Geriatric psychiatric mental health problems

1. Geriatric/old age mental
illnesses
Ms Samina Roohi
Nursing Instructor
The University of Faisalabad

2. Ageing
• Ageing is a progressive deterioration of physiological function, an
intrinsic agerelated process of loss of viability and increase in
vulnerability.

3. Ageing and Diseases (contd.)
• Major Mental Health Disorders
• Impaired memory, rigid outlook and resistance to change are some of the mental
changes in the elderly. Major mental health problems of older adults are:
• Organic Disorders
• Late Life Functional Diseases
• Mood (Affective) Disorders
• Neurotic, Stress Related and Somatoform Disorders
• Schizophrenia, Schizotypal and Delusional Disorders (Functional Psychoses)
• Psychoactive Substance Use Disorders
• Suicidal Behaviors in the Elderly
• Loneliness

4. Concerns/Life Events of Elderly
• Retirement
• Lowered Self Esteem
• Economic Insecurity
• Loss of Control
• Decreasing Health Abuse/Neglect and Isolation
• Dependency
• Loss and Loneliness
• Chronic illnesses
• So many Medications
• Lack of caregiver
• Boredom

5. Risk factors include
• Loss of social roles
• Loss of autonomy
• Deaths
• Declining health
• Increased isolation
• Financial constraints
• Decreased cognitive functioning

6. Delirium
• is a condition of severe confusion and rapid changes in brain function.
It is usually caused by a treatable physical or mental illness
• Usually acute and fluctuating
• Altered state of consciousness (reduced awareness of and ability to
respond to the environment)
• Cognitive deficits in attention, concentration, thinking, memory, and
goal-directed behavior are almost always present

7. Symptoms
• Altered awareness, disorientation, clouding of consciousness
• Impaired attention, concentration, and memory
• Inability to process visual and auditory stimuli
• Increased motor activity (e.g., restlessness)
• Anxiety, and agitation
• Misinterpretation, illusions, delusions, or hallucinations
• Speech abnormalities
• Reduced wakefulness; sleep disturbance

8. Features of delirium
• May be accompanied by:
• Inattention
• Hallucinations,
• Illusions,
• Emotional lability,
• Alterations in the sleep-wake cycle,
• Evening worsening of symptoms
• Fluctuations in Symptoms
• Psychomotor slowing or hyperactivity,
• Searching and picking behavior
• Removing clothes, life support equipments (like IV line, Catheter, Nasogastric tube, Ventilator
support)

9. Types of delirium
• Types:
• Hyperactive , hyperalert delirium: almost always consultation
Hypoactive, hypo alert delirium: no consultation
• Mixed: Fluctuation between hyperactive and hypoactive

10. Causes of Delirium: I WATCH DEATH
• Infectious
• Withdrawal
• Acute metabolic
• Trauma
• CNS Pathology
• Hypoxia
• Deficiencies
• Endocrinopathies
• Acute vascular
• Toxins/drugs
• Heavy Metals

11. Dementia
It is a syndrome due to disease of the brain usually of chronic and
progressive nature.
There is disturbance of multiple higher mental functions such as
memory, thinking, orientation, concentration, comprehension,
calculation, learning capacity and language.
Dementia produces an appreciable decline in intellectual functioning
and usually some interfere with activities of daily living such as
washing, dressing, eating, personal hygiene, excretory and toilet
activities.

