COMPS: PT Exam & Intervention of Psychosocial Issues Flashcards
(55 cards)
1
Q
It’s getting better all the time:
Happiness, Well-Being INC after 50yo
A
see pics
Stress
Worry
Anger
Sadness
Happiness
2
Q
The Reality for Many
Story of Mr. Smith, an 83yo retired salesman in NYC…
Why should we care?
A
- What are the psychosocial issues experiencing?
- suggestions to help cope?
- How does PT fit into this HC schema??
3
Q
Depression is NOT Normal Aging
What is it?
A
Primarily the result of loss of health, as well as cognitive impair, incontinence, chronic cond’s, and personal/emotional loss
4
Q
Depression is NOT normal aging
Contributing Factors:
A
- social iso
- substance misuse
- financial insecurity
- depression
- elder abuse
- caregiver burden
- self-neglect
- housing issues
5
Q
Depression is NOT Normal Aging
W/ contributing factors, and depression:
what happens?
A
- Pts LESS likely to take meds, obtain necessary tests and proc’s, and access routine and preventative med care
- The course of acute and chronic illnesses can be negatively effected
6
Q
Depression
aka….
A
“The common cold of the elderly”
7
Q
MOST common psychological problem in the elderly is_______
A
Depression
8
Q
NIH stats on depression
A
Of the 35mil Am’s age >65yo→ about 2mil suffer from full blown depression→ nearly 20% of Am’s 65+
*another 5mil suffer from LESS severe forms of depression
9
Q
Major Depressive Disorder (MDD)
5 or more sx’s present for @ least 2wks:
A
-
At least ONE of the following:
- Depressed or irritable mood OR loss of interest or pleasure
-
AND the rest from the following:
- Sig wt loss or Dec in appetite
- Insomnia or hypERsomnia
- Psychomotor agitation or retardation
- Fatigue or lack of energy
- Feelings of worthlessness or guilt
- Dec concentration or indecisiveness
- Recurrent thoughts of death or suicide
10
Q
S/S Depression in Older Adults:
Older adults who deny feeling sad or depressed may still have major depression
Clues:
A
- Unexplained or aggravated aches and pains
- Hopelessness
- Helplessness
- Anxiety+worries
- Memory probs
- Loss of feelings of pleasure
- Slowed mvmt
- Irritability
- Lack of interest in personal care
- skip meals
- forget meds
- neglect personal hygiene
11
Q
Depression and Physical Illness:
Factors INC’ing risk of depression in pts w/ phys illness
Biological:
A
- hormonal, nutritional, endocrine
- meds effects
- phys consequences of systemic or cerebral dis’s
- CVAs
- PD
- DM
- CA
- AD
- MI
12
Q
Depression and Physical Illness:
Factors INC’ing risk of depression in pts w/ phys illness
Psychological
A
- Sense of loss assoc’d w/ serious illness
- Effects of body img, self-esteem
- Impaired capacity to work and maint relationships
13
Q
Depression and Phys Illness
Somatic concerns found in 60% of men and women 60+
What does this entail?
A
- Exaggerated focus on self and sx magnification replace social interactions
- Can lead to w/draw+social iso.
- Loss of autonomy→ results in phys sx’s in an effort to get attn, signal for help, control others
14
Q
Pain-Anxiety-Depression Connection
Explain…
A
People suffering from depression tend to experience more severe and long-lasting pain than other people
15
Q
The Pain-Anxiety-Depression Connection is particularly evident in pain syndromes such as:
A
- fibromyalgia
- IBS
- LBP
- HAs
- Nerve pain
16
Q
Pain-Anxiety-Depression Connection
*Researchers once thought the relationship bw pain, anxiety, and depression resulted mainly from psychological rather than biological factors:
A
- Chronic pain is depressing, and likewise major depression may feel phys painful
- BUT researchers have learned more about how brain works, how NS interacts w/ other parts of body→ discovered that pain shares bio. mech’s w/ anxiety and depression
17
Q
Tx When Depression Overlaps Pain
5:
A
- Relaxation
- Exercise***
- Psychotherapy
- Hypnosis
- Pharmacologic
18
Q
Tx When Depression Overlaps Pain
Relaxation Training
A
- Muscle relaxation
- yoga
- mindfulness
19
Q
Tx When Depression Overlaps Pain
Exercise
A
- Strong evidence that exercise boosts mood and alleviates anxiety
- Less evidence on impact about pain
20
Q
Tx When Depression Overlaps Pain
Psychotherapy
A
- Cognitive Behavior Therapy (CBT)
21
Q
Tx When Depression Overlaps Pain
Hypnosis
A
******
22
Q
Tx When Depression Overlaps Pain
Pharmacologic:
A
- Dr may prescribe anti-depressants or mood stabs to address BOTH depress and pain
- SNRI’s
- Tricyclic Antidepressants
23
Q
Depression or Dementia?
