usefulr for nursing students

1. Psychosocial Problems in Elderly
People
Mr Yogendra Mehta
Lecturer, HOD (Adult health Nursing)
TU IOM BRNC, Biratnagar

2. Objectives
• Explain the psychological problems in elderly people
 Senile dementia
 Sleep disturbance
 Empty nest syndrome
 Sun down syndrome
 Depression
 Anxiety
 paranoia
• Explain the social problem in elderly people.
Social Isolation
Change in societal role

3. Introduction
Successful psychological aging is reflected in the older
person's abil-ity to adapt to:
 physical
 social
emotional losses and to achieve:
 Contentment: state of being happy and satisfied
 Serenity: peace of mind, patience
 life satisfactions

4. Social problem in elderly people
 Social Isolation
 Change in societal role
Social Isolation:
 Individual lacks a sense of belonging socially, lack of engagement with
others, minimal number of social contacts and deficit in fulfilling
quality relationship.
 It can exacerbate person’s feeling of
a. Low self worth
b. Shame
c. Loneliness
d. depression

5. Social problem in elderly people contd......
Social Isolation management:
a. Increase awareness
b. Address depression
c. Increase opportunities for the elderly to contribute their wisedom
to the society.
d. Geriatric club
e. promote living with family

6. Social problem in elderly people contd......
Change in societal Role:
Retirement
a. Often the first major transition faced by elderly.
b. Reduced income and altered social role.
Retirement management:
c. Preretirement counselling
d. Involving in social activities
Widowhood
e. Usually less financially secure and enter into poverty status.
f. Lack of independency
g. Abuse
 Transition from parents to grand parents
 Loss of identity in society.

7. Senile Dementia in elderly people
a. Senile Dementia
 Senile dementia is the mental deterioration in memory, thinking,
behavior and the ability to perform every days activities.
 difficulty learning or remembering recent events.
Normal Aging
a. Rarely Forgetting names of people
b. Slightly forgetting the part of an experiences.
c. Mood change in response to an appropriate causes.
d. Change in their interest

8. Senile Dementia Contd....
Early Signs of dementia
a. Forgetting the names of people close to them
b. Forgetting the things more than they used too.
c. Unpredictable mood change.
d. Decreased interest in activities.
Causes
e. Alzheimer’s disease
f. Major depression
g. Trauma or infection
h. Parkinson’s disease

9. Senile Dementia Contd....
e. Pick’s Disease: frontotemporal dementia, a neurodegenerative
disease
f. Creutzfeldt-Jakob disease: Change in brain tissues and affects muscle
coordination thinking, and memory.
g. Lewy body dementia:
 Disease associated with abnormal deposits of a protein called
alpha-synuclein in the brain.
 lead to problems with thinking, movement, behavior, and mood.

10. Clinical Features of Senile dementia
a. Physical Changes
• Stooped posture
• Wrinkled skin
• Decrease in muscle strength
• Changes in the lens and muscles of the eye
• Brittleness of bone and stiffness of the joints
• Hardening of the arteries

11. Clinical Features of Senile dementia Contd.....
a. Mental Changes
• Impaired judgment
• Loss of memory
• Sometimes childish behavior

12. Management of Senile dementia Contd.....
a. No medicine have been shown to correct the dementia. It can be
controlled the symptoms.
Goal of treatment
b. Maximize the functional abilities
c. Improve quality of life
d. provision for support for the family.
e. Help their memory, thinking skills, mood, and behavior

13. Management of Senile dementia Contd.....
Cholinesterase inhibitors
 Donepezil, rivastigmine and galantamine are used to treat the
symptoms of mild to moderate Alzheimer's disease.
 slow the breakdown of a brain chemical involved in memory and
judgment.
Memantine: helps control a different brain chemical needed for
learning and memory.
Antidepressants: especially selective serotonin reuptake inhibitors
(SSRIs), can improve low mood and irritability.
Anxiolytics: such as lorazepam or oxazepam can ease anxiety or
restlessness.
Antipsychotic: Aripiprazole, Haloperidol, Olanazapine can help
control feelings and behaviors such as aggression, Hallucination.

