Chapter 25 The Elderly Copyright 2011 Delmar Cengage

Most Common Mental Health Problems in Elderly • • • Anxiety Severe cognitive impairment

Delirium • Acute change in level of consciousness and cognition • Usually develops over

Delirium • Possible causes: – – – Infections Dehydration Adverse drug reactions Electrolyte imbalances

Depression • May be symptom of physical disorder • Drugs may cause depression •

Symptoms • Symptoms may be cognitive, social, physical, or emotional – E. g. ,

Subtypes of Depression • • Major clinical depression Dysthymic disorder Adjustment disorder Grief and

Assessment • • • Screening tools Onset and pattern of symptoms Listen closely Family

Nursing Diagnosis • Hopelessness • Self-esteem – Situational low – Chronic low Copyright ©

Planning/Interventions • • Choose drug therapy carefully Consider safety issues Identify pleasurable activities Consider

Dementia • Impairment of memory with at least one of the following: – –

Alzheimer’s Disease • Number one mental health problem among elderly • Progressive impairments and

Diagnosis and Etiology • Cause unknown • Plaques and neurofibrillary tangle in brain •

Treatment • Cholinesterase inhibitors – E. g. , donepezil hydrochloride (Aricept) • Slows down

Vascular Dementias • • Multi-infarct dementia 10 to 20 percent of all dementias Result

Other Dementias • Alcoholic dementia – Korsakoff’s syndrome • Creutzfeldt-Jakob disease • Acquired immunodeficiency

Other Dementias • Lyme disease • Parkinson’s disease • Huntington’s disease Copyright © 2011

Symptoms and Sequelae • • Memory loss Confabulation Aphasia Delayed response time • Paranoia

Assessment • Dementia – Diagnosis of exclusion • Rule out reversible cause • May

Nursing Diagnosis • Reflect physical and emotional stresses of caring for every physical need

Nursing Diagnosis • Extended period of time for caregiving – Including financial, legal, and

Caring for Caregivers • • Honesty with diagnosis Relationship tensions Financial and legal affairs

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Most Common Mental Health Problems in Elderly • • • Anxiety Severe cognitive impairment Delirium Depression Dementia Suicide rate for people age 85 and older is twice overall national rate Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Delirium • Acute change in level of consciousness and cognition • Usually develops over short period of time • Visual hallucinations common • Damage to brain can become permanent (continued) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Depression • May be symptom of physical disorder • Drugs may cause depression • Nutritional deficiencies and alcohol may cause depressive symptoms Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Symptoms • Symptoms may be cognitive, social, physical, or emotional – E. g. , paranoia, pessimism, sadness, selfdegradation, difficulty concentrating or thinking, disturbances of appetite and sleep • Early treatment important Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Planning/Interventions • • Choose drug therapy carefully Consider safety issues Identify pleasurable activities Consider environmental influences Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Alzheimer’s Disease • Number one mental health problem among elderly • Progressive impairments and dependency • Average duration of illness: – Eight years • Estimated that 14 million will have disease in next 50 years Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Diagnosis and Etiology • Cause unknown • Plaques and neurofibrillary tangle in brain • Some cases may be genetic • Some cases may be due to environment • Diagnosis made by neuroimaging Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Treatment • Cholinesterase inhibitors – E. g. , donepezil hydrochloride (Aricept) • Slows down progression of disease • Vitamin E, nonsteroidal antiinflammatory drugs (NSAIDs), or estrogen may help Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Vascular Dementias • • Multi-infarct dementia 10 to 20 percent of all dementias Result of multiple small strokes Diagnosed by CT, MRI, or history Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Other Dementias • Alcoholic dementia – Korsakoff’s syndrome • Creutzfeldt-Jakob disease • Acquired immunodeficiency syndrome (AIDS) (continued) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Symptoms and Sequelae • • Memory loss Confabulation Aphasia Delayed response time • Paranoia • Alterations in perception • Wandering • Disinhibition • Catastrophic reactions Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Nursing Diagnosis • Reflect physical and emotional stresses of caring for every physical need • Coping with difficult behavioral responses • Coping with safety risk imposed by person who may wander (continued) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Nursing Diagnosis • Extended period of time for caregiving – Including financial, legal, and ethical issues • Emotional adjustments to role changes Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Caring for Caregivers • • Honesty with diagnosis Relationship tensions Financial and legal affairs Use of community resources Guilt over nursing home placement Humor Positive aspects Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.