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Psych in elders — Transcript

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0:00yeah it's a welcome this lecture will be
0:04about the psychiatric conditions in the
0:07elderly please make sure you have read
0:11chapter 21 out of your elders text it is
0:16actually just a few pages most of it
0:20will probably read as a review but I
0:24think it is still very important because
0:26it gives specific things that we need to
0:30look at in to consider when we're
0:32looking at the elderly population so as
0:35we go through what are some of the
0:39statistics kind of some of those
0:46statistics well as we've probably
0:49already talked about before more older
0:54people are representing a larger
0:57population than ever had before and the
1:00book even says by 2030 they expect it to
1:06be 70 1.5 million people over the age of
1:0865
1:10so everybody's living longer you know
1:14with all the new medical advancements so
1:17I think it just some of the mental
1:19health issues start to become more
1:23obvious and I hope as well you begin to
1:28see that because people have gotten
1:30older and having to deal with more
1:32things some things that they had dealt
1:36with fine earlier in their lives might
1:38tend to now lead to some mental health
1:42issues that they didn't have before some
1:47of those things that we need to consider
1:48or that they develop those because of
1:51the aging process often times you can
1:55develop some of the anxiety and
1:58depressive disorders because of aging
2:01but you can also don't forget that you
2:06know just because you have anxiety and
2:08depression doesn't mean you never get
2:09old so
2:11because of those medical advancements
2:14and many newer medications if you were
2:17diagnosed earlier in life those things
2:20don't go away
2:22so now someone's gotten over the age of
2:2565 they've always dealt with depression
2:27and anxiety now you add on top of things
2:31you know maybe some physical things
2:33going on with them because of Aging that
2:36can make the anxiety and depression
2:39worse which then turns into depression
2:44often times resulting in suicide it's
2:47becoming one of the number one killers
2:52in the older population Oh suicides
2:55becoming more common but I don't know
2:58that we always hear about it
3:00I think sometimes that's because there's
3:05other medical conditions going on that
3:08we might think that that's what might
3:12have killed the person instead of maybe
3:14necessarily a suicide and then also
3:17dementia you know that is you know I
3:20have really affects mental health and
3:22it's you know a mental disorder so it
3:25can truly really affect someone and not
3:29only the person who has the dementia but
3:32as well as think about the loved ones
3:35who are taking care of the person with
3:38dementia they oftentimes will also
3:40present with some anxiety and depressive
3:42disorders
3:47oftentimes what you'll see is an elder
3:54will be admitted into the hospital into
3:57an acute setting but then they the
4:00patient can't stay there as they
4:02stabilize their meds so they're
4:03discharged to the nursing home you know
4:06we know that a lot of our psychotropic
4:09meds take several weeks in order to see
4:12how they're gonna react so they can't
4:14keep somebody in an acute setting that
4:16long so they'll discharge them to the
4:18nursing home so oftentimes those become
4:22the caregivers before our
4:26with all this mental illness and they
4:28are not equipped to have the training to
4:32treat these mental illnesses you know I
4:35think a lot more nursing home staff you
4:37know know how to deal with the physical
4:41ailments that someone might have and not
4:43necessarily be really good and
4:47identifying any of those mental
4:50illnesses or just think oh the person's
4:54gotten older that's just the way they
4:56are there's nothing we can do you know
4:59they're just not with familiar with what
5:02we can do or even to identify that there
5:07is an actual mental illness going on
5:11another thing to consider with the
5:14elderly population er there's also an
5:16increased number of single adults as
5:20they grow older you know it could be
5:22that they've there's an increased
5:24divorce rate they've moved away people
5:28have moved away or they have been
5:31widowed so we have this that people
5:36start getting isolating themselves
5:37because they're afraid to go out you
5:40know they've been around people all
5:42their lives and all of a sudden maybe
5:44all their kids move away their spouse
5:46has passed away significant other is
5:49gone you know so now there's thing only
5:52they don't know what to do with
5:53themselves so it becomes a huge issue
5:58that even the APA is calling a spiritual
6:01crisis because people just don't know
6:05what to do with themselves anymore and
6:07what a better thing for OT to come in
6:10and focus on we know how to help people
6:14find what they can enjoy to do help them
6:17find new things or maybe rekindle
6:21something that they like to do when they
6:24were younger you know to give them that
6:26sense of purpose so that's why I really
6:32think you know we've been talking about
