DISEASES OF MENTAL STATUS AND ELDER ABUSE

Delirium  Disturbance of consciousness with deficits of attention and changes in cognition or perception that develop over a short period and fluctuate over the course of a day (DSM-IV, 2000)

Delirium  Often misdiagnosed as mania, depression, psychosis or depression  Common complication of general hospital admission  Caused by infection, medication/drug use, nutrition, psychiatric disorders, metabolic disorders and trauma Guccione, Chapter 9; Caplan and Rabinowitz, 2010

Dementia  Essential feature is impairment in short- and long- term memory, associated with a decline in abstract thinking, judgment and other disturbances of higher cortical function (DSM-IV, 2000)

Dementia Alzheimer’s Type (DAT)  60% of patients with dementia have Alzheimer’s type  Memory impairment essential for diagnosis Accompanied by aphasia, apraxia, or disturbance in executive function

Dementia Alzheimer’s Type  Three phases of disease  Early phase Forgetfulness Memory impairment  Middle phase Cognitive deficits Intellectual decline  Late phase Incapable of self care Mute Inattentive Guccione, Chapter 9

Multi-infarct Dementia  Organic mental disorder due to cerebrovascular disease  Common disturbances in…  Memory  Abstract thinking  Judgment  Impulse control  Personality Guccione, Chapter 9

Pseudodementia  Dementia-like behavior that is the result of a major depressive disorder Guccione, Ch. 9

Anxiety  Occurs in response to stressors of aging  Alcohol withdrawal, PE, and COPD all predisposing factors Guccione, Ch. 9

Cognitive Decline and Depression  Depression and cognitive decline affect 25% of elderly (Yaffe et al, 2010)  The greater the number of depressive symptoms the greater the likelihood of cognitive decline (Yaffe et al, 2010)  Measure cognition with Mini Mental State Exam (see handout)

Caregiver Issues  Depressive symptoms in caregivers related to behavioral disturbance and ADL impairment  Need to Identify anger, denial, depression, exhaustion or health problems in caregivers Guccione, Ch 9

Bush, 2006 Elder Abuse  Physical abuse-any action intended to cause pain and/or injury  Emotional abuse-caregiver acts in a way to cause emotional distress or mental suffering  Financial abuse-using elder’s financial resources for one’s gain  Neglect-may be intentional or unintentional

Bush, 2006 Risk Factors for Elder Abuse  Caregiver is a spouse or family member  Caregiver is a male  Psychological issues of caregiver  Substance abuse by caregiver  Caregiver stress  History of family violence  Elder has dementia or depression  Triggering event such as an argument may begin abuse if other risk factors are present

References  Andrew MK, Rockwood K. Social vulnerability predicts cognitive decline in a prospective cohort of older Canadians. Alzheimer’s and Dementia. 2010:6:  Caplan JP, Rabinowitz T. An approach to the patient with cognitive impairment: delirium and dementia. Med Clin North Am. 2010: 94:  Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4 th ed. Washington, DC: American Psychiatric Association;  Schunk C. Cognitive impairment. In: Guccione, AA. Geriatric Physical Therapy. 2 nd ed. St. Louis: Mosby; 2000:150.  Yaffe K, Blackwell T, Gore R, Sands L, Reus V et al. Depressive symptoms and cognitive decline in nondemented elderly women. Arch Gen Psychiatry. 1999:56: