1. Caring for Older Adults Holistically, 4th Edition Chapter Seventeen Common Clinical Problems: Psychological

2. Caring for Older Adults Holistically, 4th Edition Psychological Problems  Disturbances in mental or emotional health as a result of external or internal stimuli  Assessed by evaluating thought patterns, behaviors, and emotions  Can be difficult to diagnose

3. Caring for Older Adults Holistically, 4th Edition Communicating With Older Adults  Three stages of a relationship  Beginning the relationship  Individuals with psychological problems may have a difficult time starting a relationship  Establish trust  Use humor or find person’s interests

4. Caring for Older Adults Holistically, 4th Edition Communicating With Older Adults  Three stages of a relationship (cont.)  Developing a relationship  Listen and guide discussion  Ending a relationship  People generally try to avoid the termination process  Let person know when to expect the separation

5. Caring for Older Adults Holistically, 4th Edition Communicating With Older Adults  Verbal communication  Use open questions instead of closed questions  Give directions slowly and step by step  Provide two choices for activities  Express empathy by maintaining eye contact, using caring tone of voice, making confirming statements, being genuine  Listen to feelings, words, and behaviors

6. Caring for Older Adults Holistically, 4th Edition Communicating With Older Adults  Nonverbal communication  Most honest communication  Touch  Important part of communication  Individuals will respond differently to touch  Matching and mirroring  Doing exactly what the person is doing  Use same pattern and voice tone

7. Caring for Older Adults Holistically, 4th Edition Communicating With Older Adults  Universal symbols  An object from the present that represents something from the past

8. Caring for Older Adults Holistically, 4th Edition Problem Behaviors  May include wandering, shouting, aggressive or withdrawn behaviors  Can be caused by change in environment or changes in medications  Monitor individual closely  Agitation  Caused by stress, anxiety, flashbacks from traumatic experiences, post-abuse reactions, dementia

9. Caring for Older Adults Holistically, 4th Edition Problem Behaviors  Agitation (cont.)  Person can become violent towards self or others  Signs of agitation include pacing, sudden loud outbursts, making threatening comments  Behaviors caused by stress  Decrease stress by providing continuity in care providers and the person’s environment

10. Caring for Older Adults Holistically, 4th Edition Problem Behaviors  Violent behaviors  Protect person from his or her violent behaviors  Stay calm and do not raise your voice  Sexual acting out  Demonstration of sexual activity that is not socially appropriate  Notice factors that trigger behavior

11. Caring for Older Adults Holistically, 4th Edition Specialized Communicating Skills  Neurolinguistic programming  Observation of person’s words and behaviors to best decide how to relate to that person  Validation  Method to communicate with disoriented older adults

12. Caring for Older Adults Holistically, 4th Edition Specialized Communicating Skills  Preferred sense words  Some people relate to their surroundings through their senses  Visual or auditory  Vague pronouns  Use when person is unable to fill in the details with enough facts to understand

13. Caring for Older Adults Holistically, 4th Edition Specialized Communicating Skills  Speaking slowly  Use slower speech and allow plenty of time for the person’s response  Asking the extreme  Ask questions about the extremes of a situation

14. Caring for Older Adults Holistically, 4th Edition Grieving and Depression  Older adults survive several types of losses  Death, retirement, relocation, social roles, financial security, loss of physical functioning  Anger and depression are part of the grieving process  Individuals may get stuck at these two stages

15. Caring for Older Adults Holistically, 4th Edition Grieving and Depression  Depression  Serious condition in older adults  Linked to amount of neurotransmitters serotonin and norepinephrine in the nerve synapses  Stress and decrease in sun exposure can effect levels of neurotransmitters  Influenced by lack of exercise, loss, and poor nutrition

16. Caring for Older Adults Holistically, 4th Edition Grieving and Depression  Depression (cont.)  Treated with antidepressants and therapy  Do not use tricyclic antidepressants in the older adult population  Depressed individuals may become confused and be diagnosed with dementia while depression may not be treated

17. Caring for Older Adults Holistically, 4th Edition Grieving and Depression  Depression (cont.)  Suicide rates are high in depressed older adults  Depressed older adults may suffer from failure to thrive

18. Caring for Older Adults Holistically, 4th Edition Delirium and Dementia  Delirium  Rapid change in behavior and thinking ability  May cause agitation and rapidly changing moods  Person will have anxious facial expression  May respond slowly to new surroundings  May talk in a rambling manner, making no sense  Caused by many physiological factors that can be reversed

