tabloski ch07 lecture

Gerontological NursingGerontological Nursing

CHAPTER

THIRD EDITION

Copyright © 2014, © 2010, © 2006 by Pearson Education, Inc.All Rights Reserved

Psychological and Cognitive Function

7

Gerontological Nursing, Third EditionPatricia A. Tabloski

Learning Objectives

1. Describe age-related changes that affect psychological and cognitive functioning.

2. Explain the impact of age-related changes on stress and coping.


Learning Objectives

3. Detect risk factors for high levels of stress, poor coping, and impaired mental health, including alcoholism, stress-related disorders, and depression.

4. Examine risk factors that influence cognitive functioning in older adults.


Learning Objectives

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.

6. Identify means to strengthen social support groups and healthy aging.


Learning Objectives

7. Formulate interventions directed toward alleviating risk factors for late-life depression, treating depression in older adults, and preventing suicide.


Introduction

• Undiagnosed and untreated mental disorders such as depression or despondent mood marked by decreased energy, feeling worthless and guilty, problems with concentration, and thoughts of death or suicide can lead to increased disability, premature death, increased morbidity, cognitive decline, increased risk of institutionalization, and a significant decrease in an older person’s quality of life.


Normal Changes in Aging

• Positive mental health is a necessary component of successful aging.


Box 7-1 Mental Health: ThemesSource: Centers for Disease Control and National Association of Chronic Disease

Directors (2009).


Cultural Considerations

• The older population is highly heterogeneous and includes a diverse mix of immigrants, refugees, and multigenerational Americans with vastly different histories, languages, spiritual practices, demographic patterns, and cultures.


Personality and Self-Concept

• An older person’s self-concept can be eroded or enhanced over time as a result of circumstance and life experiences.

• An older person’s personality influences self-concept and adaptation to role transitions, such as widowhood or retirement.


Life Satisfaction and Life Events

• Life satisfaction is an attitude toward one’s own life; it may be defined as a reflection of feelings about the past, present, and future. Life satisfaction and morale are closely related to well-being.

• Recent studies document that life satisfaction increases until about the age of 65 and then begins to decrease.


Stress and Coping

• Excessive and persistent stress has been linked to the development of illness.

• Gerontological nurses should recognize and understand stress and its influence on older persons.


Personality Disorders

• Psychiatric symptoms that should be investigated and not written off as normal changes of aging include:– Memory and intellectual difficulties– Change in sleep patterns– Changes in sexual interest and capacity– Fear of death


Personality Disorders

• Psychiatric symptoms that should be investigated and not written off as normal changes of aging include:– Delusions– Hallucinations– Disordered thinking– Problems with emotional expression


Psychotic Disorders

• The most common form of psychosis in later years is paranoia.

• The most common stressor that leads to adjustment disorder in later life is physical illness.


Bereavement

• Factors that can affect the duration and course of grieving include:– Centrality of the loss– Health of the survivor– Survivor’s religious or spiritual belief

system– History of substance abuse– Nature of the death


Depression

• Depression is the mental health problem of greatest frequency and magnitude in the older population.

• Depression in older adults is often undetected and untreated.


Nursing Assessment of Depression

• Various instruments are used to assess depression in the older adult. Each instrument has advantages and limitations.

• The Geriatric Depression Scale (GDS) is a screening instrument used in many clinical settings to assess depression in older people.


Box 7-3 Symptoms of Mania in Bipolar DepressionSource: National Institute of Mental Health. (2009). Bipolar disorder. Retrieved from

http://www.nimh.nih.gov/health/publications/bipolar-disorder/what-are-the-symptoms-ofbipolar-disorder.shtml


Alcohol Abuse/Substance Abuse

• Nursing actions that may be appropriate include teaching the patient to:– Review all medications and instructions

for use on a routine basis.– Urge older persons not to drink alcohol if

they are taking medications for sleep, pain, anxiety, or depression.


Alcohol Abuse/Substance Abuse

• Nursing actions that may be appropriate include teaching the patient to:– Keep track of all side effects or changes

in cognition or function (especially when new medications are started).

– Clean out the medicine cabinet every year.

– Ask your primary healthcare provider to review all medications each year.


Basic Principles for Psychological Assessment

• The gerontological nurse may be the first to notice signs and symptoms of psychological change and recommend the referral to the geriatric mental health specialist.


Nursing Interventions

• Treatment of mental health problems in the older person can use nonpharmacological approaches, pharmacological approaches, or a combination of the two.

• Educating patients and families is critical so that nurses can interpret scientific data and individualize the nursing care plan.

tabloski ch07 lecture

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