Transcript Caring for Older Adults Holistically, 4th Edition Chapter Seventeen

Caring for Older Adults Holistically, 4th Edition
Chapter Seventeen
Common Clinical
Problems:
Psychological
Caring for Older Adults Holistically, 4th Edition
Psychological 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 Edition
Communicating 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 Edition
Communicating 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 Edition
Communicating 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 Edition
Communicating 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
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Communicating With Older Adults
 Universal symbols
 An object from the present that represents
something from the past
Caring for Older Adults Holistically, 4th Edition
Problem 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withdrawn behaviors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 Edition
Problem 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
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Problem 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 Edition
Specialized 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 Edition
Specialized 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 Edition
Specialized 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 Edition
Grieving 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 Edition
Grieving 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 Edition
Grieving 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 Edition
Grieving 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 Edition
Delirium 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 Edition
Delirium 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 Edition
Delirium 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 Edition
Delirium 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
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Delirium 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
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Delirium 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 Edition
Delirium 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 Edition
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 Edition
Developmental 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 Edition
Substance Abuse
 Access to drugs from several sources
 Alcoholism common in older adults
 Make sure abuse is diagnosed and treated
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Eating 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
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Groups 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
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Groups 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 selfesteem
 Group members are assigned various roles
Caring for Older Adults Holistically, 4th Edition
Groups 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 Edition
Groups 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 Edition
Psychotropic 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 Edition
Psychotropic Medications
 Common side effects are constipation and
orthostatic hypotension
Caring for Older Adults Holistically, 4th Edition
Physical 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 Edition
Patient 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