTS)
Addenbrooke’s cognitive examination III (ACE-III)
Montreal Cognitive Assessment (MOCA).
Insight and judgement refers to the ability of a patient to understand that they have a mental health problem e.g. “What do you think the cause of the problem is?” Judgement-What would you do if you could smell smoke in your house?”
Risk; risk to self and risk to others.
Name 4 clinical tests used to asses cognition?
- Mini mental state examination (MMSE)
- Addenbrooke’s cognitive examination III (ACE-III)
- Abbreviated mental test score (AMTS)
- Six Item Cognitive Impairment Test (6CIT)
What is meant by congruency?
Whether the patient’s affect/body language facial expressions etc appears in keeping with the content of their thoughts.
e.g. are they saying they are happy and at the same time smiling = congruent
or
are they saying they are happy and the tone is dull and they are frowning /crying=incongruent
Suggets 3 ‘tool’s you can use to discriminate between dementia and delirium?
- Clinical assessment tools e.g. cognitive testing, CAM test
- History taking
- Imaging and additional tests
Understand the organisation and the roles of the different agencies in primary and secondary health care, social services and voluntary organisations in the provision of the care for older people presenting with cognitive impairment, and the needs of their carers.
Primary Care; GPs are often the first point of contact for older adults with cognitive impairment. They conduct initial assessments, manage chronic conditions, and coordinate referrals to specialists.
Secondary Care; Specialists such as neurologists, geriatricians, and psychiatrists provide expert assessments and management for cognitive impairments. Memory clinics focus on the assessment, diagnosis, and management of dementia and other cognitive disorders.
Social Services; Social workers help individuals and families navigate the social and community aspects of care.Assessing social needs, connecting families with resources, and advocating for support services.
Voluntary Organisations e.g. Alzheimers Association, provide support, education, and advocacy for individuals with Alzheimer’s disease and related dementias. Offering caregiver support groups, educational resources, and advocacy efforts to improve services and support for those affected by dementia.
What is the difference between implied and expressed consent?
Expressed consent is typically given with words, either on paper or verbally, while implied consent is usually understood through actions
What is Mental Capacity?
Mental capacity is the ability to make an informed decision based on understanding a situation, the options available, and the consequences of the decision.
Mental capacity is time specific and decision specific. What is meant by this?
This means you should assess a patient’s ability to make a specific decision at the time the decision needs to be made
Decision:
Mental capacity can vary depending on the complexity and nature of the decision. For example, an individual may be able to make simple, everyday decisions (like what to eat for breakfast) but might struggle with more complex decisions (such as financial investments or end-of-life care choices).
Time:
Mental capacity can fluctuate over time due to factors such as illness, medication, emotional state, or cognitive changes. A person might have the capacity to make decisions at one point but not at another. For instance, someone experiencing acute confusion due to a temporary illness may lack capacity at that time but regain it once their condition improves.
Suggest some reasons why people might lack capacity?
- Alcohol or substance abuse
- Mental health
- Infection
- learning disability
- Dementia
- Stroke/brain injury
What are the 5 principles of the Mental Capacity Act 2005?
1. Presumption of capacity – you have the right to make your owndecisions and must be assumed to have capacity to do so, unless it is proved otherwise.
2. Support to make your own decisions – all practicable steps must be taken to help you make your own decision, before anyone concludes you
are unable to do so.
3. Eccentric or unwise decisions – you are not to be treated as being unable to make a decision simply because the decision you make is seen as unwise.
4. Best interests – any decision made, or action taken, on your behalf if you lack capacity must be made in your best interests.
5.Least restrictive intervention – anyone making a decision on your behalf must consider all effective alternatives and choose the less restrictive of your basic rights and freedoms in relation to risks involved.
What is the Two-stage Capacity Test?
Stage 1: Is there an impairment of, or disturbance in, the functioning of the person’s mind or brain?
If so:
Stage 2: Is that impairment or disturbance sufficient that the person lacks the capacity to make a particular decision?
