Mental Health Concerns and The Older Adult
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MENTAL HEALTH DIAGNOSES FOR THE OLDER ADULT Neurocognitive disorders Changes in cognition are statistically significant for the older adult population (Boyd, 2017). The healthcare worker must understand the differences in neurocog- nitive disorders for assessment, interven- tion, treatment, and when to refer to oth- er disciplines and community resources. According to the APA (2013), the DSM-5 diagnosis of a neurocognitive disorder is a deficiency in the following: attention (distractibility with multiple stimuli), exec- utive functioning (decision making, plan- ning, and working memory), learning and memory (recollection and recognition), language (expressive, fluency, grammar, receptive), perceptual-motor (visual and motor perception), and social cognition deficits (emotion recognition, ability to re - late to another). Differentiating cognitive regression and disruption can be difficult, especially when a baseline of functioning or collateral information is not available. The healthcare worker who assesses and/ or treats older adults will encounter older adults with neurocognitive disorders. Delirium Delirium is a neurocognitive disorder that a healthcare worker will come across in the older adult population. Delirium is an acute cognitive impairment caused by an underlying medical culprit (Boyd, 2017). The healthcare worker needs sharp attention of its presence; however, treat- ment is often administered in the acute care setting by medical professionals. There are a multitude of risk factors and known causes for delirium in the older adult population. Delirium risk factors for the older adult include the following (Boyd, 2017): ● Advanced age (65 years and older).
● Male. ● History of falls. ● Preexisting dementia. ● Functional dependence (long-term care facility residents). ● Endocrine and metabolic disorders. ● Fractures in bones. ● Medications (consider AGS 2019 BEERS criteria for potentially inappropriate medications in older adults). ● Vital sign changes (hypotension, hypo- or hyperthermic). ● Imbalances in intake (dehydration, renal failure, hyponatremia). ● Long-term care admission. ● Pain (acute or chronic). ● Stress (acute or chronic, notable risk during loss or bereavement). ● Substance use and alcohol withdrawal (alcohol is greatest offense). Known causes that induce acute deliri- um include the following (Sadock et al., 2015): ● Seizures. ● Trauma (especially head trauma after a fall). ● Diabetes. ● Infection. ● Insufficient nutritional status. ● Uncontrolled pain. ● Medications (e.g., pain medication, antibiotics, antivirals, antifungals, steroids, anesthesia, cardiac medications, anticholinergics). ● Serotonin syndrome. ● Over-the-counter substances (e.g., herbs, teas, supplements). ● Cardiac disturbances (failure, arrhythmias, myocardial infarction). ● Disease (abnormality or failure in pulmonary, endocrine, renal, and hepatic systems).
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