14. Management of Senile dementia Contd.....
Therapies
• Reminiscence therapy
 might include things like talking with your loved one about their
hometown, school days, work life, or favorite hobbies.
 It can be done one-on-one or in groups as part of an
organized therapy.
 The person leading the session might use music from your loved
one’s past, or things like photos or treasured items, to help.
• Cognitive stimulation therapy (CST) : is a structured program for
groups of people with mild to moderate dementia.
 At meetings, the group does mentally engaging activities, like talking
about current events, singing, playing word games, or cooking from a
recipe.

15. Management of Senile dementia Contd.....
• Reality orientation training : goes over basic things like the person’s
name, and the date and time. They might have signs with that
information placed around their home.
• Lifestyle Changes
 Stay active
o it’s a fitness class for seniors or other physical activity such
as walking, dancing, and gardening.
o exercise may slow down dementia symptoms such as thinking
problems, and ease anxiety or depression.
 Prioritize good sleep
avoid caffeinated tea and coffee especially in the evening, and to limit
daytime naps.

16. Management of Senile dementia Contd.....
• Focus on foods
MIND Diet: Researchers say the MIND diet includes:
• Vegetables, especially leafy greens like; spinach
• Nuts, Berries , Beans , Whole grains
• Fish
• Olive oil
• Wine
• limits red meat, butter and stick margarine, cheese, sweets, and fried
foods.
• If your loved one is able to cook, let them join in and make sure they
are involved in what they eat.

17. Management of Senile dementia Contd.....
• Stay organized: Keep a calendar and other easy-to-see reminders
around their home to help remember upcoming events and plans.
• Rethink the home. remove items that create clutter and noise and
hide things that can be dangerous, such as knives or car keys.
• Check Hearing and Vision
• Counseling and Support

18. PARANOIA
• A mental disorder in which a person has an extreme fear and distrust
of others. A paranoid person may have delusions that people are
trying to harm him or her.
• Extreme and unreasonable feeling that other people do not like you
or are going to harm or criticize you.
• Often linked to memory loss, paranoia can occur in the elderly if they
misplace things, forget instructions, or no longer recognize people.
• In fact, 70% of older adult patients with Alzheimer’s experience
paranoid delusions.

19. Causes of PARANOIA
• Dementia, including Alzheimer's disease
• Brain tumors
• Brain damage caused by stroke or injury
• Medication side effects
• Psychiatric conditions
• Dehydration or heat-related illness
• Untreated urinary tract infections
• Social isolation

20. Features of PARANOIA
• believing that someone is out to get you
• is taking your stuff
• is in the house at night
• Delusions, which means believing things that aren’t true or real.
• Hallucinations, which means seeing or hearing things that aren’t
there.
• Disorganized thoughts or speech, meaning saying or thinking things
that seem illogical or bizarre to others.

21. Management of Paranoia
As a geriatrician, assess an older person in the following five domains:
a. Ability to manage key life tasks
 include the ability to manage ,key tasks we usually learn as young
children, such as walking, dressing, feeding ourselves, and toileting.
 Instrumental Activities of Daily Living (key tasks we learn as
teenagers, such as managing finances, transportation, meal
preparation, home maintenance, etc).
b. Physical health red flags
 These include weight loss, declines in strength or physical
abilities, falls, frequent ER visits, and complaints of pain.

22. Management of Paranoia
c. Mood and brain health red flags
 These include common signs of depression (especially sadness
and/or loss of interest in activities), signs of loneliness or isolation,
new or excessive worrying.
d. Medication management red flags
 These include signs of difficulty taking prescriptions as directed,
checking on possible medication side-effects, and medications that
older people should avoid or use with caution.

23. Management of Paranoia
Aside from medications, prevention plans that include the following
can be of great help:
• Walking as a physical exercise for the patient.
• Patient awareness of the location and time they’re in
• Letting the patient rest and sleep adequately
• Older adults need fluids, their glasses, and hearing aids

24. Management of Paranoia
Steps that should follow for treatment:
 Visit to the family doctor
 Non-Drug Interventions and Therapy
• doing art and being involved in music.
• Walking, running
• Adequate rest and sleep to make the body and mind function well.
Medication
• Antipsychotic medications: risperidone , olanzapine

25. Nursing Care of Paranoia Elderly People
• Be understanding to patient.
• Keep their surroundings calm and quiet.
• Avoid arguing about anything that is making them paranoid.
• Assess the client’s neurological status.
• Talk openly with the client about their beliefs and thoughts, showing
empathy and support.
• Explain all procedures clearly and carefully, and their purpose, before
starting them.
• Avoid startling the client, sudden movements or touching the client
unnecessarily.
• Discuss feelings and help the client identify behaviors that cause
conflict or alienate.

