Geriatric Alterations Associated with Neurological Conditions

Transcription

1 Geriatric Alterations Associated with Neurological Conditions I have no conflicts of interest. Julie Bronson The Older Adult According to the World Health Organization Africa or United Nations 60 US 65 Geriatric Population Growth eurological_epidemic Biologic vs Chronologic The Aging Neurological System Assessing the Older Adult Reduced visual acuity Hearing acuity Senses Kinesthesia High-speed performance Movement, strength, coordination Noisy, confused, rushed atmosphere may cause findings that mimic mental processing deficiencies. Time of day and time for accurate assessment Adequate lights and font size 1

2 Comprehensive Assessment Functional Activities of daily living, Functional Activities Questionnaire, Independent activities of daily living. Alterations Associated with Neurological Conditions Cognitive Mini-Mental status Exam Depression Geriatric Depression Scale Thermoregulation Impaired neuro communication to activate adaptive systems Autonomic nervous system Sweat and shiver Head Injury Motor Deficit Muscle tissue lost with age and nerve function cell decline. Loss of grip strength. Slowed reflexes and dulled peripheral sensation leading to burns and abrasions. Trauma and Falls 5 th leading cause of death over the age of 65. Why are they falling? Mental Status Changes and Mood Disorders What is important to assess? 2

3 Delirium Sudden reversible transient syndrome that comes and goes Types - general medical conditions, substance intoxication, substance withdrawal, multiple etiologies. Classification ¼ hyperactive, 25%hypoactive, 35% mixed, 15% no changes to psychomotor activity pattern. Treatment - Non-pharmacological is first line Reorientation Decrease stimulation Provide a quiet room Continuity of care with staff changes Bringing items from home music, photo, objects Keep room bright during the day and dark at night Calendar and clock in view Encourage family and friends to visit Sensory enhancement with glasses and hearing aids Get patient up to chair for meals Minimize restraint use Dementia Acquired intellectual impairment characterized by persistent deficits in at least 5 areas Memory Language Visual spatial skills Personality or emotional state cognition Depression - under diagnosed in older patients Dementia is a general term for decline in mental ability. Alzheimer's is the most common type of dementia. 14% over 65 have AD and 40% over 80. DSM IV requires presence of at least 5 symptoms: diminished interest in usual activities; loss of appetite or weight; insomnia or hypersomnia; psychomotor agitation; fatigue or loss of energy; difficulty thinking, concentrating, or making decisions; and recurrent thoughts of death or suicide. 3

4 Anxiety Positive coping mechanism preventing injury and producing information-seeking and problem solving action. Term often used incorrectly to explain behaviors ranging from physical discomfort to psychosis. Sundowning refers to the timing of increased agitation and anxiety surrounding late-day activities Objective Poor attention and concentration, disruption of organization, vigilance, fearful expression, pacing, restlessness, tachycardia, palpitations, hypertension, diarrhea, tingling in extremities, urinary frequency Subjective Decreased activity, reduced perception of health, decreased quality of life, increased loneliness, panic Common Geriatric Issues Many treatment drugs can be disruptive, dangerous, and interfere with medical regimens. Medication Management Overall amount of drug absorbed is not affected. Hepatic drug metabolism affects first drug pass through liver. Absorption increases with increased gastric PH. Decreased PH decreases absorption - ampicillin. Decline in body muscle and water can decrease volume of distribution with hydrophilic drugs - lithium. Lipophilic drugs have increased volume of distribution due to high lipid content - Diazepam and trazodone Metabolism - aging liver has reduced blood supply, size, and mass causing reduction in drug clearance. Kidney has decline in glomerular filtration rate and renal tubular secretions decreasing rate of elimination of drug. Polypharmacy prescriptions a year and 4.5 per day. 90% take OTC meds as well as homeopathic remedies 4

5 Infection Control May not exhibit classic symptoms such as high fever or >WBC. Restlessness, agitation, confusion, delirium, falling, anorexia, and other behavioral changes may be first indication of potential Infection. Pneumonia 6 th leading cause of death in US. UTI Patient - Family - Community Plan care to meet goals and needs of individual older adult. Interventions consistent with past patterns, ethnicity, culture, and individual preferences. Participation in decision making. Changes in functional abilities and assessing family support. Ethical and Legal Considerations Elder mistreatment affects 3-7% Prevalence 700, million Aging doesn't affect ability to learn, it affects the speed in which learning and recall occur. Physical, psychological/emotional, sexual abuse, neglect (unintentional and intentional), self neglect, financial or material exploitation. Placement issues, discontinuing interventions, palliative care, decision-making capacity, living will What can affect leaning? What does this mean to us as caregivers and as part of the aging population? 5