life expectancy of 2 to 10 years after diagnosis and often requires full-time care (NIA, 2022d). It can present with notable personal- ity and behavioral changes. Frontal lobe involvement can cause changes to behavior and movement; temporal lobe changes fea- ture language and emotional changes (NIA, 2022d). FTD can have distinguishable symptoms. It can present with Klüver-Bucy syn- drome: hypersexuality, placidity or complacency, and hyperorality or oral compulsions (Sadock et al., 2015). There is no cure and no way to prevent disease progression. Treatment focuses on symp- tom control (sometimes using antidepressants or antipsychotics) and quality of life. This disease can be distressing for family mem- bers and caregivers. The mental healthcare provider can refer all involved to resources and support groups. The most common form of dementia is Alzheimer’s disease. The mental healthcare worker will treat older adults with it or will see a family member affected by it. The NIA (2022b) states that over six million Americans, most 65 years and older, are diagnosed with Alzheimer’s disease. It often presents as dementia. The causes of Alzheimer’s disease remain unclear, but what has been discov- ered is brain atrophy and inflammation, genetic predispositions on chromosome 17, and environmental exposures such as alu- minum toxicity (Sadock et al., 2015). Older adults or caregivers usually note the first symptoms as forgetfulness. The NIA (2022b) notes symptoms of Alzheimer’s disease as difficulty finding words, struggles with vision and spatial perception, reduced reasoning and poor judgement, length of time it takes to complete ADLs, repetition of stories or questions, danger due to wandering and Sleep difficulties Sleep is a crucial component of physical and mental health and warrants an assessment during every psychiatric mental health ex- amination. Dementias, most notably Alzheimer’s disease, can be a perpetuating cycle of negative sleep and interference with cogni- tion (Boyd, 2017). Sleep changes are a natural part of advancing age but can contribute to worsening states of mental health if natural adaptations are not rendered or medications are improp- erly prescribed. With advancing age, restful sleep decreases and interruptions in the sleep pattern shorten, both of which contrib- ute to a decreased quality of sleep. Rapid eye movement (REM) during sleep (the deepest and most restful part of sleep) becomes less frequent, as do circadian rhythms (Sadock et al., 2015). Fall- ing asleep, staying asleep, and feeling rested become more dif- ficult with advancing age. Sleep deficiencies can worsen cognitive functioning and can be magnified if the older adult has cognitive disorders. It’s necessary to routinely assess the older adult’s qual- ity and quantity of sleep. Interventions for sleep difficulties will vary for the older adult. The safest sleep intervention is nonphar- macological. The healthcare worker can encourage and educate the older adult on healthy sleeping habits. Nonpharmacological sleep interventions for the older adult include the following (Boyd, 2017): Depression The healthcare worker is likely to interact with an older adult ex- periencing depressive symptoms or suffering from a diagnostic depressive disorder. Depression is more common in people who suffer from illness or decreased functioning; 80% of older adults have at least one chronic health condition, and 50% have two or more (CDC, 2021b). Remembering ageism and bias is important as the healthcare worker assesses for depression. Depression is not part of the aging process, and not all older adults experience depression (CDC, 2021b). The healthcare worker must be able to identify risks for the older adult. The NIA (2021b) lists the risk factors for older adults as physical conditions (most notably stroke and cancer), genetics (familial history increases risk), stress (be- ing a caregiver can cause greater stress), sleep difficulties (falling asleep or staying asleep), isolation and loneliness (assess the root cause of it if found and the subjective impact), sedentary lifestyle, limited physical functioning (struggling with ADLs), and alcohol addiction. Older adults can find themselves alone and socially dis - connected. Loneliness can contribute to depression and height- ens the risk of suicide for the older adult population (NIA, 2021b). Loneliness is a common feeling experienced by older adults and
getting lost, losing common items, and change in mood and per- sonality (usually more irritable). There are three stages of Alzheimer’s defined by the NIA (2022b): ● Early-stage Alzheimer’s : When a person begins to experi- ence memory loss and other cognitive difficulties, though the symptoms appear gradual to the person and their family. Al- zheimer’s disease is often diagnosed at this stage. ● Middle-stage Alzheimer’s : Damage occurs in areas of the brain that control language, reasoning, sensory processing, and conscious thought. People at this stage may have more confusion and trouble recognizing family and friends. ● Late-stage Alzheimer’s : A person cannot communicate, is completely dependent on others for care, and may be in bed most or all the time as the body shuts down. Cognitive testing can be performed, as can brain scans. The men- tal healthcare worker can refer to neurology if needed. There is no cure, but the U.S. Food and Drug Administration (FDA) has approved medication to treat symptoms and slow the progression of invasion. The life expectancy with a diagnosis of Alzheimer’s disease varies from 3 to 10 years (NIA, 2022b). The mental health- care provider can prepare the older adult and family members for the future and focus treatment options on quality of care that is uniquely important to the older adult. ● Use awareness for when to go to bed and go to bed when feeling tired. ● Create a routine and stick to it (it can take time). ● Use your bed only for intimacy or sleep. ● Decrease or eliminate stimulating foods after lunch (caffeine). ● Avoid naps. ● Add or increase physical exercise. ● Include relaxation techniques (simple relaxation, guided imag- ery, or distraction). The use of pharmacological interventions needs further assess- ment and possible referral. The AGS (2019) notes possible dan- gers in prescribing medications that are potentially inappropriate for older adults: zolpidem (Ambien), zalepon (Sonata), eszopiclone (Lunesta), alprazolam (Xanax), lorazepam (Ativan), and diazepam (Valium). Sleep hygiene is the primary recommendation from the AGS (2019) for older adults. If the older adult is technologically savvy, the healthcare worker can suggest apps for healthy sleep regimen reminders, sleep logs, relaxation techniques, or medica- tion reminders. Getting restful sleep is important for the health and well-being of the older adult. is an indication for further assessment to determine the level of distress. The healthcare worker needs an understanding of the signs and symptoms of depression and can teach them to the older adult to empower them to speak up. Caregivers should also receive this intervention so that they can request early intervention when possible. Symptoms of depression include sad mood, persistent feelings of hopeless/worthless/helplessness, an inability to find pleasure in regular activities (including sex), a low energy level, markedly slow speech (noticed by others), cognitive struggles (dif- ficulty concentrating/remembering/making decisions), problems sleeping (more or less than usual), changes in appetite (increased or decreased), and thoughts of death or suicide (NIA, 2021b). If multiple symptoms are found and last more than two weeks, the healthcare worker (if allowed within scope of practice) can con- sider a clinical diagnosis of major depressive disorder (MDD) in line with the DSM-5 (APA, 2013). Recent loss, grief, bereavement, and culture must be taken into consideration prior to diagnos- ing. Untreated depression can lead to physical detriment for the older adult. Coping inappropriately with food can lead to obe- sity or geriatric anorexia (APA, 2022f). Depression can also alter
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