caring for older adults holistically, 4th edition chapter seventeen common clinical problems:...

Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition

Chapter SeventeenChapter Seventeen

Common Clinical Problems:

Psychological


Psychological ProblemsPsychological 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


Communicating With Older AdultsCommunicating 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



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



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



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



Universal symbols An object from the present that represents

something from the past


Problem BehaviorsProblem 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May include wandering, shouting, aggressive or withdrawn behaviors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



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



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


Specialized Communicating SkillsSpecialized 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



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



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


Grieving and DepressionGrieving 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



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



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



Depression (cont.) Suicide rates are high in depressed older adults Depressed older adults may suffer from failure to

thrive


Delirium and DementiaDelirium 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



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



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



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



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



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



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


Paranoia 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


Developmental DisabilitiesDevelopmental Disabilities

Individuals living longer Set limits on behavior Recognize person’s feelings Allow person to express anger on set limits


Substance AbuseSubstance Abuse

Access to drugs from several sources Alcoholism common in older adults Make sure abuse is diagnosed and treated


Eating DisordersEating 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


Groups for the ElderlyGroups 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



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 self-esteem Group members are assigned various roles



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



Validation Combine some of the other techniques Focus is on support and problem solving Focus is on resolving losses and expressing

feelings


Psychotropic MedicationsPsychotropic 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


Psychotropic MedicationsPsychotropic Medications

Common side effects are constipation and orthostatic hypotension


Physical and Mental HealthPhysical 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


Patient RightsPatient 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

caring for older adults holistically, 4th edition chapter seventeen common clinical problems:...

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disoriented older adults

older adults universal

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