6:35all of you know of all those are these
6:37psyche things that we can do for
6:38patients
6:39we tend to kind of focus on you know mid
6:44or early mid adults but a lot of you are
6:49gonna be working in the nursing homes
6:50and working with an elderly population
6:52so we need to be open and aware that we
6:59can use some of those same strategies
7:01that we've used for younger men adults
7:05for our elderly population too we need
7:09to be open to be consultants I also
7:13think we need to be just open to
7:15listening being that ear for them to you
7:20know when they're having a really bad
7:21day and you know the physical ailments
7:24are just overwhelming them being that
7:27ear to listen to help them you know to
7:32help them realize you know things that
7:35they still can do even though they have
7:38these deficits or help them find new
7:42interests so they can still find a sense
7:45of purpose I think that's the one true
7:47thing that everybody wants whether
7:50you're young old disabled you know not
7:54you want to have a sense of purpose and
7:56I think the older you get you tend to
8:01lose you know your sense of purpose
8:04because things have happened and you no
8:07longer have the original purposes that
8:09you did before you know kids have grown
8:12you know you don't have a spouse to take
8:14care of anymore
8:15you know maybe you've retired you know
8:18your whole life is kind of shifted and
8:21we need to use that as an opportunity to
8:25push ot you know make this you know an
8:30emerging area of practice not just
8:32mental health but mental health in the
8:34elderly you know find these specific
8:37groups of people whether they are in the
8:39nursing home or you know think senior
8:42centers you know these are true people
8:46that we can really make a connection and
8:48a difference in
8:50we need to find ways to be creative so
8:54we can be less dependent on those
8:57third-party payors because oftentimes
9:00they're gonna pay and reimburse very
9:03little for mental health you know they
9:07want to see that you're treating these
9:08major medical conditions you know
9:11oftentimes you know the insurance and
9:13the medical model doesn't always value
9:18the mental component the mental health
9:20component I'm sure you've been seeing
9:23some of that you know in your mental
9:26health settings that it's hard to get
9:28some reimbursement for things but I also
9:30think that that's when we need to become
9:32creative you know and be advocates for
9:36our patients even if it's just being
9:39that you know that one treatment we just
9:41truly listen and help guide them through
9:45their medical conditions so they don't
9:49allow the mental illness to take over
9:51you know we as OTS are capable of doing
9:55that that is in our realm of treatment
9:59our met you know our model of practice
10:03so I just want to encourage you all to
10:06make sure you are open-minded to all of
10:09those things and you know the signs and
10:12symptoms you're gonna see you know with
10:14them that I looked old young adult you
10:18would see some of those signs and
10:19symptoms and the elderly as well so be
10:22aware of those things you know trying to
10:25tie in your strategies that we've taught
10:30you you know for other adults tie them
10:33into the elderly population as well
10:37there are several assessments that we as
10:42ot can use as well as the textbook also
10:46talks about some assessments that are
10:50very interdisciplinary
10:51I think getting other disciplines
10:55involved is very helpful as well I think
10:59especially in the nursing home because
11:00you have access easy access
11:04to other disciplines so thinking just
11:08some of our assessments you have the EPI
11:11you could want to do an amps you can do
11:15a co PM oh we know how to do that one
11:18backwards and forwards write an activity
11:22card sort do with a coat scale bring a
11:27Kel's in you know figure out where some
11:30of their deficits are and what we can
11:33maximize volition question or volition
11:39questionnaire you know thinking back to
11:41our Moho model that we've discussed you
11:44know where are their values of interests
11:46lying I think some of you are using this
11:50these as well as some of your other
11:52projects maybe with your Findlay project
11:54some of these assessments so make sure
11:58you feel well versed in these that you
12:01could perform these to give some
12:05concrete evidence to why our patients
12:09need some of this mental health and to
12:12be able to tie it back into their
12:14function okay so we have some
12:18multidisciplinary assessments the first
12:23one is a R and quad health survey
12:26questionnaire and it just has 36
12:28questions they capture reliable and
12:32valid information regarding the
12:34participants perceptions about their
12:37health status so just you where do you
12:40see yourself you know do you think
12:42things are good bad it gives you a sense
12:44of where they think their health is and
12:49then back has an anxiety inventory and a
12:53depression inventory so several
12:57disciplines can use this to come
12:59together okay
12:59where are they falling anxiety arises as
13:02more depression is it a little of both
