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DISEASES OF MENTAL STATUS AND ELDER ABUSE
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Delirium Disturbance of consciousness with deficits of attention and changes in cognition or perception that develop over a short period and fluctuate over the course of a day (DSM-IV, 2000)
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Delirium Often misdiagnosed as mania, depression, psychosis or depression Common complication of general hospital admission Caused by infection, medication/drug use, nutrition, psychiatric disorders, metabolic disorders and trauma Guccione, Chapter 9; Caplan and Rabinowitz, 2010
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Dementia Essential feature is impairment in short- and long- term memory, associated with a decline in abstract thinking, judgment and other disturbances of higher cortical function (DSM-IV, 2000)
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Dementia Alzheimer’s Type (DAT) 60% of patients with dementia have Alzheimer’s type Memory impairment essential for diagnosis Accompanied by aphasia, apraxia, or disturbance in executive function
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Dementia Alzheimer’s Type Three phases of disease Early phase Forgetfulness Memory impairment Middle phase Cognitive deficits Intellectual decline Late phase Incapable of self care Mute Inattentive Guccione, Chapter 9
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Multi-infarct Dementia Organic mental disorder due to cerebrovascular disease Common disturbances in… Memory Abstract thinking Judgment Impulse control Personality Guccione, Chapter 9
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Pseudodementia Dementia-like behavior that is the result of a major depressive disorder Guccione, Ch. 9
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Anxiety Occurs in response to stressors of aging Alcohol withdrawal, PE, and COPD all predisposing factors Guccione, Ch. 9
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Cognitive Decline and Depression Depression and cognitive decline affect 25% of elderly (Yaffe et al, 2010) The greater the number of depressive symptoms the greater the likelihood of cognitive decline (Yaffe et al, 2010) Measure cognition with Mini Mental State Exam (see handout)
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Caregiver Issues Depressive symptoms in caregivers related to behavioral disturbance and ADL impairment Need to Identify anger, denial, depression, exhaustion or health problems in caregivers Guccione, Ch 9
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Bush, 2006 Elder Abuse Physical abuse-any action intended to cause pain and/or injury Emotional abuse-caregiver acts in a way to cause emotional distress or mental suffering Financial abuse-using elder’s financial resources for one’s gain Neglect-may be intentional or unintentional
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Bush, 2006 Risk Factors for Elder Abuse Caregiver is a spouse or family member Caregiver is a male Psychological issues of caregiver Substance abuse by caregiver Caregiver stress History of family violence Elder has dementia or depression Triggering event such as an argument may begin abuse if other risk factors are present
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References Andrew MK, Rockwood K. Social vulnerability predicts cognitive decline in a prospective cohort of older Canadians. Alzheimer’s and Dementia. 2010:6:319-25. Caplan JP, Rabinowitz T. An approach to the patient with cognitive impairment: delirium and dementia. Med Clin North Am. 2010: 94:1103-16 Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4 th ed. Washington, DC: American Psychiatric Association; 2000. Schunk C. Cognitive impairment. In: Guccione, AA. Geriatric Physical Therapy. 2 nd ed. St. Louis: Mosby; 2000:150. Yaffe K, Blackwell T, Gore R, Sands L, Reus V et al. Depressive symptoms and cognitive decline in nondemented elderly women. Arch Gen Psychiatry. 1999:56:425-430.
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