General

info

about

ELDERLY Clients

MI more prevelant

Psychosis increases >65yrs old

more frequent suicide

Dementia is the 4th leading cause of death

15% have chronic physical probs. that can result in neg. psychological responses

AGEISM

Bias vs. older people b/c of their age

Dislike for elderly

Dicrimination

stereotypes

facts & myths

Results of ageism

ISSUES AFFECTING

the

MENTAL HEALTH

of

ELDERLY CLINETS

chemical & physical restraints

death & dying

AIDS

suicide (elderly white males)

alcoholism

COGNITIVE DISORDERS

Cognition:

The act, process, or result of knowing, learning, or understanding.

Cognitive Disorders:

Psychiatric disorders that are manifested in deficits in memory, perceptions, & prob.solving.

Categories

of

COGNITIVE DISORDERS

Delirium

Dementia

Amnestic Disorder

Mental disorders due to general medical conditions

Substance related disorders

DELIRIUM

Disturbances in consciousness

Change in cognition

Develops over a short period of time= hrs to days

Common in hospitalized pts (esp. elderly)

Always 2* to another physiological condition

Is a transient disorder

IF underlying condition corrected, complete recovery should occur

2* physiological EX. infections, meds, post-op, febrile

Risk Factors

for

DELIRIUM

Advanced age

pre-existing illness

infection

pain

admission to long-term care facility

electrolyte or metabolic imbalances

DELIRIUM

Assessment

4 CARDINAL FEATURES:

1) Acute onset & fluctuating course

2) Inattention

3) Disorganized thinking

4) Disturbance of consciousness

DELIRIUM

Assessment

cont.

*COGNITIVE & PERCEPTUAL DISTURBANCES:

-illusions

-hallucinations

-atten. deficits

-visual tactile hallucinations cuase anxiety

PHYSICAL NEEDS:

SAFETY

simple & clear in comm. w/pt

elevate HOB

eye glasses, hearing aides,clocks, calendars

skin care

potential INC

Obs. for increased HR, B/P, fever

MOOD & PHYSICAL BEHAVIORS:

r/t mood @ moment

Labile

confusion

fear

NSG DX

for

DELIRIUM

Risk for injury

Acute confusion

Deficient fluid volume

Insomnia, Sleep deprivation

Impaired verbal comm.

Fear

Self-care deficit

Disturbed though process

DELIRIUM

Outcome Identification

Pt will return to premorbid level of functioning

Pt will remain safe & free from injury while in hospital

Pt will be oriented to time, place, & person (state where they are)

Pt will be free from FALLS & injury

Pt will be free from hallucinations/decreased in # of admission

NSG

Interventions

&

Implementations

w/Delirium

TX the underlying organic causes

-meds

-tx infection

-tx fever

Antipsychotic or anxiety meds

-titrate carefully, dropped too rapidly or titrated too much can cause probs.

Frequent supervision

Use simple language, direct comm.

reorientation via comm.

night lights

soothing music

use calm matter of fact approach

hearing aides in, glasses on

NSG Eval.

of

DELIRIUM

Is the client safe?

Is client oriented to time, place, & person

Has client's anxiety decreased?

DEMENTIA

Develops more slowly

Progressive deteroration of cognitive functioning & global impairment of intellect

No change in consciousness

Diff. w/memory, thinking, & comprehension

****majority of DEMENTIAS are irreversible****

DEMENTIA

cont.

develops more slowly

multiple cognitive deficits

Steady decline

REVIEW p. 371

DEMENTIA:

PRIMARY  vs. SECONDDARY

PRIMARY:

-irreversible

-progressive

-not 2* to any other disease

-EX. Alzheimer's disease:70% of all dementias, Pick's disease

SECONDARY:

-result of some other pathological process

-EX. AIDS related dementia, TB, parkinsion's, syphillus, Bvit deficiencies

-can be TX

-can be reversed

ALZHEIMER'S DISEASE

(AD)

progressive deteroration of cognitive functioning

Early onset: <55

Late onset: >65

Triggers:

Patho= brain shrinks, surface becomes smoother.

down syndrome

advancing age

increased cholesterol levels

decreased folic acid

heart disease

NSG

Assessment

of

AD

Defense behaviors:

- Denial

- Confabulation= making up stories

-Perseveration= intensified r/t stress

-Avoiding questions

(not on pupose, or consciously)

CARDINAL SIGNS

of

AD

*AMNESIA=

short-term memory

*APHASIA=

loss of speech & language, loss of right word(s)

*APRAXIA=

impaired motor skills

EX. tying shoes-now cannot

*AGNOSIA=

loss of recognizing fam. ojects

*Disturbances in executive functioning

DX

of

AD

Other disorders can mimic AD

ALSO:

Drug toxicity

Infection

Nutritional deficits

Metabolic diorders

Disease Progression

of

AD

8-10 years

3-20 years

STAGES

of

ALZHEIMER'S DISEASE

(1-4)

STAGE 1) (mild) forgetfulness

STAGE 2) (mod) confusion

STAGE 3) (mod to severe) unable to identify fam. objects or people

STAGE 4) (late) end-stage

- agraphia= can't read or write

- hyperality= everything in mouth

- blunted emotions= end up in stupor

NSG DX

for

AD

Risk for injury

Impaired verbal comm.

Impaired enviro. interpretation syndrome

Impaired memory

Confusion

Caregiver role strain

AD

Outcomes & Identification

Areas to target:

injury

comm.

agitation level

carefiver role strain

impaired enviro. interpretation: chronic confusion

self-care needs

AD  NSG

Planning

geared towards person's immediate needs

identify level of functioning

assess caregiver's  needs

plan & identify appropriate community resources

AD

NSG

Implementation

counseling & comm. techniques

health teaching & health promotion (important legal & finacial)

referral to community supports

pharmacological interventions

speak well= calm & effectively no matter what they are saying

AD

MEDS

Donepezil(Aricept)

Rivastigmine(Exelon)

Galantamine(Reminyl)

Memantine(Namenda)

AD meds

Donepezil

(Aricept)

inhibits breakdown of acetycholine (slow deteroration of mental breakdown)

mild-mod

mod-severe

does not effect liver

SE= N/V/D

DOSE:

5mg daily (2 yrs) can go up to 10mg

AD meds

Rivastigmine

(Exelon)

cholinesterase inhibitor

DOSE:

multiple daily doses (2 doese), 3-12mg

If dose is tolerated increase @2weeks

AD meds

Galantamine

(Reminyl)

cholinesterase inhibitor

mild-mod

DOSE:

2X daily, 8-16mg (extended release X1, if needed)

SE= N/V/D, wt loss

AD meds

Memantine

(Namenda)

regulates glutamate; excess glutamate leads to neuron deteroration

Delays S/SX= mod-severe

DOSE:

5mg daily, increase dose weekly up to 20mg

SE= dizziness, confusion, constipation

AD meds

are

used

to

TX

other behavioral symptoms

psychotic symptoms

severe mood swings

anxiety

verbal & physical aggression

behavioral s/sx

AMNESIC DISORDER

Loss of short-term & long-term memory sufficient to cause some impairment in functioning

ALWAYS 2* to some other cause

Disorientation

Confabulation

Primary

causes

of

AMNESIA

head trauma

tumor

stroke

cardiovascular disease

substance abuse

toxin exposure= lead, mercury, carbon monoxide, insecticides.

TX of

AMNESIA

Remove underlying cause

EX. tx lead toxicity

Rehab=

to prevent any further probs.

can still have some memory impairment, if TX can be prevented.