MH 5.1 Judith Wikel RN BSN MEd

MH 5.1 Problems in Late Adulthood, Cognitive Impairment, Alzheimer’s Disease & Dementia In this chapter will have the opportunity to learn about normal age-related changes in cognition as well as confusion and how it can be caused by medication. This chapter provides information on the signs and symptoms of dementia, delirium, and Alzheimer’s disease as well as mental health care goals for clients with Alzheimer's disease and support groups for caregivers.

Chapter 17 Cognition The words cognition and cognitive describe activities of the mind involved in thinking and thought processes.

Chapter 17 Confusion The Five “Ds” of Confusion The word confusion is a very general term that is difficult to define. For health care providers, confusion is a symptom of an underlying problem that requires immediate attention.

Chapter 17 Confusion The Five “Ds” of Confusion Confusion Damage – from head injuries or conditions that cause a lack of oxygen (hypoxia) to the brain can lead to confusion. Depression – people who suffer a great losses can experience confusion related to depression. When one’s focus is inner sadness, outside stimuli can be misinterpreted or misunderstood. The individual becomes “labeled “confused” and the depression is ignored.

Chapter 17 Confusion The Five “Ds” of Confusion Damage Depression Deprivation Dementia Delirium Please refer to figure 17-1 on page 180 to foster understanding.

Myths of Aging Myths Elders live in Nursing Homes Most individuals with Alzheimer’s disease are care for in their home. The majority of elderly are rich The majority of elderly are poor 12% of older adults live in poverty

Alzheimer’s Disease Alzheimer’s Disease – is a progressive, degenerative disorder that affects brain cells and results in impaired memory, thinking, and behavior.

Stages of Alzheimer’s Disease Early stage Begins with the loss of recent memory. Inability to learn, to process, and to retain information. Individuals in the early stage forget where they put things and begin to have difficulty performing the activities of daily living. Family members begin to report strange behaviors and mood swings.

Stages of Alzheimer’s Disease Intermediate Stage – inability to recall any recent events or process new information. Aphasia – loss of language Apraxia – loss of ability to perform everyday actions, activities Visual agnosia - loss of recognition of previously known or familiar people and objects. Family support becomes very important nursing action.

Stages of Alzheimer’s Disease Severe Stage – in ability to do anything… Clients usually become incontinent Unable to walk Entirely dependent on others for care Memory, both recent and remote is completely lost Inability to swallow increases their risk for developing pneumonia and malnutrition.

Stages of Alzheimer’s Disease End Stage Client slips into a coma and death from pneumonia or other infection occurs.

Alzheimer’s Disease Affective loss Alzheimer’s disease slowly robs an individual of his or her “personhood” (personality) Each decline is accompanied by a loss. Individuals with Alzheimer’s Disease become unable to make even the simplest decisions or choices.

Sundown Syndrome Sundown Syndrome - describes a group of behaviors characterized by confusion, agitation, and disruptive actions that occur in the late afternoon or evening.

Alzheimer’s Disease People with Alzheimer’s Disease may live from 2 to 20 years after diagnosis. The average is about 8 years. Although they are in great emotional turmoil, family members must cope with the reality of the disease and begin planning for the future.

Nursing Management of the Patient with Alzheimer's Disease. Family support – families have a difficult time adjusting to the changing personality and behavior of the loved one. Drug therapy is showing promise with medications that improve cognition, behavior, and functioning in some patients.

Communication and Alzheimer’s Disease Please refer to Box 17-7 on page 187 Always approach from the front –no surprise appearances. Use familiar words and short, simple sentences. If the person is a pacer, walk with him or her, in step, while you talk.

Orienting Environmental Cues for Patient with Alzheimer’s Disease Please refer to Box 17-8 on Page 188 Keep environment simple and “user friendly.” Put large signs that identify each room on the doors. Color-code hot and cold faucets red and blue. Keep rooms brightly lit with no glare.

Functional Assessment Refer to Box 17-5 on page 187 A Functional Assessment Daily Functions Cognitive Status Medical Condition Behavioral Problems Psychological Status Psychosocial Status After assessment nurse is able to determine the patients ability to perform ADLs.

