Aging and Neurocognitive Disorders

Aging: Physical and Psychological Aspects

Physical Assessment

  • Loss of elastin in the skin, leading to fine lines and wrinkles.
  • Development of age spots or liver spots.

Erickson's Stages of Development

  • Generativity versus stagnation: Psychological growth is crucial for maturing and developing.
    • Lack of psychological growth can lead to feeling like one has done nothing with their life.
    • This can increase the risk of suicidal ideation and depression.

Losses Associated with Aging

  • Loss of friends and loved ones.
  • Loss of youth.
  • Decreasing social networks due to reduced socialization.

Social Interaction

  • Interaction with peers is necessary.
  • Retirement requires finding new forms of social engagement.

Anxiety

  • Anxiety over the process of aging and dying.

Short-Term Memory Deterioration

  • Hormone loss:
    • Contributes to worse short-term memory in women compared to men.
    • Premature hysterectomies may correlate with early onset of Alzheimer's in women.
  • Importance of preserving ovaries during hysterectomies to maintain hormone levels.
  • Hormone replacement therapy is an option, but contraindicated in hormone-sensitive cancer patients.

Psychiatric Problems in Older Adults

  • Often underdiagnosed and undertreated.
  • Older adults often don't seek treatment or accept the problem.
  • Mental health perceptions:
    • Can be impacted regarding postpartum depression.
    • It is necessary to highlight and discuss mental health.

Common Concerns in the Elderly

  • Neurocognitive disorders.
  • Delirium.
    • Leading causes and factors:
      • Dehydration.
      • UTI.
      • Malnutrition.
  • Depression.
  • Sleep disorders.
  • Alcohol and substance abuse.
  • Anxiety and phobias, such as agoraphobia, which can lead to OCD, depression, or anxiety.

Cultural Aspects of Aging

  • Needs and interests among elderly vary across cultures.
  • Cultural competence requires asking about specific cultural practices rather than making assumptions.

Family Care

  • Families may provide care by having elderly relatives live with them.
  • Financial considerations:
    • Nursing homes are not free; seniors often need to sell their homes to pay for care.
    • Once funds are exhausted, the state may take over payment through Medicaid.
  • Stress on acute and long-term care:
    • Nursing shortages exacerbate the problem.

Satisfying Life

  • Living the most satisfying life possible.
  • Protection from hazards.
  • Dignity and respect during life and death.
  • Potential employment discrimination.

Baby Boomers

  • Born during the baby boom after the war.
  • Known for being stubborn, hard workers, but potentially difficult to work with.
    • The way that they work can clash with younger generations.
    • May face workforce differences due to being less tech-savvy.
    • Different attitudes towards paid time off.

Retirement

  • Can lead to isolation and stress, especially if forced out of the workforce.

Long-Term Care

  • Associated with stigma:
    • Including staffing issues, mistreatment, laziness, illness spread, and lack of visitation.

Risk Factors for Institutionalization

  • Dementia.
  • Illness.
  • Depression and anxiety.
  • Lack of family support.
  • Lack of resources for care.

Elder Abuse

  • Reportable: One in ten older adults in the U.S. are victims of abuse.
  • Signs:
    • Bruising.
    • Malnourishment.
    • Dirtiness.
    • Timidity.
    • Injuries.
  • Types:
    • Physical.
    • Emotional.
    • Neglect.
    • Financial.
  • Abusers are often relatives who live with and care for the elderly person.
  • Only 45% of adults 65 and older report it to the nurses.
  • Risk factors for abuse:
    • Caucasian females.
    • Those 70+.
    • Mental or physical impairment.
    • Need for more care.
    • Caregiver fatigue.
    • Inability to meet daily care needs.

Suicide in the Elderly

  • 85 and up have the second-highest suicide rates.
    • Highest group is 45 to 54 years of age.
  • Predisposing factors:
    • Loneliness.
    • Financial problems.
    • Physical illness.
    • Loss.
    • Depression.

Neurocognitive Disorders

  • Signs and symptoms may be related.
  • Differential Diagnoses:
    • Lack of sleep w/ memory loss.
    • Side effects of medications can mimic symptoms.
Delirium
  • Sudden onset; acute.
  • Waxing and waning (libel).
  • Affects mental functions like memory, thinking, language, behavior, mood, and personality.
  • Reversible (secondary).
  • Symptoms: hallucinations, illusions, distractibility, sleep disruptions.
  • Delirious is a state of behavior.
  • Anxiety-provoking; daily rituals may help.
  • Predisposing factors:
    • Liver or kidney failure.
    • Medications.
    • Systemic infection (sepsis).
    • COPD leading to hypoxia.
    • Stroke, seizures, or head trauma.
    • Substance intoxication or withdrawal.
Dementia
  • Progressive and irreversible.
  • Alzheimer's is the most common cause, accounting for 60-80% of cases.
    • Ten percent of individuals over 65 have Alzheimer's.
    • Fifth leading cause of death in this age group.
  • Goals:
    • Slow progression to maintain ADLs.
    • Manage patient and family needs.
Stages of Dementia
  • Stage 1: No symptoms, but detectable by PET scan.
  • Stage 2: Very mild symptoms noticed by others.
  • Stage 3: Mild symptoms like getting lost driving; noticeable functional impact.
  • Stage 4: Moderate; forget major events and confabulation (creating false memories to fill in gaps).
    Example: Remembering deaths but making up how they died.
  • Stage 5: Moderately severe: need assistance; disoriented to time (LOC); issues at bedtime (circadian cycle).
  • Stage 6: Severe: misidentifies spouse; sundowning; wandering; incontinence; safety issues.
  • Stage 7: Very severe; bedbound; aphasia (inability to get words out correctly) dysphasia (swallowing; what not to eat); anorexic; biggest injury- pressure/comfort

Nursing Care

Delirium Nursing Care
  • Assess for the underlying cause and treat it.
  • Treat with low-dose antipsychotics (haloperidol, risperidone) or melatonin.
  • Maintain safety, including moving the patient closer to the nurse's station, keeping lights on, lowering stimulation, and keeping items within reach.
  • Establish constant, consistent, structured routines.
  • Allow extra time to complete tasks.
  • Therapeutic communication:
    • Use a slow, calming voice.
    • Provide simple instructions with limited choices.
    • Avoid confirming or arguing with delusions or hallucinations.
    • Validate feelings.
    • Reorient.
  • Have the patient be physically active with supervision, and do not let the patient out there and walk by themselves.
  • Provide memory support with large calendars, clocks, and photos of family.
  • Use validation therapy, respecting their feelings in whatever time and place is real to them.
Medications for Neurocognitive Disorders
  • Anticholinesterase inhibitors (donepezil) for early stages to prevent progression.
  • NMDA receptor antagonists (memantine) for moderate stages.
Reminiscence Therapy
  • Helpful for elderly patients, can be done one-on-one or in group therapy.
  • Involves reminiscing through journals, identifying pets, music, special foods, photographs, events, or asking about special events and times.
  • Can help to reduce suicide risks and the risk of depression.