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Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Chapter SeventeenChapter Seventeen
Common Clinical Problems:
Psychological
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Psychological ProblemsPsychological Problems
Disturbances in mental or emotional health as a result of external or internal stimuli
Assessed by evaluating thought patterns, behaviors, and emotions
Can be difficult to diagnose
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Communicating With Older AdultsCommunicating With Older Adults
Three stages of a relationship Beginning the relationship
Individuals with psychological problems may have a difficult time starting a relationship
Establish trust Use humor or find person’s interests
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Communicating With Older AdultsCommunicating With Older Adults
Three stages of a relationship (cont.) Developing a relationship
Listen and guide discussion Ending a relationship
People generally try to avoid the termination process Let person know when to expect the separation
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Communicating With Older AdultsCommunicating With Older Adults
Verbal communication Use open questions instead of closed questions Give directions slowly and step by step Provide two choices for activities Express empathy by maintaining eye contact, using
caring tone of voice, making confirming statements, being genuine
Listen to feelings, words, and behaviors
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Communicating With Older AdultsCommunicating With Older Adults
Nonverbal communication Most honest communication Touch
Important part of communication Individuals will respond differently to touch
Matching and mirroring Doing exactly what the person is doing Use same pattern and voice tone
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Communicating With Older AdultsCommunicating With Older Adults
Universal symbols An object from the present that represents
something from the past
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Problem BehaviorsProblem Behaviors
May include wandering, shouting, aggressive or withdrawn behaviors
Can be caused by change in environment or changes in medications
Monitor individual closely Agitation
Caused by stress, anxiety, flashbacks from traumatic experiences, post-abuse reactions, dementia
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Problem BehaviorsProblem Behaviors
Agitation (cont.) Person can become violent towards self or others Signs of agitation include pacing, sudden loud
outbursts, making threatening comments Behaviors caused by stress
Decrease stress by providing continuity in care providers and the person’s environment
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Problem BehaviorsProblem Behaviors
Violent behaviors Protect person from his or her violent behaviors Stay calm and do not raise your voice
Sexual acting out Demonstration of sexual activity that is not socially
appropriate Notice factors that trigger behavior
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Specialized Communicating SkillsSpecialized Communicating Skills
Neurolinguistic programming Observation of person’s words and behaviors to
best decide how to relate to that person Validation
Method to communicate with disoriented older adults
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Specialized Communicating SkillsSpecialized Communicating Skills
Preferred sense words Some people relate to their surroundings through
their senses Visual or auditory
Vague pronouns Use when person is unable to fill in the details
with enough facts to understand
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Specialized Communicating SkillsSpecialized Communicating Skills
Speaking slowly Use slower speech and allow plenty of time for the
person’s response Asking the extreme
Ask questions about the extremes of a situation
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Grieving and DepressionGrieving and Depression
Older adults survive several types of losses Death, retirement, relocation, social roles, financial
security, loss of physical functioning Anger and depression are part of the grieving
process Individuals may get stuck at these two stages
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Grieving and DepressionGrieving and Depression
Depression Serious condition in older adults Linked to amount of neurotransmitters serotonin
and norepinephrine in the nerve synapses Stress and decrease in sun exposure can effect
levels of neurotransmitters Influenced by lack of exercise, loss, and poor
nutrition
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Grieving and DepressionGrieving and Depression
Depression (cont.) Treated with antidepressants and therapy Do not use tricyclic antidepressants in the older
adult population Depressed individuals may become confused and
be diagnosed with dementia while depression may not be treated
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Grieving and DepressionGrieving and Depression
Depression (cont.) Suicide rates are high in depressed older adults Depressed older adults may suffer from failure to
thrive
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Delirium and DementiaDelirium and Dementia
Delirium Rapid change in behavior and thinking ability May cause agitation and rapidly changing moods Person will have anxious facial expression May respond slowly to new surroundings May talk in a rambling manner, making no sense Caused by many physiological factors that can
be reversed
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Delirium and DementiaDelirium and Dementia
Dementia Loss of intellectual ability that interferes with
activities of daily living Individuals have problems with cognitive ability,
personality changes, impaired memory, changed judgment and mood
Occurs gradually due to deterioration of brain
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Delirium and DementiaDelirium and Dementia
Dementia (cont.) Caused by neurological diseases, Alzheimer’s
disease, vascular problems, advanced AIDS Validation therapy is a method used to
communicate with individuals who have dementia
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Delirium and DementiaDelirium and Dementia
Dementia (cont.) Stages of disorientation
Naomi Feil identified four stages Malorientation
Individuals appear as if nothing is wrong but are beginning to forget information important for maintaining activities of daily living
Try to cover memory loss by making up excuses
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Delirium and DementiaDelirium and Dementia
Dementia (cont.) Time confusion
Individuals are more disoriented, withdraw more from real world
Individuals confuse past time with present time Lose sense of real time
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Delirium and DementiaDelirium and Dementia
Dementia (cont.) Repetitive motion
Movements or sounds repeated continuously Use single-syllable words Eye contact made only after someone touches or talks to
the person Vegetation
Individual rarely moves or make sounds Eye contact is rare
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Delirium and DementiaDelirium and Dementia
Alzheimer’s disease Most common type of dementia Diagnosed by ruling out other forms of delirium and
dementia Increased incidence as people age Drugs being investigated for management of
Alzheimer’s
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Paranoia Paranoia
Fear that people are trying to hurt you Can occur with dementia, schizophrenia, and
other psychological illnesses Be consistent and reliable while providing care
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Developmental DisabilitiesDevelopmental Disabilities
Individuals living longer Set limits on behavior Recognize person’s feelings Allow person to express anger on set limits
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Substance AbuseSubstance Abuse
Access to drugs from several sources Alcoholism common in older adults Make sure abuse is diagnosed and treated
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Eating DisordersEating Disorders
Problems with eating can be attributed to physical or psychological problems
Eating problems may be related to controlling or resisting behaviors
Treating eating disorders requires creativity
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Groups for the ElderlyGroups for the Elderly
Reminiscence Based on memories of similar events or
experiences Improves feelings of self-worth and opportunity to
review life Also use individually Live review process more structured form
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Groups for the ElderlyGroups for the Elderly
Remotivation Use of real objects to simulate senses and provide new
motivation in life Works best with individuals with depression and early
stages of disorientation Resocialization
Assuming social roles increases feelings of self-esteem Group members are assigned various roles
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Groups for the ElderlyGroups for the Elderly
Reality orientation Help individuals become oriented to present reality Provide constant reminders
Date, time, month, current events Not helpful for individuals with moderate to severe
disorientation
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Groups for the ElderlyGroups for the Elderly
Validation Combine some of the other techniques Focus is on support and problem solving Focus is on resolving losses and expressing
feelings
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Psychotropic MedicationsPsychotropic Medications
Education about drugs for individuals and their families is important
Require a period of time before therapeutic effect is achieved
May show signs of toxicity at lower doses Do not use for behavioral problems until all other
interventions are tried
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Psychotropic MedicationsPsychotropic Medications
Common side effects are constipation and orthostatic hypotension
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Physical and Mental HealthPhysical and Mental Health
Somatization Expression of emotional problems through physical
complaints Easier to acknowledge a physical problem than an
emotional problem May develop backache, headache, stomach ache
Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition
Patient RightsPatient Rights
Older adult has the right to least-restrictive form
of treatment Physical restraints
Use least-restrictive device Check on person often Remove every 2 hours for a brief period of time