UT NURS 3630 - Psychosocial Needs of Older Adults

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Psychosocial Needs of Older Adults- NOT NORMAL sign of agingo Depression o Cognitive Deficits (Severe Memory Loss)o Prolonged Grieving- Mental health issueso Depression – not normal part of aging but have higher incidenceo Depression and suicide risk –white males older than 75 years of age at highest risko Anxiety disorderso Delirium – secondary to general medical conditiono Dementiao Alcohol abuse o Pain- Depressiono Depression is often confused with dementia or delirium and may go unrecognized and under diagnosed.o Depression can be caused by medication, metabolic or endocrine diseases, or chronic pain.o Depression is treatableo SSRI’s are first-line treatment of depression: also helpful in treating anxietyo ECT may be used in elderly if severe depression- Anxietyo Anxiety is twice as prevalent as dementia and four to eight times as common as major depressive disorders.o Unique anxiety in elderly is fear of falling. Anxiety is also related to physical complaints, pain, sleep disturbanceso Treatment is SSRI medication, relaxation trainingo Avoid use of benzodiazepines- Why? Bc its sedating causing falls- Deleriumo Delirium occurso secondary to a general medical conditiono is reversibleo causes fluctuations in consciousness and changes in cognition which develop over a short period of time (hours to days)- Dementiao Dementia is usually of the vascular or Alzheimer’s type. o It is characterized by o long-term memory losso disturbances in executive functioningo is irreversibleo Onset develops slowly (over months)- ELDER interventionso 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 teachingo Promotion of self-care activitieso Milieu management - Cognitive function involveso 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 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 antipsychoticDEMENTIA 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)- AriceptNORMAL Making a bad decision once in a while Missing a monthly payment Forgetting which day it is and remembering later Sometimes forgetting which wordto use Losing things from time to timeDEMENTIA Poor judgment & decision making 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 themAlzheimer’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 disordero Initially, delay cognitive declineo Later, protect patient from hurting selfo 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 frustrationMEDS- 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 stageo 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

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UT NURS 3630 - Psychosocial Needs of Older Adults

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