A
see pics
24
Q
Depression or Dementia?
Sx’s of Depression
*NOTE the key words highlighted
A
- Mental decline is relatively rapid
- Knows correct time, date, and where he/she is
- Diff concentrating
- Lang and motor skills are slow, but normal
- Notices or worries about memory probs
25
Depression or Dementia?
## Footnote
**Sx's of Dementia**
**NOTE key words highlighted**
* Mental decline happens **slowly**
* **Confused and disoriented;** becomes lost in familiar loc's
* Diff w/ **STM**
* Writing, speaking, motor skills are **impaired**
* **Does NOT notice memory probs** or **seem to care**
26
Depression Scales
## Footnote
**Several used to examine depression:**
**GO TO LINKS PROVIDED!!!**
* Geriatric Depression Scale short form:
* **extensively used for older adult pop**
* geriatrictoolkit.missouri.edu/cog/GDS\_SHORT\_FORM.PDF
* Beck Depression Scale
* **BDI used for 35yrs to ID and assess depressive sx's→ highly _reliable_ regardless of pop.**
* southlakepsych.org/index.htm/Patient\_Forms\_files/BeckDepressInv.jpg
27
Whooley Questions for Depression Screening
* A **positive test** (~95% Sn) IDs pts who may benefit from further eval
* A **negative test** essentially **rules OUT** depression
* SnNOUT
* Sn→ great **S**cree**n**ing test
* The Whooley Questions (~65% Sp) cannot be used to dx or measure severity of depression
28
Mgmt of Depression
**Create a \_\_\_\_\_\_\_\_\_** **and provide the pt w/ a sense of \_\_\_\_\_\_\_**
Trusting therapeutic relationship; autonomy
* Lessens feelings of **despair** and **helplessness**
* Be an **active listener, unbiased listener→** allowing for pts to reveal **concerns/issues** that may affect **tx**
29
Mgmt of Depression
INVOLVE THE Pt\*\*
in the exam process, setting goals, creating POC
30
Mgmt of Depression
Clear and concise explanations of…
Explanations of interventions, proc's and expected outcomes
31
Mgmt of Depression
## Footnote
**Depressed pts often become ______ in their communication abilities and req assist w/ \_\_\_\_\_\_**
immobilized; motivation
* Diffs making decisions
* Become overwhelmed
* Extra time given to help them make decisions about their care
32
Mgmt of Depression
W/ _LOW_ motivation, how can PTs assist?
Assist by **providing encouragement, emphasizing** pts **strengths,** offering **positive feedback and promoting perceptions of self-worth**
33
Mgmt of Depression
Info about the **good prognosis of depression w/ pharmaco. intervention**
VERY VALUABLE\*\*\*\*
\*depends on person
34
Mgmt of Depression
\***Drug tx remains _most common approach_**
**5 Categories:**
1. **Selective Serotonin Reuptake Inhibitors (SSRIs)**
2. Hetercyclic Antidepress's
3. Tricyclic Antidepress's
4. Serotonin/NE Reuptake Inhibitors
5. Monoamine Oxidase Inhibitors (MAO inhibitors)
35
Mgmt of Depression
Drug Tx **SE's:**
* balance dysf
* OH
* blurred vision
* constipation\*\*\*
* Urinary retention
* mild tremor\*\*\*
36
Mgmt of Depression
**This** is NOT used as freq'ly as **pharmacotherapy** and older adults are LESS LIKELY to access it….
Psychotherapy\*\*\*
37
Mgmt of Depression
\***Pyschotherapy (less accessed by older adults)**
**What is it?**
* Involves counseling that helps people **cope w/ depression** and **reinforces + outlook**
38
3 Professions that can provide **psychotherapy**
1. Psychologist
2. Psychiatrist
3. Social Worker
39
Mgmt of Depression
## Footnote
**EXERCISE\*\*\***
* Effective tx for depression
* Bastone and Filho (2004)→ report that ex program produces bennies w/ regard to **reduction of deprssive sx's** and **prevention of decline in mental status in institutionalized elderly**
* Research shows **clear relationship** bw **phys act and Dec lvls of depression\*\*\*\*\*\*\* USE IT!!!!**
40
Ways to assist in **prevention of depression:**
## Footnote
**ALL GIVE _PURPOSE_\*\*\***
* **Getting out** into world
* **Connecting** to others
* **Participating** in acts.