13:06and then I know a very popular one when
13:08I was in the nursing house was the
13:11mini-mental oftentimes either activities
13:14or social work would do a minute mini
13:17mental exam to kind of see where their
13:19cognitive status was that's why I think
13:23it's very important to kind of make sure
13:25you're working with those disciplines
13:27maybe they already did a mini-mental at
13:30the beginning when the patient was a
13:32minute admitted to the facility and you
13:36can then perform one of the OT
13:38assessments and bring that information
13:40together to hopefully come up with a
13:43plan
13:45you can then utilize the other
13:49disciplines expertise in certain areas
13:52you know maybe social work can help you
13:55out with some of the mental health
13:58issues while you're working on a
13:59physical issue or you can help social
14:03you know you guys kind of have some
14:04ideas off of each other to be able to
14:07best suit this patient but don't forget
14:11about those other disciplines because
14:12they you know can bring some ideas to
14:16the table and can help you find you know
14:20some ideas maybe they've seen something
14:22that has worked for a patient before so
14:25please don't forget about those
14:30specifically going over depression
14:33depression is the most common
14:35psychiatric disorder affecting people of
14:37this age so I do think that that is you
14:42know extremely Jarre you know that you
14:46know it's the biggest dis or so we know
14:48we have to deal with this it can be from
14:53long-term it can also be very
14:56situational you know we've talked about
14:58you know imagine if you were you know a
15:00very functioning adult and you've had a
15:02stroke and you can no longer do the
15:05things that you want to be able to do
15:06you know you've come with you know an
15:08illness has made you not be able to do
15:12what you did for yourself before and
15:15you're in the hospital then you've gone
15:17into the nursing column and every you
15:19know the control has been taken away
15:21from you that can be very depressing you
15:25know so sometimes it's not even just
15:27okay think you've see it diagnosed
15:29depression they've had it all their
15:32lives be on the lookout for those people
15:35who you know because of the illness have
15:38now seemed to turn and you know you know
15:41that this is a likelihood you know
15:43they've had a major illness a major
15:46accident injury that you know depression
15:49is very likely and you want to try and
15:52help avoid those things from further
15:56sliding and impacting the patient's
16:00well-being know that if it is just new
16:05and situational hopefully the severity
16:07will not be as bad or it might be bad
16:12because this was a very very functioning
16:14adult and all the sudden you know
16:17strokes can come out of nowhere and all
16:20of a sudden they're not even able to
16:21feed themselves you know so that could
16:23cause you know severe depression but
16:27also look at those okay if they've been
16:28dealing with depression all their lives
16:30and one more thing happens with their
16:33physical health that could just spiral
16:37them and you want to help them control
16:40that because oftentimes the depression
16:44will have negative effects on their
16:46health the book even points out that you
16:50know some like heart doctors they you
16:53know it's kind of a chicken and the egg
16:54thing did the heart condition lead to
16:58the depression or the depression lead to
17:00the heart condition you don't know you
17:03know so it is very common to see that
17:07someone will develop depression and then
17:09their overall health will decline
17:11because they're not as active they're
17:14not following through with things
17:15they're not enjoying life anymore
17:18and then their overall health will
17:21suffer because of that so we have to
17:23keep that in mind also anxiety is
17:29another major deficit or diagnosis
17:36that's seen in this population we
17:39oftentimes need to have more
17:42supportive counseling and meds
17:45I also anxiety often accompanies the
17:50depression so you need to keep in the
17:53back of your mind if you've seen someone
17:55who is depressed you have to keep an eye
17:59out for the anxiety as well they will
18:02probably go hand-in-hand especially if
18:05there has been some sort of major
18:10illness or accident that has you know
18:13kind of halted their life birth or if
18:18there is some terminal diagnosis this
18:22patients going to become very anxious
18:23about what's going to happen they don't
18:25understand what has happened to them
18:30there is another specific assessment for
18:34anxiety that the hospital tends to use
18:39so hopeful I'm hoping you know you just
18:42kind of hope that these things get
18:44caught sooner I do think I tend to win
18:48the hospital hurries and discharges
18:51quickly the anxiety the depression is
18:54often not caught right away so that is
18:58when you'll see you know the people in
19:00the nursing home nursing therapy social
19:04work they're the ones finding the
19:08anxiety and the depression coming out
19:09because hospital just kind of gets
19:11unstable and then you know discharges
