Week 4 Flashcards
cognitive function
changes in memory, attention and processing speed
mental disorders
depression, anxiety, cognitive impairments, etc.
well-being
general sense of feeling good and being able to adapt to various life events
coping mechanisms
strategies used to manage stress and life changes
resilience
ability to adapt positively to adversity or significant life events
life satisfaction
overall contentment and fulfillment with life experiences
purpose and meaning
a sense of contribution and meaningful engagement in daily activities and relationships
social support
relationships with family, friends and communities
social isolation
the degree to which an individual lacks a sense of engagement with others
cultural identity
the preservation and influence of one’s cultural background
cultural competence
the ability to interact effectively with people from diverse cultural backgrounds
retirement (life transitions)
adjusting to a new phase of life with changes to ones routine, responsibilities, and identity
bereavement (life transitions)
coping with loss and the associated grief processes
largest life transitions in adults older than 65
- retirement
- bereavement
self-esteem
maintaining a positive self-image and self-worth
autonomy
maintaining independence and control over one’s life decisions
- decreases with age which effects mental health and well-being
mental illness
alteration in thinking, mood or behaviour, associated with distress and impaired functioning
examples of the many forms of mental illness
- mood disorders
- schizophrenia
- anxiety disorders
- personality disorders
- eating disorders
- addiction (substance/gambling)
mental illness vs. mental health
mental illness: specific diagnosed disorders
mental health: quality of life and well-being
***distinct but interconnected
prevalence of mental health problems in adults over age of 65
20-30%
- increased more for hospital or LTC
what is the most common mental health condition among older adults?
depression
percentage of suicides in older adults
25% are aged 60 or older
- highest for older males (highlights gap in discussion and treatment)
what effects mental health?
- physical factors (exercise, nutrition, sleep, etc.)
- social factors (relationships, activites)
- emotional factors (self-esteem, knowledge, etc.)
- spiritual factors (meaning of life)
- services (health, dental, vision, etc.)
- income
- housing
- transportation and mobility
what is missing from what effects mental health?
organizational and policy effects
why are mental illnesses missed?
- signs an symptoms are different in older adults in comparison to younger adults (don’t have “usual” symptoms)
- older adults are les likely to self-identify
- can accompany or stem from serious physical illnesses and disorders
- environmental, social and cultural factors can affects signs and symptoms and willingness to seek treatment
- caregiver stress and burnout - less likely to notice changes in their loved one
- depression can be an early sign on dementia - dementia can mask depression too
proportion of Canadian adults that did not get mental health services when needed
15% = below average
things that contribute to compromised dignity
- lack of policy
- increased frailty and dependence
- less focus on functional recovery
- neurocognitive disorders
- institutionalization
- healthcare inequalities
- social stigma and discrimination
- ageism and elder abuse
- loneliness
what does compromised dignity cause
- stops them from getting care/help
- violates the right to have dignity and care
- affects mental health
dopamine
- reward-motivation system
- motor control, decision making, teaching, motivation, pleasure
- declines with age causing motor performance and cognition to decline
- also causes emotional problems with age
serotonin
- boost when you feel significant and important
- mood, memory, sleep, cognition
- declines with age causing the things above to decline as well
norepinephrine
- regulates blood pressure
- memory formation and retrieval
- stress and sleep regulation
- declines with age causing the things above to decline and cause anxiety
what happens when the neurotransmitters decline?
poor mental health
common mental health disorders in older adults
- depression
- suicide
- anxiety disorders
- dementia
- loneliness and isolation
- delusion
- delirium
- paraphrenia (paranoid delusions with no hallucinations)
- concurrent disorders (disorders that work together against eachother)
- mental illness + substance abuse problem
depression and aging
- NOT a normal part of aging
- depressive symptoms are very similar to dementia, so the person is often labelled as having dementia
symptoms of depression
S: sleep
I: interest
G: guilt
E: energy
C: concentration
A: appetite
P: psychomotor
S: suicide
SIGECAPS
mneumonic for the symptoms you should be looking for if you are a caregiver/family member to diagnose depression
sleep symptom of depression
change in sleep patterns
- daytime napping
- unable to fall sleep
- fatigued even with sleep though
interest symptom of depression
lack of interest or pleasure in life daily activities, anhedonia, physical limitations
guilt symptom of depression
feeling like a burden, worthlessness, grief, loss, feeling sad without reason
concentration symptom of depression
directly linked to fears
- fears about cognitive decline and memory loss and acute stress = concentration problems
energy symptom of depression
changes in energy (lethargy and fatigue)
- increase in angry, aggressive, agitated, or irritable energy
appetite symptom of energy
changes to appetite
- unintended weight loss of gain
- increased or decreased sense of hunger and satiety
- digestive problems
psychomotor symptom of depression
reduced activity, like energy, feeling they have slowed down, or sense of restlessness
suicide symptom of depression
feelings of hopelessness, helplessness, and sadness
- thoughts of death or better off dead
late-life depression
depressive disorder developed at beginning of old age
- serious and life-threatening disorder
- underdiagnosed and inadequately treated
- challenging to distinguish from dementia
prevalence of late-life depression
1 in 5 seniors
what is late life depression characterized by
atypical cluster of symptoms
- somatic, anxiety, and psychotic symptoms
- less likely characterized by sadness
why is late-life depression difficult to distinguish from dementia?
