week 8- mental health and older adults Flashcards
1
Q
mental health
A
a state of wellbeing in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community
2
Q
mental illness
A
a health condition generally characterized by a combination of abnormal thoughts, perceptions, emotions, behaviour and relationships with others
3
Q
stress
A
- an internal state accompanying threats to oneself
- can be adaptive, motivating us toward growth
- can be maladaptive, diminishing our ability to cope
4
Q
most prevalent mental health issues
A
anxiety, severe cognitive impairment, mood disorders, alcohol abuse and dependence
5
Q
mental illness prevalence
A
- 1 in 3 canadians will experience a mental illness
- up to 30% of older adults will experience a mental illness
6
Q
assessing for a mental illness
A
- observation of appearance
- behaviour and examination of cognitive function
- functional abilities
- anxiety, adjustment
- reactions
- depression, suicidal risk
- substance abuse
7
Q
anxiety
A
anxiety is a normal reaction to stressors but can becomes problematic when it is prolonged or exaggerated and begins to interfere with function
8
Q
anxiety disorders
A
- unpleasant and unwarranted feelings of apprehension that may be accompanied by physical symptoms
- can include GAD, phobic disorder, OCD< panic disorder, PTSD
9
Q
assessment of anxiety
A
- focuses on social, physical and environmental factors, as well as family history and recent events
- can use GAD scale
- Can you say what triggers your feeling anxious?
- Have you been concerned about or fretted over a number of things?
- Is there anything going on in your life that is causing you concern?
- Do you find that you have a hard time putting things out of your mind?
The following questions are useful in identifying how and when physical symptoms began: - What were you doing when you noticed the chest pain?
- What were you thinking about when you felt your heart starting to race?
- When you can’t sleep, what is usually going through your head?
10
Q
interventions for anxiety
A
- treatment depends on the symptoms, diagnosis, co-morbid medical conditions and current medication regimen
- nonpharm interventions are preferred and often used in conjunction with medication (CBT)
- medications can include SSRIs, short-acting benzos alprazolam, lorazepam) or non-benzo anxiolytic agents (buspirone)
11
Q
cognitive behavioural therapy
A
- designed to modify thought patterns, improve skills and alter the environmental states that contribute to anxiety
- individual or group formats
- may involve relaxation training, cognitive restructuring or education about signs and symptoms of anxiety
12
Q
why might we be hesitant to prescribe medication to treat anxiety in older adults?
A
decrease in liver function/metabolic function, decrease in glomerular function/excretion ability
13
Q
OCD
A
- characterized by recurrent and persistent thoughts, impulses, or images that are repetitive and purposeful and intentional urges
- ritualistic behaviours that improve a person’s comfort level
14
Q
PTSD
A
affects people who have experienced or witnessed a traumatic event such as a natural disaster, serious accident, terrorist act or sexual violence
15
Q
psychosis
A
- a syndrome that occurs in a number of physical and mental conditions
- main symptoms include hallucinations and delusion
- risk factors for OA include social isolation, chronic bed rest, sensory deficits, physical illness, cognitive impairment, polypharmacy
16
Q
paranoia
A
- an intense and strongly defended irrational suspicion
- can be induced by meds or alcohol
- dynamics include loss of control and challenge assessing social situations
17
Q
delusions
A
- fixed, false beliefs that guide one’s interpretation of events and help make sense of the disorder
- not shared by others
- delusions may be comforting or threatening, but they always form a structure for understanding situations that otherwise might seem unmanageable
- conceivable ideas without foundation in fact, that persist for more than one month
ie. being poisoned, children taking assets, being held prisoner, deceit by spouse
18
Q
hallucinations
A
- sensory perceptions of a nonexistent object that may be in relation to any of the five senses
- often associated with dementia, parkinson’s, physiological and sensory disorders and medications
19
Q
schizophrenia
A
severe mental disorder characterized by two or more of the following symptoms; hallucinations, delusions, disorganized speech, catatonic behaviour, affective flattening, poverty of speech or apathy
20
Q
BPD
A
- characterized by periods of mania and depression
- people tend to have longer periods of depression later in life
- uncommon later in life, although relapses may be precipitated by medical problems
21
Q
substance use disorder- alcohol
A
- alcohol is the most commonly abused substance
