Week 7 Dementia, Delirium, Elder Abuse Flashcards
Types of Elder Abuse
physical, emotional, sexual, neglect, exploitation, abandonment, and self-neglect
Physical Abuse
causing physical pain or injuring a vulnerable elder
-fractures, bruises, abrasions
Emotional Abuse
verbal and nonverbal actions that cause anguish, distress or pain to the elder
-change in personality
Sexual Abuse
any form of sexual contact without the consent of the elder
-unexplained STD’s or bruising/bite marks around breasts and genitals
Neglect
failing to provide food, shelter, healthcare or protection to a vulnerable elder
Exploitation
refers to taking the assets of the elder, either their funds or their property, when this is without the consent of the elder and not for the benefit of the elder
Abandonment
leaving the elder after assuming responsibility of care of the elder
Self-Neglect
The elder lacks the ability to care for self
- Such as hygiene, grooming, food, safe housing, ability to hand finances
- Might have dependence on drugs of alcohol
- Refusing medications
Signs of neglect and/or abandonment
- Alackof hygiene
- Failure to meet the patient’s needs (ex: missed medical appointments)
- Does the patient have needed assistance like a cane or eyeglasses?
- Is the patient losing weight?
- Ask what he or she eats, is someone providing meals?
- Does the patient have decubiti?
Signal Symptoms of Elder Abuse
- Bruises
- Broken bones
- Poor personal hygiene
- Abrupt changes in finances
- Sudden withdrawal from normal activities
- Unexplained weight loss
- Excessive power or control by a close family member or friend
Common Perpetrator Features
- Partners or spouses living with victim
- History of drug or alcohol abuse
- History of mental illness
- History of unemployment
- Being socially isolated
- Typically male
- Past trouble with law enforcement
- Financially dependent on elder
- Under major stress
- Family member (90%)
Risk Factors of Elder Abuse
• Diminished cognitive function
• Increases as dependence on others increases
• Community setting - living with others
• Lack of social support
○ Social isolation
• Female > male
• Physical impairment and poor health
Provider Responsibilities in Suspected Abuse
- National Center on Elder Abuse (NCEA) - resource to use when suspecting abuse
- Perform thorough physical exam and order any necessary tests
- Perform cognitive screen
- Interview patient and caregiver separately
What is the most common form of dementia?
Alzheimer’s dementia
Distinguishing Features of Alzheimer’s
Progressive cognitive decline
Array of emotional and behavioral problems that result from cognitive decline:
– Impaired ability to learn new information or recall previously learned information and one or more additional cognitive disturbance in language (aphasia), function (apraxia), perception (agnosia), or executive function
Risk Factors of Alzheimer’s Disease
lower educational and occupational levels family history head injury Down Syndrome vascular disease increases with age
What is the duration of Alzheimer’s disease?
3-20 years
average 10 years
Subjective Complaints of Alzheimer’s
○ Complaints of memory problems (family member mentions this)
○ Change in pattern: getting lost in familiar places, inability to accomplish a demanding task at work, or increasingly slow response to any cognitive challenge
○ Difficulty balancing the checkbook, preparing dinner, traveling alone or maintaining employment
○ Later stages the person needs help with dressing, bathing and staying continent
○ Eventually the person loses the capacity to converse, walk, sit or hold up the head
○ Behavioral problems: hostility, aggression, suspiciousness, and paranoia, delusions, agitation, sundowning, incontinence and inappropriate or impulsive sexual behavior
○ Impaired executive functioning, language deficits, coordination and perception
Objective Findings of Alzheimer’s
Concern about cognitive decline expressed by the patient or family or changes in behavior or cognition are noted that should trigger assessment for dementia
Learning and memory signs and symptoms of Alzheimer’s
the patient becomes repetitive; has trouble remembering recent conversations, events, appointments; or frequently misplaces objects. these problems disrupts daily life
Handling complex tasks signs and symptoms of Alzheimer’s
the patient has trouble following a complex set of tasks that require many steps, such as, organizing bills or following a recipe.
Reasoning ability signs and symptoms of Alzheimer’s disease
the patient is unable to respond with a reasonable plan to challenges at work or home, such as, knowing what to do if the kitchen sink is plugged; shows poor judgement
Spatial relationships signs and symptoms of Alzheimer’s disease
the patient has trouble remembering directions or driving to what once was a familiar place, organizing objects around the house, unfamiliarity with familiar objects and places
Speech signs and symptoms of Alzheimer’s disease
the patient has increasing difficulty with finding the words to express him or herself and following along with conversations
Changes in behavior signs and symptoms of Alzheimer’s disease
the patient appears less social and responsive; is more irritable, depressed, anxious, and suspicious than usual
Preclinical Stage of Alzheimer’s Disease Associated Symptoms
- impaired memory, excused or covered
- insidious instrumental ADLs losses (money handling, bills)
- preserved basic ADLs
- poor judgement and decisions
- subtle personality changes
- decreased spontaneity, sense of initiative
- increased anxiety, socially normal
Mild-Moderate Stage of Alzheimer’s Disease Associated Symptoms
- obvious memory impairment
- overt instrumental ADL impairment
- basic ADL’s failing
- prominent behavioral difficulties
- shortened attention span
- language difficulty
- variable social skills
- supervision required
Severe Stage of Alzheimer’s Disease Associated Symptoms
- memory fragments only
- no recognition of familiar people
- assistance with basic ADLs required
- fewer troublesome behaviors
- reduced mobility
- weight loss, infections
- seizures, dysphagia
- incontinence
- groaning, moaning, grunting
