Mental Health A CNA Guide

Objective

• The purpose of this presentation is to provide a basic understanding of the most common mental illnesses affecting the elder population here at Ridgecrest Nursing and Rehabilitation Facility

• You will not be an expert at the end of this presentation. You will be better informed and in turn more prepared to give caring, professional care to our population

Mental Health Myths

Mental Health Reality

What is Mental Illness?• A mental illness is a medical condition that disrupts a person's

thinking, feeling, mood, ability to relate to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.

• Mental illnesses can affect persons of any age, race, religion or income. Mental illnesses are not the result of personal weakness, lack of character or poor upbringing. Mental illnesses are treatable. Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan.

Mental Health Among the Elder Population

• According to the World Health Organization:• Globally, the population is ageing rapidly. It is projected

that the number of persons aged 60 or over is expected to more than triple by 2100.• Mental health and emotional well-being are as important in

older age as at any other time of life.• Neuropsychiatric disorders among the older adults account

for 6.6% of the total disability (DALYs) for this age group.• Approximately 15% of adults aged 60 and over suffer from

a mental disorder.

Mental Health Conditions Affecting the Elderly

• The elderly often experience mental health issues and mental disorders. Some of the most common mental health issues and concerns are:• Depression• Dementia• Pseudodementias• Bi-polar disorder• Schizophrenia• Post Traumatic Stress Disorder• Alzheimer's disease

Depression

The changes that often come in later life:

• Retirement

• The death of loved ones

• Increased isolation

• medical problems

All of these issues can lead to depression. Depression prevents you from enjoying life like you used to. But its effects go far beyond mood. It also impacts your energy, sleep, appetite, and physical health. However, depression is not an inevitable part of aging, and there are many steps you can take to overcome the symptoms, no matter the challenges you face.

Signs and Symptoms

• Sadness• Fatigue• Abandoning or losing interest in hobbies or other pleasurable pastimes• Social withdrawal and isolation (reluctance to be with friends, engage in

activities, or leave home)• Weight loss or loss of appetite• Sleep disturbances (difficulty falling asleep or staying asleep, oversleeping,

or daytime sleepiness)• Loss of self-worth (worries about being a burden, feelings of worthlessness,

self-loathing)• Increased use of alcohol or other drugs• Fixation on death; suicidal thoughts or attempts

Depressed but not Sad?• While depression and sadness might seem to go hand and hand, many depressed

seniors claim not to feel sad at all. They may complain, instead, of low motivation, a lack of energy, or physical problems. In fact, physical complaints, such as arthritis pain or worsening headaches, are often the predominant symptom of depression in the elderly.

• Unexplained or aggravated aches and pains• Feelings of hopelessness or helplessness• Anxiety and worries• Memory problems• Lack of motivation and energy• Slowed movement and speech• Irritability• Loss of interest in socializing and hobbies• Neglecting personal care (skipping meals, forgetting meds, neglecting personal

hygiene)

Dementia• Dementia isn't a specific

disease. Instead, dementia describes a group of symptoms affecting thinking and social abilities severely enough to interfere with daily functioning.

• Memory loss generally occurs in dementia. However, memory loss alone doesn't mean you have dementia. Dementia indicates problems with at least two brain functions, such as memory loss and impaired judgment or language, and the inability to perform some daily activities such as paying bills or becoming lost driving.

Signs and Symptoms• Memory loss• Difficulty communicating• Difficulty with complex

tasks• Difficulty with planning

and organizing• Difficulty with coordination

and motor functions

• Problems with disorientation, such as getting lost• Personality changes• Inability to reason• Inappropriate behavior• Paranoia• Agitation• Hallucinations

Causes of Dementia • Alzheimer's disease• Lewy body dementia• Vascular dementia• Frontotemporal dementia•Huntington's disease

• Traumatic brain injury•HIV-associated dementia• Creutzfeldt-Jakob disease• Secondary dementias

Is Dementia Permanent?• Some causes of dementia or dementia-like symptoms can be reversed.