due to overlapping symptom profiles
- especially when depression affects the cognition and is presented as “pseudodementia”
causes of late life depression
- medical illness
- executive dysfunction
- vulnerable personality
- stressful life events
- poor social networks
treatment for major depression in older adults - prevention
- reduce isolation
- PA
- eat well
- social activities
- mindfulness, etc.
treatment for major depression in older adults - assessment
- prolonged bereavement
- social isolation
- chronic illness
- memory difficulties
- recent onset anxiety, etc.
screening for depression
- geriatric depression scale
- the hamilton rating scale for depression
delirium
acute change in mental status causing shift in cognitive functioning, reduced environmental awareness, altered attention, and behaviour changes
types of delirium
- hypoactive
- hyperactivity
- mixed
hypoactive delirium
- withdrawn
- reduced speech and activity
- apathy
- unawareness
hyperactivity delirium
- increased activity
- irritability
- restlessness
- combativeness
mixed delirium
fluctuations psychomotor activity
short-term delirium outcomes
- falls
- pressure injuries
- aspiration pneumonia
- distress
- prolonged hospital stay
- long-term care admission
- increased risk mortality
long-term delirium outcomes
- functional and cognitive impairment
- dementia
- PSTD symptoms
- sleep disturbances
- increased risk mortality
factors reducing the risk of delirium
- cognitive reserve
- social support and interactions
- environmental influences
- pain management
cognitive reserve and delirium
capacity of the mature adult brain can buffer the effects of neurological disease or injury
social support and interactions with delirium
regular visits from care partners help to reduce burden of cognitive impairment and provide comfort with frequent reorientation
environmental influences and delirium
exposure to natural daylight can support the promotion of regular circadian rhythms and healthy sleep cycles
pain management and delirium
appropriate and consistent pain assessments should be conducted to ensure pain is adequately controlled and severity is monitored, especially is communication becomes difficult with delirium
delirium distress symptoms
- anger
- fear
- frustration
- hopelessness
- loss of control
- embarrassment
- guilt
delirium and mental health conditions
some of the populations most vulnerable to delirium are older adults who have dementia, depression and acute psychiatric syndrome
delirium superimposed on dementia
when an individual with pre-existing dementia develops delirium
loneliness
perception of being alone and isolated matters the most
- a state of mind
- subjective, negative feeling related to the deficient social relations
- more dangerous to health than smoking
what does a high degree of loneliness cause
- suicidal ideation
- para-suicide
- alzheimers disease
- dementia
- negative effects of immune system
- negative effects of cardio-vascular system
- increased risk of hospitalization
- increased risk of LTC facility placement
types of loneliness
- developmental
- internal
- situational
developmental loneliness
lack of balance between individualism and innate desire to relate to others
internal loneliness
perception of being along
- associated with low self-esteem and worth
situational loneliness
socio-economic and cultural milieu
- effected by environment
interventions for loneliness
- activity involvement
- volunteer roles
- developing and keeping quality relationships **most imp
- pharmacological management of
physical ailments - staying in contact with family and friends
social isolation
a state in which the individual lacks a sense of belonging socially, lacks engagement with others, has a minimal number of social contacts and are deficient in fulfilling and quality relationships
the prevalence of social isolation
43% in community dwelling older adults
what health effects does social isolation lead to?
- increased risk for all-cause mortality
- dementia
- increased risk for rehospitalization
- increased number of the falls
- can be avoided through prevention and mitigation efforts if detected early
what three factors should patient care efforts be focused on assessing and improving?
physical, mental and social well-being
impacts of social isolation
- health behavioural
- psychological
- physiological
- other outcomes
interventions for social isolation
- no one-size fits all approach, tailor programs to individual needs
- group based social activities and support groups
- patient-centred approach is essential
principals for a comprehensive approach to aging and mental health
- elderly must have access to mental health treatment
- they should receive the care and supports needed to live safely
- equity, safety and inclusion must be embedded
- policy, programs, and practices should support mentally healthy aging
- government must prioritize and invest
