Community and Mental Health Nursing Department

Faculty of Nursing
University of Airlangga

Ageing Issues:
Cognitive and
Psychological Changes
Setho Hadisuyatmana, S.Kep.Ns

Preface
It is a common finding that as people age become

cognitively and psychologically impaired.

The development of dementia is not a normal process,

but it is pathological.
The most three disease of older is known as Three Ds

(Dementia, Delirium, and Depression)

It is important to gain a good understanding as a basis

to provide an appropriate treatment

Learning Objectives
1. Describe prevalence of the Three Ds
2. Discussing the symptoms of the Three Ds
3. Identify the importance and components of mental

assessment
4. Discussing treatment option
5. Contrast criteria for differentiation among the Three

Ds

Delirium
Transient state of global cognitive impairment (APA,

1994 cited in Wallace 2008: 216)

Suddenly occur, often in twilight
Short, diurnal fluctuations, worse at night and

awakening
Reduced consciousness, hours to less then one month

Diagnostic Criteria
Decreased ability to maintain attention to external

stimuli and to shift appropriate attention to the new

one
Disorganized thinking, and at least two of the
following:
1. reduced level of consciousness;
2. perceptual disturbances;
3. disturbance of the sleepwake cycle

Diagnostic Criteria (contd)

increased or decreased psychomotor behavior;
disorientation to person, place, or time;
6. memory impairment.
These symptoms of delirium, commonly thought of as acute
confusion, usually develop over a short period of time
Confusing Assessment Method (CAM) to be the most suitable
tool to classify the delirium symptoms.
Difficulty concentrating on tasks, or conversations and either
display disorganized thinking or altered level of consciousness
Diagnosed as Delirium
4.
5.

Causes
Not fully known, but believed to be (Balas et all, 2007) :
Previous brain pathology
Acute and chronic diseases
Cognitive impairment, alcoholism, burden co-

morbidity and depression are to be independent

predictors besides medications and surgical procedures
(Short and Winsted, 2007)

Treatment
Delirium is a temporary and reversible condition

First line treatment eliminate the cause and

predictor of delirium

If the change of familiar envy became the trigger

adding the familiar items and family surrounding the

older
Remove the possible other causes alcohol,

medications, etc

Safe Environment
Fall prevention strategies
Warning System
Reduce the frightening activities

Depression
Usual Finding Loses of the older :
Family, Friends, and Spouses
Job and Financial Resources
Health alterations
Home or Housings

Depressive

Study Findings
Psychological changes occur
Older are susceptible to effect of altered

neurotransmissions
Coexisting medical conditions raised the probability of

depression in older
Chemical imbalances alteration of

neurotransmission, the primary cause

The Characteristic of Depression

Moods and Thinking are changing Primary
Sleep impairment
Changes in appetite
Others may vary depends on culture, ethnic, gender,

and family history

Thus. . .
The DSM-IV criteria to diagnose the finding are used

to detect the depression.

It is essential to regulate any possibilities of medical

concern
One of the way to assess clients condition is the use of

Geriatric Depression Scale

Suicide
High Risk Factors :
Living alone
Relocation from home to long time care institution
Widowhood
Medical Status of Chronic Illness

Nurses Awareness
The attempt is vocalized, such as: Lord, please take me! I

am ready to die now

Demonstrate feeling of Hopelessness, Helplessness,

Worthlessness
80% older who committed suicide told to someone about it

first, often care provider

Standardized Geriatric Depression Scale is needed to

measure the statements

Dementia
Although the decrease of brain weight and the

proportion of gray mater, dementia considered to be

not normal in older.
It occurs as a result of a life style, disease, heredity, and

others 60 probability of possible diseases

Dementia defined as long-time, chronic, and

progressive cognitive function loss

Alzheimer Association (1999)

Dementia identified as loss of mental function in two

or more areas, such as language, memory, visual and

spatial abilities, or judgment to interfere with daily life.

Common sense :

If you lose your car keys, maybe you are

experiencing memory loss. If you find them and dont
know what they are for you are experiencing a
cognitive trouble

Alzheimer Disease (AD)

Causes remain unclear
Risk Factors : Family History with AD, Advanced age

Early Warning (alzheimer association)

Misplacing items,
Loss of initiative,
Changes in

personality,
Poor judgment,
Changes in mood or

behavior,

Disorientation to time and

place,

Memory loss that affects job

skills,

Difficulty performing familiar

tasks,

Difficulty with finding the

right words, and

Problems with abstract

thinking.

Patients Difficulty
Aphasia : Unable to choose the right words to speak
Apraxia : Unable to perform a fine motor task
Agnosia : remembering

All of this may bring desperation to the older.

Assessment and Diagnostic

A Mini Mental State Examination (MMSE) is used to assess,

if the cognitive declined is detected.

A Low score of MMSE indicate that the patient is needed to

have a further diagnostic assessment using :

1. MRI
2. CT scan
3. PET (Positron Emission Tomography)

Intervention Consideration

The patient may present with : Communicating difficulty,

inattentiveness, think disorganizing, consciousness alteration,
sleep-wake disorder, wandering and disorientation.

It is both challenging and frustrating to work with patients

The focus is to maintain function and independence as much as

possible.

Provide a safe environment, including environmental

manipulation

Contd. . .
Maintain daily schedule. The alteration of daily routine

may worsen the dementia.

Translocation of the patient is not recommended
Physical and emotional support are needed by both the

patient and the family.

Thats all folks

Wallace, Meredith (2008). Essentials of Gerontological

Nursing. New York : Springer

Balas, M. C., Deutschman, C. S., Sullivan-Marx, E. M.,

Stumpf, N. E., Alston, R. P., &Richmond, T. S. (2007).

Delirium in older surgical intensive care unit. Journal of
Nursing Scholarship, 39 (2) 147154.
Short, M., & Winstead P. (2007). Delirium dilemma.

Orthopedics, 30(4), 273-276.