- affects men 4x more than women, although women are more vulnerable to the effects of alcohol misuse and it often goes undetected
- alcohol interacts with 50% of prescription meds
- OA have higher BACs as they have changes in ADME of alcohol
- increased risk of GI bleed or ulceration
22
Q
alcohol-medication interactions
A
analgesics, antibiotics, antidepressants, benzos, H2 receptor blockers, NSAIDs, herbal meds, oral hypoglycemics, anticoagulants, anticonvulsants
23
Q
medication misuse
A
use of a medication for reasons other than those for which it was prescribed, often occurs unintentionally with OA
24
Q
substance use disorder assessment
A
- comprehensive medical history
- physical exam
- cognitive/functional assessment
- medication history
- screen for alcohol use and depression
- social networks, housing situation, financial situation
- brain damage
ie. short michigan alcoholism screening test- geriatric version
25
acute alcohol withdrawal
- can be a life-threatening emergency
- detox should be done in an inpatient setting
- delirium tremmens describes alcohol withdrawal
26
mood measures
- should be evaluated separately from cognition
- used to screen of absence/presence of depression
ie. geriatric depression scale, cornell scale for depression in dementia
27
to be deemed capable, a person must be able to...
1. understand information that is relevant in making a decision
2. evaluate data
3. appreciate the consequences of the decision/not making the decision
- people are assumed to be capable until deemed otherwise
28
power of attorney
legal document and legal device in which one person designates another person to act on their behalf
29
SDM hierarchy
1. legally appointed SDM
a) court appointed guardian
b) attorney for personal care
c) CCB representative
2. automatic SDMs
a) spouse
b) parents/children
c) parent with right of access only
d) siblings
e) any other relative
3. last resort SDM
a) public guardian
30
cognitive measures
mini mental state exam, clock drawing test, mini-cog, moCA screening, cognitive performance scale, confusion assessment method, delerium index
31
risks of loneliness and social isolation
- high BP/heart disease, obesity, anxiety, depression, cognitive decline, dementia, alzheimer's
- increased risk of death is comparable to smoking 15 cigarettes a day or having an alcohol use disorder
32
risk factors for social isolation
physical health issues, advanced age, low income, small networks, widowed/divorce, living alone
33
supports requested by caregivers
telephone check-ins, tech support, caregiver support, clear communication, incentives to work in home care, supports to age at home, funding to support seniors
34
proposed supports for aging at home
1. promote public health guidelines
2. promote services, programs and policies to support seniors and their caregivers
3. promote emerging technology to support families
4. facilitate communication
5. advocate for expanding safe opportunities for social and physical health opportunities
6. advocate for incentives to work in home care
7. advocate for affordable, supportive, communal housing options
8. advocate for enhanced financial and physical resources
9. advocate for scaling up rural transportation
10. advocate for enhanced service required by seniors
35
assessment of social supports
social network and support scale, focuses on emotional support and feelings of usefulness provided the four types of social ties
36
assessing caregiver strain
financial, physical, psychological, social and personal domains
ie. modified caregiver strain index
37
risk factors for elder abuse
isolation, lack of support, cognitive impairment, responsive behaviours, living with a person who has mental illness, living with people who have substance use disorders, dependency on others to complete ADLs, recent worsening of health, arguing with relatives
38
types of elder abuse
physical, sexual, psychological, financial, neglect
39
emotional abuse
using words or actions to control, frighten, isolate or erode a person's self respect
40
financial abuse
acting without the older adult’s consent in a way that benefits the abuser at the expense of the older adult through threats, intimidation, or deceit
41
physical abuse
using physical force against a person without the person’s consent
42
neglect
failing to adequately provide necessities or care for a dependent older adult
43
interventions for elder abuse
- stop mistreatment and neglect of older adults
- provide care and treatment for consequences of abuse
- protect victim from inappropriate/illegal acts
- hold abusers accountable
- rehabilitate the offender
- order restitution of property and payment for expenses incurred as a result of the abusers conduct
- report
44
systemic abuse
refers to rules, regulates, policies or social practices that harm or discriminate against older adults
