Slide 1Student Learning OutcomesMental HealthFunctions of the brainSlide 5Temporal LobeStress & StressorsStress & StressorsStress & StressorsStress & StressorsFactors Influencing Mental Health Care for Older AdultsFactors Influencing Mental Health Care for Older AdultsAccess to Mental Health Care Among Older AdultsDepressionSymptoms of DepressionCauses of DepressionAssessmentEthnic / cultural considerationsSuicideSuicidal Risk (SLAP)Case StudyCont.Depression InterventionsWheelchair bikingSlide 25MedicationsAnxiety DisordersAnxiety DisordersAnxiety DisordersPTSDOCDParanoiaSchizophreniaBipolar D/OAlcohol use in the Older AdultSlide 36Alcohol Use and Misuse12 oz beer = 5 oz wine = 1 shot of liquorScreening for Alcohol UseEffects of ETOH on the Older AdultPhysiologyETOH complicationsRx and OTC drug misuseIn Summary …In Summary …In Summary …Slide 47Student Learning OutcomesCognitionNormal aging CognitionCognitive ReserveCognitive PrescriptionsPreparing Instructional Materials for OAsCognitive ImpairmentDeliriumDeliriumPrevalenceHealthcare attitudesDelirium Predisposing risk factorsDelirium precipitating risk factorsCont.Key Features of DeliriumDeliriumPost operative DeliriumOutcomesToolsDelirium MnemonicDelirium Superimposed on DementiaPrevalence of Delirium superimposed on DementiaSlide 70Dementia VideosDementiaTypes of DementiaCostsNeurotransmittersDementia MnemonicGlobal deterioration scaleSlide 78Vascular DementiaParkinson’s DementiaFrontotemporal DementiaHIV/AIDS related DementiaNeurosyphillisHuntington’s diseaseCreutzfeldt-Jakob diseasePrevalence of Alzheimer’sPlaques & Tangles in ADSlide 88Risk factors for ADProtective factors against ADSymptoms of ADCont.DiagnosisMMSECont.TreatmentsPrescribed treatmentsPrognosisComplicationsWandering in Older Adult with DementiaDementiaDementiaDementiaIn Summary …In Summary …In Summary …Module 7Challenges to Mental WellnessAlcohol Use & MisuseStudent Learning OutcomesDiscuss factors contributing to mental health & emotional wellness in older adults.Identify the most common mental disorders in older adults.Describe the similarities and differences in depression, delirium, & dementia.Discuss common concerns in care of persons with dementia and nursing responses.Discuss the effect of chronic mental health problems on individuals as they age.Specify several indications of substance abuse in elders & nursing responses.Mental HealthMental health is not different in later life, but the level of challenge may be greater.What can nurses do to use the “resilience” older adults bring with them as they age to help them stay mentally healthy?Resilience: The Oak tree vs. The Mulberry TreeFunctions of the brainTemporal LobeLimbic System: Hippocampus & Amygdala – Regulate emotion and memoryStress & StressorsStress reduces one’s coping abilityMay impair immune systemMany situations/conditions occur as we age that may create disruptions in daily life and drain one’s inner resources.Individual differences in how OAs define, perceive, & react to stress.Crises & stress can create emotions affecting OAs physical healthStress & StressorsStress can appear as cognitive impairment or behavior change – disappears when stress reduced.Social relationships & support are particularly salient to stress management and coping.Stress & StressorsPotential stressors in late life ... Can you name a few of these?What are some of the factors that might influence an older adult’s ability to manage stress?Stress & StressorsCoping strategies? What do you think might work for an older adult? Box 18-4, p.341.Factors Influencing Mental Health Care for Older AdultsWhy is the rate of utilization of mental health services for elders, even when available, less than that of any other age-group?Estimated that 63% of older adults with a mental health disorder do not receive the services they need.Only about 3% report seeing mental & behavioral health professionals for treatment.Factors Influencing Mental Health Care for Older AdultsAttitudes & BeliefsAvailability & Adequacy of Mental Health careSettings of CareCultural & Ethnic DisparitiesGeropsychiatric NursingAccess to Mental Health Care Among Older Adults Lack of access significant problem for community-dwelling older adults.Especially for those in rural areasStrategies to improve access must be targeted at the individual-provider-&-system levels.Symptom recognition by older adult & familyCommunities & health care organizations need to work togetherDepression Not a normal part of agingAffects 6 million 65 years & older (18%)Only 10% receive treatmentPresentation of somatic complaintsMost common mental health problem of late lifeCan be life-threatening if unrecognized and untreatedOlder white men complete more suicides than any other groupSymptoms of DepressionPersistent sadnessLoss of pleasure in activitiesFatigueLack of motivation Insomnia / hypersomnia Changes in appetite / weight Difficulty concentrating, focusing, thinking and making decisions Excessively worrying Feelings of guilt, worthlessness, hopelessnessThoughts of death or suicidePsychomotor retardation** Vague c/o pain are common in the older adult**Causes of Depression Genetic BiologicalPossible decrease in levels of 5HTP, NE, D2HormonalWomen at highest risk during menopauseMedication side effectsSteroids, hormones, chemotherapy, antiparkinsonian agentsNutritional deficitsIncreased co-morbid chronic disease conditions** Diabetes**Assessment Assess using the Geriatric Depression Scale Short formPHQ 9 Asking, “how are you feeling”Reluctance to say “happy” or “enjoying life” needs to be further evaluatedEthnic / cultural considerationsPg. 352 in textMinority groups less likely to receive traditional treatmentMay seek services at church or community Using words like “depressed” are highly stigmatized in the older adult**80% of suicides are related to Depression*SuicideHigher than any other age groupHighest for 85 years old & older Non-Hispanic white males 5x more likely14 / 100,000 deaths in ≥6511 / 100,000 deaths in general population.Suicidal Risk (SLAP)1. Does the pt. have SOCIAL SUPPORT2. Is the plan LETHAL?3. Does the pt. have ACCESS to the means to end their life?4. Does the pt. have a PLAN