26. Nursing Care of Paranoia Elderly People
• Encourage socialization with others, but do not force participation in
activities.
• Administer medications appropriately and monitor for reactions to
medications.
• Provide education, resources, and support for client’s family and
loved ones.
• Involve patients’ family or loved ones in care as appropriate in
treatment plan .

27. Sleep Disturbance(Insomnia)
• Sleep can e defined as a normal state of altered consciousness during
which the body rests; it is characterized by decreased responsiveness
to the environment, and a person can be aroused from it by external
stimuli.
• Sleep disorders in older adults involve any disrupted sleep pattern.
• This can include problems falling or staying asleep, too much sleep,
or abnormal behaviors with sleep.
• Sleep patterns change with age, anxiety levels and many other
factors.
• In elderly individuals, sleep maintenance insomnia and early
‐
awakening are more common complaints.

28. Factors leading to Sleep Disturbance
• Physical illness (eg. Nausea, mood disorders, breathing difficulty,
pain)
• Drugs and substances (eg. Tryptophan)
• Lifestyle (eg. Daily routines, exercises)
• Usual sleep patterns and excessive daytime sleepiness
• Emotional stress
• Environment ( ventilation)
• Sound
• Exercise and fatigue
• Food and caloric intake

29. Symptoms of Insomnia
• difficulty falling asleep at the start of the sleep period
• waking up during the night and having difficulty falling back asleep
• waking up early and being unable to get back to sleep.

30. Effects of Insomnia
• increase confusion,
• memory loss
• depression
• Stress
• Physical Effect
• Social Isolation

31. Treatment of Insomnia
Cognitive-behavioral therapy (CBT)
 can improve your sleep by changing your behavior before bedtime as
well as changing the ways of thinking that keep you from falling
asleep.
 It also focuses on improving relaxation skills and changing lifestyle
habits that impact your sleeping patterns.

32. Treatment of Insomnia
• A study at Northwestern University found that aerobic exercise
resulted in the most dramatic improvement in quality of sleep,
including sleep duration, for middle-aged and older adults with a
diagnosis of insomnia.
• Melatonin is often prescribed to treat insomnia in older patients.
• Suvorexant or low-dose doxepin can improve sleep maintenance.
• Eszopiclone or zolpidem extended release can be utilized for both
sleep onset and sleep maintenance.
• Low-dose zolpidem sublingual tablets or zaleplon can alleviate
middle-of-the-night awakenings.
• Benzodiazepines should not be used routinely.

33. Nursing Care in Insomnia
• offer meals at regular times, corresponding to client’s previous
pattern.
• provide active meaningful activities during daytime hours, including
exposure to natural light, and an outdoor environment when
possible.
• monitor frequency and duration of naps.
• create an individualized bedtime ritual that includes a quieting
activity, a light carbohydrate snack, going to the bathroom and
settling a routine.
• Do not waken even if incontinent. Change and assist the client to the
bathroom when he or she spontaneously awakens.
• if turning or other care is necessary, try to provide for periods up to 2
hours of undisturbed sleep time whenever possible.

34. Empty Nest Syndrome
• Sadness or emotional distress affecting parents whose children have
grown up and left home.
• This condition is typically more common in women, who are more
likely to have had the role of primary carer.
Loss of Motherhood
 Once the last child moves out, the mother may feel that her most
important job is finished.
 the mother may feel worthless, disoriented and unsure of what
meaning her future may hold.
 However, most mothers adapt in time.
 It may take between 18 months and two years to make the successful
transition from ‘mum’ to independent woman.

35. Empty Nest Syndrome
• Some parents are more susceptible than others
People who suffer the most from empty nest syndrome tend to have
things in common, including:
 Change is considered stressful.
 They found moving out of home a difficult and emotional experience.
 Their marriage is unstable or unsatisfactory.
 Parents who worry that their children aren’t ready to take on adult
responsibilities tend to experience more grief.

36. Empty Nest Syndrome
New challenges
The challenges faced by parents experiencing empty nest syndrome
includes:
• Establishing a new kind of relationship with their adult children.
• Filling the void in the daily routine created by absent children.
• Lack of sympathy or understanding from others, who consider
children moving out to be a normal, healthy event.

