Geriatric-Related Mental Health Problems Discuss Dementia and delirium in relation to the mental health of elderly. Causes and Risk Factors for Mental Illness

1. Geriatric Related Mental Health
Problems
Muhammad Saber
RN, Dip Pediatrics, Post RN

2. Objectives
At the end of this session students will be able to …………..
 Identify and describe the elements of a comprehensive psychiatric
assessment of elderly clients with compromised cognition
 Discuss Dementia and delirium in relation to mental health of
elderly
 Analyze nursing care needs for elderly clients with mental health
problems

3. The Human Life Cycle Stages
 Pre-birth
 Birth
 Infancy (0-3)
 Early Childhood (3-6)
 Middle Childhood (6-8)
 Late Childhood (9-11)
 Adolescence (12-20)
 Early Adulthood (20-35)
 Midlife (35-50)
 Mature Adulthood (50-80)
 Late Adulthood (80+)
 Death and Dying

4. Definition of Mental Illness
A mental illness is a condition that affects a person’s thinking,
feeling or mood. Such conditions may affect someone’s ability to
relate to others and function each day. Each person will have
different experiences, even people with the same diagnosis.

5. Some Basics About Geriatrics
 Changes of the brain
 Changes of the body
 Changes of many levels of functioning
 Changes of tolerance in medication, alcohol, foods

6. Causes and Risk Factors for Mental Illness
 Physical disability
 Long-term illness (e.g., heart disease, cancer)
 Dementia-causing illness (e.g., Alzheimer’s disease)
 Change of environment, like moving into assisted living
 Illness or loss of a loved one
 Medication interactions
 Alcohol or substance use
 Poor diet or malnutrition

7. Symptoms of Mental Illness
 Sad or depressed mood lasting longer than two weeks
 Social withdrawal; loss of interest in things that used to be enjoyable
 Unexplained fatigue, energy loss, or sleep changes
 Confusion, disorientation, problems with concentration or decision-
making
 Increase or decrease in appetite; changes in weight
 Memory loss, especially recent or short-term memory problems

8. Cont….
 Feelings of worthlessness, inappropriate guilt, helplessness; thoughts of
suicide
 Physical symptoms that can’t otherwise be explained: aches,
constipation, etc.
 Changes in appearance or dress, or problems maintaining the home or
yard
 Trouble handling finances or working with numbers

9. Mental Health Goals / Interventions
 Healthy adjustment to stage of life
 Acceptance of loss
 Involvement in life activities as fully as possible
 Reminiscence therapy : to help individuals with dementia remember
events, people and places from their past lives. As part of the therapy,
care partners may use objects in various activities to help individuals
with recall of memories

10. Cont….
 Explore spirituality
 Acceptance of how a person has lived their life
 What are they proud about in their life
 Do they want to talk about death / the after life? Do they have
an opinion about this
 What is their meaning of life

11. A Comprehensive Assessment
The key components of a Comprehensive Assessment include:
 History
 Psychosocial/developmental and personal history
 Mental State
 Cognitive Assessment
 Substance Use
 Medical/Biological – Physical assessment
 Risk

12. History
 History of present illness
 Psychiatric history and medical history
 Psychosocial/Developmental History (Personal History)
 Social History
 Family History

13. Psychosocial / Developmental History
Gather their story:
 What is their current living situation?
 Who are their supports?
 Where did they grow up?
 How would they describe their childhood?
 Is their a history of trauma – what type?
 Educational achievement .

14. Social History
 Current situation
 Family
 Work
 Finance
 Friendship groups
 Hobbies - interests

15. Family History
 Genogram
 Attitude to family – how do they see themselves within the
family group
 Quality of relationships and contact with family
 History of mental illness
 History of suicide in other family members

16. Mental State Examination
Why do a MSE?
 Provides baseline information regarding a person’s mental state at the time of
interview
 Helps identify who may need a more comprehensive psychiatric assessment
 To assist with diagnosis
 To guide interventions
 To evaluate patient’s progress
 To inform the risk assessment
 To support discharge planning
 Structured approach to understanding the psychological state of patients

17. When do Nurses Conduct MSE?
 On admission – scheduled and structured and systematic data gathering
 Ongoing assessment and evaluation – structures and informal
 During crisis – structured and focused.

