Ageing Issues.pptx.pdf

8/10/2019 Ageing Issues.pptx.pdf

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Ageing Issues:Cognitive andPsychological ChangesSetho Hadisuyatmana, S.Kep.Ns

Community and Mental Health Nursing Department

Faculty of Nursing

University of Airlangga


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PrefaceIt is a common finding that as people age becomecognitively and psychologically impaired.

The development of dementia is not a normal process,

but it is pathological.The most three disease of older is known as Three Ds

(Dementia, Delirium, and Depression)

It is important to gain a good understanding as a basis

to provide an appropriate treatment


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Learning Objectives1. Describe prevalence of the Three Ds

2. Discussing the symptoms of the Three Ds

3. Identify the importance and components of mental

assessment

4. Discussing treatment option

5. Contrast criteria for differentiation among the Three

Ds


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DeliriumTransient state of global cognitive impairment (APA,

1994 cited in Wallace 2008: 216)

Suddenly occur, often in twilightShort, diurnal fluctuations, worse at night and

awakening

Reduced consciousness, hours to less then one month


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Diagnostic CriteriaDecreased ability to maintain attention to externalstimuli and to shift appropriate attention to the new

one

Disorganized thinking, and at least two of the

following:

1. reduced level of consciousness;

2. perceptual disturbances;

3. disturbance of the sleepwake cycle


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Diagnostic Criteria (contd)4.

increased or decreased psychomotor behavior;

5. disorientation to person, place, or time;

6.

memory impairment.

These symptoms of delirium, commonly thought of as acuteconfusion, usually develop over a short period of time

Confusing Assessment Method (CAM) to be the most suitabletool to classify the delirium symptoms.

Difficulty concentrating on tasks, or conversations and eitherdisplay disorganized thinking or altered level of consciousness !Diagnosed as Delirium


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CausesNot fully known, but believed to be (Balas et all, 2007) :

Previous brain pathology

Acute and chronic diseases

Cognitive impairment, alcoholism, burden co-

morbidity and depression are to be independentpredictors besides medications and surgical procedures

(Short and Winsted, 2007)


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TreatmentDelirium is a temporary and reversible condition!First line treatment!eliminate the cause andpredictor of delirium

If the change of familiar envy became the trigger!adding the familiar items and family surrounding theolder

Remove the possible other causes!alcohol,

medications, etc


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Safe EnvironmentFall prevention strategies

Warning System

Reduce the frightening activities


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DepressionUsual Finding Loses of the older :

Family, Friends, and Spouses

Job and Financial Resources

Health alterations

Home or Housings

Depressive


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Study FindingsPsychological changes occur

Older are susceptible to effect of altered

neurotransmissions

Coexisting medical conditions raised the probability of

depression in older

Chemical imbalances!alteration of

neurotransmission, the primary cause


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The Characteristic of DepressionMoods and Thinking are changing!Primary

Sleep impairment

Changes in appetite

Others may vary depends on culture, ethnic, gender,

and family history


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Thus. . .The DSM-IV criteria to diagnose the finding are used

to detect the depression.

It is essential to regulate any possibilities of medical

concern

One of the way to assess clients condition is the use of

Geriatric Depression Scale


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SuicideHigh Risk Factors :

Living alone

Relocation from home to long time care institution

Widowhood

Medical Status of Chronic Illness


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Nurses AwarenessThe attempt is vocalized, such as: Lord, please take me! Iam ready to die now

Demonstrate feeling of Hopelessness, Helplessness,

Worthlessness

80% older who committed suicide told to someone about itfirst, often care provider

Standardized Geriatric Depression Scale is needed tomeasure the statements


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DementiaAlthough the decrease of brain weight and the

proportion of gray mater, dementia considered to be

not normal in older.

It occurs as a result of a life style, disease, heredity, and

others 60 probability of possible diseases

Dementia defined as long-time, chronic, and

progressive cognitive function loss


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Alzheimer Association (1999)Dementia identified as loss of mental function in twoor more areas, such as language, memory, visual andspatial abilities, or judgment to interfere with daily life.

Common sense :

If you lose your car keys, maybe you are

experiencing memory loss. If you find them and dontknow what they are for you are experiencing a

cognitive trouble


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Alzheimer Disease (AD)Causes remain unclear

Risk Factors : Family History with AD, Advanced age


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Early Warning (alzheimer association)Misplacing items,

Loss of initiative,

Changes in

personality,

Poor judgment,

Changes in mood orbehavior,

Disorientation to time and

place,

Memory loss that affects job

skills,

Difficulty performing familiar

tasks,

Difficulty with finding the

right words, and

Problems with abstract

thinking.


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Patients DifficultyAphasia : Unable to choose the right words to speak

Apraxia : Unable to perform a fine motor task

Agnosia : remembering

All of this may bring desperation to the older.


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Assessment and DiagnosticA Mini Mental State Examination (MMSE) is used to assess,if the cognitive declined is detected.

A Low score of MMSE indicate that the patient is needed to

have a further diagnostic assessment using :1. MRI

2. CT scan

3. PET (Positron Emission Tomography)


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Intervention ConsiderationThe patient may present with : Communicating difficulty,inattentiveness, think disorganizing, consciousness alteration,sleep-wake disorder, wandering and disorientation.

It is both challenging and frustrating to work with patients

The focus is to maintain function and independence as much as

possible.

Provide a safe environment, including environmental

manipulation


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Contd. . .Maintain daily schedule. The alteration of daily routine

may worsen the dementia.

Translocation of the patient is not recommended

Physical and emotional support are needed by both the

patient and the family.


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Thats all folksWallace, Meredith (2008). Essentials of GerontologicalNursing. New York : Springer

Balas, M. C., Deutschman, C. S., Sullivan-Marx, E. M.,

Stumpf, N. E., Alston, R. P., &Richmond, T. S. (2007).Delirium in older surgical intensive care unit.Journal ofNursing Scholarship, 39 (2) 147154.

Short, M., & Winstead P. (2007). Delirium dilemma.

Orthopedics, 30(4), 273-276.

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Ageing Issues.pptx.pdf