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N450__Gero Midterm UGH (2)
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N450__Gero Midterm UGH (2)
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N450::Gero Midterm UGHPsychological and Cognitive Function - ANS-- Undiagnosed and untreated mental disorders
such as depression or despondent mood marked by decreased energy, feeling worthless and
guilty, problems with concentration, and thoughts of death or suicide can lead to increased
disability, premature death, increased morbidity, cognitive decline, increased risk of
institutionalization, and a significant decrease in an older person's quality of life.
***Positive mental health is a necessary component of successful aging***
- Mimics normal age related changes
- Assume depression normal consequence of aging
- Older adults--> atypical presentation- won't say crying or sad --> withdrawn or somatic
symptom (hx fatigue/abdominal pain)
- Mental health problems in older adults is lower than any other population (when first retired not
as many responsibilities)
**Positive attitude can help older adult cope w/a lot of changes of aging**
Mental Health Themes - ANS-- Don't have geriatric mental health providers
- Healthy tips: for pt/resident to stay active, engage in social activities, thinking games, read,
new hobbies or cont old hobbies, continue w/education (ex. community college lower cost
courses), control stress, yoga or tai chi
- Mental health is fundamental to health
- Mental illnesses are real health problems.
- The efficacy of mental health tx is well documented
- Mind and body are inseparable
- Shortage of trained mental health professionals to meet the need for services
- Stigma is a major obstacle preventing older people from getting help
Normal Age Related Changes - ANS-- Mental Health remains relatively stable
- Information processing speed declines but intelligence remains the same
- Ability to divide attention between 2 tasks declines (multitasking decreased)
- Ability to maintain sustained attention declines
- Ability to filter out irrelevant information declines
- Minor decrease in recent memory, word finding and remembering names (someone you
haven't seen in a while)
**Vocabulary improves (b/c they tend to read more)**
- Visuospatial task ability declines, such as drawing and construction ability
- Abstract thinking and mental flexibility declines
Cultural Considerations - ANS-The older population is highly heterogeneous and includes a
diverse mix of immigrants, refugees, and multigenerational Americans with vastly different
histories, languages, spiritual practices, demographic patterns, and cultures.
,- Cultural considerations - current population = more caucasian = new generation much more
heterogeneous
- Non whites: Language- barrier, not as high education, lack/lower health literacy, lack insurance
- Delay in seeking treatment, lack trust in healthcare providers, use mental health services less
Personality and Self-Concept - ANS-- An older person's self-concept can be eroded or
enhanced over time as a result of circumstance and life experiences.
- An older person's personality influences self-concept and adaptation to role transitions, such
as widowhood or retirement.
- How much they have to adapt as they age is a big deal - some might not want to use a hearing
aide b/c of stigma but then will be social isolated b/c cant hear
- Its about pt acceptance and about how they can adapt to their situation
Life Satisfaction and Life Events - ANS-Life satisfaction is an attitude toward one's own life; it
may be defined as a reflection of feelings about the past, present, and future.
Life satisfaction and morale are closely related to well-being.
Recent studies document that life satisfaction increases until about the age of 65 and then
begins to decrease.
***Two major components of wellbeing are happiness (affect) and satisfaction (realized
expectations)**
**Independence with IADL's and perceived sense of control can aide in adjustments such as
death of SO, family, friends, and/or pets, negative attitudes towards aging, retirement, chronic
illness, functional impairment, relocation, and loss of driving privileges**
**Consider how these events alone or in combination may affect the mood and personality of
the older adult and do not dismiss risk for anxiety or depression during coping** **Be alert to
significant changes in mood, cognitive ability, and personality**
Stress and Coping - ANS-- Excessive and persistent stress has been linked to the development
of illness.
- Gerontological nurses should recognize and understand stress and its influence on older
persons.
