Lecture 12: Older Adults & Neurocognitive Concerns

mental health notes Lecture 12: 3/24 Older Adults & Neurocognitive Concerns Care of Older Adult Patients Statistics on Aging & Mental Health Pain Life expectancy and number of older adults have increased Healthcare Concerns for Older Adults arriers to accurate pain assessment Older Adult ClassiYcation Iinancial burden Assessment kools goun-:old6 57:4M years old 8edicare part , for help (ith meds on-: a/er IACqN Gain Eatin- Ncale 8iddle:old6 47 to 1M years old Care-iver burden Gain assessment in Advanced ,ementia )GA3PA,T Ncale Old:old6 17 to 0HH years old Lan-ua-eS public policyS research Gain 8ana-ement Centenarians6 0HH to 0HM years old Gharmacotherapy6 Pon:opioidsS opioids 8ental jealth Healthcare Decision Making Ponpharmacolo-ical Late:life mental illness Advanced directives 8aDor ,epressive ,isorderS suicide Gortable medical orders Anxiety disorders wuardianship ,elirium6 Necondary to -eneral medical condition Court:ordered relationship in (hich the se: lected -uardian acts on behalf of another individual )the (ardT Peuroco-nitive disorders Alcohol use disorder khe (ard must be proven to lac/ capacity to mana-e personal andzor Ynancial aRairs Delirium Clinical Presentation Nursing Process Application Epidemiology & Risk Factors ,isturbance in attention Co-nitive and perceptual disturbances )illusionsS hallucinationsT Abrupt onset (ith periods of lucidity Ghysical needszbehaviorsS moods Common cause of hospitaliFation ,isor-aniFed thin/in- Nelf:assessment 0H:2H; of -eneral medical patients ,isorientation qpidemiolo-y Assessment wuidelines 'p to 5H; in olderS frail patients Anxiety and a-itation ,o not assume confusion is baseline in the older patient Goor recall Assess for acute onset and Vuctuatin- levels of a(areness ,elusions and hallucinations )visualT Assess their ability to attend to the immediate environment Co-nitive impairment qstablish usual level of co-nition and past co-nitive impairment 3mmobiliFationS dehydrationS infection 3dentify disturbances in physiolo-ical status Gsychoactive medications Assess %zNS LOCS and neurolo-ical si-ns Nleep deprivation Assess for availability of immediate medical interventions to help prevent irreversible brain dama-e %ision or hearin- impairment Nursing Diagnosis Eis/ for inDury Altered perception jallucinations ,isorientation Eestlessness IearS a-itation Acute confusion BH:1M; of critically ill patients 8ultifactorial Ghysiolo-ical Causes 8onitor situational factors that (orsen or improve symptoms Outcome Criteria Nursing Process (Continued) Gatient (ill remain safe and free from inDury and falls 3mplementation ,urin- periods of clarityS patient (ill be oriented to timeS placeS and person )possibly (ith aidsT Grevent physical harm due to confusionS a--ressionS or Vuid imbalance Iluid balance and adeUuate nutrition (ill be maintained 8inimiFe use of restraints )increases confusionT Gatient (ill be comforted by UuietS calm presence Glannin- Assist (ith identiYcation and tx of cause qnsure necessary aids and supportive home team Nupportive measures to relieve distress %isual cues in the environment for orientation qvaluation Continuity of care providers Gatient (ill remain safeS orientedS and underlyin- cause (ill be treated Mild and Major Neurocognitive Disorders Characteristics Mild ND Criteria Gro-ressive deterioration of co-nitive functionin- and -lobal impairment of intellect )dementiaT Major Neurocognitive Disorders qvidence of modest co-nitive decline from previous level of performance in one or more co-nitive domains Po chan-e in level of consciousness AlFheimer s disease Irontotemporal lobar de-eneration Le(y body disease Co-nitive deYcits to not interfere (ith independence in A,Ls ,i&culty (ith memoryS problem solvin-S and complex attention 8ild6 Po interference (ith A,LsW does not necessarily pro-ress Gar/inson s disease )(ith pro-ressionT kraumatic brain inDury Co-nitive deYcits do not occur exclu: sively in the context of delirium 8aDor6 3nterferes (ith daily functionin- and independence Cerebrovascular disease Co-nitive deYcits are not better ex: plained by another mental disorder Epidemiology & Risk Factors Alzheimer's Disease qpidemiolo-y Nursing Process: Assessment Ni-ns Nymptoms Confabulation6 Creation of stories in place of missin- memories to maintain self:esteem Gerseveration6 Eepetition of phrases or -estures lon- after stimulus is -one Late:onset Clinical Presentation Iemale 3mportant to distin-uish normal for-etfulness and memory deYcits in dementia iolo-ical Iactors 3n dementiaS memory loss interferes (ith A,Ls wenetics Gro-ression of mildS moderateS and severe Cardiovascular disease Ni-ns jead inDury and trauma Nymptoms A-raphia6 ,iminishin- ability to read or (rite 8emory impairment jyperorality6 kendency to put obDects in mouth ,isturbances in executive functionin- qxercise and sleep AphasiaS apraxiaS a-nosia Aphasia6 Loss of lan-ua-e abiity Nocial en-a-ementzdiet Nundo(nin-zNundo(n syndrome6 kendency for mood to drop and a-itation to rise as li-ht of day diminishes Apraxia6 Loss of purposeful movement qducation A-nosia6 Loss of sensory ability to reco-niFe obDects 8ental stimulation 8odiYable Eis/ Iactors 8emory impairment 3nitially for recent events Gro-resses to both recent and remote events ,isturbances in executive functioninGroblem:solvinGlannin- and or-aniFinAbstract thin/in,iminished emotional expression Nursing Process: Self-Assessment Nursing Diagnoses Eealistic understandin- of the disease 3mpaired sleep Ntress mana-ement Eis/ for inDury )and (anderin-T Nupport and education resources Nelf:care deYcit Eealistic outcomes and reco-nition (hen these are achieved AnxietyS confusionS hopelessness 8aintainin- self:care Care-iver stressS anticipatory -rief 3mpaired verbal communication ,ia-nostic kests Ck scan Gqk scan Nursing Process (Continued) 8ental status Uuestionnaires Outcomes 3dentiYcation Complete physical and neurolo-ical exam Complete medical and psychiatric history Eevie( of recent NzNS medsS and nutrition Assessment wuidelines Community Support ,irect correlation to nursin- dia-noses GlanninConnect family to support services 3mplementation kransportation services Nupervision and care (hen the primary care-iver is out of the homeW referrals to daycare centers 3nformation on support -roups in the community 8eals on heels qvaluate current co-nition level Gerson:centered care approach 3nformation on respite and residential services 3dentify and address any threats to safetyS in: cludin- home jealth teachin- and promotion kelephone numbers for help lines Eeferral to community support jome health services 3ntervie( family to assess preparationzcopinEevie( available resources 3dentify teachin-z-uidance about sundo(nin- Pharmacotherapy 8edications for Co-nitive Nymptoms wA A inhibitors )doneFepilS -alantamineT Eivasti-mine transdermal system )qxelon patchT P:methyl:,:aspartate )P8,AT receptor anta-onists )memantineT 8edications for ehavioral Nymptoms Pone approvedS ris/ is hi-h (hen antipsychotics are used oR:labelW exercise extreme caution 3nte-rative kherapy Ome-a:2 fatty acids