MENTAL HEALTH OF

ELDERLY CLIENTS
Qurat ul ain

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 Objectives
Identify and describe the elements of a
comprehensive psychiatric assessment of
elderly clients with compromised cognition.
Discuss Dementia and delirium in relation
to mental health of elderly
Analyze nursing care needs for elderly
clients with mental health problems.

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 THEORIES OF AGING
Biological Theories
Biological Programing Theory
This theory proposes that the life span of a cell is
stored with in the cell itself
Wear and Tear Theory
It suggests that structural and functional changes
may be speeded by abuse and slowed by care
Stress Adaptation Theory
It emphasizes the positive and negative effects of
stress on biopsychosocial development

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 THEORIES OF AGING
Psychological Theories
Erickson’s stage of Ego integrity VS despair
Life review theory
Sociocultural Theories
Disengagement theory
It postulates that older adults and society mutually
withdraw from active exchange with each other as
part of the normal aging process

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 THEORIES OF AGING
Activity theory
It emphasizes the positive influence of activity
on the older person’s personality, mental health,
and satisfaction with life

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 DEMENTIA
It is a form of diffuse brain dysfunction characterized by
gradual, progressive, chronic deterioration of
intellectual function, judgment, orientation, memory,
emotional stability, cognition and attention
(Shavies, 2002)

Is a chronic, irreversible brain disorder characterized by

impairments in memory, abstract thinking, and
judgment, as well as changes in personality
(Fontaine, 2003)

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 DEMENTIA
Predisposing Factors:
Vascular dementia
o The blood vessels of the brain are affected due to
arterial hypertension, emboli and thrombosis
Dementia of the Alzheimer's type
o Affected regions of the brain responsible for memory
Dementia due to other medical conditions
o Frontal or temporal lobe lesions
o Systemic infections

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 CHARACTERISTICS OF DEMENTIA
BEHAVIORAL CHARACTERISTICS
Decline in recent memory
Decline in personal appearance
Wandering behavior
Need assistance in ADLs
Agitation
AFFECTIVCE CHARACTERSTICS
Labiality of emotions
Catastrophic reactions
Less enthusiastic, less cheerful, and less affectionate

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 CHARACTERISTICS OF DEMENTIA

COGNITIVE CHARACTERSTICS
Memory impairment with decrease concentration
Disoriented about time
Deterioration in language skills
Psychotic symptoms
Misidentification syndrome
Aphasia

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 CHARACTERISTICS OF DEMENTIA
SOCIAL CHARACTERSTICS
May feel burden on family
Communication problems may lead to frustrations, loneliness
and isolation
Feelings of anger, resentment, depression, and hopelessness
PHYSIOLOGICAL CHARACTERSTICS
Hypertonia
Loss of energy
Sleep deprivation
Susceptible to injuries/ falls
Urine and bowel incontinence
Anorexia

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 CLINICAL COURSE OF DEMENTIA

Mild Starts with forgetfulness, difficulty in

finding words, frequently loses object,
anxiety, avoidance towards social setting
Moderate Apparent confusion, progressive memory
loss, oriented to person and place, requires
assistance due to disorientation to time
Severe Personality and emotional changes,
delusional, may wander at night, forgets
the names of spouse and children, requires
assistance in ADL
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 DELIRIUM
Disturbance of consciousness and a change in
cognition that develop rapidly over a short
period (APA, 1994)

Disorder of acute cognitive impairment and is

caused by a medical condition (Keltner, 2002)

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 DELIRIUM
Predisposing factors
General medical condition
o Systemic infections
o Fluid or electrolyte imbalances
o Metabolic disorders
o Thiamine deficiency
o Hepatic or renal disease
o Head injury
o Postoperative states

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 DELIRIUM
Substance induced Delirium
o Analgesics
o Diuretics
o Psycho pharmacological agents
o Cardiovascular medications
o Anticonvulsant
o Anti Parkinsonism

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 DELIRIUM
Substance withdrawal
o Termination or reduction of alcohol,
sedative, hypnotics or anxiolytics

Substance intoxication
o Higher dose of cannabis and cocaine

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 CHARACTERSTICS OF DELIRIUM

BEHAVIOURAL CHARACTERTSTICS
Alteration in psychomotor activity
Poor impulse control
Agitated and tremulous
Altered speech (Dull/fast or pressured)
Restlessness
Bizarre and destructive behavior

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 CHARACTERSTICS OF DELIRIUM

AFFECTIVE CHARACTERSTICS
Apathy to extreme irritability to euphoria
Labile emotions
Fear
COGNITIVE CHARACTERSTICS
Disorganized thinking
Lack of judgment
Impaired decision making
Attention deficit
Memory impairment
Disorientation
Frightening illusions, delusions and hallucinations
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 CHARACTERSTICS OF DELIRIUM

SOCAIL CHARACTERSTICS
Family relationship disturbed
Anxious and frightened families

PHYSIOLOGICAL CHARACTERSTICS
Hypersomnia/ insomnia
Increased heart rate and B.P, flushed face, dilated pupils,
sweating, and altered respiratory depth or rhythm
Irregular tremors or some times generalized seizures

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Features Delirium Dementia

Onset Rapid (hours to days) Gradual (years)

LOC Hyper alert to difficult to arouse Normal
Orientation Disoriented/ confused Same
Affect Fluctuating Labile, Apathy
Attention Always impaired May be intact
Sleep Always disturbed Usually normal
Behavior Agitated, restless Agitated, may
wonder
Speech Rapid, incoherent Rapid and repetitive
Memory Recent impaired Same
Cognition
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Disordered reasoning Same 20
 Features Delirium Dementia

Thought Content Confused, Delusions Rich content,

disorganized,
delusional, paranoid
Perception Illusion, No Change
Hallucination

Judgment Poor Poor

Insight May be present Absent

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NURSING MANAGEMENT
Assess patient for stressors and coping
mechanisms
Communicate client in clear and low pitch voice
Introduce yourself to client and address the
client by name
Reassure and comfort a client who seems lost
and confused
Convey patience and understanding
Give reality orientation
Allow client to do things for himself

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NURSING MANAGEMENT
Break down task into individual steps
Do not let client sleep during day and staying awake
during the night
Assist client in basic care and personal hygiene
Refrain from confronting and arguing with
suspicious client about the truthfulness of the
complaint
Teach family about reminiscences
Teach family about the cognitive dysfunction and
care
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 References
Boyd, M. A. (2002). Psychiatric nursing:
Contemporary practice (2nd ed). Philadelphia:
Lippincott.
Burgess, A. W. (1998). Advanced practice of
psychiatric nursing. London: Prentice Hall.
Fortinash, K. M., & Holoday-Worret, P.A.
(2004). Psychiatric mental health nursing (5th
ed). St. Louis: Mosby.

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 THANK YOU

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