Table 2: Differentiating Symptoms of Depression, Dementia, and Delirium Depression Dementia
Delirium
Onset Course
Rapid (weeks to months). Self-limited or chronic without treatment.
Gradual (years).
Rapid (hours to days).
Chronic; slow but continuous decline. Disoriented or confused. Labile; apathy in later stages. May be intact; may focus on one thing for long periods.
Wide fluctuations; may continue for weeks if cause not found.
Orientation
Disoriented.
Disoriented or confused.
Affect
Sad; depressed; worried; guilty.
Fluctuating.
Attention
Difficulty concentrating.
Always impaired.
Sleep
Disturbed; excess sleeping or insomnia, especially early morning waking. Fatigued; apathetic; may occasionally be agitated. Flat; sparse; may have outbursts; understandable. Slow recall; often short-term deficit.
Usually normal.
Always disturbed.
Behavior
Agitated; apathetic; may wander.
Agitated; restless.
Speech
Sparse or rapid; repetitive; may be incoherent. Impaired, especially for recent events.
Sparse or rapid; may be incoherent.
Memory
Impaired, especially for recent events.
Cognition
May seem impaired.
Disordered reasoning and calculations.
Disordered reasoning.
Thought content
Negative; paranoid; hypochondriac; thoughts of death. Distorted; negative interpretation of people and events.
Disorganized; delusional; paranoid. Incoherent; confused; delusional; stereotyped.
Perception
No change.
Misinterpretations; illusions; hallucinations.
Judgment
Poor.
Poor; socially inappropriate.
Poor.
Insight
May be impaired.
Absent.
May be present in lucid moments. Poor but variable; improves during lucid moments and with recovery.
Performance on mental status exam
Memory impaired; calculation drawing, following directions usually
Consistently poor; progressively worsens; attempts to answer all questions.
not impaired; frequent “I don’t know” answers.
institutions and can affect older adults of various socioeconomic and ethnic backgrounds. Elder abuse affects one in ten older adults, with female adults being abused at a higher rate. Warning signs for elder abuse include physical markings on the adult, unexplained changes in mood, and strained or tense relationships. As with other forms of abuse, elder abuse is complex. Older adults at higher risk for elder abuse include those with dementia or cognitive impairments and those with a history of domestic (e.g., spousal) violence. Elder abuse is also more likely to occur when adult children who live with and care for their elderly parents have personal problems of their own, such as mental illness, financial stress, or alcohol or substance abuse. Ninety percent of persons who abuse an elderly person are family members – either a spouse, a partner, or an adult child of the victim. Many states have enacted laws that designate healthcare providers as “mandatory reporters” who are required to report suspicions of elder abuse to their state’s adult protective services agency (National Center on Elder Abuse [NCEA], n.d.). Anxiety Late-life anxiety is commonly described as an apprehensive feeling or expectation that leads to excessive and often unnecessary worrying (Smith, Ingram, & Brighton, 2008). While anxiety may be less prevalent in older adults than in younger adults, it is more likely to be persistent and linked to chronic health conditions (Gum, King-Kallimanis, & Kohn, 2009). In older adults, anxiety frequently goes unrecognized due to factors such as: ● Mistaking psychological symptoms for physical problems (e.g., headaches or nausea). ● Ageism (e.g., anxiousness is a natural state for older adults). ● Alternate labels (e.g., being “worked up” or nervous). ● Diagnostic challenges (e.g., determining realistic vs. unrealistic fears) (Smith et al., 2008).
Suicide was ranked as the tenth leading cause of death in the United States in 2016, accounting for more than 36,000 deaths (CDC, 2016). The following are common indicators of possible impending suicide: ● Past history of suicidal attempts or current/past threats of suicide, especially direct threats. ● Symptoms of depression, ongoing bodily complaints, or other psychiatric disorders. ● Discharge from a healthcare facility against medical advice or recommendation. ● Spontaneous recovery from a depressed mood, including sudden euphoria. ● Substance abuse or dependence. ● Bereavement, severe losses in life, or identifying with a person who is deceased, especially a life partner. ● Giving things away or putting one’s affairs in order (Robnett, 2015, p. 127). Primary suicide prevention in older adults involves screening members of this population who may be depressed and are considering suicide. Any mention of death or suicide should be taken seriously. Community and healthcare providers need to recognize the signs of potential suicide, know to whom to make referrals, and ensure that the person at risk is being monitored and that his or her needs are being served (U.S. Department of Health & Human Services, 2012). Additionally, health services must be accessible to those in need. Community services or programs – such as medical/health interventions, interventions for substance abuse, and help with bereavement/grief through support groups or networking – can assist by providing resources to address the factors that put older adults at risk for suicide (CDC, 2010). Elder abuse Elder abuse can present in various forms, including physical, emotional, and sexual abuse; exploitation; neglect; and abandonment. Elder abuse can be found in the community and
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