Week 8: Mental health of kids and elderly

Question 1

Three diagnoses are the primary mental health issues affecting the elderly

Answer 1

• Depression, delirium, dementia

- These disorders are not part of the normal ageing process

Question 2

DEMENTIA

Answer 2

• Onset→ Chronic
• Course→ Slow, progressive cognitive loss; symptoms may be worse in the evening (sundowning)
• Duration→ Years
• Signs and Symptoms→ Highly dependent on stage of illness
• Consciousness→ Short term memory loss but good long term memory
• Sleep disturbance not a feature, but sleep- wake cycle may be set at wrong time frame
• Aimless wandering or searching
• Hallucinations are rare
• Mood may be flattened or labile

Question 3

DELIRIUM

Answer 3

• Prevalence→ Very common in older people, especially in nursing homes or hospitals
• Onset→ Acute
• Course→ Brief course of treatment, dependent on care
• Duration→ Hours, days, weeks
• Signs and Symptoms
• Clouding of consciousness
• Sleep disturbance; restless and uneasy
• Visual hallucinations that are usually disturbing
• Emotional lability and distress

Question 4

DEPRESSION

Answer 4

• Onset→ Usually abrupt and may coincide with life events such as death of a loved one
• Course→ Diurnal fluctuations (usually worse in the morning)
• Duration→ Weeks to years
• Signs and Symptoms→ Typical features of depression- depressed mood, sleep disturbance, feelings of hopelessness

Question 5

WHAT SHOULD WE CONSIDER WHEN CARING FOR ELDERLY PATIENTS/ CONSUMERS?

Answer 5

• Sensory needs of the elderly: sight and hearing impairment
• Valuable input from family and carers
• Elder abuse
• Polypharmacy interactions
• The implications of mobility, role, health, loneliness etc

Question 6

MENTAL HEALTH AND ILLNESS OF THE ELDERLY

Answer 6

• Sundowners→ An acute state of confusion and agitation usually occurring in the late afternoon and early evening
• S&S→ People experiencing sundowners may seem upset, agitated, restlessness and exhibit wandering behaviour
• Sundowners may be attributable to exhaustion, medications wearing off, confusion and boredom
• Managing sundowners may involve diversional therapy (games or activities) that keep the person’s attention) features to limit falls, PRN medication if behaviour is dangerous

Question 7

TRAUMA

Answer 7

• Trauma may arise from single or repeated adverse events that can interfere with a person’s ability to cope or to integrate the experience
• It is an experience of real or perceived threat to life, bodily integrity and/or sense of self
• The impacts of traumatic experiences can be cumulative across the lifespan
• An inescapably stressful event that overwhelms peoples coping mechanism

Question 8

TRAUMA INFORMED CARE

Answer 8

Strengths based framework grounded in an understanding of an responsiveness to the impact of trauma, that emphasises physical, psychological and emotional safety for both providers and survivors, an that creates opportunities for survivors to rebuild a sense of control and empowerment

Question 9

TRAUMA INFORMED CARE: PRINCIPLES

Answer 9

• Recognises the prevalence and impact of trauma
• Promotes safety
• Supports individuals to enact their choice, cultures and values
• Fosters healing relationships
• Collaborative strengths based practices
• Recognises and shares power

Question 10

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

Answer 10

• Key features→ inattention, hyperactivity, impulsivity
• People with ADHD have difficulty with
• Keeping attention on the task at hand
• Avoiding distraction
• Getting started on tasks (procrastination)
• Maintaining mental effort to get the job done
• Remembering to do things
• Losing or misplacing things
• Being impulsive (acting without thinking things through)
• Planning and organising
• Making good use of time (including being on time)
• Managing emotions such as frustration and boredom
• Sitting still

Question 11

AUTISM SPECTRUM DISORDER (ASD)

Answer 11

Neurodevelopmental disorder characterised by

• Impaired social interaction
• Impaired verbal and non-verbal communication
• Restricted and repetitive behaviour and interests

Question 12

BORDERLINE PERSONALITY DISORDER

Answer 12

Mental disorder typically characterised by

• Impulsivity and risky behaviour
• Fear of real or imagined abandonment
• Identity insecurity/ uncertainty/conflict
• Relationship splitting (radical idealisation and radical devaluation)
• Intensity of emotions and expression
• Unstable interpersonal relationships
• Self harm
• BPD is mainly diagnosed in girls, and risk factors include a history of trauma, abuse or a challenging childhood

Question 13

ANOREXIA NERVOSA

Answer 13

• Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory and physical health)
• Either an intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain (even though significantly low weight)
• Disturbance in the way one’s body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

Question 14

BULIMIA NERVOSA

Answer 14

• Recurrent episodes of binge eating. An episode of binge eating is characterised by both of the following:
• Eating in a discrete period of time (e.g. within any 2 hour period) an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
• A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating, or control what or how much one is eating
• Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics or other medications, fasting or excessive exercise
• The binge eating and inappropriate compensatory behaviours both occur, at average at least once a week for 3 months
• Self evaluation is unduly influenced by body shape and weight
• The disturbance does not occur exclusively during episodes of Anorexia Nervosa

Question 15

TRAUMA EARLY LIFE AFFECTED

Answer 15

• Early trauma is a strong antecedent of future mental illness and challenge
• Trauma may be mediated by a single event, or numerous cumulative events
• The contributing factors may have been experienced first hand, or witnesses abuse, neglect, domestic violence etc
• Childhood abuse tends to have the most complications with long-term effects out of all forms of trauma because it occurs during the most sensitive and critical stages of psychological development
• Issues with attachment and attachment disorder are strongly predictive of future ill health, both mental and physical