179 Mental Health Concerns and The Older Adult
Mild cognitive impairment (MCI) MCI lives in the space between nor - mal age-related cognitive changes and dementia. Older adults with MCI are at greater risk for developing dementia or Alzheimer’s disease (NIA, 2022f). The mental healthcare provider can note sub- jective data from the older adult or from caregivers, family, or friends (with con- sent). Data to note for older adults with suspicion of MCI: increased frequency of losing items; forgetting important dates, events, or appointments; and difficulty with word selection (NIA, 2022f). These symptoms can be concerning to the older adult. The NIA recommends tips to improve MCI. These suggestions can empower the older adult who feels em- barrassed or saddened by their cognitive state. Recommendations for improving memory include the following (NIA, 2022f): ● Stick to a daily routine—predictability is key. ● Utilize tools such as calendars, to-do lists, notes, and reminders. ● Place daily objects in the same place in your house. ● Consider learning a new skill (check community resources). ● Volunteer time (give back to the local community). ● Increase time spent with friends and family. ● Ensure adequate sleep at night. ● Prioritize exercise and nutrition. ● Avoid alcohol (receive help if needed). The older adult with MCI needs to be assessed regularly to recognize increased symptoms that would warrant interven- tion. The findings of MCI do not predict further impairment, do not necessitate treatment, and can cease without medical intervention (NIA, 2022f). Further evalua-
Delirium can be life threatening but is usually reversible with treatment. The healthcare worker must be able to iden- tify the signs of delirium. Key features of delirium include rapid and abrupt onset, decreased level of consciousness, altered attention, impaired cognitive functioning (can look like disorientation), and dimin- ished memory (Sadock et al., 2015). It can present like other mental health disor- ders. A psychotic episode of schizophre- nia, mania, or a factitious disorder can look like delirium upon the first encoun - ter. Generally speaking, schizophrenia presents with better organization and a more stable level of consciousness; ma- nia will be explained historically with a bi- polar diagnosis or become apparent over time; and in a factitious disorder, incon- sistencies will surface during examination or be easily revealed after an electroen- cephalography (Sadock et al., 2015). The healthcare worker can provide or request further examination of the older adult. Cognitive testing can be administered and compared to a baseline examination if available, along with laboratory studies looking for underlying causes of delirium. The treatment will often be dependent on the underlying cause of the delirium. Caution is needed for the older adult re- ceiving treatment for psychosis. The AGS (2019) highly recommends avoidance of antipsychotic medications such as halo- peridol (Haldol), risperidone (Risperdal), and quetiapine (Seroquel) due to their increased affiliation with tremors, fall risk, stroke, and death in patients with de- mentias. A refined assessment and un - derstanding of underlying sequalae of psychosis are needed for treatment of delirium long term.
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