Chapter 25 The Elderly

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

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)

Delirium Possible causes: Infections Dehydration Adverse drug reactions Electrolyte imbalances Hypoglycemia Hypoxia

Depression May be symptom of physical disorder Drugs may cause depression Nutritional deficiencies and alcohol may cause depressive symptoms

Symptoms Symptoms may be cognitive, social, physical, or emotional E.g., paranoia, pessimism, sadness, self-degradation, difficulty concentrating or thinking, disturbances of appetite and sleep Early treatment important

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

Assessment Screening tools Onset and pattern of symptoms Listen closely Family history Suicidal ideation

Nursing Diagnosis Hopelessness Self-esteem Situational low Chronic low

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

Dementia Impairment of memory with at least one of the following: Aphasia Apraxia Agnosia Disturbance in executive functioning

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

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

Treatment Cholinesterase inhibitors Slows down progression of disease E.g., donepezil hydrochloride (Aricept) Slows down progression of disease Vitamin E, nonsteroidal anti-inflammatory drugs (NSAIDs), or estrogen may help

Vascular Dementias Multi-infarct dementia 10 to 20 percent of all dementias Result of multiple small strokes Diagnosed by CT, MRI, or history

Other Dementias Alcoholic dementia Creutzfeldt-Jakob disease Korsakoff’s syndrome Creutzfeldt-Jakob disease Acquired immunodeficiency syndrome (AIDS) (continued)

Other Dementias Lyme disease Parkinson’s disease Huntington’s disease

Symptoms and Sequelae Memory loss Confabulation Aphasia Delayed response time Paranoia Alterations in perception Wandering Disinhibition Catastrophic reactions

Assessment Dementia Rule out reversible cause Diagnosis of exclusion Rule out reversible cause May use screening instrument

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)

Nursing Diagnosis Extended period of time for caregiving Including financial, legal, and ethical issues Emotional adjustments to role changes

Caring for Caregivers Honesty with diagnosis Relationship tensions Financial and legal affairs Use of community resources Guilt over nursing home placement Humor Positive aspects