Transcript long version

Module Six
MENTAL DISORDERS IN
ELDERLY

Lesson 1: Elders’ experiences
(2 training hours)

Lesson 2: Mental Disorders in elders
(2 training hours)

TOTAL TIME 4 TRAINING HOURS OF 45
MINUTES
Lesson 1
ELDERS’ EXPERIENCES
TIME :
90 minutes (2 training hours of 45 minutes)
Step 1: Introduction (10΄)
Passing to the elder age for every person is related to the
complicated interaction of biological, psychological and
social factors. People differ a lot from each other in the
way they deal with this transition.
It is important to :
 have good physical health.
 Social support.
 Keep the patient active.
 Be focused in entertaining activities.
 Maintaining family and other close relationships.
Step 2: Brainstorming and
discussion (15΄)
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What are your feelings when thinking of
yourself old?
What are the positive and the negative
points ?
What’s your opinion for retirement ?
How would you spend your time when old
or retired?
What would you like to do?
Step 3: Group discussion (20΄)
Pen and paper
In what way (s) differ the needs of elderly to
the one’s of younger people?
Step 4: Theory presentation
(15΄)
People that suffered for many years from
severe chronic mental disorders have
usually very different experiences in their
life.
The impact of passing to the elder age might
be really different for them.
Step 4 (continued)
Even though in many cases the symptoms of mental
disorders become milder, the difficulties become harder.
This is due to the fact that:
 These persons apart from the chronic mental disorder, are
also influenced from other problems of elders.
 They might have lost because of the long-lasting term of
the disease and the hospitalization the ability to
understand and proceed to the necessary adjustments for
elderly.
 Very often, while their needs are more demanding, they
have already over passed all limits of their family support.
Step 4 (continued)
As a result to these, they need special attention
which includes:
 Taking care of their physical health.
 Observation of their mental disorder.
 Support for the family that looks after the person.
 Eventually a place to stay (hostel, house for the
elderly).
 Day occupation (Day Care center).
 Maintenance if possible of their abilities,
especially those that help them looking after
themselves.
 Maintenance of their social activity.
Step 5: slide projection (10΄)
Slide 6.1.1: The most important transition points
during people’s lifetime
 Graduation
 First job
 Marriage
 Children’s birth
 Promotion
 Retirement
 Parents’ death
 Wife’s / husband’s death
Step 6: Brainstorming (10΄)
People with chronic psychosis experience the
same or different transition points and
which are these?
Step 7: Questions and
comments (5΄)
Step 8: Lesson’s evaluation
(5΄)
Lesson 2
MENTAL DISORDERS IN ELDERLY
TIME :
90 minutes (2 training hours of 45 minutes)
Step 1: Introduction (5΄)
The last 100 years, human’s life span has increased
and as a consequence the elderly population has
gone up. In western Europe at the beginning of
the 20th century only 5% of the population was
over 65 years old, while at the end of this century
the number came up to 15-20% . Actually, one
third of these people are more than 75 years old.
A further increase is expected in the 21st century.
The rising age of the population creates a serious
problem related to the looking after of these
people, as it is more likely they suffer from
various disorders and disabilities.
Step 2: Slide projection (10΄)
Slide 6.2.1: Mental Disorders appeared in elderly
Senile dementia
Depression
Paranoid psychoses
Neuroses
Personality Disorders
% appearance at
persons >65 years old
3.5
11
0.3
28
Step 3: Theory presentation
(30΄)
Depression
 Is quite regularly manifested in elderly
(one in ten persons aged more than 65).
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Factors as social isolation, manifestation of
physical disease, the loss of loved ones and
the lack of satisfaction in life play an
important role to its manifestation.
Step 3 (continued)
It might not be manifested with no obvious sadness, but with
atypical symptoms such as :
 Uneasiness and anxiety
 Behavioral change
 Neglecting oneself
 Physical disturbances
 Guilt
 Apathy
 Unable to concentrate
 Memory loss
 Insomnia
 Odd or aberrant ideas
Suicide is a major risk especially for socially isolated men.
Step 3 (continued)
Therapeutical intervention includes:
 Hospitalisation in many cases
 Care of physical health
 Antidepressants
 Antipsychotic medication where there are
psychotic characteristics
 Social intervention
Step 3 (continued)
Paranoid psychosis
 The manifestation of psychosis like Paranoid
Schizophrenia is quite usual in elderly.
 It really often in elders with hear impaired of
vision problems.
 Sometimes many stressful events are anticipated.
 The symptoms are usually characterized by odd
aberrant ideas.
 The majority of these patients appear as
Depressive.
 In most of the cases hospitalization and
antipsychotic medication is necessary for their
treatment.
Step 3 (continued)
Senile dementias
 This term includes Alzheimer disease as well as, MID
(multi infract dementia) and other types of senile diseases
( alcoholic, Huntington, Creutzfeldt-Jacob, Pick disease
etc.).
 Half of the elderly population suffer from Alzheimer’s
disease.
 For every man there are two women that suffer from
Alzheimer’s disease.
 The causes of the Alzheimer disease are unknown but
there are suspicions for genetic, environmental, toxic and
infectious factors.
Step 3 (continued)
There are characteristic deteriorations of the brain
outer surface.
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Multi infarct dementia is due to many little
blood clots that cause ischaemia and necrosis in
several areas of the brain.
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It has abrupt onset and escalating
recrudescence.
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It develops slower than Alzheimer disease.
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In many cases the patient also suffers from
hypertension.
Step 3 (continued)
slide 6.2.2: dementia characteristics.
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Memory loss
Cognitive loss
Talking problems
Anxiety and depression
Loss of skills
Behaviour and personality alterations
Step 3 (continued)
There are three steps of progress. During the
first there is just memory disturbance,
during the second general loss of cognitive
function takes place and during the third
neurologic signs and double incontinence
(urine and excrement).
Step 3 (continued)
The treatment includes family support,
patient’s support in order to maintain his /
her abilities and a series of daily activities,
prescription of special medication (like
Tacrine), especially during the early stages
for delaying the progress of the disease.
Step 3 (continued)
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Multi infarction dementia (MID) Η
πολυεμφραγματική άνοια οφείλεται σε πολλά
μικρά έμβολα στον εγκέφαλο που προκαλούν
ισχαιμία και νέκρωση σε διάφορες περιοχές του.
Έχει οξεία έναρξη και επιδεινώνεται κλιμακωτά.
Εξελίσσεται με ποιο αργό ρυθμό από ότι η Νόσος
του Alzheimer.
Στις περισσότερες περιπτώσεις τα άτομα είναι
υπερτασικά.
Step 4: Clinical cases (20΄)
Leaflet 6.2.1:Clinical cases
Based to these cases, discuss your own
experiences.
Step 5: Slide projection (15΄)
Slide 6.2.3: general principles of treating elders
with psychiatric problems
 Early and total diagnose of medical and social
factors.
 Stay of the patient in his home for as long as
possible.
 Support of the family so that their able to keep
looking after the patient.
 Visits by social worker and health visitor, offer of
economical and practical help and patients
attendance to Day Care centers.
Step 5 (continued)
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Hospitalization and short stay in the hospital
when necessary.
Care of physical health.
Accurate use of medication prescription.
Psychotherapeutical approach of the patients
insisting in support and encouragement, as well
as cognitive – behavioral approach.
Development of Psychiatric Services for elders
and scientific approach from the therapeutical
group.
Step 6: Questions and
comments (5΄)
Step 7: Lesson’s evaluation (5΄)