- Most older adults are far less stressed
- More are stressed if --> financial problems, health problems --> can be stressful as they age to
have more than 1 change at a time
Stress= sleep problems Decrease in immune system, increase in anxiety, increase bp,
exasterbate hrt disease and cancers, lead to substance abuse
Stress - ANS-causes:
- sleep problems
- decrease in immune system
- increase in anxiety, increase bp, exacerbate heart disease & cancers, lead to substance abuse
,Personality Disorders - ANS-Psychiatric symptoms that should be investigated and not written
off as normal changes of aging include:
- Memory and intellectual difficulties
- Change in sleep patterns
- Changes in sexual interest and capacity
- Fear of death
- Delusions
- Hallucinations
- Disordered thinking
- Problems with emotional expression
**Any psychiatric symptom or change in personality NOT NORMAL AGING- needs to be
investigated**
***Pre-occupation of death/ fear of death= NOT NORMAL AGING**
- Look at meds- anything new started, look for delirium, dementia, or depression (all the ds)- can
be causing psychotic symptoms
Psychotic Disorders - ANS-- The most common form of psychosis in later years is paranoia.
- The most common stressor that leads to adjustment disorder in later life is physical illness.
***MOST COMMON PARANOIA : can be a result of hearing loss***
- Social isolation, decrease in cognition, or delirium can be seen as pt having psychosis
- Early in dementia- pt will blame others if can't find belongings- often times just misplaced
- Those dx with schizo will have it throughout old age
Bereavement - ANS-Factors that can affect the duration and course of grieving include:
- Centrality of the loss
- Health of the survivor
- Survivor's religious or spiritual belief system
- History of substance abuse
- Nature of the death & loss - common in aging
Becomes pathological if person preoccupied with death, experiences excessive guilt,
overwhelmed by the loss, experiences worthlessness, or decrease in ability to fx
(US culture believes 2 yrs is length of bereavement)
Depression - ANS-- Depression is the mental health problem of greatest frequency and
magnitude in the older population.
- Depression in older adults is often undetected and untreated.
- RN alert to communication "I am too tired to do anything with my kids. I told them to go ahead
and I will see them another time."
- Women twice as likely as men to experience depression
- Depression more likely if the patient has chronic illness, chronic pain or a decline in functioning
- More likely to experience physical symptoms: body aches, headache, pain fatigue or changes
in sleep
- Poor hygiene, self-care neglect
, - Indifferent, does not care, responds with "don't know,"
- Because of loss- depression can occur in older adults
20% will experience some depressive sympt, 13% older adults living in comm exp dep, 43%
living in long term care experience it
- Chronic illneses that will exp dep symp- 57% of pt with alz, 40% pt with Parkinson disease,
30-60% of pt with cva, 25% pt with cancer
Meds that can cause Symptomatic Depression - ANS-- Depression can occur secondary to
medications
- A lot of CNS meds can lead to depression - antipsychotics, etc.
- Analgesics (Narcotics, NSAIDS), Antihypertensives (clonidine), Antipsychotics (haloperidol),
Anxiolytics (diasepam), Chemotherapeutics (vincristine), Sedative (pentobarbital), Other (anti
ulcer, anti cholesterol, corticosteroids, alcohol)
Nursing Assessment of Depression - ANS-- Various instruments are used to assess depression
in the older adult. Each instrument has advantages and limitations.
- The Geriatric Depression Scale (GDS) is a screening instrument used in many clinical settings
to assess depression in older people.
- Example - Hypothyroid- complain of fatigue and no energy --> Important to rule physical
causes out as well as ruling out delirium and dementia
- Difficult- to differentiate normal comorbidities and s/s of depression
Geriatric Depression Scale (GDS) - ANS-- Scored based on if pt bolded the pt gets 1 pt
- 5 or above- further assessment
- Above 10- indicative of depression - but pt still needs full eval - to rule out physical causes and
other neuropsych tests
- (pt with malnutrition can appear to be depressed)- bc withdrawn
Suicide - ANS-- Older adults age >65 have the highest rate of suicide of all age groups
- Depression is a major risk factor
- Older Caucasian men, >85 years, have the highest death rates
- Rational Suicide, Passive Suicide, Active euthanasia, Assisted suicide
Screening questions:
- Over the past two weeks, have you felt sad, depressed or hopeless? Have you felt little
pleasure in doing things?
With depression can come suicide so keep it in mind:
70% of those that comitted suicide have seen provider within alst month
- Suicide not a cry for help in most older adults- person really trying to die --> trying to have a
successful suicide as opposed to it just being an attempt
- B/c of frailty/oldness - more likely to die from suicide or complications
- Screening for depression - asking have you felt sadness, hopelessness, less pleasure in doing
the things you like
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