Common Mental Health Problems in Older Populations

7/28/2019 Common Mental Health Problems in Older Populations

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COMMON ILLNESSES IN OLDER POPULATIONS

DEPRESSION

Itis the most common affective or mood disorder of old age and is often responsive totreatment.

Its classification and diagnosis vary according to the number, severity, and duration ofsymptoms.

Depression disrupts quality of life, increases the risk of suicide, and becomes self-perpetuating. It may also be an early sign of a chronic illness or the result of physical illness.

Signs of depression include:

Feelings of sadness Fatigue Diminished memory and concentration Feelings of guilt or worthlessness Sleep disturbances Appetite disturbances with excessive weight loss or gain Restlessness Impaired attention span Suicidal ideation

Although depression among the elderly is widespread, it is often undiagnosed and untreated. Attentive

clinical evaluation is essential.

Geriatric depression and symptoms of dementia often overlap, so cognitive impairment may be a result

of depression rather than dementia.

When depression and medical illnesses coexist, as they often do, neglect of the depression can retard

physical recovery.

Assessing the patients mental status, including assessing for depression, is vital and must not beoverlooked.

Depressive illness in late life should be vigorously treated with antidepressants. Psychosocial approaches have also been found to be effective. Selective serotonin reuptake inhibitors (SSRI) are clinically useful and exhibit rapid action with a

low occurrence of adverse effects.

It may take 4 to 6 weeks for symptoms to recede, so the nurse/caregiver should offer

explanations and encouragement during this period.

Alcohol abuse related to depression is significant in the elderly population. Alcohol-related problems in

older people often remain hidden, since many older adults deny their habit when questioned.

Alcohol abuse is especially dangerous in the older person because of changes in renal and liver function

as well as the probability of side effects in interactions with prescriptive medications.

DELIRIUM

Delirium, often called acute confusional state, begins with confusion and progresses to disorientation.

The patient may experience an altered level of consciousness ranging from stupor to excessive activity.

CHARACTERISTICS:

Thinking is disorganized Attention span is short Hallucinations Delusions Fear Anxiety Paranoia

Continuous

Identifying the nature of cause

Characterized by emotion

learning and reasoning

Alcohol is a depressant

feeling of distress and disbelief


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Because of the acute and unexpected onset of symptoms and the unknown underlying cause, delirium

is a medical emergency.

Delirium occur secondary to a number of causes:

Physical illness Medication or alcohol toxicity Dehydration Fecal impaction Malnutrition Infection Head trauma Lack of environmental cues Sensory deprivation or overload

Older adults are particularly vulnerable to acute confusion because of their decreased biologic reserve

and the large number of medications that many take. The nurse must recognize the grave implications

of the acute symptoms and report them immediately. If the delirium goes unrecognized and the

underlying cause is not treated, permanent, irreversible brain damage or death can follow.

Delirium is sometimes mistaken for dementia. Therapeutic interventions vary, depending on the reason

for the symptoms. Because medication interactions and toxicity are often implicated, nonessential

medications should be stopped.

CAREGIVING RESPONSIBILITIES:

Nutritional and fluid intake should be supervised and monitored The environment should be quiet and calm. To increase orientation and provide familiar environmental cues, we encourage family members

or friends to touch and talk to the patient.

It is important to question the family carefully about the patients prior cognitive state. Ongoingmental status assessments using this baseline are helpful in evaluating responses to treatmentand to the hospital or extended care facility admission.

THE DEMENTIAS: MULTI-INFARCT DEMENTIA AND ALZHEIMERS DISEASE

Dementia reportedly affects 3% to 11% of community-residing adults older than 65 years of age and

20% to 50% of community residing adults older than age 85. Most of those suffering from dementia who

are in the over-85 age group reside in institutional settings.

In order for a diagnosis of dementia to be made, at least two domains of altered function must exist

memory and at least one of the following:

Language Perception Visuospatial function Calculation Judgment Abstraction Problem-solving

Symptoms are usually subtle in onset and often progress slowly until they are obvious and

devastating.

The changes characteristic of dementia fall into three general categories:

Cognitive Functional Behavioral

inability to discern

spaces likebuilding legos and

the likes

Becoming aware

of something via

the senses


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CAUSES OF DEMENTIA CAN BE CLASSIFIED INTO TWO:

A. Reversible causes of dementia alcohol abuse medication use (polypharmacy) psychiatric disorders normal-pressure hydrocephalus

B. The three most common nonreversible dementias are: Alzheimers disease Multi-infarct dementia Mixed Alzheimers and multi-infarct dementia

Alzheimers disease accounts for more than 60% of all dementias, and multi -infarct

dementia (vascular dementia) accounts for another 5% to 20%.

Other non-Alzheimers dementias include

Parkinsons disease AIDS-related dementia Picks disease

These remaining dementias account for fewer than 15% of cases and are relatively uncommon.

Dementia is characterized by an uneven, downward decline in mental function.

Multi-infarct, or vascular dementia, has the following defining characteristics:

There must be evidence of dementia. There must be evidence of cerebrovascular disease (by history, clinical examination, or brain

imaging).

