1. MH 5.1
Judith Wikel RN BSN MEd

2. MH 5.1 Problems in Late Adulthood, Cognitive Impairment, Alzheimer’s Disease & Dementia
In this chapter will have the opportunity to learn about normal age-related changes in cognition as well as confusion and how it can be caused by medication.
This chapter provides information on the signs and symptoms of dementia, delirium, and Alzheimer’s disease as well as mental health care goals for clients with Alzheimer's disease and support groups for caregivers.

3. Chapter 17
Cognition
The words cognition and cognitive describe activities of the mind involved in thinking and thought processes.

4. Chapter 17 Confusion The Five “Ds” of Confusion
The word confusion is a very general term that is difficult to define. For health care providers, confusion is a symptom of an underlying problem that requires immediate attention.

5. Chapter 17 Confusion The Five “Ds” of Confusion Confusion
Damage – from head injuries or conditions that cause a lack of oxygen (hypoxia) to the brain can lead to confusion.
Depression – people who suffer a great losses can experience confusion related to depression.
When one’s focus is inner sadness, outside stimuli can be misinterpreted or misunderstood. The individual becomes “labeled “confused” and the depression is ignored.

6. Chapter 17 Confusion The Five “Ds” of Confusion Damage Depression
Deprivation
Dementia
Delirium
Please refer to figure 17-1 on page 180 to foster understanding.

7. Myths of Aging Myths Elders live in Nursing Homes
Most individuals with Alzheimer’s disease are care for in their home.
The majority of elderly are rich
The majority of elderly are poor
12% of older adults live in poverty

8. Alzheimer’s Disease
Alzheimer’s Disease – is a progressive, degenerative disorder that affects brain cells and results in impaired memory, thinking, and behavior.

9. Stages of Alzheimer’s Disease
Early stage
Begins with the loss of recent memory. Inability to learn, to process, and to retain information. Individuals in the early stage forget where they put things and begin to have difficulty performing the activities of daily living.
Family members begin to report strange behaviors and mood swings.

10. Stages of Alzheimer’s Disease
Intermediate Stage – inability to recall any recent events or process new information.
Aphasia – loss of language
Apraxia – loss of ability to perform everyday actions, activities
Visual agnosia - loss of recognition of previously known or familiar people and objects.
Family support becomes very important
nursing action.

11. Stages of Alzheimer’s Disease
Severe Stage – in ability to do anything…
Clients usually become incontinent
Unable to walk
Entirely dependent on others for care
Memory, both recent and remote is completely lost
Inability to swallow increases their risk for developing pneumonia and malnutrition.

12. Stages of Alzheimer’s Disease
End Stage
Client slips into a coma and death from pneumonia or other infection occurs.

13. Alzheimer’s Disease Affective loss
Alzheimer’s disease slowly robs an individual of his or her “personhood” (personality)
Each decline is accompanied by a loss.
Individuals with Alzheimer’s Disease become unable to make even the simplest decisions or choices.

14. Sundown Syndrome
Sundown Syndrome - describes a group of behaviors characterized by confusion, agitation, and disruptive actions that occur in the late afternoon or evening.

15. Alzheimer’s Disease
People with Alzheimer’s Disease may live from 2 to 20 years after diagnosis. The average is about 8 years.
Although they are in great emotional turmoil, family members must cope with the reality of the disease and begin planning for the future.

16. Nursing Management of the Patient with Alzheimer's Disease.
Family support – families have a difficult time adjusting to the changing personality and behavior of the loved one.
Drug therapy is showing promise with medications that improve cognition, behavior, and functioning in some patients.

17. Communication and Alzheimer’s Disease
Please refer to Box 17-7 on page 187
Always approach from the front –no surprise appearances.
Use familiar words and short, simple sentences.
If the person is a pacer, walk with him or her, in step, while you talk.

18. Orienting Environmental Cues for Patient with Alzheimer’s Disease
Please refer to Box 17-8 on Page 188
Keep environment simple and “user friendly.”
Put large signs that identify each room on the doors.
Color-code hot and cold faucets red and blue.
Keep rooms brightly lit with no glare.

19. Functional Assessment
Refer to Box 17-5 on page 187
A Functional Assessment
Daily Functions
Cognitive Status
Medical Condition
Behavioral Problems
Psychological Status
Psychosocial Status
After assessment nurse is able to determine the patients ability to perform ADLs.

