(Exam 4) Older Adult Mental Health & Neurocognitive Disorders

neurocognitive

cognitive functions linked to areas of the brain that have to do with thinking, reasoning, memory, learning and speaking

neurocognitive disorders (NCDs)

clinically significant deficit in cognition or memory, representing a notable change from a previous level of functioning

delirium

affects lower-level functioning, and is acute and reversible

mild neurocognitive disorders

characterized by a decline in higher level cognitive functioning

major neurocognitive disorders

referred to as dementia, are progressive and irreversible

delirium (6)

- medical emergency; requires immediate attention to prevent irreversible and serious damage

- begins abruptly

- usually brief

- common in hospitalized pts (older!!)

- associated with a high mortality rate

- may shift into a more permanent cognitive disorder

what are the 7 risk factors for delirium

- serious medical, surgical, or neurological conditions

- older than 65

- depression, falls, elder abuse

- substance intoxication delirium

- substance withdrawal delirium

- medication-induced delirium

- delirium due to another medical condition

what is the nursing process for delirium (5)

perform mental and neurological status examination AND physical examination

- determine underlying cause

- remain with patient

- SAFETY!!! (avoid restraints)

- quiet environment, lighted room

- fluid balance and adequate nutrition

mild neurocognitive disorder

Deficits do not interfere with independence in everyday activities

major neurocognitive disorder

Cognitive deficits are sufficient to interfere with independence in everyday activities

dementia

broad term used to describe the deterioration of cognitive functioning and global impairment of cognitive functioning

- alzheimer's disease = MOST common cause of dementia

alzheimer's disease (7)

- decreased ACh results in cognitive process disturbances

- excess glutamate = overstimulation NMDA receptors

- plaques (beta peptides clump together)

- tangles (tai protein tangle; interferes w/ neuronal transport)

- plaques and tangles contribute to death of neurons

- head trauma: increased risk for AD

- genetic factors

alzheimer S/S

- frontal lobe: impaired reasoning, inability to perform tasks, poor judgment

- parietal lobe: impaired orientation and visuospatial skills

- occipital lobe: impaired language interpretation, inability to recognize objects

- temporal lobe: inability to recall words or use correctly

- hippocampus: impaired memory

- amygdala: impaired emotions, depression, anxiety, personality changes, paranoia

progression of Alzheimer's

stage I: no apparent sx

stage II: forgetfulness

stage III: altered work performance, gets lost, altered concentration, poor word & name recall

stage IV: forgets events, less able to complete ADLs, social withdrawal

stage V: inability for ADLs, forgets names of close relatives, disorientation, social withdrawal

nursing process for neurocognitive disorders (7)

- MSE

- confabulation (creating stories)

- aphasia (loss of language ability)

- apraxia (loss of purposeful movement in absence of motor or sensory impairment)

- agnosia (inability to recognize words)

- behavior may be uninhibited, inappropriate

- sundowning

what are the nursing interventions of neurocognitive disorders (6)

- supportive care

- individualized care plan

- anticipate needs

- SAFETY!!

- teach strategies for communicating and structuring self-care

- DO NOT ARGUE, gently redirect

what are our pharm options

cholinesterase inhibitors (increase ACh)

- donepezil, rivastigimine, galantamine

SE: dizziness, GI upset, fatigue, HA

NMDA antagonist (regulates the activity of glutamate)

- memantine

SE: dizziness, HA, constipation

for behavioral sx: antipsychotics for dementia-related psychosis

mental health and aging (4)

- emotional and mental illnesses INCREASE over the life-cycle

- severe memory loss is not normal

- older adults = less likely to be dx

- economic concerns

depression and older adults

- more are likely to die by suicide

- psychomotor & cognitive slowing of depression = can resemble neurocognitive disorder (pseudodementia)

what is reminiscence therapy

thinking about the past and reflecting on it; promotes mental health

what is life review

a more directed cognitive process that constructs a history in an autobiographical way

what are the interventions for depression in older adults (6)

- structure milieu environment

- safety risk assessment

- promotion of self-care activities

- encourage group activities

- antidepressant medications

- ECT for severe depression

what are the special considerations of working with older adults

- orient; making questions short

- allow time to respond

- interview in a quiet setting

- medications: start slowly, lower doses

- consider the effects of polypharm

- Medication adherence can be challenging