Your doctor may identify and treat these causes:• Infections and immune disorders• Metabolic problems and endocrine abnormalities• Nutritional deficiencies• Reactions to medications• Subdural hematomas• Poisoning• Brain tumors• Anoxia• Heart and lung problems• Normal-pressure hydrocephalus

PseudodementiasA condition in elderly people who appear to be suffering from dementia, but actually are suffering from depression which is causing dementia-like symptoms. These symptoms like apparent memory loss or failure to adequately be able to care for the self may present concurrently with symptoms of depression, and a person may seem confused or on common tests that evaluate dementia be unable to answer many questions except by saying, “I don’t know.” It is important to view pseudodementia as a real illness and not something a person “fakes.” It really is depression that masquerades as conditions like Alzheimer’s

BIPOLAR DISORDER

• Bipolar disorder — sometimes called manic-depressive disorder — is associated with mood swings that range from the lows of depression to the highs of mania. When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts in the other direction, you may feel euphoric and full of energy. Mood shifts may occur only a few times a year, or as often as several times a day. In some cases, bipolar disorder causes symptoms of depression and mania at the same time.

• Although bipolar disorder is a disruptive, long-term condition, you can keep your moods in check by following a treatment plan. In most cases, bipolar disorder can be controlled with medications and psychological counseling (psychotherapy).

Phases of Bipolar Disorder: Manic

• Signs and symptoms of the manic or hypomanic phase of bipolar disorder can include:

• Euphoria• Inflated self-esteem• Poor judgment• Rapid speech• Racing thoughts• Aggressive behavior• Agitation or irritation• Increased physical activity• Risky behavior

• Spending sprees or unwise financial choices

• Increased drive to perform or achieve goals

• Increased sex drive• Decreased need for sleep• Easily distracted• Careless or dangerous use of drugs or

alcohol• Frequent absences from work or school• Delusions or a break from reality

(psychosis)• Poor performance at work or school

Phases of Bipolar Disorder: Depression

• Signs and symptoms of the depressive phase of bipolar disorder can include:• Sadness• Hopelessness• Suicidal thoughts or behavior• Anxiety• Guilt• Sleep problems• Low appetite or increased

appetite

• Fatigue• Loss of interest in activities

once considered enjoyable• Problems concentrating• Irritability• Chronic pain without a known

cause• Frequent absences from work

or school• Poor performance at work or

school

Types of Bipolar Disorder• Bipolar I disorder. Mood swings with bipolar I cause significant

difficulty in your job, school or relationships. Manic episodes can be severe and dangerous.

• Bipolar II disorder. Bipolar II is less severe than bipolar I. You may have an elevated mood, irritability and some changes in your functioning, but generally you can carry on with your normal daily routine. Instead of full-blown mania, you have hypomania — a less severe form of mania. In bipolar II, periods of depression typically last longer than periods of hypomania.

• Cyclothymic disorder. Cyclothymic disorder, also known as cyclothymia, is a mild form of bipolar disorder. With cyclothymia, hypomania and depression can be disruptive, but the highs and lows are not as severe as they are with other types of bipolar disorder.

Schizophrenia

Schizophrenia is a severe brain disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking

and behavior.

Contrary to popular belief, schizophrenia isn't a split

personality or multiple personality. The word

"schizophrenia" does mean "split mind," but it refers to a disruption of the usual balance of emotions

and thinking.

Schizophrenia is a chronic condition, requiring lifelong

treatment.

Signs and Symptoms• Delusions. These are false beliefs that are not based in reality. For example, you're being

harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame; another person is in love with you; a major catastrophe is about to occur; or your body is not functioning properly. Delusions occur in as many as 4 out of 5 people with schizophrenia.

• Hallucinations. These usually involve seeing or hearing things that don't exist. Yet for the person with schizophrenia, they have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination.

• Disorganized thinking (speech). Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can't be understood, sometimes known as word salad.

• Extremely disorganized or abnormal motor behavior. This may show in a number of ways, ranging from childlike silliness to unpredictable agitation. Behavior is not focused on a goal, which makes it hard to perform tasks. Abnormal motor behavior can include resistance to instructions, inappropriate and bizarre posture, a complete lack of response, or useless and excessive movement.

• Negative symptoms. This refers to reduced ability or lack of ability to function normally. For example, the person appears to lack emotion, such as not making eye contact, not changing facial expressions, speaking without inflection or monotone, or not adding hand or head movements that normally provide the emotional emphasis in speech. Also, the person may have a reduced ability to plan or carry out activities, such as decreased talking and neglect of personal hygiene, or have a loss of interest in everyday activities, social withdrawal or a lack of ability to experience pleasure.

