Chapter 38

2. Chapter 38 Geropsychiatric Nursing

3. Components of Geropsychiatric Nursing Assessment • Interviewing—Therapeutic communication skills; comfortable, quiet setting • Mental status examination—Mini-Mental State Examination; evaluation for depression, anxiety, and psychosis • Behavioral responses—Description of behavior and triggers; assessment of behavioral change; frequently observed challenging behaviors • Functional abilities—Mobility; activities of daily living; risk for falls • Physiological functioning—General health; nutrition; substance abuse • Social support—Social support systems past and current; family-patient interaction; caregiver concerns

4. Diagnosis of the Geriatric Patient • Disturbed thought processes—Impaired memory; confusion; paranoia • Affective responses—Dysfunctional grieving and hopelessness; risk for self-directed violence; situational low self-esteem • Somatic responses—Disturbed sleep pattern; imbalanced nutrition: less than body requirements • Stress responses—Progressively lowered stress threshold (PLST); relocation stress syndrome; risk for caregiver role strain • Behavioral responses—Social isolation; self-care deficit/behavioral deficit; challenging behaviors/behavioral excess

5. Evidence-Based Treatments for Depression and Anxiety in the Aged Disorder: Depression and anxiety in the aged Treatment: • The primary classes of antidepressant medications (SSRIs and TCAs) were effective in both the acute and maintenance phases of late-life depression, although the latter has a heightened risk of adverse side effects. • Electroconvulsive therapy (ECT) has shown its effectiveness and safety in the short-term management of late-life, severe psychotic depression and mania. • Psychosocial interventions were efficacious, especially cognitive, behavioral, and cognitive-behavioral therapy, in treating major depressive disorders in the aged.