Psychiatric Care: Older Adult Flashcards
(46 cards)
Erickson: Aging and the Life Cycle
- Young Adulthood
- Middle-Aged
- Elderly
- Intimacy vs Isolation (20-40)
- Generativity vs Self-Absorption (40-64)
- Integrity vs Despair (65+)
(Fear of death is usually a mid-life issue)
Other Tasks of Elderly
- Reminiscence
- Loss
- On time normative incidents do not usually result in ______.
- ______ are usually pain, disability, abandonment, and dependency
Crisis
Fears
Learning - The ability to gain new skills and information may be ______ in elderly, especially verbal learning.
Slower
Memory in Elderly
Immediate - ______
Short-Term - ______
Long-Term - ______
Immediate remains intact
Short-Term remains intact
Long-Term is most affected by aging (retrieval is less efficient, the elderly need more clues)
Intelligence - The ability to use information in an ______ way or ______ knowledge to specific circumstances
Adaptive
Apply
Benign Forgetfulness - The elderly have age associated ______ memory problems. Cognitive problems are due to ______.
Mild
Anxiety
(Examples include forgetting names, misplacing items, difficulty w complex problem-solving)
Psychiatric Evaluation - Include information from caregiver/family. Allow more _____ due to slower response. Family Hx. Review of all ______. Alcohol and substance abuse Hx.
Time
Medications (OTC, Rx, Herbal)
MSE - General description. Moods, feelings, affect. Perceptual disturbances. Language output. Visual-spatial functioning - some decline is normal with age.
MMSE - Affected by educational level. Median score for 9-12 years of school is 26, HS diploma 28. Less sensitive in those with high intelligence. Less specific in those below average intelligence.
Cognitive disorders, depressive disorders, phobias, and alcohol use are ______ mental disorders of old age. This results in a high risk for ______.
Common, Suicide
Risk factors are loss of social roles, loss of autonomy, deaths, declining health, increased isolation, financial constraints, and decreased cognitive functioning.
Delirium is ______ and fluctuating. Altered state of consciousness result in reduced awareness of and ability to respond to the ______. ______ deficits in attention, concentration, thinking, memory, and goal-directed behavior are almost always present.
Acute
Environment
Cognitive
Features of delirium may be accompanied by ______, ______, emotional ______, ______ in the sleep wake cycle, psychomotor slowing or hyperactivity, and is usually abrupt.
Hallucinations
Illusions
Lability
Alterations
Causes of delirium are
I WATCH DEATH
Infectious Withdrawal Acute metabolic Trauma CNS Pathology Hypoxia Deficiencies Endocrinopathies Acute Vascular Toxins/Drugs Heavy Metals
Treatment of delirium includes treating the underlying ______. Close ______, especially by family, frequent reorientation, ______ restraints (may worsen confusion), ______ only if behavioral attempts fail.
Cause Supervision Avoid Medications (Avoid polypharmacy, Low dose neuroleptic is Tx of choice unless withdrawal is cause then short acting benzodiazepine)
What affects cognition, memory, language, personality change, abstract thinking, aphasias, visual spacial functioning, level of awareness and alertness are usually intact in early stages?
Dementia
What differentiates dementia from delirium?
Level of awareness and alertness usually intact in early stages of dementia
Amnestic disorders differs from delirium and dementia because major problem is short term ______ only. Impairment may be due to ______ in mamillary bodies or ______ changes in the dorsal medial nucleus of the thalamus. Most common cause is ______.
Memory
Hemorrhage
Degenerative
Alcoholism
Only ______ is more common in geriatric population than dementing disorders. 5% have severe dementia and 15% mild dementia in those over 65. Age over 80 years 20% have severe dementia. Name most common causes (3) and risk factors (3)
Arthritis
Alzheimer’s disease, Vascular Dementia, Alcoholism
Age, Family Hx, Female Gender
Noncognitive Sx Accompanying Dementia: Mood disorders: \_\_\_\_\_\_ Pathological \_\_\_\_\_\_ and \_\_\_\_\_\_ occurs. Irritability Excessive \_\_\_\_\_\_ outbursts that occur after task failure are "catastrophic reactions" and can be avoided by educating family members to avoid confrontation.
Depression
Laughter, Crying
Emotional
(Delusions or hallucinations occur during the course of dementias in nearly 75%)
Behavioral problems in dementia include
Agitation, restlessness, wandering, violence, shouting, social and sexual disinhibition, impulsiveness, sleep disturbances
Dementia and Treatable Conditions:
10-15% of cases that include
Heart disease, Renal disease, CHF, Endocrine disorder, Vitamin deficiency, Medication misuse, Primary mental disorders.
Dementia of the Alzheimer’s Type (DAT):
50-60% of patients w dementia. %5 who reach 65 have DAT and 15-25% who are 85+. Occupy 50% of all nursing home beds.
Treatment of Behavior Problems:
______ should not be first choice, unless pt is psychotic and should be on a PRN basis. Consider the likelihood of ______ and ______ first. Consider using ______ methods if at all possible.
Neuroleptics
Depression
Anxiety
Behavioral
Medications for behavioral problems include
Valproic acid (Depakote), Trazodone (Deseryl), Buspirone (Buspar), Benzodiazepines - may aggravate confusion.
Social recommendations should include refering to ______ group or other support groups, continue preventative care, caregiver stress.
Alzheimer’s