The two disorders must be reasonably related. Alzheimers disease is a progressive, irreversible,degenerative neurologic disease that begins insidiously and is characterized by gradual losses of

cognitive function and disturbances in behavior and affect.

Alzheimers disease is not found exclusively in the elderly; in 1% to 10% of cases, its onset occurs in

middle age.

TWO ESTABLISHED RISK FACTORS FOR ALZHEIMERS DISEASE

A family history of Alzheimers disease The presence of Down syndrome

Pathophysiology

Specific neuropathologic and biochemical changes are found in patients with Alzheimers disease.

These include neurofibrillary tangles (a tangled mass of nonfunctioning neurons) and senile or neuritic

plaques (deposits of amyloid protein, part of a larger protein,APP) in the brain.

Clinical Manifestations

EARLY STAGES OF ALZHEIMERS DISEASE

Forgetfulness and subtle memory loss Small difficulties in work or social activities but has adequate cognitive function to hide the loss Can function independently Depression may occur at this time

In FURTHER PROGRESSION OF THE DISEASE, the deficits can no longer be concealed. Forgetfulness is manifested in many daily actions Loses their ability to recognize familiar faces, and objects May get lost in a familiar environment Repeat the same stories because they forget that they have already told it Conversation becomes difficult, and there are word-finding difficulties The ability to formulate concepts and think abstractly disappears

loss of intellectual ability and transitory aphasia

Inability to use or understand language

Amyloid - a waxy translucent complex protein resembling

starch that results from degeneration of tissue


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The patient is often unable to recognize the consequences of his or her actions and willtherefore exhibit impulsive behavior.

The patient has difficulty with everyday activities, such as operating simple appliances andhandling money.

Personality changes are also usually evident. The patient may become depressed, suspicious, paranoid, hostile, and even combative.

Trying to reason with the person and using reality orientation only increase the patients anxiety without

increasing function.

PROGRESSION OF THE DISEASE intensifies the symptoms:

Speaking skills deteriorate to nonsense syllables Agitation and physical activity increase The patient may wander at night Assistance is needed for most ADLs, including eating and toileting, since dysphagia occurs and

Incontinence develops.

TERMINAL STAGE

The patient is usually immobile and requires total care May last for months or years The patient may or may not recognize family or caretakers. Death occurs as a result of complications such as pneumonia, malnutrition, or dehydration

10 WARNING SIGNS OF ALZHEIMERS DISEASE

A person with several of these symptoms should see a physician for a thorough evaluation:

1. Memory loss that affects job skills2. Difficulty performing familiar tasks3. Problems with language, as in word-find problems or inappropriate word substitutions4. Disorientation about time and place5.

Poor or decreased judgment

6. Problems with abstract thinking7. Misplacing things8. Changes in mood or behavior9. Changes in personality10.Loss of initiative

Assessment and Diagnostic Findings

Depression can closely mimic early-stage Alzheimers disease and coexists in many patients.

Probable Alzheimers disease is determined when physicians and psychiatrists rule out all other

disorders that might produce similar symptoms.

A diagnosis of possible Alzheimers disease is made when Alzheimers disease is considered the primary

reason for the symptoms but is complicated with the presence of another disorder that might confuse

the general progression of the disease

A diagnosis of probable Alzheimers disease is made when the medical history, physical examination,

and laboratory tests have excluded all known causes of other dementias. The diagnosis can be

confirmed only by cerebral biopsy.

Nursing Management

Interventions are aimed at maintaining the patients: Physical safety Reducing anxiety and agitation Improving communication Promoting independence in self-care activities Providing for the patients needs for socialization Self-esteem and intimacy Maintaining adequate nutrition


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Managing sleep pattern disturbances Supporting and educating family caregivers

Research has demonstrated that when the nurse can provide such support, older adults are able to

maintain higher levels of perceived and actual health.

SUPPORTING COGNITIVE FUNCTION

As the patients cognitive ability declines, we should provide a calm, predictable environment that helps

the person interpret his or her surroundings and activities.

Environmental stimuli are limited, and a regular routine is followed. A quiet, pleasant manner of speaking, clear and simple explanations, and use of memory aids

and cues help to minimize confusion and disorientation and give the patient a sense of security.

Prominently displayed clocks and calendars may enhance orientation to time. Color coding the doorway may help the patient who has difficulty locating his or her room. Active participation may help the patient to maintain cognitive, functional, and social interaction

abilities for a longer period.

Physical activity and communication have also been demonstrated to slow some of the cognitivedecline of Alzheimers disease.

PROMOTING PHYSICAL SAFETY

A safe environment allows the patient to move about as freely as possible and relieves the family of

constant worry about safety.

To prevent falls and other injuries, all obvious hazards are removed. Nightlights are helpful. The patients intake of medications and food is monitored. Smoking is allowed only with supervision. A hazard-free environment allows the patient maximum independence and a sense of

autonomy. Because of a short attention span and forgetfulness, wandering behavior can oftenbe reduced by gently persuading or distracting the patient.

Restraints are avoided because they may increase agitation. Outside the home, all activities must be supervised to protect the patient, and the patient

should wear an identification bracelet or neck chain in case he or she becomes separated from

the caregiver.

Common Mental Health Problems in Older Populations

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