20. Therapeutic Interventions for Alzheimer’s Disease
Refer to Table 17-4 on Page 189
Validation Therapy – Caregiver buys into client’s illusion and plays along (validates it) until opportunity refocus behaviors is present, based on the premise that the client’s illusion cannot be changed, but it can be directed.
Audio presence intervention - Playing of tape-recorded memories by family members to help decrease agitation.

21. Medications and Alzheimer’s Disease
Please refer to Drug Alert 17-2 on page 187.
Donepezil (Aricept)
Side effects
Nausea, vomiting, diarrhea
Dizziness
Headache
Insomnia
High or low blood pressure
Urinary problems

22. Medications and the Elderly Population
Elderly patients may take numerous medications and this can cause confusion.
Over the counter medications
cold medications, my cause confusion, disorientation, and memory loss.
Metabolism is slower in older adults
This means drugs are eliminated more slowly and can reach toxic levels is not closely monitored.
The nurse must continuously assess for medication interactions.

23. Nursing Responsibilities related to Medications
Nurses have a special responsibility to ensure that their older clients are using their medications correctly.
Refer to Drug Alert 16-1 on page 174, read and focus on the Planning section.
Arrange for the client to show you the steps in identifying and taking the medications if necessary. The nurse should be continuously monitoring for noncompliance related medications.

24. Nursing Responsibilities related to Medications
Age-related nursing interventions
The capacity of the brain to process, store, and retrieve information begins to function less efficiently.
When teaching elderly people, there are several things to keep in mind.
First, assess any physical or sensory changes that may interfere with their learning (and your teaching)
Continued on next slide…

25. Nursing Responsibilities related to Medications
Teach clients about their medications, refer to the medications by name and shape rather than color.
Face client, speak slowly and clearly in lower tones.
Be patient and respectful.
Write out important points.
Your clients’ willingness and ability to learn will greatly improve when using interventions.

26. Medicare
In the United States people 65 years and older are coved by national health program called Medicare.

27. Hoarding
Hoarding
The act of collecting and saving assorted, seemingly useless items.

28. Elder Abuse
Elder abuse is defined as any action that takes advantage of an older person, his or her emotional well-being or property.
The typical abused elder is a woman, at least 75 years of age, with physical or mental problems who is living with a relative. This would be an example of domestic abuse.
Can you think of an example of
Exploitation?

29. Depression
Depression is probably the most common mental health disorder of late adulthood.
Depression is commonly underdiagnosed and undertreated.

30. Depression Signs and symptoms of depression
Please refer to Box 16-4 on page 176
Physical Symptoms
Abdominal pain
Dry mouth
Cognitive
agitatioin
Emotional
Fatique
Lack of interest
Behavioral

31. Mental Changes of Aging
Please refer to Table 16-1 on Page 171
Attention - Alertness, maintaining focus, noticing
Crystallized intelligence - Specialized accumulated knowledge (nursing, engineering, technical skills)
Memory – Names and faces

32. Validation Therapy Please refer to Box 16-5 on Page 176 Eye contact
Touch
Mirroring the client’s body movement
Matching the client’s voice and rhythm patterns
Empathy****
Putting the client’s cues about feelings into words
Accepting the client withour passing judgement
Genuine, total listening

33. People Older than 45 years
Please refer to Box 16-3 on page 174
Seventy-five percent use some kind of medication
13% of population is over age 65.

34. Standards of Geriatric Care
The American Nurses Association (ANA) has developed guidelines (standards) for nurses who work with older adults.
These standards offer nurses a means for providing and measuring the nursing care they deliver to older adults.

35. Q & A
Refusing to throw away expired medications, saving sugar packets from hospital meal trays, collecting old newspapers and junk mail, and having a refrigerator full of plates of half-eaten food are examples of:
A) loss
B) ageism
C) memory loss
D)hoarding
The answer is D) hoarding.

36. Q & A
One of the most common mental health problems that the elderly face is which of the following?
A) depression
B) ageism
C) elder abuse
D) hoarding
The answer is A) depression

37. Q & A A typical victim of elder abuse would be:
A) a 69-year-old man living at home with his confused wife.
B) a 70-year-old blind woman living in assisted living facility.
C) a 79-year-old woman with diabetes living with her daughter.
D) a 72-year-old widow living in a mobile home park.
The answer is c.

38. MH 5.1
Remember the PowerPoint is an outline to guide one in areas to study for the test.
Read assigned material
Watch videos prn
Utilize objectives to foster understanding.
Good luck, JudithRN