Psychosocial Needs of Older Adults NOT NORMAL sign of aging o Depression o Cognitive Deficits Severe Memory Loss o Prolonged Grieving Mental health issues o Depression not normal part of aging but have higher incidence o Depression and suicide risk white males older than 75 years of age at highest risk o Anxiety disorders o Delirium secondary to general medical condition o Dementia o Alcohol abuse o Pain Depression o Depression is often confused with dementia or delirium and may go unrecognized and o Depression can be caused by medication metabolic or endocrine diseases or chronic under diagnosed pain o Depression is treatable o SSRI s are first line treatment of depression also helpful in treating anxiety o ECT may be used in elderly if severe depression Anxiety o Anxiety is twice as prevalent as dementia and four to eight times as common as major o Unique anxiety in elderly is fear of falling Anxiety is also related to physical complaints depressive disorders pain sleep disturbances o Treatment is SSRI medication relaxation training o Avoid use of benzodiazepines Why Bc its sedating causing falls Delerium o Delirium occurs o secondary to a general medical condition o is reversible o causes fluctuations in consciousness and changes in cognition which develop over a short period of time hours to days Dementia o Dementia is usually of the vascular or Alzheimer s type o It is characterized by o long term memory loss o disturbances in executive functioning o is irreversible o Onset develops slowly over months ELDER interventions o Provide empathetic understanding and active listening o Encourage expression of feelings o Allow adequate time to process information o Assure hearing aides are working o Providing written information in large print o Nurses play a vital role in monitoring reporting and managing medication side effects o Health teaching medication teaching o Promotion of self care activities o Milieu management Cognitive function involves o Attention ability to focus on environmental cues without distraction o Short term memory immediate recall of recent events o Plan and problem solve executive function o Long term memory learn and retain information o Social cognition reading social cues DELERIUM DEMENTIA Attention ability to focus on environmental cues without distraction Short term memory immediate recall of recent events Plan and problem solve executive function Long term memory learn and retain information Social cognition reading social cues SAFETY 1st Medicate with antipsychotic Slowly over months Stable course No impaired LOC Impaired cognition memory judgement Normal may worsen in evening sundowning Flat delusions Incoherent slow Medicate with anticholinesterase AchEI Aricept NORMAL while DEMENTIA making Making a bad decision once in a Poor judgment decision Missing a monthly payment Forgetting which day it is and remembering later Sometimes forgetting which word to use Losing things from time to time Inability to manage a budget Losing track of the date or season Difficulty having a conversation Misplacing things and being unable to retrace steps to find them Alzheimer s dementia Memory impairment Disturbances in executive thinking Essential feature multiple cognitive deficits Aphasia Difficulty in forming words Apraxia Loss of ability to perform purposeful movements Agnosia Loss of the ability to recognize familiar objects Use of defense mechanisms denial confabulation perseveration MULTIPLE stages 1 7 o Priorities will change throughout the course of the disorder o Initially delay cognitive decline o Later protect patient from hurting self o Later physical needs become the focus of care Reinforce reality Introduce self with each new contact Short simple sentences one item of information at a time Limit number of choices when dressing or eating Minimize the need for decision making and abstract thinking to avoid frustration MEDS Acetylcholinesterase inhibitors AChEI Work by increasing CNS acetylcholine concentrations by inhibiting breakdown by enzyme AChEl o Donepezil Aricept for dementia Most common side effects nausea vomiting May also cause bradycardia use with caution in clients with asthma or COPD bronchoconstriction d t increase of acetylcholine Medication Food interaction Use with NSAIDs such as aspirin may cause bleeding Antihistamine tricyclic antidepressants antipsychotics can reduce effects od donepezil block cholinergic receptors Memantine Namenda blocks excess glutamate and reduces calcium and blocks the entry of calcium into nerve cells Tangles and plaques are associated with excess glutamate o For later stage o Is only medication that is approved for moderate to severe stages of AD o Common side effects dizziness headache confusion constipation Antipsychotics FDA warning against use of antipsychotics in elderly with dementia