Mental health in the elderly Flashcards Preview

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Flashcards in Mental health in the elderly Deck (30):
1

What can be done prior to nursing home admission that significantly reduces inappropriate placement?

Psychiatric assessment.

2

Why is mental health challenging to manage in the elderly?

Presentation is often atypical, and frequently there are coexistent physical conditions that further complicate assessment and mx.

3

What are the 'three D's'?

Dementia, depression, and delirium.

4

What are three important corollaries for the three D's?

Suicide, caregiver stress, and social isolation.

5

____ to ____% of older people living in the community experience depression symptoms.

10 - 15%

6

What percentage of older people living in the community experience anxiety?

10%

7

What percentage of aged care residents suffer from depression?

34.7%

8

What three factors comprise the common final pathway resulting in depression?

Genetics, neurochemistry, and adverse life events.

9

Which neurotransmitter is thought to be primarily responsible for depression?

Serotonin (depletion).

10

List some risk factors of depression in elderly people. 

  • Increase in physical health problems
  • Chronic pain 
  • Side effects of medications 
  • Losses 
    • Self-worth
    • Income 
    • Work
    • Independence
    • Mobility 
    • Flexibility
    • Relationships
  • Social isolation
  • Significant change in living arrangements 
  • Admission to hospital
  • Anniversaries/invoked memories

11

What is dementia?

A global impairment of higher cortical functions including memory, capacity to solve everyday problems of day-to-day living, performance of learned perceptuo-motor skills, correct use of social skills, and control of emotional reactions, in the absence of gross clouding of consciousness. 

12

Over ____% of all dementia is caused by Alzheimer's Disease. 

50%

13

What percentage of dementia is caused by vascular dementia?

20%

14

What percentage of dementia is caused by a combination of Alzheimer's Disease and vascular dementia?

15%

15

List some other causes of dementia.

  • Picks disease
  • Lewy body disease
  • Huntingtons Chorea
  • Jakob-Creutzfeld disease

16

Clinical presentation of dementia includes disruption to: 

  • Memory
  • Orientation
  • Judgement and problem solving
  • Community affairs
  • ADL's
  • Personal care

17

Which has a longer survival rate, Alzheimer's Disease or vascular dementia?

Alzheimer's Disease.

18

Death of dementia pts is usually the result of ____ ____. 

Systemic infection.

19

List the neurological changes that occur in dementia.

  • Development of: 
    • Neurofibrillary angles 
    • Plaques
    • Disruption to Tau proteins
    • Acetylcholine

20

List the macroscopic changes in the brain that occur in dementia. 

  • Loss of overall brain volume due to atrophy
  • Widening of the sulci
  • Enlargement of the ventricles

21

List the characteristic pattern of deficits due to cortical impacts of dementia.

  • Amnesia
  • Aphasia
  • Apraxia
  • Agnosia
  • Abnormal affect
  • Acalculia
  • Impaired abstraction

22

List some characteristics of sub-cortical dementia impacts.

  • Forgetfulness
  • Normal language but abnormal speech
  • Slowed cognition in absence of parietal signs
  • Apathy and depression
  • Stooped posture, increased tone, tremor, abnormal gait

23

What is the aim of dementia management?

To reduce 'excess disability'.

24

What is the definition of delirium?

A disturbance of consciousness that is accompanied by a change in cognition that cannot be better accounted for by a pre-existing or evolving dementia. 

25

How long does delirium take to develop and how long does it last? 

Hour to days; ~ a day.

26

What are some characteristics of delirium?

  • Reduction in clarity of awareness
  • Inability to focus
  • Distractibility
  • Change in cognition

27

____ to ____% of elderly pts have delirium on admission to hospital.

15 to 30%

28

Up to ____% of elderly pts will develop delirium during their stay in hospital.

56%

29

Incidences of delirium are higher in which subgroups?

  • Cancer
  • AIDS
  • Terminal illness
  • Post-surgical (significant surgery)
  • Those in ICU and palliative care wards

30

List some possible adverse outcomes of delirium.

  • Prolonged hospital stay
  • Increased mortality chance in hospital
  • Increased risk of developing complications 
  • Poor physical and/or cognitive recovery
  • Risk of nursing home placement 
  • Risk of developing dementia (even in those with no cognitive impairment at baseline)

Odds of a poor income are increased by pt frailty and dx delays