week 6 Flashcards
Mental illness
mental illness ’ and ‘ mental disorder ’ describe a wide spectrum of mental health and behavioural disorders which • Vary in duration and severity • Interfere with an individual’s cognitive, social and emotional abilities ‘mental health problems’ are sub-clinical (e.g., stress, anxiety, depression or dependence on alcohol and/or drugs)
Are older adults more or less mentally healthy than younger adults?
Around half of all lifetime mental disorders start by the mid-teens, and three- quarters by the mid-20s
Mental illness and aging
10–15% older Australians in the community experience anxiety or depression This is substantially higher for • Those in hospital • Individuals with physical comorbidities • Those with dementia • Older people who are carers
Mental illness and aged care
In 2012 52% of all permanent aged care residents in Aus had symptoms of depression Newly admitted residents; • 22% mild symptoms of depression • 13% had moderate • 11% had major symptoms 73% of those with symptoms of depression had high care needs compared with 53% overall
Mental illness and aging
Older adults with a mental illness tend to:
1.
Have a lifetime of chronic or relapsing mental
illness
2.
Recent onset of mental illness as the result of
a significant stressor
Which means that mental illness in older
age tends to be more chronic in nature
mental illness in the elderly
normative changes
clinical presentation may?
somatic complaints
Normative changes can mimic mental disorders • Clinical presentation may be different, making detection more difficult • Older adults may present with somatic complaints and experience symptoms that do not meet the full criteria for disorder
Assessment and detection
detections complicated by?
Detection complicated by: • High co-morbidity of mental illness with other medical disorders • The fact that symptoms of somatic disorders may mimic or mask psychopathology • Older individuals are more likely to report somatic symptoms rather than psychological ones
Assessment and detection
Primary care providers often do not recognize
and properly identify disorders
A large number of depressed adults are neither diagnosed nor treated 55% PC interns felt confident in diagnosing depression,
35% felt
confident in prescribing anti
depressants to older persons.
Estimated that up to 63% of older adults aged
65 + have an unmet need for mental health
services
How can we make assessment
accurate?
Multidimensional Physical Cognitive Psychological Social
Multi method Interview Self-report Other report Psychophysiological Observation Performance
Depression
Atypical in general but…
1. More likely in vulnerable older people
- Less likely to be detected
3 major characteristics (1
) Dysphoria (2) Physical
Symptoms (3) Duration > 2 weeks
- Insomnia
- Changes in appetite
- Diffused pain
- Trouble breathing
- Headaches
- Fatigue
- Sensory losl
Causes of Depression (in elderly)
Biological
-Genetics
-Neurotransmitters (serotonin, brain derived neurotrophic factor
BDNF, norepinephrine)
Psychosocial
-Loss and grief
Cognitive - Behavioural
- Helplessness
- Lack of control / mastery
Pharmacological
Treatment (of depression in elderly)
Medication
Psychotherapy
Treatment for depression is
typically successful, but this
generally takes longer for other adults
Older adults with depression
use more medication, incur
higher outpatient charges, an
d stay longer in the hospital
Depression and suicide
Depression is the leading trigger for suicide in
older adults
Undiagnosed and untreated depression in the
primary care setting plays a large role in
suicide
More than ½ older individuals who committed
suicide had seen their primary care physician
within one month of the suicide
–Almost half had symptoms, but these were recognized in less
than 1/3
–Treatment was offered in less than ¼ of the cases
Delirium
what is CAM?
Disturbance of consciousness that develops
rapidly. The ability to focus is impaired and
fluctuates
Most common complication in older adults
(30%) who have been hospitalised
Confusion Assessment Method (CAM)
- Acute onset
- Inattention
- Disorganized thinking
- Altered consciousness (hypoactivie, hyperactive, mixed)
Causes of delirium
Medical
-Illness – stroke, CVD, metabolic, hypotension, urosepsis,
pneumonia
Pharmacological
-Medication side effects, changes in medication affects,
interactions between medications
Substance use
Toxins
-Tends to be multiple factors
Treatment for delirium
The most preventable adverse event that can occur
to a hospitalised older person. Is often
misdiagnosed or ignored
Potentially modifiable risk
factors for delirium
Sensory impairment (hearing or vision)
Immobilisation (catheters or restraints)
Medications
Illness (e.g., infection, anemia,
dehydration, poor nutrition, fracture or
trauma)
Surgery
Pain
Emotional distress
Sustained sleep deprivation
Non-modifiable risk factors
for delirium
Dementia or cognitive impairment
Advancing age (>65 years)
History of delirium, stroke, neurological
disease, falls or gait disorder
Multiple comorbidities
Chronic renal or hepatic disease
Dementia
Affects over 46m globally (131m by 2050), most older adults do not have dementia but the risk of dementia nearly doubles every 5 years after 60
Dementia is a family of diseases
characterised by cognitive and
behavioural deficits involving permanent
damage to the brain
In high-income countries only 20-50% of
people with dementia are recognised
and documented in primary care
Dementia
prevalence in AUS (2017)
n 2017 413k living
with dementia in Aus
Of those 65+ 9% had
dementia, and among
those aged 85+ and
over, this was 30%
An estimated 26k under
the age of 65 live with
early onset dementia
Dementia is the second
leading cause of death
Alzheimer’s
- Progressive
- Degenerative
- Fatal
Alzheimer’s risk factors
1.Most evidence – old age, genetic
2.Evidence – hypothyroidism, vascular (smoking, high blood pressure,
diabetes, obesity), head injury, education, low birth weight
3.Some evidence – depression, fatty diet
Protective factors for Alzheimer’s
- Diet and nutrition
- Activity
- Heart healt
Other Dementia types
5
Vascular Dementia
Parkinson’s Disease
Lewy Body Dementia
Huntington’s Disease
Alcohol-Related Dementia