Therapeutic Interventions for Alzheimer’s Disease Refer to Table 17-4 on Page 189 Validation Therapy – Caregiver buys into client’s illusion and plays along (validates it) until opportunity refocus behaviors is present, based on the premise that the client’s illusion cannot be changed, but it can be directed. Audio presence intervention - Playing of tape-recorded memories by family members to help decrease agitation.

Medications and Alzheimer’s Disease Please refer to Drug Alert 17-2 on page 187. Donepezil (Aricept) Side effects Nausea, vomiting, diarrhea Dizziness Headache Insomnia High or low blood pressure Urinary problems

Medications and the Elderly Population Elderly patients may take numerous medications and this can cause confusion. Over the counter medications cold medications, my cause confusion, disorientation, and memory loss. Metabolism is slower in older adults This means drugs are eliminated more slowly and can reach toxic levels is not closely monitored. The nurse must continuously assess for medication interactions.

Nursing Responsibilities related to Medications Nurses have a special responsibility to ensure that their older clients are using their medications correctly. Refer to Drug Alert 16-1 on page 174, read and focus on the Planning section. Arrange for the client to show you the steps in identifying and taking the medications if necessary. The nurse should be continuously monitoring for noncompliance related medications.

Nursing Responsibilities related to Medications Age-related nursing interventions The capacity of the brain to process, store, and retrieve information begins to function less efficiently. When teaching elderly people, there are several things to keep in mind. First, assess any physical or sensory changes that may interfere with their learning (and your teaching) Continued on next slide…

Nursing Responsibilities related to Medications Teach clients about their medications, refer to the medications by name and shape rather than color. Face client, speak slowly and clearly in lower tones. Be patient and respectful. Write out important points. Your clients’ willingness and ability to learn will greatly improve when using interventions.

Medicare In the United States people 65 years and older are coved by national health program called Medicare.

Hoarding Hoarding The act of collecting and saving assorted, seemingly useless items.

Elder Abuse Elder abuse is defined as any action that takes advantage of an older person, his or her emotional well-being or property. The typical abused elder is a woman, at least 75 years of age, with physical or mental problems who is living with a relative. This would be an example of domestic abuse. Can you think of an example of Exploitation?

Depression Depression is probably the most common mental health disorder of late adulthood. Depression is commonly underdiagnosed and undertreated.

Depression Signs and symptoms of depression Please refer to Box 16-4 on page 176 Physical Symptoms Abdominal pain Dry mouth Cognitive agitatioin Emotional Fatique Lack of interest Behavioral

Mental Changes of Aging Please refer to Table 16-1 on Page 171 Attention - Alertness, maintaining focus, noticing Crystallized intelligence - Specialized accumulated knowledge (nursing, engineering, technical skills) Memory – Names and faces

Validation Therapy Please refer to Box 16-5 on Page 176 Eye contact Touch Mirroring the client’s body movement Matching the client’s voice and rhythm patterns Empathy**** Putting the client’s cues about feelings into words Accepting the client withour passing judgement Genuine, total listening

People Older than 45 years Please refer to Box 16-3 on page 174 Seventy-five percent use some kind of medication 13% of population is over age 65.

Standards of Geriatric Care The American Nurses Association (ANA) has developed guidelines (standards) for nurses who work with older adults. These standards offer nurses a means for providing and measuring the nursing care they deliver to older adults.

Q & A Refusing to throw away expired medications, saving sugar packets from hospital meal trays, collecting old newspapers and junk mail, and having a refrigerator full of plates of half-eaten food are examples of: A) loss B) ageism C) memory loss D)hoarding The answer is D) hoarding.

Q & A One of the most common mental health problems that the elderly face is which of the following? A) depression B) ageism C) elder abuse D) hoarding The answer is A) depression

Q & A A typical victim of elder abuse would be: A) a 69-year-old man living at home with his confused wife. B) a 70-year-old blind woman living in assisted living facility. C) a 79-year-old woman with diabetes living with her daughter. D) a 72-year-old widow living in a mobile home park. The answer is c.

MH 5.1 Remember the PowerPoint is an outline to guide one in areas to study for the test. Read assigned material Watch videos prn Utilize objectives to foster understanding. Good luck, JudithRN