What is it Like to Have a Schizophrenia

Post Traumatic

Stress Disorder

Post-traumatic stress disorder (PTSD) is a mental health condition that's triggered by a terrifying event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.

Many people who go through traumatic events have difficulty adjusting and coping for a while, but they don't have PTSD — with time and good self-care, they usually get better. But if the symptoms get worse or last for months or even years and interfere with your functioning, you may have PTSD.

What Are the Causes of PTSD?

• War• Natural disasters• Car or plane crashes• Terrorist attacks• Sudden death of a loved

one• Rape• Kidnapping

• Assault• Sexual or physical abuse• Childhood neglect• Or any shattering event

that leaves you stuck and feeling helpless and hopeless

Signs and Symptoms• Symptoms of PTSD: Re-

experiencing the traumatic event

• Intrusive, upsetting memories of the event

• Flashbacks (acting or feeling like the event is happening again)

• Nightmares (either of the event or of other frightening things)

• Feelings of intense distress when reminded of the trauma

• Intense physical reactions to reminders of the event (e.g.

pounding heart, rapid breathing, nausea

• Symptoms of PTSD: Avoidance and numbing

• Avoiding activities, places, thoughts, or feelings that remind you of the trauma

• Inability to remember important aspects of the trauma

• Loss of interest in activities and life in general

• Feeling detached from others and emotionally numb

• Sense of a limited future

(you don’t expect to live a normal life span, get married, have a career)

• Symptoms of PTSD: Increased anxiety and emotional arousal

• Difficulty falling or staying asleep

• Irritability or outbursts of anger

• Difficulty concentrating• Hypervigilance (on constant

“red alert”)• Feeling jumpy and easily

startled

Alzheimer's Disease

Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, and eventually even the ability to carry out the simplest tasks.

Alzheimer’s disease is the most common cause of dementia among older people. Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities, to such an extent that it interferes with a person’s daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living.

Signs and Symptoms• Memory:

• Repeat statements and questions over and over, not realizing that they've asked the question before

• Forget conversations, appointments or events, and not remember them later

• Routinely misplace possessions, often putting them in illogical locations

• Eventually forget the names of family members

• Speaking and writing:

• Those with Alzheimer's may have trouble finding the right words to identify objects, express thoughts or take part in conversations. Over time, the ability to read and write also declines.

• Thinking and reasoning:

• Alzheimer's disease causes difficulty concentrating and thinking, especially about abstract concepts like numbers. It may be challenging to manage finances, balance checkbooks, and keep track of bills and pay them on time. These difficulties may progress to inability to recognize and deal with numbers.

Signs and Symptoms Cont.• Making judgments and

decisions:• Responding effectively to

everyday problems, such as food burning on the stove or unexpected driving situations, becomes increasingly challenging.

• Planning and performing familiar tasks:• Once-routine activities that

require sequential steps, such as planning and cooking a meal or playing a favorite game, become a struggle as the disease progresses. Eventually, people with advanced Alzheimer's may forget how to perform basic tasks such as dressing and bathing.

Signs and Symptoms Cont.

• Changes in personality and behavior• Brain changes that occur in Alzheimer's disease can affect the way you

act and how you feel. People with Alzheimer's may experience:• Depression• Social withdrawal• Mood swings• Distrust in others• Irritability and aggressiveness• Changes in sleeping habits• Wandering• Loss of inhibitions• Delusions, such as believing something has been stolen

Giving Back Memories

Strategies for Care During Your Shift• Make sure they are taking their medication. Facing a mental

disorder can be very stressful for an elderly parent and so every effort to lower anxiety should be considered• Choose a time when both of you are calm. This will make it

easier for you and your patient to listen to each other and speak your minds. Then, explain your needs, stress the benefits of care—and be prepared to compromise.• Take resistance in stride. Shift the conversation to less

inflammatory aspects of your concerns. Threats or emotional outbursts will only add anxiety and shut down communication. Remember not to take outbursts personally and know that they often stem from fear of the unknown.

QUESTIONS?

References• http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH00017

48/• http://

www.helpguide.org/mental/depression_elderly.htm• http://www.mayoclinic.org/diseases-conditions/• http://

www.nia.nih.gov/alzheimers/publication/alzheimers-disease-fact-sheet• http://

www.mentalhealth.gov/basics/myths-facts/index.html• https://images.search.yahoo.com/search/images