19:15them here you go so you need to be on
19:19the lookout for those things and to know
19:24that if you see a person with anxiety
19:28you have to intervene
19:30it will limit their function you know
19:33some people if they've been anxious all
19:35their lives they will have their own
19:37strategies whatever it might be they're
19:41used to dealing with the anxiety might
19:44just be reminded of their strategies but
19:49if not if this is a new thing that
19:51they're like you know what does this
19:53mean you know
19:55what does this diagnosis mean what are
19:56all these meds you know why are you
19:59telling me I can't do this anymore they
20:01get very anxious and that's gonna
20:03interfere with their ability to function
20:06so you have to intervene kind of think
20:10of this way with the depression and the
20:12anxiety you can't help them physically
20:15if you don't help them mentally as well
20:18you know they're going to refuse there
20:21because they don't understand all of the
20:23big words that everybody's using you
20:26know they don't understand why they
20:27can't go home you know what do you mean
20:30my arm doesn't work anymore and or
20:33they'll refuse because that's their way
20:36of controlling the situation you know
20:38they don't want to go down to dinner at
20:40five o'clock they always ate at six you
20:43know you'll see some of these things
20:45come out and you're not gonna be able to
20:47help with their physical deficits if you
20:51don't work on their mental deficits as
20:54well so you have to be open to listening
20:56to all that and be willing to kind of
21:00tie them both in at the same time and to
21:04be able to talk your patient through
21:06that you know what I understand this is
21:09difficult you know here's what these
21:11things mean you know here's why we don't
21:14think you could go home yet you know
21:16being able to explain and take the time
21:20out will be huge huge for your patients
21:27thinking of suicide in it obviously it's
21:30not a very you don't want to think about
21:33it but older Americans are more likely
21:37to die by suicide than any other age
21:39group and they say older men are more
21:44likely to commit suicide than any other
21:46group and but you know likely use a
21:50firearm I think this is because they
21:53they don't know what to do anymore
21:55you know they've totally lost
21:58you know everything that they thought
22:00was themselves it's gone and they don't
22:03know how to get back out of that hole
22:05you know everything you know things were
22:08fun
22:08all up until you know their health
22:11started deteriorating or they've now
22:14lost a spouse that and they don't know
22:16how to deal with being alone you know
22:19those should be huge red flags that you
22:22know I really think we forget about our
22:27elderly and we just kind of tend to push
22:31them into a corner they have gotten old
22:32they've lived a long life they're good
22:34you know well know maybe you know just
22:37because they're 75 doesn't mean they
22:39couldn't live for another 20 years
22:41you know it's or even if it is only
22:44another year can we make that a good
22:46quality of life can we you know help
22:49them make their last year or six months
22:53whatever it will be can we help make
22:56that as bet as good as we possibly can
23:00and allow them to feel some satisfaction
23:04in wherever they are you know in their
23:08life and I know that's difficult you
23:10know some sometimes it's just easier
23:13just to focus on the physical deficits
23:17with our older Americans but they go
23:23hand in hand
23:24I really truly believe you cannot help
23:27one without working on the other one as
23:30well
23:33dementia we might not think of it as a
23:36mental illness but it truly is you can
23:40get dementia from other underlying
23:42conditions I think you know Alzheimer's
23:46is the most common form but that is one
23:50thing that everybody needs to remember
23:53you know demit Alzheimer's is a form of
23:56dementia it's not the other way around
23:58so there are other different types of
24:02dementia Lewy body being another one
24:06there's also Parkinson's patients can
24:10develop dementia from the Parkinson's so
24:15dementia is the big global word and then
24:17there's the other like kind of
24:18subcategories
24:21but they can have this for you know a
24:23decade you know from early onset until
24:28you know the patient passes away there
24:31is the slow decline of their skills and
24:36that can really weigh on especially the
24:40patient but their caregivers as well you
24:43know all of a sudden you're watching
24:44your loved one slowly forget you know
24:48who they are who you are you know then
24:52you're trying to make sure they remember
24:54to eat you know keeping them safe that
24:57they're not taking too many meds are
24:59they taking their meds you know so
25:02dementia can cause you know mental
25:07illness for both sides you know in the
25:11early stages imagine what we like to
25:14sell you know we all have those days or
25:17you know I find it my head wasn't
25:19attached I you know I'd forget it how
25:22where are my keys where you know where'd
25:23I leave this but you can figure out
