1996 OPEN FORUM Abstracts
Mental Health and Aging: Perspectives, on Assessment and Preventive Techniques
Pam Z. Cacchione, RN, MSN, C-GNP Wednesday, November 6, 1996
The mental health of the older adult can greatly impact their ability to function. This presentation will focus on the three "D's" cognitive health: Dementia, depression and delirium. Definitions of these conditions, their causes and treatments will be discussed. A review of the normal changes of aging which impact on mental and cognitive health will also be provided. Prevention and tips on maintaining cognitive health will be discussed particularly for the areas of depression and delirium. Screening tools for dementia, depression and delirium will be described including the Folstein Mini-Mental Status Exam (1978), the Yesavage Geriatric Depression Scale (1983), and the Confusion Assessment Method by Inouye (1990). Community resources for supporting aging adults with mental health problems and their families will be discussed. Alternative living situations ranging from home care, assisted living and nursing homes will be described.
CLINICAL FEATURES OF DELIRIUM, DEMENTIA & DEPRESSION
CHARACTERISTICS DELIRIUM DEMENTIA DEPRESSION
Onset Sudden Insidious Precipitating
event
Course over Fluctuating, Stable Stable
24 hours with nocturnal
exacerbation
Consciousness Reduced Clear manic or
decreased
Attention Globally Normal except Disordered
disordered in severe
cases
Orientation Usually Often May be impaired
impaired impaired,
at least for time
Psychomotor Increased, Often normal, Agitated
Activity reduced or pacing or decreased
shifting,
unpredictable
Speech Often Word finding Decreased or
incoherent, problems forced
slow or rapid
Physical One or both Often absent Absent meds may
Illness are present with SDAT be a problem
drug toxicity
Sleep-wake Disturbed, Fragmented Insomnia,
cycle cycle reversed early morning
awakening
Mental Distracted from Frequent near Answers I don't
Status task misses know
Testing
Adapted From: Foreman, Grabowski, (1992). Journal of Gerontological Nursing, p. 5-12, Lipowski, (1989). The New England Journal of Medicine, 32(9), 578-582