* Volunteering
* **Caring** for a pet
* **Learning** a new skill
* **Enjoying** jokes and stories
* **Maintaining healthy diet**
* **Exercising/phys activity\*\*\*\***
41
**Bipolar** Older Adults
Dx of **Mania req's…..**
* Dx of **mania** req's a **distinct pd** of **persistently elevated mood _lasting for 1 or more weeks_**
* **Three add. sx's may include:**
* inflated self-esteem or grandiosity
* hyper-sexuality
* incd act.
* dec'd need for sleep
* pressured speech
* racing thoughts or flight of ideas
* distractibility
* **Grandiose or paranoid delusions may be present**
42
Bipolar Older Adults
## Footnote
**Criteria for Dx'ing**
* Identical to those for younger adults\*\*
* **pds of unusual elevation or irritability in mood that _are coupled with_ inc's in energy, sleeplessness, fast thinking or speech**
43
Bipolar in Older Adults may also be a \_\_\_\_\_\_\_\_\_\_
Reoccurence or undx'd from younger days
44
Bipolar in Older Adults may be ______ that presents as \_\_\_\_\_\_
Depression that may present as irritability
45
Stress and the Older Adult
## Footnote
**What is Stress?**
* Stress response is like an airplane readying for take-off
* All systems are primed all the time
* Heart and blood vessels
* Immune system
* Lungs
* GI
* Sensory organs
* Brain
* ALL modified to meet **perceived danger (stuck in fight or flight)**
* **Systems effected by stressful situations**
* Dec's efficiency
* Acute (over time) + Long term (chronic)
46
Ability to achieve a _________ after a **stressful event** becomes more difficult
**Relaxation response**
**\***can't let it go even just “for now”
\*talk to them about things **but stay _productive_**
47
What reduces the efficiency of the brains response to stress?
Aging
48
Older adults are often exposed to **major stressors** such as:
* med probs
* loss of spouse or friends
* change in living situation
* retirement or financial worries
49
Determining **these** in an older adult patient's life during Hx taking can provide you w/ info that can help you with your _____, ______, \_\_\_\_\_\_
Stressors;
Dx, Prognosis, creating POC
50
Stress and Older Adult
## Footnote
**Ex's of _Stressors_**
* Caregiving
* Loss and grief
* Changing _roles_ as we age
* **Ex. move in w/ son/daughter**
* Change in social status
51
Stress and Older Adult
## Footnote
**Caregiver Issues:**
* Health of caregivers **overlooked**
* Research has demo'd that over 23% of family caregivers met the req's for home health services for themselves and that 50% report their own health to be fair or poor
* **Most common self-reported health problem of caregivers:**
* depression- 66%
* HTN- 34%
* arthritis- 30%
52
Stress and Older Adult
## Footnote
**Caregiver Issues Stats**
* ¼ Am households provide some degree of caregiving
* 7.3mil older adults (65+) need care
* 61% of “intense” family caregivers (providing @least 21hrs care/week) suffer from **depression**
* some studies say caregiver stress inhibits healing
53
Stress Scale
* Holmes and Rahe Life Events Scale → widely used tool for eval'ing stress
* purported as an **indicator to determine chance of serious illness _if high score is rendered_**
* en.wikipedia.org/wiki/Holmes\_and\_Rahe\_stress\_scale
54
Coping Strategies for Stress and Older Adult
* thinking **confidently and optimistically** in the face of bad news
* **more time doing a few selected activities→** get the most out of them
* participating in **family and community activities**→ personal satisfaction
* **social networks→** emo/phys support
* **spiritual or religious involve.**
* **Positive healthy behaviors**
55
Add. Tx Strategies for Stress and Older Adult
* **Relaxation**
* meditate
* progress. relaxation
* guided imager, hypno.
* biofeedback
* breathing tech's
* **Phys act/exercise**
* aerobic
* dancing
* **_Prioritize_ stressors**
