Term
Topic 2: Aged Persons Mental Health
Assx of an aged person with a mental illness: |
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Definition
- Mental Status Examination (MSE)
- Suicide and Self-harm Risk Assessment
- Mini-Mental Status Exam (MMSE)
- Physical Assessment
- ADLs Assessment |
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Term
Topic 2: Aged Persons Mental Health
Risk factors for the development of mental disorders in later life: |
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Definition
- Loss of social supports (death of spouse/friends, family move away)
- Societal attitudes towards older adults
- Socioeconomic status
- Relocation to unfamiliar environments (facilities?)
- Deteriorating physical health
- Incorrect Medications
- Substance abuse
- Spiritual beliefs |
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Term
Topic 2: Aged Persons Mental Health
Management of an older person with a mental illness: |
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Definition
- Allow pt maximum autonomy
- involve family members in treatment
- utilize community services (meals on wheels)
- refer to specialists as required
- Encourage building of social networks to prevent isolation
- Use respectful language and mannerisms when communicating
- Medications:
- be aware of phsyical barriers (inability to swallow) and cognitive barriers (such as delusions) that could affect compliance.
- utilize appropriate route of administration
- considerations (allergies, caregiver abilities, cost, monitoring requirements before prescribing)
- be aware of potential polypharmacy/interactions with OTC drugs |
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Term
Topic 3: Depression in the Elderly
Prevalence of depression in the elderly? |
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Definition
| Estimated at 5-25% of the population. particularly associated with the presence of co-morbidities. |
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Term
Topic 3: Depression in the Elderly
Assx and screening tools used for the elderly: |
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Definition
- MMSE
- Psychogeriatric assessment scales
- MSE
- Clifton Assessment Procedures for the Elderly (CAPE)
- Suicide and Self-harm risk assessment
- Physical Assessment
PLUS:
- Geriatric Depression Scale |
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Term
Topic 3: Depression in the Elderly
Risk factors for an elderly person related to suicide: |
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Definition
- social isolation
- retirement and possible loss of purpose
- loss of family home and movement to a retirement facility
- increased likelihood of divorce, or widow
- presence of untreated mood disorders
- alterations to physical health
- financial stressors |
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Term
Topic 3: Depression in the Elderly
Elderly Depression common symptoms: |
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Definition
- gradual onset (unless sudden personal loss)
- sleep disturbances
- appetite changes
- decreased pleasure in usual activities
- feelings:
- sadness
- worthlessness
- guilt |
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Term
Topic 3: Depression in the Elderly
MSE findings in Elderly Depression:
P - Perceptions: worthlessness (believe the world would be better off without them)
A - Affect/Mood: blunted, unreactive, depressed mood, anhedonia
M - Motor Activity: decreased (possibly due to psychomotor retardation/physical handicap)
S - Speech: not spontaneous
G - General Appearance: decreased interest in hygiene (may appear sleepy due to poor sleep patterns) |
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Definition
O - Orientation: not really affected (may not care about time/place)
T - Thought: self-doubt, suicidal ideation and repeating negative thoughts
J - Judgement: impaired
I - Intellectual Functioning: decreased attention span/cpncentration
M - Memory: declines due to lack of interest/ruminations
I - Insight: varies. (some are insightless, others recognise depression as a cause for suicidal ideation. Others don't recognise depression at all and therefore exhibit physical symptoms) |
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Term
Topic 3: Depression in the Elderly
Nursing interventions/management for elderly person with depression: |
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Definition
- Assessment (MSE, GDS, CAPE, MMSE, PAS, Physical Assessment)
- Risk Assessment (incl. religious beliefs, SAD PERSONS mneumonic, polypharmacy, general health assessment)
- decrease RFs
- provide basic nursing care
- establish hygiene/sleeping patterns
- provide motivation/encouragement
- Psychotherapy (CBT_:
- positive thinking
- routine
- exercise
- encouraging purpose
- showing pt they have something to offer the world
- Alternative therapies (meditation, yoga, music, group therapies)
- If other treatements ineffective --> ECT |
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Term
Topic 3: Depression in the Elderly
Psychopharmacology for elderly pts with depression: |
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Definition
- SSRI's (fluoxetine/Sertraline) 1st line
- SSNRI's (venlafaxine/Duloxetine)
- TCA's (Amitriptyline/Doxepin)
- Reversible and non-reversible MAOI's (moclobemide/Iproclozide) Last line
*Avoid Benzodiazepines due to long half life and ability to induce confusion
**Must be started on low doses of anti-depressants then titrated upwards due to decrease liver/kidney clearance |
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