Management of Psycho Geriatric Problems_blok 18_UNTAD_2011

8/12/2019 Management of Psycho Geriatric Problems_blok 18_UNTAD_2011

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Management of Psycho geriatric

ProblemsRonny T Wirasto

Program Studi Pendidikan Dokter

FMIPAUniversitas Tadulako

2011


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Topik

Definisi

Gangguan

Diagnosis Terapi


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Normal Aging

Factors associated with normal aging include:-Decreased muscle mass/ increase fat

-Decrease brain wt/ enlarged ventricles & sulci

-Impaired vision & hearing

-Minor forgetfulness (benign senescent forgetfulness)


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ADULTINFANT ELDERLY

REGRESSIONAGING

INVOLUTION

PROGRESSIVE

DEVELOPT

Social activity Ageism Counter transference Socio economic Retirement Sexual activity Long tem care


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5

What Kinds Of Changes

Learn slowly

To adapt with difficulty to new situations

To persevere with old habit of thoughtfail to remember recent event


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6

Old People Suffer From

Nutritive deficiencies that result chiefly

from economicpsychological or

physical problems


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7

Whatreversible

- irreversible

Why

-Biological

-Sociocultur

-Physiological

-Psychosocial

How

- to manage

- to prevent

many kind of elderly

Who

aware the conditiondoctor familyWhere

-they must seeking

Emotional Cognitivebehavior change

in elderly


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Stages of Dying

***Normal emotional response when facing death or loss of body part

include:

-Denial

-Anger (blaming others for illness)-Bargaining(ex. Ill never smoke or drink again if my cancer is cured)

-Depression

-Acceptance

***May be experienced in any order or may occur simultaneously


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Major Depression

-common in geriatric population

-Elderly are twice as likely to commit suicide as general population

-15% of nursing home residents

-Symptoms of major depression in elderly often include problems with

memory & cognitive functioning, termed Pseudo Dementia, so we have towork up an elderly patient for major depression when presents with

memory loss


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Depressive symptoms include:-sleep disturbances (early morning awakening).

-decrease appetite and weight loss.

-feeling of worthlessness and suicidal ideation.

-lack of energy and diminished interest in activities.


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Pseudo Dementia

-The presence of apparent cognitive deficits in patients with major depression

i.e. DEMENTIA + DEPRESSION

-Because of depression symptoms, patient may appear demented and it is nottrue!!

-Demented pts are more likely to confabulate ( guess) when they dont know

an answer, whereas depressed pts will just say they dont know and whenyou pressed for an answer, depressed pts will often give the correct one.


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Pseudo Dementia

( Depression )

Dementia

More acute onsetInsidious onset

Emphasizes failureDelights in accomplishments

UncommonSun downing Common

(increase confusion at night)

Often answer Dont KnowGuess at answer( confabulate )

Pt is aware of problemPt unaware of problem


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TREATMENT

-Supportive psychotherapy

-Psychodynamic psychotherapy

-Low dose antidepressant (SSRIs)

-Electroconvulsive Therapy

-Mirtazapine: Sedative (good for insomnia)

-Methylphenidate: adjunct to antidepressant for psychomotor retardation

(DONT give in late afternoon or evening, lead to insomnia)


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Bereavement

-Elderly are more likely to experience losses of

lovers, relatives & friends.

-Its important to distinguish b/w normal grief

rxn from pathological ones (depression).


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Normal grief rxn

INVOLVES:-Feeling of guilt and sadness

-Mild sleep disturbance and wt loss

-Illusions (seeing the deceased person or hearing his/her voice)

-Attempts to resume daily activities & work

-Symptoms resolve within 1 yr (worst symptoms within 2 months)


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Abnormal grief (major depression)

INVOLVES:-Feeling of sever guilt and worthlessness

-Significant sleep disturbance and wt loss

-Hallucinations and delusions

-No attempt to resume activity

-Suicidal ideation

-Symptoms persist >1 yr (worst symptoms >2 months)


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Sleep Disturbances

-Incidence increase with aging

-Difficulty sleeping, Daytime drowsiness & Daytime napping

-Causes:

*medical conditions.

*Environment.

*Medications.

*Normal changes associated with aging .


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Changes in Sleep Structure

***REM Sleep:-Increase no. of REM episodes at night

-REM episodes are shorter than normal

-Total amount of REM sleep not changed

***Non-REM Sleep:-Increase awakening after sleep onset

-Increase amount of stage 1 & 2 sleep

-Decrease amount of stage 3 & 4 sleep


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Tx of Sleep Disturbances

-Approaches should be tried first:Alcohol cessation, Increased structure of daily routine, Elimination of daytime

naps & treatment of underlying medical conditions

-Sedative HypnoticsHydroxyzine (Vistaril) & Zolpidem (Ambien)

Important Noteprefer not to be used due to their S/E in elderly like memory

impairment, ataxia, paradoxical excitement & rebound insomnia


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Elder Abuse

- -10% of all people >65 yrs underreported by victims

-Perpetrator is usually caregiver who lives with the victim

-Types:

Physical, Sexual, Psychological, neglect (withholding of care) & exploitation

(misuse of finance).


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Care for the elderly

-Restraints:-Often overused in nursing homes & hospitals

-Always try alternatives such as closer monitoring & tilted chairs

-Nursing Homes:-provide care and rehabilitation for chronically ill and impaired pts as well as

for pts who are in need of short term care before returning to their prior

living arrangement-50% stay permanently, 50% discharged after few months


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Cont,,, Elder Care

-Old Age Home:Elderly can live for the rest of their lives with no attempt to rehabilitate.

-medications:Many older people on multiple medications, they suffer from more side

effects because of decreased lean body mass and impaired liver and

kidney function.


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Selesai

Documents

Management of Psycho Geriatric Problems_blok 18_UNTAD_2011