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Mental & Psychological Problems
in Older Persons王春波醫生 Dr WONG Chun Por JP
Specialist in Geriatric Medicine
MBBS(HKU) FHKCP FHKAM(Medicine) MHA(UNSW)
MRCP(UK) FRCP(London) FRCP(Edinburgh) FRCP(Glasgow)
Outline
Normal Ageing of the Brain
Dementia
Depression
Delirium
Anxiety
Tips
Normal Ageing of the Brain
Decreased hippocampal, frontal and temporal lobe volumes – normal
Neurotransmitters and myelin sheath degenerated
Atherosclerosis of blood vessels
Degenerative plaques and tangles
Cognitive Functions
Impaired Visual and verbal memory, visuo-spatial abilities, immediate memory or the ability to generate words or name objects – normal
Impaired Control and maintenance of attention and immediate memory – normal
Memory best at 16-18 of age
Vocabulary and verbal reasoning even better at 60
Dementia 認知障礙症Alzheimer’s Disease 阿爾茲海默氏症 63%
Vascular Dementia 20%
Other degenerative diseases
Parkinson’s Disease with Dementia
B12 deficiency
Alcohol
Brain Tumor
Prevalence of Dementia
100,000 cases now
Alzheimer’s Disease
Dr Alois Alzheimer
(1864-1915)
1906 first case
Mild Cognitive Impairment
A slight but noticeable and measurable decline in cognitive abilities, including memory and thinking skills.
Changes that are serious enough to be noticed by the individuals experiencing them or to other people.
But not severe enough to interfere with daily life or independent function.
Cognitive Deficit
Executive function
Language
Working (immediate) memory
Spatial memory
Verbal memory
Impairment in Social Function
Impairment in Independent Living
Independent Living
Shopping
Managing finance
Household duties
Appropriate social behavior
Symptoms to watch for
Getting lost in familiar places
Repetitive questioning
Odd or inappropriate behaviors
Forgetfulness of recent events
Repeated falls or loss of balance
Personality changes
Decline in planning and organization
Changes in diet/eating habits
Changes in hygiene
Increased apathy
Changes in language abilities, including comprehension
Later Stage
Inappropriate outbursts of anger
Problems recognizing friends and family members
Restlessness, agitation, anxiety, tearfulness, wandering—especially in the late afternoon or at night
Hallucinations, delusions, suspiciousness or paranoia, irritability
Loss of impulse control (shown through undressing at inappropriate times or places or vulgar language)
V Late Stage
Weight loss
Seizures
Skin infections
Difficulty swallowing
Groaning, moaning, or grunting
Increased sleeping
Lack of bladder and bowel control
Drugs
Aricept
Exelon (oral and patch)
Ebixa
Reminyl
Behavioral Problem
Quetiapine
Olanzapine
Risperidone
Risk Factors
High blood pressure, diabetes, poor nutrition and social isolation are associated with a higher probability of developing a neurodegenerative condition
Heart disease
Family history of dementia
Psychological factors such as stress and depression also negatively affect the healthy aging process
Tips to prevent
Treat Hypertension, High Cholesterol, Heart Disease
Exercise your body
Stop smoking, reduce drinking
Healthy Diet
Extensive Social Network
Tips for care
Keep patient safe from accident
No arguments
Keep in comfort
Reminiscing
DepressionIn the Elderly
Outline
Depression and Ageing
Common Diseases in Elderly
Depression affecting Diseases
Diseases affecting Depression
Elderly suicide
Decreasing rate
Prevalence of elderly depressionin different care settings
Care setting Prevalence of depressive symptoms
Prevalence of major
depressive disorder
Community 15% 1-3%
Primary care 20% 10-12%
Acute hospital 20-25% 10-15%
Long term care 30-40% 16%
Risk factors for depressionin general
female gender
low education
loss of partner
cognitive decline
somatic diseases
functional impairment or disability
High Risk Groups with diseases
Current alcohol /substance-use disorder
Specific comorbid conditions: dementia, stroke, cancer, arthritis, hip fracture, myocardial infarction, chronic obstructive pulmonary disease, and Parkinson’s disease
Functional disability (especially new functional loss)
Widow/widowers
Caregivers
Social isolation/absence of social support
Diminished perception of light in one's environment
Depression affecting Diseases
amplification of pain and disability
delayed recovery from illness and surgery
worsening of drug side effects
excess use of health services
cognitive impairment
Subnutrition
increased suicide- and nonsuicide-related death.