19. Caring for Older Adults Holistically, 4th Edition Delirium and Dementia  Dementia  Loss of intellectual ability that interferes with activities of daily living  Individuals have problems with cognitive ability, personality changes, impaired memory, changed judgment and mood  Occurs gradually due to deterioration of brain

20. Caring for Older Adults Holistically, 4th Edition Delirium and Dementia  Dementia (cont.)  Caused by neurological diseases, Alzheimer’s disease, vascular problems, advanced AIDS  Validation therapy is a method used to communicate with individuals who have dementia

21. Caring for Older Adults Holistically, 4th Edition Delirium and Dementia  Dementia (cont.)  Stages of disorientation  Naomi Feil identified four stages  Malorientation  Individuals appear as if nothing is wrong but are beginning to forget information important for maintaining activities of daily living  Try to cover memory loss by making up excuses

22. Caring for Older Adults Holistically, 4th Edition Delirium and Dementia  Dementia (cont.)  Time confusion  Individuals are more disoriented, withdraw more from real world  Individuals confuse past time with present time  Lose sense of real time

23. Caring for Older Adults Holistically, 4th Edition Delirium and Dementia  Dementia (cont.)  Repetitive motion  Movements or sounds repeated continuously  Use single-syllable words  Eye contact made only after someone touches or talks to the person  Vegetation  Individual rarely moves or make sounds  Eye contact is rare

24. Caring for Older Adults Holistically, 4th Edition Delirium and Dementia  Alzheimer’s disease  Most common type of dementia  Diagnosed by ruling out other forms of delirium and dementia  Increased incidence as people age  Drugs being investigated for management of Alzheimer’s

25. Caring for Older Adults Holistically, 4th Edition Paranoia  Fear that people are trying to hurt you  Can occur with dementia, schizophrenia, and other psychological illnesses  Be consistent and reliable while providing care

26. Caring for Older Adults Holistically, 4th Edition Developmental Disabilities  Individuals living longer  Set limits on behavior  Recognize person’s feelings  Allow person to express anger on set limits

27. Caring for Older Adults Holistically, 4th Edition Substance Abuse  Access to drugs from several sources  Alcoholism common in older adults  Make sure abuse is diagnosed and treated

28. Caring for Older Adults Holistically, 4th Edition Eating Disorders  Problems with eating can be attributed to physical or psychological problems  Eating problems may be related to controlling or resisting behaviors  Treating eating disorders requires creativity

29. Caring for Older Adults Holistically, 4th Edition Groups for the Elderly  Reminiscence  Based on memories of similar events or experiences  Improves feelings of self-worth and opportunity to review life  Also use individually  Live review process more structured form

30. Caring for Older Adults Holistically, 4th Edition Groups for the Elderly  Remotivation  Use of real objects to simulate senses and provide new motivation in life  Works best with individuals with depression and early stages of disorientation  Resocialization  Assuming social roles increases feelings of self- esteem  Group members are assigned various roles

31. Caring for Older Adults Holistically, 4th Edition Groups for the Elderly  Reality orientation  Help individuals become oriented to present reality  Provide constant reminders  Date, time, month, current events  Not helpful for individuals with moderate to severe disorientation

32. Caring for Older Adults Holistically, 4th Edition Groups for the Elderly  Validation  Combine some of the other techniques  Focus is on support and problem solving  Focus is on resolving losses and expressing feelings

33. Caring for Older Adults Holistically, 4th Edition Psychotropic Medications  Education about drugs for individuals and their families is important  Require a period of time before therapeutic effect is achieved  May show signs of toxicity at lower doses  Do not use for behavioral problems until all other interventions are tried

34. Caring for Older Adults Holistically, 4th Edition Psychotropic Medications  Common side effects are constipation and orthostatic hypotension

35. Caring for Older Adults Holistically, 4th Edition Physical and Mental Health  Somatization  Expression of emotional problems through physical complaints  Easier to acknowledge a physical problem than an emotional problem  May develop backache, headache, stomach ache

36. Caring for Older Adults Holistically, 4th Edition Patient Rights  Older adult has the right to least-restrictive form of treatment  Physical restraints  Use least-restrictive device  Check on person often  Remove every 2 hours for a brief period of time