Mood & Cognitive Disorders in the Older Adult- The “Most Common” Mental Health Problem in Late Life

1. Mood & Cognitive Disorders in the Older Adult-The “Most Common” Mental Health Problem in Late Life

2. Theories of Late Life Depression • Psychosocial Theory – • Multiple losses;loss of self-esteem; • Meaning and purpose of life;learned helplessness; one expects bad things to happen Protective Measures- provide freedom to make choices;purpose/reason for existence;strengthen self-efficacy

3. Theories • Cognitive Triad Theory – (Beck) • People appraise themselves by viewing one’s self-image, environment, future. • Depressed person judges self as lacking features necessary for happiness.

4. Beck’s theory • Three components: • Cognitive distortions (person unable to accurately appraise self) • Schemas (assumptions that influence thoughts,feelings,behaviors)—lead to faulty conclusions • Logical Errors (personalization, minimization,over generalizations)

5. Biologic Theories • Relationship between Aging,Depression,& Bio Chemical changes in the brain, nervous system and neuro-endocrine system. • Neurotransmitters: Seratonin, Dopamine, Acetylcholine, Norepinephrine, ^ cortisol levels, altered growth hormone secretion,alt’d thyroid

6. Assessment of Needs

7. Functional Consequences of depression – older adult • Impact on physical health- • < functional capacity/ worse for those with cognitive impairment • Mortality rates increased • Physiologic changes:bowels/sleep/lytes • Psychomotor agitation/slowing • Highest suicidal risk: 25% of all suicides

8. More likely to report sx of depression & sadness/ expresses verbal/passive means of Suicide Hopelessness Helplessness Negative towards self Insomnia/eating d/o Reports cognitive & physical changes Less talk about SI -- More successful Apathy/emptiness Dec’d interest,wt loss Hypersomnia/early morning awakening Younger Vs. Older adult

9. Onset : gradual Unaware of sx’s Emotions: labile Response: evasive Appearance: inappropriate Physical: vague fatigue Triggered event Aware of memory changes Feelings of sadness “I don’t know” response Not concerned re: appearance Dementia vs. Depression

10. Neurological: Aphasia,agnosia, apraxia,persever-ation Reality:denial Anorexia/wt. Loss Insomnia/ reduced energy Neuro: dysphasia w/o physiologic basis Increased sense of gloom Dementia vs. Depression

11. Normal vs. Alzheimer brain • The top image shows a normal brain, facing left. The brain tissue occupies most of the space available inside the skull. • The brain below shows the changes with Alzheimer's disease. The cortical gyri have atrophied. • Under a microscope, you see grey cells. Brain weight is significantly lighter.

12. Suicide assessment • Up to 90% of older adults who commit suicide have an informant!!! • >15% of elders with chronic conditions are depressed • Post Stroke depression –common • Prevalence in LTC – 25% -> stressors of chronic illness,disability, dementia,chronic pain,loss of spouse,relocation to institution

13. Levels of Assessment • Level I : be aware for vocal clues to suicide intent –ask “ Do you ever think life is not worth living” or “want to escape from your problem?” • Level II: ask “Do you think about harming yourself?” “ or taking your own life?”

14. Suicide assessment • Level III: ask “ Do you have a plan?” • Ask “what would you do?” • Level IV: Ask “Have you ever started to act on the plan? –Under what circumstances would you act on this plan?”

15. Onset- slow –inscidious JOMAC s/sx. Progressive d/o Decline of functioning Psych & Behavioral disturbances may occur: Delusions/hallucinations/agitation/beligerence Onset – rapid Cognition fluctuates Decreased attention Distractable Sensory disturbance/illusions Misinterpretation of stimuli 10-15% in hosp can suffer from delirium. Dementia vs. Delirium

16. Abnormal APOE gene identified in genetic AD Plaques & tangles Cortical atrophy Identifiable condition Ie. Physiologic Metaboloic Cerebral disturbance Drug intoxication Poly-pharmacy Etiology Dementia v.s. Delirium

17. Review questions :the older adult with cognitive & mood disorders

18. The nurse is talking to a woman who is worried that her mother has Alzheimer’s disease. She correctly tells the daughter that EARLY signs of dementia include: • Memory loss that is more than forgetfulness. • Symptoms vary with different persons • Disorientation to person, place and time • Inability to perform self-care tasks without assistance.

19. The nurse has been teaching caregivers about donepezil(Aricept). The nurse evaluates the teaching to be effective by the following statement: • “I’ll be eager to see if this medication makes any improvement in concentration. • “This medication will slow the progress of Alzheimer’s disease temporarily.” • “Let’s hope this medication will stop Alzheimer’s disease from progressing any further.” • “It is important to take this medication on an empty stomach.”

20. A client with late moderate stage of dementia has been admitted to a long term care facility. Which of the following nursing interventions will help the client to maintain optimal cognitive function? • Discuss pictures of children and grandchildren with the client. • Do word games or crossword puzzles with the client. • Provide the client with a written list of activities. • Watch and discuss the evening news with the client.

21. A client with delirium is attempting to remove the intravenous tubing from his arm, saying to the nurse ”Get this snake off me - Go away!” The nurse recognizes that the client is experiencing which of the following: • Delusions • Hallucinations • Illusions • Disorientation

22. Which of the following interventions is most appropriate for helping a client with early stage dementia complete ADL’s ? • Allow enough time for the client to complete ADL’s as independently as possible. • Tell the client to finish ADL’s before breakfast or the nursing assistant will do them. • Plan to provide step by step prompting to complete ADL’S. • Provide the client with a written list of all the steps to complete the ADL’s.

23. In admitting a client with Alzheimer’s disease to the unit. Which placement variable would have the highest priority? • Place the client with a roommate. • Place the client without a roommate. • Place the client close to the nurse’s station. • Place the client at a distance from the nurse’s station.

24. A client hospitalized with Alzheimer’s disease is found wandering in the streets. What measure(s) should be taken in the unit to prevent the client from wandering off? • Place the client in daytime restraints. • Place the client in nighttime restraints. • Provide a security guard at the door. • Use electronic surveillance devices.

25. The nurse is conducting a home health assessment visit with an 84 year-old client who is living alone. Which aspect of lifestyle noted by the nurse would be of greatest concern? • The family visits twice a month, and rarely calls. • The family maintains only phone contact daily. • The client uses a cordless telephone rather than a standard phone. • The client prefers not to attend a senior center for meals and recreation.

26. Which of the following would the nurse incorporate in the care plan of a client with dementia to aid in memory retention? • Daily activity schedule • Large motor activities • Simple word games • Discussion groups

27. The nurse is assessing an elderly client who presents with symptoms of decreased concentration, sadness, and somatic complaints using the Mini-Mental State Examination. This assessment is used for the purpose of differentiating depression from which of the following? • Anxiety • Dementia • Paranoia • Somatization