Module Six MENTAL DISORDERS IN ELDERLY Lesson 1: Elders’ experiences (2 training hours) Lesson 2: Mental Disorders in elders (2 training hours) TOTAL TIME 4 TRAINING HOURS OF 45 MINUTES

Lesson 1 ELDERS’ EXPERIENCES TIME : 90 minutes (2 training hours of 45 minutes)

Step 1: Introduction (10΄) Passing to the elder age for every person is related to the complicated interaction of biological, psychological and social factors. People differ a lot from each other in the way they deal with this transition. It is important to : have good physical health. Social support. Keep the patient active. Be focused in entertaining activities. Maintaining family and other close relationships.

Step 2: Brainstorming and discussion (15΄) What are your feelings when thinking of yourself old? What are the positive and the negative points ? What’s your opinion for retirement ? How would you spend your time when old or retired? What would you like to do?

Step 3: Group discussion (20΄) Pen and paper In what way (s) differ the needs of elderly to the one’s of younger people?

Step 4: Theory presentation (15΄) People that suffered for many years from severe chronic mental disorders have usually very different experiences in their life. The impact of passing to the elder age might be really different for them.

Step 4 (continued) Even though in many cases the symptoms of mental disorders become milder, the difficulties become harder. This is due to the fact that: These persons apart from the chronic mental disorder, are also influenced from other problems of elders. They might have lost because of the long-lasting term of the disease and the hospitalization the ability to understand and proceed to the necessary adjustments for elderly. Very often, while their needs are more demanding, they have already over passed all limits of their family support.

Step 4 (continued) As a result to these, they need special attention which includes: Taking care of their physical health. Observation of their mental disorder. Support for the family that looks after the person. Eventually a place to stay (hostel, house for the elderly). Day occupation (Day Care center). Maintenance if possible of their abilities, especially those that help them looking after themselves. Maintenance of their social activity.

Step 5: slide projection (10΄) Slide 6.1.1: The most important transition points during people’s lifetime Graduation First job Marriage Children’s birth Promotion Retirement Parents’ death Wife’s / husband’s death

Step 6: Brainstorming (10΄) People with chronic psychosis experience the same or different transition points and which are these?

Step 7: Questions and comments (5΄)

Step 8: Lesson’s evaluation (5΄)

Lesson 2 MENTAL DISORDERS IN ELDERLY TIME : 90 minutes (2 training hours of 45 minutes)

Step 1: Introduction (5΄) The last 100 years, human’s life span has increased and as a consequence the elderly population has gone up. In western Europe at the beginning of the 20 th century only 5% of the population was over 65 years old, while at the end of this century the number came up to 15-20%. Actually, one third of these people are more than 75 years old. A further increase is expected in the 21 st century. The rising age of the population creates a serious problem related to the looking after of these people, as it is more likely they suffer from various disorders and disabilities.

Step 2: Slide projection (10΄) Slide 6.2.1: Mental Disorders appeared in elderly % appearance at persons >65 years old Senile dementia 3.5 Depression 11 Paranoid psychoses 0.3 Neuroses 28 Personality Disorders

Step 3: Theory presentation (30΄) Depression Is quite regularly manifested in elderly (one in ten persons aged more than 65). Factors as social isolation, manifestation of physical disease, the loss of loved ones and the lack of satisfaction in life play an important role to its manifestation.

Step 3 (continued) It might not be manifested with no obvious sadness, but with atypical symptoms such as : Uneasiness and anxiety Behavioral change Neglecting oneself Physical disturbances Guilt Apathy Unable to concentrate Memory loss Insomnia Odd or aberrant ideas Suicide is a major risk especially for socially isolated men.

Step 3 (continued) Therapeutical intervention includes: Hospitalisation in many cases Care of physical health Antidepressants Antipsychotic medication where there are psychotic characteristics Social intervention

Step 3 (continued) Paranoid psychosis The manifestation of psychosis like Paranoid Schizophrenia is quite usual in elderly. It really often in elders with hear impaired of vision problems. Sometimes many stressful events are anticipated. The symptoms are usually characterized by odd aberrant ideas. The majority of these patients appear as Depressive. In most of the cases hospitalization and antipsychotic medication is necessary for their treatment.

Step 3 (continued) Senile dementias This term includes Alzheimer disease as well as, MID (multi infract dementia) and other types of senile diseases ( alcoholic, Huntington, Creutzfeldt-Jacob, Pick disease etc.). Half of the elderly population suffer from Alzheimer’s disease. For every man there are two women that suffer from Alzheimer’s disease. The causes of the Alzheimer disease are unknown but there are suspicions for genetic, environmental, toxic and infectious factors.

Step 3 (continued) There are characteristic deteriorations of the brain outer surface.  Multi infarct dementia is due to many little blood clots that cause ischaemia and necrosis in several areas of the brain.  It has abrupt onset and escalating recrudescence.  It develops slower than Alzheimer disease.  In many cases the patient also suffers from hypertension.

Step 3 (continued) slide 6.2.2: dementia characteristics. Memory loss Cognitive loss Talking problems Anxiety and depression Loss of skills Behaviour and personality alterations

Step 3 (continued) There are three steps of progress. During the first there is just memory disturbance, during the second general loss of cognitive function takes place and during the third neurologic signs and double incontinence (urine and excrement).

Step 3 (continued) The treatment includes family support, patient’s support in order to maintain his / her abilities and a series of daily activities, prescription of special medication (like Tacrine), especially during the early stages for delaying the progress of the disease.

Step 3 (continued) Multi infarction dementia (MID) Η πολυεμφραγματική άνοια οφείλεται σε πολλά μικρά έμβολα στον εγκέφαλο που προκαλούν ισχαιμία και νέκρωση σε διάφορες περιοχές του. Έχει οξεία έναρξη και επιδεινώνεται κλιμακωτά. Εξελίσσεται με ποιο αργό ρυθμό από ότι η Νόσος του Alzheimer. Στις περισσότερες περιπτώσεις τα άτομα είναι υπερτασικά.

Step 4: Clinical cases (20΄) Leaflet 6.2.1:Clinical cases Based to these cases, discuss your own experiences.

Step 5: Slide projection (15΄) Slide 6.2.3: general principles of treating elders with psychiatric problems Early and total diagnose of medical and social factors. Stay of the patient in his home for as long as possible. Support of the family so that their able to keep looking after the patient. Visits by social worker and health visitor, offer of economical and practical help and patients attendance to Day Care centers.

Step 5 (continued) Hospitalization and short stay in the hospital when necessary. Care of physical health. Accurate use of medication prescription. Psychotherapeutical approach of the patients insisting in support and encouragement, as well as cognitive – behavioral approach. Development of Psychiatric Services for elders and scientific approach from the therapeutical group.

Step 6: Questions and comments (5΄)

Step 7: Lesson’s evaluation (5΄)