Somatic Disease vs Disabilities
Disability, especially disability regarding participation, self-care, or social activities is strongly related to late-life depression.
Somatic diseases in itself are less of a risk for depression, except that somatic diseases are related to disability.
Relationship was stronger for people of 60-69 years old than for those older than 70 years
Prevalence of depressionafter major disease
Depressive symptoms were prevalent in 38.3% of the subjects during the post-event year; in about 19.1%, symptoms were mild.
Risk factors: age, smoking, poor general health, poor well-being, and neuroticism.
Drugs & Depression
Steroids
Narcotics
Sedative/hypnotics, Benzodiazepines
Antihypertensives
H2 antagonists
Beta-blockers
Antipsychotics
Immunosuppressives, Cytotoxic agents
Geriatric depression scale
Count for symptoms
Depressive symptoms
Depressed or irritable mood, frequent crying
Loss of interest, pleasure (in family, friends, hobbies, sex)
Weight loss or gain (especially loss)
Sleep disturbance (especially insomnia)
Fatigue/loss of energy
Psychomotor slowing/agitation
Diminished concentration
Feelings of worthlessness/guilt
Suicidal thoughts or attempts, hopelessness
Psychosis (i.e., delusional/paranoid thoughts, hallucinations)
History of depression, current substance abuse (especially alcohol), previous coping style
Recent losses or crises (e.g., death of spouse, friend, pet; retirement; anniversary dates; move to another residence, nursing home); change in physical health status, relationships, roles
Treatment
Drug Treatment
Psychological Counseling
DeliriumIn the Elderly
Confusion
Acute brain failure associated with autonomic dysfunction, motor dysfunction and homeostatic failure
A disturbance of consciousness that is accompanied by a change in cognition that cannot be better accounted for by a pre-existing or evolving dementia
= Acute Confusional State
Causes
Infection
Drugs
Electrolytes
Pain
Management
Treat the precipitating cause
Comfort the patient
Avoid accidents
Restraints
Chemical Sedation
AnxietyIn the Elderly
Geriatric Giant
Twice as common as dementia
4-8 x as common as major depression
Causing significant impact on the quality of life, morbidity, and mortality of older adults
10-15% of older adults
Types
General Anxiety Disorders or specific phobia 90%
Obsessive Compulsive Disorders, Post-traumatic stress and Panic attacks 10%
Cognitive Symptoms
Hyper-vigilance to threat
Seeing oneself as vulnerable
Perceiving the demands of life as exceeding the available resources to cope
Risk Factors
A lack of social supports
A recent traumatic event
Medical illnesses and medications
Poor self-rated health
Presence of another psychiatric illness (particularly another anxiety disorder or depression)
An early-onset anxiety disorder
Female gender
Physical symptoms
Restlessness
Fatigue
Muscle tension
Insomnia that interfere with social or occupational functioning
Headaches, back pain, or a rapid heartbeat
Short of breath, sweating, hot flushes, urine frequently
Worry about everything
Phobias
Persistent irrational fear of a situation, object, or activity
Desire to avoid the phobic situation
Drugs
SSRI (Selective Serotonin Reuptake Inhibitors)
Benzodiazepines
Cognitive Behavior Therapy
For children and younger adults
Conclusion
The brain is the most mysterious organ
Complex, varied, inconsistent
Need support from friends and family to persevere
Tranquility, Serenity, Peace of Mind are the most wanted gift of mankind