Module Six MENTAL DISORDERS IN ELDERS

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Module SixMENTAL DISORDERS IN ELDERS

• Lesson 1 Elders experiences
• Lesson 2 Mental Disorders in elders

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Lesson 1

• ELDERS EXPERIENCES

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Step 1 Introduction

• 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.

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Step 2 Brainstorming and discussion

• What are your feelings when thinking of yourself
  old?
• What are the positive and the negative points ?

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Step 3 Theory presentation

• 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.   

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Step 3 (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.
•    

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Step 3 (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.

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Step 4 slide projection

• Slide 6.1.1 The most important transition points
  during peoples lifetime
• Graduation
• First job
• Marriage
• Childrens birth
• Promotion
• Retirement
• Parents death
• Wifes / husbands death

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Step 5 Questions and comments

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Lesson 2

• MENTAL DISORDERS IN ELDERLY

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Step 1 Introduction

• During the last 100 years, humans life span has
  increased and as a consequence the elderly
  population has increased. 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.

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Step 2 Slide projection

• Slide 6.2.1 Mental Disorders appeared in elderly
•   appearance at
  persons gt65 years old
• Senile dementia 3.5
• Depression 11
• Paranoid psychoses 0.3
• Neuroses
  28
• Personality Disorders

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Step 3 Theory presentation

• Depression
• Is quite regularly manifested in elderly (one in
  ten persons aged more than 65).
• 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.     

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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.

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Step 3 (continued)

• Therapeutical intervention includes
• Hospitalisation in many cases
• Care of physical health
• Antidepressants
• Antipsychotic medication where there are
  psychotic characteristics
• Social intervention

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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.

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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
  Alzheimers disease.
• For every man there are two women that suffer
  from Alzheimers disease.
• The causes of the Alzheimer disease are unknown
  but there are suspicions for genetic,
  environmental, toxic and infectious factors.

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Step 3 (continued)

• There are characteristic deteriorations of the
  brain outer surface.
•            Multi infarct dementia is due to many
  little blood clots that cause ischaemia and
  necrosis in several areas of the brain.
•       It has abrupt onset and escalating
  recrudescence.
•       It develops slower than Alzheimer
  disease.
•       In many cases the patient also suffers
  from hypertension.

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Step 3 (continued)

• slide 6.2.2 dementia characteristics.
•   
• Memory loss
• Cognitive loss
• Talking problems
• Anxiety and depression
• Loss of skills
• Behaviour and personality alterations

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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).

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Step 3 (continued)

• The treatment includes family support, patients
  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.

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Step 3 (continued)

• Multi infarction dementia (MID) Multi infarction
  dementia is caused by multiple small emboli in
  the brain and the occurring necrosis.
• It starts acutely and progresses gradually.
• It progresses slower than Alzheimer disease.
• In most cases it is accompanied by hypertension.

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Step 4 Slide projection

• 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.

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Step 4 (continued)

• 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.

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Step 5 Questions and comments