12. Signs and symptoms
• Marked loss of memory for recent events
• Losing items
• Getting lost in ‘familiar’ places
• Missing appointments
• Loss of ability for abstract thought; planning and doing complex tasks
• Trouble cooking, paying bills, driving
• Can’t understand books, movies, or news items

13. Ctd…
• Difficulty finding common words and names
• Substitution of approximate phrases
• Misidentifying people
• Difficulty inhibiting behavior
• Impulsivity
• ‘Thoughtless’ comments
• Socially inappropriate behaviors

14. Ctd…
• Primary dementias are those, which the dementia itself is the major
sign of some organic brain disease not directly related to any other
organic illness. Secondary dementias are caused by or related to
another disease or condition.
• It affects between 5 to 7 percent of adults over age 65 and 40 percent
of those over age 85
• Alzheimer’s disease: most common form of dementia (70%)
• Depression and/or anxiety are common

15. Alzheimer's disease
• is a degenerative brain disorder of unknown etiology which is the
most common form of dementia, that usually starts in late middle age
or in old age, results in progressive memory loss, impaired thinking,
disorientation, and changes in personality and mood. There is
degeneration of brain neurons especially in the cerebral cortex and
presence of neurofibrillary tangles and plaques containing beta-
amyloid cells

16. This is a chronic and irreversible brain disease that affects the cells of
brain and causes impairment in intellectual functioning.
This destroys the ability of the brain to reason, remember, imagine and
learn.

17. Ten warning signs of Alzheimer’s disease
• 1. memory loss
• 2. difficulty performing familiar tasks
• 3. problems with language
• 4. disorientation to time place and person
• 5. poor or decreased judgment
• 6. problem with abstract thinking
• 7. Misplacing things
• 8. Changes in mood or behavior
• 9. changes in personality
• 10. loss of initiative

18. Origin of Alzheimer’s disease
• The disease was first described by Dr. Alois Alzheimer, a German
physician, in 1906. Alzheimer had a patient named Auguste D, in her
fifties who suffered from what seemed to be a mental illness. But
when she died in 1906, an autopsy revealed dense deposits, now
called neuritic plaques, outside and around the nerve cells in her
brain. Inside the cells were twisted strands of fiber, or neurofibrillary
tangles. Since Dr. Alois Alzheimer's was the first person who
discovered the disease, AD was named after him.

19. Schizophrenia
• It begins in late adolescence or young adulthood and persists
throughout life.
• first episodes diagnosed after age 65 are rare, a late-onset type
beginning after age 45 has been described.
• Women are more likely to have a late onset of schizophrenia than
men.
• greater prevalence of paranoid schizophrenia in the late-onset type.
• About 20 percent of persons with schizophrenia show no active
symptoms by age 65; 80 percent show varying degrees of impairment.

20. Ctd..
• Older persons with schizophrenic symptoms respond well to
antipsychotic drugs. Medication must be administered judiciously
• Psycho education for family members
• Supportive Psychotherapy
• Day Programs (esp. focused on rehabilitation

21. Delusional disorder
• The age of onset of delusional disorder usually is between ages 40
and 55, but it can occur at any time during the geriatric period.
• Delusions can take many persecutory” delusions are common
• Somatic delusions also can occur in older persons. In one study of
persons older than 65 years of age, pervasive persecutory ideation
was present in 4 percent of persons sampled.

22. Ctd..
• • It can occur under physical or psychological stress and can be
precipitated by the death of a spouse, loss of a job, retirement, social
isolation, adverse financial circumstances, debilitating medical illness
or surgery, visual impairment, and deafness.
• Delusions also can accompany other disorders such as dementia of
the Alzheimer's type, alcohol use disorders, schizophrenia, depressive
disorders, and bipolar I disorder
• It can also can result from prescribed medications or be early signs of
a brain tumor.

23. Ctd..
• A late-onset delusional disorder called paraphrenia is characterized
by persecutory delusions.
• It develops over several years and is not associated with dementia
• Patients with a family history of schizophrenia show an increased rate
of paraphrenia.

24. Somatoform disorders
• It is characterized by physical symptoms resembling medical diseases,
are relevant to geriatric psychiatry because somatic complaints are
common among older adults.
• More than 80 percent of persons over 65 years of age have at least
one chronic disease
• After age 75, 20 percent have diabetes and an average of four
diagnosable chronic illnesses that require medical attention
• Hypochondriasis is common in persons over 60 years of age, although
the peak incidence is in those 40 to 50 years of age. The disorder
usually is chronic