18. Mental Status Examination
The mental state examination is
recorded under the following
headings:
 Appearance and behavior
 Rapport
 Speech
 Mood
 Affect
 Thought
 Perception
 Cognition
 Insight

19. Dementia vs. Delirium
 What’s the difference, and strategies to help the patient and
caregiver

20. Cont….
Delirium
 Disturbance of consciousness with reduced ability to focus, sustain, or shift attention
 A change in cognition, a perceptual disturbance not accounted for by preexisting,
established or evolving dementia
 Occurs over a short time period and fluctuates during the day
 Has a causal component
Dementia
 Chronic acquired decline in memory and at least on other cognitive function
 Decline usually evident over longer periods with mild to severe cognitive decline,
hallucinations, and delusions

21. Delirium vs. Dementia
Acute
 Reversible
 Consciousness: fluctuating
 Decreased awareness of self
 Perceptions: illusions, hallucinations
common
 Speech: slow, incoherent
 Disorientation: time, others
 Cognitive dysfunction
 Illness, med. toxicity: often
 Diurnal disruptions
 Outcome: excellent if corrected early
Gradual
 Irreversible
 Consciousness: rarely alters
 Decreased awareness of self
 Perceptions: Hallucinations not common
 Speech: repetitive difficulty finding
words
 Disorientation: time, person, place
 Memory impairment
 Illness, med. toxicity: rarely
 Diurnal disruptions
 Outcome: poor

22. Delirium
 A medical emergency
 Triggered by
 Oxygen deprivation
 Drug use/poisons, meds
 Infections, recent surgery, or trauma
 Severe chronic illness
 Electrolyte imbalances
 Pre-morbid brain conditions, and functional status
 Preexisting cognitive impairment
 Old age/ sensory losses

23. Prevention Risk factors
 Cognitive impairment
 Dehydration/electrolyte
imbalance
 Sensory deprivation/ sleep
disturbances
 Pharmacy
 Routine mental status
assessment, staff education
 I&O, skin assessment, early
recognition
 Non pharmacologic sleep aids,
decreased noise and light at
night, frequent rest periods,
daytime activities
 Staff education of medication
side effects, pharmacy link
 Intervention

24. Dementia
 Comes on over time, short term memory loss becomes evident
 May progress slowly or quickly
 May affect younger persons as well as elderly
 Treatment generally depends on the stage/ severity of the disease
 Becoming old doesn’t mean you will develop dementia

25. Nursing Management
Nursing interventions are aimed at maintaining
 Patient’s physical safety
 Reducing anxiety and agitation
 Promoting independence in self-care activities
 Maintaining adequate nutrition
 Managing sleep pattern
 Supporting and educating family caregivers
 Improving communication

26. Communication Strategies

27. Getting their attention
 Gain the persons attention
 Turn off extraneous noise
 Stand in front of the person and maintain eye contact
 Go slow, direct and redirect their attention

28. Be aware of your tone of voice
 Do not shout!
 Do not speak in a condescending tone
 Speak slowly

29. Take care with your use of language
 Use adult language
 Concrete simple language, short phrases
 Be positive and reassuring
 Don’t talk about the person as if they weren’t there

30. Try Yes or No Questions
 Use 2 choice questions like do you want juice or soda?
 Are you hungry?
 Are you tired?
 Can I read to you?

31. Orient and Reorient Frequently
 Use visual aids
 Make sure they have hearing aids or glasses if they need them
 Calendars and message boards
 Keep them up to date, make sure they are easy to locate
 Orient the person with your language

32. Learn to be a Good Listener
 Listen and watch/ wait for the response
 Do not interrupt
 Be willing to talk about old times then redirect

33. Lastly-Don’t Argue
 The person with dementia is not trying to be disagreeable
they are usually unaware that they are making mistakes
 If the person is in immediate danger then correcting the thought or
behavior might be appropriate. If not-
 DON”T ARGUE you will only cause frustration, fear and anger

34. References
 Stuart GW. Principles and Practice of Psychiatric Nursing-E-Book. Elsevier Health Sciences;
2014.
 Videbeck S. Psychiatric-mental health nursing. Lippincott Williams & Wilkins; 2013 Jul 29.
 Hinkle J, Cheever K, Brunner L, Suddarth D. Brunner & Suddarth's textbook of medical-
surgical nursing. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; 2014.
Thank you