1.Understand information relevant to the decision
2. Remember the information long enough to make the decision
3. Weigh up information relevant to the decision
4. Communicate their decision – by talking, using sign language, or by any other means.
Give a brief description of ‘Lasting Power of Attorney (LPA)’?
A lasting power of attorney (LPA) is a legal document that lets you (the ‘donor’) appoint one or more people (known as ‘attorneys’) to help you make decisions or to make decisions on your behalf.
Give a brief description of ‘Deputies appointed by the Court of Protection’?
A deputy is someone appointed by the Court of Protection to deal with the property and financial affairs of a person who lacks the mental capacity to do so themselves.
Give a brief description of ‘Public Guardian’?
Office of the Public Guardian (OPG) helps people to stay in control of decisions about their health and finance and make important decisions for others who cannot decide for themselves.
The Court of Protection is different to the Office of the Public Guardian but the two work closely. Essentially, the Court of Protection makes the decisions and the Office of the Public Guardian handles the ongoing supervision of Deputies.
Give a brief description of ‘Advance Decisions to refuse treatment’?
An advance decision to refuse treatment is essentially a living will.
It is a decision you can make now to refuse a specific type of treatment for sometime in the future if you are not able to communicate then.
An advance decision may only be considered valid if
you’re aged 18 years old or over and had the capacity to make, understand and communicate your decision when you made it.
Give a brief description of ‘Independent Mental Capacity Advocate (IMCA)’?
IMCAs are a legal safeguard for people who lack the capacity to make specific important decisions: including making decisions about where they live and about serious medical treatment options.
IMCAs are mainly instructed to represent people where there is no one independent of services, such as a family member or friend, who is able to represent the person.
Give a brief description of ‘Independent Mental Health Advocate (IMHA)’?
Independent Mental Health Advocates (IMHAs) support people with issues relating to their mental health care and treatment.
They also help people understand their rights under the Mental Health Act.
An advocate can support a person to understand their rights and options, have their views and wishes heard in decisions about their care or treatment
and raise anything they are unhappy with relating to their care or treatment
What is the aim of DOLS?
The aim of DoLS is to make sure that people who lack capacity are looked after in a way that does not inappropriately restrict their freedom
Suggest 2 settings a DOLS can be used in?
- Hospital
- Care Home
What is the DOLS framework being replaced with?
The Liberty
Protection Safeguards “LPS”.
What is the Mental Health Act?
This is the law in England and Wales that allow people with a mental disorder to be sectioned, i.e. admitted to hospital, detained and treated without their consent either for their own health and safety or for the protection of other people.
Define a ‘Mental Disorder’?
A mental disorder is characterized by a clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour.
It is usually associated with distress or impairment in important areas of functioning
What does ‘sectioning’ mean?
If you are sectioned, this means that you are kept in hospital under the Mental Health Act 1983.
There are different types of sections, each with different rules to keep you in hospital.
The length of time that you can be kept in hospital depends on which section you are detained under.
Define Dementia
Dementia is a umbrella term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life.
Explain the formation of beta amyloid plaques in Alzheimers disease.
- Amyloid precursor protein is periodically replaced by enzymes.
- Alpha and gamma secretase normally slice it up for disposal into soluble parts.
- BUT, beta secretase can get involved and slice it up into non soluble parts.
- These insoluble parts accumulate outside the cell forming beta amyloid plaques.
Explain how tau tangles are formed in alzheimers disease.
- Beta amyloid plaques induce pathological processes within the neuron which result in hyperphosphorylation of tau protiens.
- This causes the tau protein to chnage shape, meaning the tau protein is no longer able to support the cytoskeleton.
- As a result we see neuronal death.
- The tau also aggregates into neurofibrillary tau tangles within the neuron.
State 5 macroscopic changes associated with Alzheimers disease.
1-General brain atrophy
2-Narrowing of gyri
3-Widening of sulci
4-Ventricular enlargement
5-Atrophy of hippocampus
Complete the table for Alzheimers Disease.
Complete the table for vascular dementia
Complete the table for Lewy Body Dementia
Complete the table for Fronto-temporal dementia
Complete the table for Parkinsons Dementia