37. Symptoms of Empty Nest Syndrome
• feelings of loss
• Sadness
• Anxiety
• Grief
• Irritability
• fear

38. Stages of Empty Nest Syndrome
Social psychologist Carin Rubenstein said three distinct stages:
• Grief
• Relief
• joy

39. Deal with an empty nest syndrome parent
• Accept that their feelings are normal.
• Acknowledge that their parenting role has changed, not ended.
• Keep in touch with their children (calls, emails, video chats, etc.)
• Find a new hobby or take a class.
• Volunteer for a meaningful cause.
• Re establish old friendships.

40. Sun Down Syndrome
• Sundowning is the name for a group of behaviors, feelings and
thoughts people who have Alzheimer's or dementia can experience
as the sun sets.
• The behaviors start or get worse around sunset or sundown.
However, this delirium can potentially occur at any time, not just at
sunset.

41. Sun Down Syndrome
Sundowning is most often experienced by people with dementia, a
group of symptoms that can affect:
• Memory
• Thinking
• Personality
• Reasoning
• Behavior
• Mood
Around 20% of people diagnosed with Alzheimer’s
disease experience sundowning.

42. Features of Sun Down Syndrome
Behavioral features
• Pacing
• Rocking in a chair
• Wandering
• Violence
• Shadowing. This is when the individual follows their caregiver very
closely, everywhere they go.
• Crying
• Insomnia
• Yelling

43. Features of Sun Down Syndrome
Emotional features
• Sadness
• Anxiety
• Fear
• Agitation
• Restlessness
• Irritability
Mental States(Thoughts)
• Confusion
• Paranoia
• Delusions and hallucinations

44. Factors that make worse Sun Down Syndrome
• Disrupted circadian rhythms (sleep-wake cycles).
• Insomnia
• Infection
• Dehydration
• Problems with seeing the difference between reality and dreams.
• Physical illnesses
• Pain
• Fatigue
• Overstimulation from a busy day
• Low lighting

45. Treatment of Sun Down Syndrome
Nonmedication treatments include:
• Light therapy
• Music therapy
• Environmental changes
 Keep familiar objects (such as family photos) nearby.
 Ensure the adequate lighting in their environment during the day and
darkness at bedtime.
 Availability of eyeglasses or hearing aids if patient needed.

46. Treatment of Sun Down Syndrome
Pharmacological treatments include:
• Antidepressant medications
• Antianxiety medications
• Antipsychotics
• Melatonin to help with sleep

47. Nursing Care of Sun Down Syndrome
Nurses must take the following steps to help them settle in at
bedtime:
• Make their bedroom room quiet.
• Turn down all noises such as televisions and other electronic devices.
• Play quiet music that’s soothing and gentle.
• Ask to do a simple activity — enjoy a snack together, work on an easy
puzzle or watch a favorite show.
• Practice sleep hygiene by having your loved one go to bed at the
same time, in the same place every night.

48. Prevention of Sun Down Syndrome
• Make sure patient one gets enough rest at night.
• Avoid caffeinated drinks after the morning.
• Avoid drinking too much alcohol.
• Try to help to get plenty of sunlight during the day by sitting by a
window or going out for walks.
• Encourage for Exercise every day.
• If a nap is necessary, make it short and early in the day.
• Plan some activities throughout the day but not too many.

49. Depression in Elderly People
• Feeling down every once in a while is a normal part of life, but if
these feelings last a few weeks or months, you may have depression.
• It can affect the way you feel, act, and think.
• Depression is a common problem among older adults, but clinical
depression is not a normal part of aging.

50. Types of Depression in Elderly People
• Major Depressive Disorder – includes symptoms lasting at least two
weeks that interfere with a person’s ability to perform daily tasks.
• Persistent Depressive Disorder (Dysthymia) – a depressed mood that
lasts more than two years, but the person may still be able to
perform daily tasks.
• Substance/Medication-Induced Depressive Disorder – depression
related to the use of substances, like alcohol or pain medication.
• Depressive Disorder Due to A Medical Condition – depression related
to a separate illness, like heart disease or multiple sclerosis.

