Begin each Course Journal entry bylisting two specific things you have learned during that module. These things might be facts, topics you find interesting, or the like.
Next, in at least 100 words, summarize what you have learned about those two things during that Week.
Lastly, in at least 100 words, discusshow you will apply to your life or the life of someone you know what you have learned about those two things.
Module 10th lecture
The big three; depression , delirium, dementia
Depression
• less than 5% of older adults in our communities show signs of depression.
• Rates of clinical diagnosis vary across ethnic groups.
• Depression commonly accompanies other choric conditions.
• Rates vary across ethnic groups:
• Higher for Latino older adults
• Lower for older African American adults
Diagnostics
• Symptoms must last at least two weeks.
• Other causes must be ruled out.
• Clinician must determine how symptoms are affecting daily life.
• Risk factors for dispersion in older population include ;
• Being female, unmarried, or widowed ; experiencing stressful life events ; and lacking
social support
• Having a chronic illness, living in nursing home, or being a caregiver
• Being an ethnic minority
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Assessment
Two major assessments scales
Beck depression inventory
21 questions must multiple choice self-report inventory
Geriatric depression scale
30 item questionnaires
Specific focus on older adults
Causes
• Biological
• genetics , brain changes, neurotransmitters
• psychological theories
• psychological effects of loss are the most common basis for depression.
• cognitive behavioral
• internal belief systems are affected by experiencing unpredictable and uncontrollable
events.
Connections to illness
• cancer
• pancreatic, breast, lung, colonic, and ovarian, carcinoma ; lymphoma, and undetected
cerebral metastasis
• chronic obstructive pulmonary disease, rheumatoid arthritis, deafness, chronic pain,
sexual dysfunction, renal dialysis, chronic constipation
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Treatment
all forms of depression benefit from some form of therapy
medication :
selective serotonin reuptake inhibitors (SSRI)
norepinephrine reuptake inhibitors (SNRI)
norepinephrine and dopamine reuptake inhibitors ( NDRI)
combined reuptake inhibitor and receptor blockers
tetracyclic antidepressants
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1. Electroconvulsive therapy ( ECT)
Generalized seizure – electrically induced.
Psychotherapy
Behavior therapy
Cognitive therapy
Delirium
• Disturbance of consciousness that develops rapidly.
• Due to medical conditions medications side effects, substance intoxication or
withdrawal, sleep deprivation, exposure to toxins , or a combination
• Most cases can be cured.
Dementia
• Affects over 48 million globally.
• Dementia is characterized by cognitive and behavioral deficits involving some form of
permanent brain damage.
Dementia vs Alzheimer’s
• Dementia = symptoms, Alzheimer’s = disease
• Alzheimer’s disease
• Progressive
• Degenerative
• Fatal
Alzheimer’s; symptoms and diagnosis
• Gradual changes in cognitive functions
• Declines in personal hygiene and self-care skills.
• Inappropriate social behavior
• Changes in personality
Neurological changes
• Rapid cell death
• Neurofibrillary tangles
• Plaques consisting of a core of beta amyloid, a protein, surrounding by degenerated
fragments of dying or dead neurons.
Alzheimer’s disease
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Sundowning; symptoms are worse in the evening.
Causes; ABCA7 gene has been linked to increased chances for Alzheimer’s disease in
African Americans
• Beta amyloid cascade hypothesis
• Changes in blood flow in the brain
• Impairments in the brain ability to use glucose.
• Intervention strategies
• Memory improvement drugs
• Behavioral strategies are more effective than drug.
Caring for patients with dementia at home
• Caregivers are at risk for depression.
• Respite care: allow family members to get away from the caregiving situation for a time
• Adult day care
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Beyond Alzheimer’s
Vascular dementia
Caused by brain damage from impaired blood flow to the brain.
Onset is sudden , more stepwise than Alzheimer’s.
Around 10- 15% of all cases
Dementia with Lewy bodies ;
Associated with Parkinson’s disease.
Cluster of motor problems, including slow walking, stiffness, difficulty getting in and out
of chairs and a slow
Around 14-40% of all Parkinson’s patients develop dementia.
Huntington’s disease
• Involuntary flicking movement of the arms and legs
• Hallucinations, depression, paranoia, and clear personality changes
Alcohol related dementia
• Confabulation to cover memory gaps.
• This disorder can be treated if caught early on and alcohol consumption is stopped.
AIDS dementia complex or ADC
• ENECPHALITIES, behavioral changes, decline in cognitive furcation’s.
• Progressive slowing of motor functions
Other mental disorders and concurs.
Anxiety ; symptoms and diagnosis
• Physical changes that interfere with functioning
• Anxiety I older adults may be appropriate to the situation or are due to underlying
health problems.
Treatment
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Treating anxiety disorders
Medications; Benzodiazepine ( valium and Librium)
Psychotherapy
Cognitive behavioral
Relaxation training
Psychotic disorders
• Personality disintegration and loss of touch with reality
• Hallucinations; distortions in perception
• Delusions: belief systems that are not based on reality
Schizophrenia
• Sever impairment of the thought processes
• Delusion
• Onset occurs most between ages 16 and 30.
• Natural course of the disorder is improvement over the adult life span.
Treatment
• Emphasizes medications of loss motor control
• Difficult to treat with therapy.
• A comprehensives and integrated program can be effective.
Substance abuse
• Elderly persona’s drug of choice is alcohol.
• AUD diagnosis includes 2 of 11 identified criteria 12- month period
• There are gender and ethnic differences in alcohol dependence.
• Two six times higher for men than women
• Widowers over age 75 had the highest rate of AUD
• Native American rates are higher than European Americans
Treatments
Stabilization
Reeducation of consumptions
Treatment of coexisting problems
Defining mental health and psychopathology
• Mentally healthy people have ;
• A positive attitude toward self
• Mastery of the environment
• Autonomy
• Personality balance
• Growth and self-actualization
• Definitions of mental health need to reflect appropriate age related criteria
A multidimension life span approach
• Biological forces
• Health problems increase with age and can provide clues about psychological difficulties
• Psychological forces
• Normative changes can mimic mental disorders.
• Nature of personal relationship
• Sociocultural forces; norms and cultural factors
• Cultural differences must be taken into account.
• Life cycle factors; the influence of one’s past experiences.
Ethnicity, gender, aging, and mental health
• Social disparities – different prevalence of mental disorders
• Inadequate access to health care
• Contextual difference in ethnic communities
• Degree of comfort revealing information about self to strangers
• Must take into account all aspects of the biopsychosocial model.
• Gender differences found.
• Korea
• Higher rates of depressions in women
• Higher suicide rates for men
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