Mental and Behavioral Health Concerns Facing Older Persons

Depression and Suicide

Depression is the most common affective or mood disorder of old age and is often responsive to treatment. Depression disrupts quality of life, increases the risk of suicide, and becomes self-perpetuating. It may also be an early sign of a chronic illness or the result of physical illness.

 Signs of depression include feelings of sadness, fatigue, diminished memory and concentration, feelings of guilt or worthlessness, sleep disturbances, appetite disturbances with excessive weight loss or gain, restlessness, impaired attention span, and suicidal ideation.

 As many as 20% of older adults in the community and up to 37% of nursing home residents suffer from depression, a condition that may lead to suicide. Suicide is the intentional act of killing oneself. Suicidal thoughts are common in people with mood disorders, especially depression.

Clinical Management
Depressive illness in late life should be vigorously treated with antidepressants. Psychosocial approaches have also been found to be effective. Selective serotonin reuptake inhibitors, such as paroxetine (Paxil), are clinically useful and exhibit rapid action with a low occurrence of adverse effects.

 Tricyclic antidepressants, specifically nortriptyline (Aventyl), desipramine (Norpramin), and doxepin (Sinequan), are also clinically effective for depression. Anticholinergic, cardiac, and orthostatic side effects, as well as interactions with other medications, require that these agents be used with care: the dosage must be managed carefully to relieve symptoms and at the same time avoid medication toxicity.

Dementia and Alzheimers Disease

Dementia reportedly affects 3% to 11% of community-residing adults older than 65 years of age and 20% to 50% of community residing adults older than age 85. Dementia is the irreversible deterioration of intellectual ability--often accompanied by emotional disturbances. People with dementia often suffer from depression, paranoia, and anxiety.

 In order for a diagnosis of dementia to be made, at least two domains of altered function must existmemory and at least one of the following: language, perception, visuospatial function, calculation, judgment, abstraction, and problemsolving.

 The most common cause of dementia is Alzheimers disease. Alzheimers disease is a progressive, irreversible, degenerative neurologic disease that begins insidiously and is characterized by gradual losses of cognitive function and disturbances in behavior and affect. Alzheimers disease is not found exclusively in the elderly; in 1% to 10% of cases, its onset occurs in middle age.

Nursing Management
Spend time with the patient. Use touch to convey concern. Provide frequent reiteration of orienting data (e.g. time, place) Have clocks or calendars in the environment. Explain all actions, procedures and routines to the patient. Address the patient by his name. Keep a routine of activities.

Substance Abuse
Alcohol abuse is a major problem of elderly and is one of the eight leading causes of death for older persons. Five percent (5%) of older men and 1% of older women have alcohol abuse and dependency problems, which lead to malnutrition, cirrhosis of the liver, osteomalacia, and a decline in cognitive functioning.

Nursing Management
Health teaching for the client and family. Dispel myths surrounding substance abuse Decrease codependent behaviors among family members Make appropriate referrals for family members Promote coping skills Role-play potentially difficult situations Focus on the here-and-now with clients Set realistic goals such as staying sober today

Safety Problems in Older Persons

 Improved living standards, better healthcare, greater awareness of the importance of a healthy diet and taking regular exercise have led to more and more people enjoying life into their 80s and 90s. However older people, in r the frail elderly, are one of the groups of our population most vulnerable to accidents, particularly in and around the home. Those over 65 years of age are most at risk, suffering both the highest mortality rate and the most severe injuries.

Falls
The risk of falling in the home increases with age. A substantial number of falls are due to unspecified reasons and whilst moving about on one level. This may reflect instability associated with impaired general health.

Risk factors
Physical ability and lack of mobility, balance and gait disorders Nutritional status - vitamin D and calcium deficiency Medication - analgesics, antidepressants etc. Acute and chronic diseases and disorders including stroke and heart disease Female gender Environmental hazards A history of previous falls

Complication
HIP FRACTURES
Fractures, particularly hip fractures are one of the most debilitating results of an accidental fall. Ninety per cent of hip fractures occur among those aged 50 and over. Hip fracture is a major cause of morbidity and mortality. It can result in medical complications, infections, blood clot in the leg and failure to regain mobility.

Prevention
Avoid leaving items on the stairs - they can become a tripping hazard Ensure stairs are carefully maintained damaged or worn carpet should be repaired or removed Try to avoid repetitive carpet patterns that may produce a false perception for those with poor eyesight Landings, stairs and hallways should be well lit with two-way light switches

 Make sure banisters are sturdy. The fitting of two easy-grip handrails gives more stability Well-fitting shoes can help with balance and stability Grab rails and places to sit down in the bathroom and kitchen could be an advantage if dizzy spells occur Spills on the floor should be cleaned up immediately to prevent slipping on them.

Fire-related Accidents
143 people over the age of 65 died in 2010 in fires to which fire brigades are called. Poor mobility, poor sense of smell and a reduced tolerance of smoke and burns contribute to fatalities. Major sources of ignition include cookers, materials, candles, coal fires, heaters and electric blankets.

Prevention
Take care with smoking materials and try to avoid smoking in bed Fit a fireguard Use electric blankets correctly and have them checked regularly Fit a smoke alarm preferably mainoperated or one with a ten-year battery Do not dry clothes on fireguards or heaters.

Poisoning
Medicines and gases, mainly carbon monoxide and pipeline gas, predominantly cause accidental poisoning of people over 65

Prevention
Have fuel burning devices checked regularly by an expert Have chimneys and flues swept at least once a year Be aware of the dangers of exceeding prescribed drug doses.

Burns and Scalds

For older people the rate of risk for severe accidents involving burns and scalds is lower than other age groups. However, older people are at the highest risk for fatal injuries from burns and scalds - four to five times greater than the population as a whole. Pre-existing conditions often contribute to their deaths.

 Contact burns to those over 65 can prove to be fatal. Frail and poor health of the victim are often contributing factors. The main sources of heat include radiators, electric fires and cookers. Many are scald injuries, involving the use of kettles.

Prevention
Encourage the use of: Coiled kettle flexes or a cordless kettle Spout-filling or jug kettles (boil only sufficient water for immediate needs) Wall-mounted heaters instead of kettles Try not to carry hot liquids further than necessary. (Re-arrange tea/coffee-making area to accommodate this.)

 Water at the point of delivery to the bath should be no more than 46 C to help prevent scalding Fit a thermostatic mixing valve When running a bath, turn the cold water on first Always use rear hot plates and turn the panhandles away from the front of the cooker Ensure that hot water bottles are of good quality and do not show signs of wear.

Hypothermia
Hypothermia occurs when the body temperature drops to 35 C. It is the main contributing factor in cause of death for more than 400 people in the over-65 age group each year.

 Wear several thin layers of clothing Natural fibers like wool are warmer than synthetic fabrics Eat regular meals and take hot drinks during the day Move about at regular intervals