51. Risk Factors of Depression
3 main causes of depression in older people are :
• Poor physical health
 Medical conditions, such as stroke or cancer
 Stress
 Sleep Disturbance
 Genes – people who have a family history of depression may be at
higher risk.
• Social Isolation & Loneliness
• Loss
• Medication: Blood pressure medication (e.g. clonidine), Beta-
blockers (e.g. Lopressor, Inderal), Tranquilizers (e.g. Valium), Calcium-
channel blockers, Sleeping pills, Steroids, Anticholinergic drugs used
to treat GI disorders.

52. Features of Depression
• more of a numbness or a lack of interest in activities.
• may not be as willing to talk about their feelings.
• Persistent sad
• Feelings of hopelessness, guilt, worthlessness, or helplessness
• Irritability, restlessness
• Loss of interest in once pleasurable activities.
• fatigue
• Moving or talking more slowly
• Difficulty concentrating, remembering, or making decisions.
• Difficulty sleeping, waking up too early in the morning, oversleeping.
• Eating more or less than usual.
• Thoughts of death or suicide, or suicide attempts

53. Treatment of Depression in Elderly People
• Selective serotonin reuptake inhibitors (SSRIs) : escitalopram and
sertraline are considered to have minimal drug interactions.
• Volunteer your time
• Take care of a pet
• Join a Club
• Create a opportunity to laugh
• Music therapy
• Cognitive Behavioural therapy(CBT)

54. Anxiety in Elderly People
• Feeling anxious or nervous is a common emotion for people of all
ages and a normal reaction to stress.
• Feeling anxious can help us handle problems and strange situations,
and even avoid danger.
• when one feels anxious often and the anxiety is overwhelming and
affects daily tasks, social life, and relationships, it may be an illness.
• An anxiety disorder causes feelings of fear, worry.
• Anxiety is a common illness among older adults, affecting as many as
10-20 percent of the older population.

55. Types of Anxiety
• Specific phobias:is an intense, irrational fear of a place, thing or
event that actually poses little or no threat.
• Agoraphobia is a fear of public places, leaving one’s home, or being
alone.
• Phobias more common to older adults include fear of death, disaster
to family, and dental procedures.
• Social Phobias: An older adult might feel intense, persistent, and
chronic fear of being judged by others and of doing things that will
cause embarrassment.
Physical symptoms can include blushing, heavy sweating, trembling,
nausea, and difficulty talking.

56. Types of Anxiety
• Generalized Anxiety disorder
 constant worries, and there may be nothing or little to cause these
worries.
 Those with GAD are overly concerned about health issues, money,
family problems, or possible disaster.
 Older adults with GAD have difficulty relaxing, sleeping and
concentrating, and startle easily.
Symptoms
 fatigue, chest pains, headaches
 muscle tension, muscle aches, difficulty swallowing
 trembling, twitching, irritability
 sweating, nausea, lightheadedness
 having to go to the bathroom frequently

57. Types of Anxiety
• PTSD: PTSD develops after a traumatic event that involved physical
harm or the threat of physical harm to the individual.
• OCD: some older people do suffer from persistent, upsetting
thoughts that they control by performing certain rituals, such as
repeatedly checking things, touching things in a particular order, or
counting things.

58. Causes of Anxiety in Elderly People
• Stressful life events (e.g., death of a loved one)
• Limited physical mobility.
• Loss of independence.
• Financial insecurity.
• Sleep disturbances (e.g., insomnia)
• Chronic health conditions (e.g., diabetes, obesity)
• Side effects of medications (e.g., steroids, stimulants)

59. Features of Anxiety in Elderly People
• irrational and excessive worry or fear.
• checking and rechecking for safety.
• avoiding routine activities.
• avoiding social situations.
• racing heart.
• shallow breathing, trembling, nausea, sweating.

60. Management of Anxiety in Elderly People
• Breathing Exercises. Deep breathing is a great way to manage the
physiological symptoms of anxiety
• Physical Activity
• Diet Changes
• Social Interaction
• Routine work
• Sleep Hygiene
• Relaxing Hobbies
Antidepressants are the first-line medications in the treatment of
anxiety disorders.
Anxiolytics drugs

61. Nursing Care of Elderly People with Anxiety
• Acknowledge the feelings the patient is experiencing.
• Administer medication as appropriate and as ordered.
• Provide active-listening to patient
• Instruct patient through guided imagery or other relaxation
techniques/methods.
• Encourage the patient to engage in regular daily exercise and activity
programs.

62. THANK YOU