Transcript lecture 5: chapter 7 Psychological and Cognitive Function

CHAPTER
7
Lecture Note PowerPoint Presentation
Psychological and
Cognitive Function
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 1
Describe age-related changes that affect
psychological and cognitive functioning.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Incidence of Diagnosable Psychiatric
Disorders in Older People
• Mental disorders occur less for older
adults than any other age group
• 20% of older persons suffer from mental
health problems
• Rate of suicide highest among older adults
compared to other age groups
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Normal Age-Related Changes
• Decline in speed of information processing
• Decreased ability to divide attention
between two tasks
• Difficulty in switching attention rapidly from
one auditory input to another
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Normal Age-Related Changes
• Difficulty with
– Sustained attention
– Filtering out irrelevant information
– Performing certain tasks such as visuospatial
– Short word finding
– Use of abstracting
– Maintaining mental flexibility
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Long-Term or Secondary Memory
• Exhibits more substantial age-related
changes
• Decline is greater for recall than for
recognition
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Intellectual Abilities
• Decline greatest in individuals
experiencing physiological disorders
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Personality
• Increasingly stable in the older adult
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Depression
• A clinical syndrome characterized by low
mood tone, difficulty thinking, and somatic
changes
• Depressive symptoms are seen in 13% of
community-dwelling older adults (meaning
those who are not in assisted living or nursing homes)
• 43% of institutionalized elderly adults may
exhibit depressive symptoms
• Symptoms may be emotional and physical
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Depression
• Experienced twice as often in men as
women
• Symptoms may be caused by medications
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nursing Assessment of Depression
• Geriatric Depression Scale (GDS)
• Mini-Mental State Examination (MMSE)
• Cornell Depression Scale (CDS)
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 2
Explain the impact of age-related changes
on stress and coping.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Methods for Coping with AgeAssociated Cognitive Changes
• Making lists
• Memory training and memory
enhancement techniques
• Playing computer games emphasizing
eye/hand coordination and memory
• Keeping the mind challenged and mentally
active
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Methods for Coping with AgeAssociated Cognitive Changes
• Use of assistive devices
• Seeking support from others
• Staying positive
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Examples of Common Events Requiring
Psychological Adjustments
• Widowhood (The condition or period of
being a widow)
• Confronting negative attitudes of aging
• Retirement
• Chronic illness
• Functional impairments
• Decisions about driving a car
• Death of friends and family
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Examples of Common Events Requiring
Psychological Adjustments
• Relocation from home to assisted living or
long-term care
• The longer a person lives, the more likely
events will occur that require coping and
adaptation
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 3
Identify risk factors for high levels of stress,
poor coping, and impaired mental health,
including alcoholism, stress-related
disorders, and depression.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Risk Factors that Influence
Psychosocial Functioning
• High levels of stress and poor coping
• Impaired mental health
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Risk Factors for High Levels of
Stress and Poor Coping
• Diminished economic resources
• Unanticipated events, such as the death of
a spouse
• Many daily hassles at the same time in
one day
• Many major life events occurring in a short
period of time
• Unrealistic appraisals of situations
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Depression Associated with
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Stroke
Heart disease
Parkinson disease
Endocrine disorders
Cancer
Epilepsy
B12 deficiency
Chronic pain
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Depression Associated with
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Viral illness
Serious losses
Difficult relationships
Changes in social roles
Retirement
Widowhood
Loneliness
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Depression Associated with
• Poverty
• Unplanned moves, such as a move to
assisted living or long-term care
• Medication side effects
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Minorities at Greater Risk of Poor
Mental Health
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Increased segregation (isolation)
Poverty
Poor quality education
Discrimination
Healthcare disparities
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 4
Examine risk factors that influence cognitive
functioning in older adults.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Cognitive Impairment Associated
with
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Physical illness
Stroke
Heart disease
Parkinson disease
Endocrine disorders
Cancers
Epilepsy
B12 deficiencies
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Cognitive Impairment Associated
with
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Chronic pain
Viral illness
Psychosocial factors
Serious or multiple losses
Difficult relationships
Changes in social roles
Loneliness
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Cognitive Impairment Associated
with
• Poverty
• Unplanned moves
• Medication side effects
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 5
Define appropriate nursing interventions
directed toward assisting the older adult to
develop coping resources, use effective
coping mechanisms, and minimize the
functional consequences of stress.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nursing Actions
• Assisting older persons in identifying
stressors and rating their levels of stress
• Educating the older person and family
about stress theory and the stress cycle
• Helping the older person identify
successful coping mechanisms used in the
past during periods of high stress
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nursing Actions
• Assisting the older person in examining
current coping mechanisms and behaviors
and altering or eliminating negative or
maladaptive mechanisms
• Reinforcing and strengthening positive
coping mechanisms
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nursing Actions
• Investigating community resources,
support groups, stress-reduction clinics,
and other stress relievers that may be
appropriate and useful to the older person.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Stress-Reducing Techniques
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Listening to music
Reading a book
Watching a movie
Exercises such as yoga, tai chi, and
walking
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Nursing Interventions
• Suicide self-restraint contracts(The patient signed a
suicide prevention contract)
• Encourage appropriate self-care behaviors
• Identify and encourage effective coping
strategies
• Encourage hopeful attitudes
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 6
Identify means to strengthen social support
groups and healthy aging.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Fostering Healthy Aging and Social
Interaction
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Support groups
Alzheimer’s Association
American Cancer Society
Other groups focused on specific illnesses
(cardiac, arthritis, lung, etc.)
• Grief and bereavement groups
• Travel with senior citizen groups
• Outside activities
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Fostering Healthy Aging and Social
Interaction
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Taking classes
Elder hostels
Volunteer work
Regular exercise
Hobbies and crafts
Increased family involvement
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
LEARNING OUTCOME 7
Identify interventions directed toward
alleviating risk factors for late-life
depression, treating depression in older
adults, and preventing suicide.
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Ways to Decrease Depression Risk
• Alternative and complementary therapies
– Relaxation techniques
– Massage
– Acupuncture
– Yoga
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Ways to Decrease Depression Risk
• Light therapy for SAD
• Seasonal Affective Disorder (SAD), also known as winter
depression or winter blues, is a mood disorder in which people
who have normal mental health throughout most of the year
experience depressive symptoms in the winter or, less frequently, in
the summer,[1] spring or autumn, repeatedly, year after year.
• Electroconvulsive therapy (ECT)
• Support groups such as AA and
bereavement groups
•
Alcoholics Anonymous (AA): Is a fellowship of men and women who share their
experience, strength and hope with each other that they may solve their common
problem and help others to recover from alcoholism
Gerontological Nursing, Second Edition
Patricia A. Tabloski
Copyright ©2010 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.