SN3704_Lecture2_Pre-reading_ topic on elderly

Lecture Overview

  • Topic: Care of elderly with mental disorders

  • Presenter: Dr. Teris Cheung NMN

Learning Objectives

  • By the end of the session, students should be able to:

    • Identify the risk factors associated with mental disorders in elderly

    • List common mental disorders in elderly

    • Describe nursing care and treatment for elderly with mental disorders

Hong Kong Population Statistics (2016-2041)

  • Population by age distribution (projected from mid-2016 to mid-2041):

    • 0-14 years

    • 15-64 years

    • 65 years and above

    • Source: Hong Kong Census and Statistics Department

Population Breakdown (2017 & 2027)

  • Statistics for age groups:

    • Age group 60-64: 2017 Male 266.4K, 2027 Male 259.8K

      • Female: 318.3K (2017), 266.5K (2027)

    • Age group 65-69: 2017 Male 286.3K, 2027 Male 206.5K

      • Female: 304.4K (2017), 210.7K (2027)

    • Notable drop in numbers as age increases

Epidemiology of Psychiatric Disorders in Late Life

  • High prevalence of psychiatric symptoms:

    • Sleep disorders, anxiety symptoms, depressive symptoms, hypochondriasis

  • Most prevalent disorders include:

    • Dementia disorders: Increase with age

    • Mood disorders: Depression increases with age, higher prevalence in females

    • Anxiety disorders: Higher prevalence in females compared to males

Unique Mental Health Problems of Older Persons

  • Multiple pathologies (e.g., diabetes and depression)

  • Atypical or nonspecific presentation of illness

  • Delay in reporting problems; underreporting of symptoms

  • Polypharmacy concerns present complications

Risk Factors for Mental Disorders in Late Life

Genetic Factors

  • Family history linked to increased risk

Environmental/Chemical Factors

  • Alcohol use correlates with cognitive decline

  • Nutritional deficiencies linked to cognitive function

  • Head trauma as a risk factor for Alzheimer's disease

Psychological Factors

  • History of depression/anxiety as a risk factor for recurrences

Social Factors

  • Life transitions (widowhood, divorce, financial changes) contribute to onset of psychiatric disorders

  • Social isolation impacts mental health

Major Mental Health Problems in Older Persons

  • Key conditions to focus on:

    • Dementia

    • Delirium

    • Depression

Understanding Dementia

  • Definition: Group of disorders due to the degeneration of the brain, affecting:

    • Memory, thinking, orientation, comprehension, learning, language

  • Impact: Severe enough to affect activities of daily living (ADLs); irreversible at cellular level

DSM-5 Major Neurocognitive Disorder Criteria

Criterion A:

  • Significant cognitive decline in one or more domains

Criterion B:

  • Cognitive deficits interfere with independence in daily activities

Criterion C:

  • Not exclusively linked to delirium

Criterion D:

  • Deficits not better explained by another mental disorder

What Causes Dementia?

  • Common causes include:

    • Alzheimer’s disease and vascular dementia

  • Factors: Low education, hypertension, smoking, diabetes

  • Evidence exists that risk can be mitigated through lifestyle changes

Five Domains of Dementia

  • BPSD (Behavioral and Psychological Symptoms of Dementia)

  • Cognitive Functional Status

  • Physical Status

  • Caregiver Burden

Common Symptoms of Dementia

Early Stage:

  • Forgetfulness about recent events and names

  • Difficulty comprehending time and place

Middle Stage:

  • Increased forgetfulness; need for assistance with personal care

Late Stage:

  • Total dependence; severe cognitive interference

Risk Factors for Dementia

  • Age (doubles every 5 years post-65)

  • Vascular risks: hypertension, diabetes, smoking, etc.

  • Protective factors: High education, social engagement, physical activity

Types of Neurocognitive Disorders (NCDs)

  • 12 categorized types, including:

    • NCD due to Alzheimer’s Disease

    • Vascular NCD

    • NCD due to HIV or traumatic brain injury

Behavioral and Psychological Symptoms of Dementia (BPSD)

  • Behavioral: Agitation, aggression, wandering

  • Psychological: Anxiety, depressive moods, hallucinations, and delusions

Delirium

  • Definition: Acute cognitive impairment, rapid onset

  • Risk factors include: older age, dehydration, drug withdrawal

DSM-5 Criteria for Delirium

  1. Disturbance in attention and awareness

  2. Develops rapidly, fluctuates in severity

  3. Additional cognitive disturbances (memory, language)

  4. Not better explained by another disorder

  5. Evidence of physiological consequences from other conditions

Types of Delirium

  1. Due to general medical conditions

  2. Medication-induced

  3. Substance-intoxication

  4. Substance-withdrawal

  5. Due to multiple etiologies

Prevalence of Late Life Depression in HK

  • 7.07% among those aged 70 or over

  • Clinically significant depressive symptoms noted in 9.7% of a 55,946 elderly community cohort

Risk Factors of Elderly Depression

  • Physiological changes with age

  • Significant life events (bereavement, retirement)

  • Social isolation and family history

Impact of Depression on Daily Life

  • Increases disability and cognitive impairment

  • Leads to treatment refusal and higher suicide risk

Suicide Statistics in Hong Kong (1981-2016)

  • Detailed age distribution of suicide deaths

Distinction between Delirium, Dementia, and Depression

  • Delirium: Sudden onset; reversible

  • Dementia: Insidious onset; chronic

  • Depression: Acute or chronic; possible reversible with treatment

Assessment Protocols

  • Symptoms and history evaluation, family assessment, activities of daily living (ADLs)

  • Use of validated assessment tools for mental health and cognitive function

Nursing Care Strategies

Dementia Care:

  • Simple communication, orientation support, safety monitoring

Delirium Management:

  • Address underlying causes, provide hydration and support

Depression Support:

  • Respect, create safe environments and ensure nutritional intake

Anxiety Disorder Care:

  • Identify anxiety triggers, promote physical activity, involve family

Schizophrenia Care:

  • Ensure safe environments; maintain a therapeutic relationship

Somatoform Disorder Support:

  • Establish trust, acknowledge issues while avoiding confrontation

Substance Abuse Management:

  • Monitor symptoms closely, assess motivation for change

Medical Treatment Modalities

  • Prioritize underlying cause identification for delirium

Pharmacological Treatment for Psychiatric Disorders

  • Highlighting important medications for late-life psychiatric disorders

psychotherapies, psychotherapy effectiveness, and alternative therapies for elderly

  • Different therapy modalities suitable for older adults

Conclusion

  • It is imperative to conduct thorough assessments, apply appropriate nursing interventions, and offer a wide range of medical and psychotherapeutic options to cater to specific needs of elderly patients with mental health disorders.