25:26where they are you know but imagine
25:28that's every day all day and you you
25:31know each day you tend to lose a little
25:33bit more and a little bit more of who
25:35you are you know and you're aware of it
25:39that can be very very difficult for
25:43patients to know you know they're slowly
25:45realizing they don't know who their
25:48spouses they don't recognize their kids
25:51you know that can be very disturbing and
25:55I think that can tend to you know to fly
26:00before about suicide I think that can
26:03tend to lead you know to that because a
26:06patient you know what no I don't want to
26:08become a burden to my family I don't
26:11want to eventually forget even how to
26:13feed myself so being aware that you know
26:18the dementia is going to cause some
26:20mental health issues as well and being
26:23open to being able to help our patients
26:26through that alcoholism I mean even if
26:32they are recovering alcoholic there
26:35still damage done to the brain from all
26:40of the alcohol excessive alcohol use is
26:45the third leading cause of death because
26:49of the lifestyle that it tends to evoke
26:54long term problems you know or
26:57short-term problems you have you know
26:59impaired judgment unintended injuries
27:03like from a fall but the longer the use
27:07they're gonna have increased
27:09neurological and cardiovascular issues
27:12it's gonna lead to psychiatric problems
27:16they have an increased risk of cancer
27:19and liver disease you know so even if
27:22you just think of you know someone who
27:25has the increased risks of those
27:27physical body illnesses and now you and
27:32on top of it we have the psychiatric
27:35changes that the alcohol causes in the
27:37brain you can see how this could cut you
27:41know be a mixture of someone wouldn't
27:46know what to do you know it's can become
27:49a huge problem and I think even those
27:54patients who are recovering alcoholics
27:56they could fall back you know into
28:00drinking again because they're trying to
28:01figure out how do I handle all of this
28:04you know cuz they'll they're aging and
28:07they don't know how to deal with you
28:09know them they've got a heart problem
28:10and I can't work like I wanted to and
28:13think you know my brain just isn't
28:16thinking clearly so I'll just go back to
28:18drinking you know and that's obviously
28:21just going to make things worse
28:23especially if some of their medications
28:26have you know and a lot of them do now
28:29have side effects you know with alcohol
28:33but I do tend to think even later in
28:36life people who weren't you know
28:39necessarily alcoholics maybe they just
28:41had an occasional social drink I think
28:44as life situations chain
28:48they can turn into alcoholics because
28:52they don't have any other outlet you
28:55know think of somebody who is now
28:57retired okay well what do I do with
29:00myself all day okay well I'll just you
29:02know I used to have a drink when I came
29:04home from work so I'll start with one
29:06and then before they know it they're
29:08drinking all of the time because they
29:11just don't know what to do with
29:13themselves so no alcohol can cause a
29:17huge problem whether it's a past problem
29:22or become a current problem and then
29:28aging with a psychosis you know as you
29:33age you also have different side effects
29:39to the medications or the long-term use
29:43of the medications can cause tardive
29:48dyskinesia some of these medications
29:50could cause dementia and they are
29:53discovering more you know certain
29:55medications at first they might not
29:58think there's any issues but when
30:01there's long term use more medications
30:05they're starting to see that there are
30:06changes in the brain that are occurring
30:10and then that could cause long-term
30:13effects like the dementia so knowing you
30:20know if someone is you know 20 30 years
30:23old when they're diagnosed taking
30:26medication all their lives they might
30:28now start developing some of these other
30:31issues because of the long term years so
30:38what are some things we need to think
30:40about when we're thinking about some
30:41interventions no it's a revolving door
30:45you're gonna see him for a little while
30:48they'll be okay then they'll come back
30:49you'll treat oh they'll go away they'll
30:52get discharged and they'll come back you
30:54know just kind of like what you're
30:56seeing in your mouth
30:57you know your outpatient mental health
30:59site this is you know like it would be
31:01you know at a nursing home you know
31:03you'll set things up something will
31:06happen and then they'll have to come
31:07back so it is always this constant
31:12revolving door with patients but you
31:16want to think about setting up some
31:18habits and rituals that this patient can
31:21follow to help them deal excuse me with
31:26how to structure their day you know if
31:29you have some structure to your day
31:30you're less likely to start mind
31:32wandering and worrying about different
31:35things or focusing on what's wrong or so
31:40you've got this nice structure I've
31:42developed some good habits through the
31:44day I can get through each day giving
31:47them some sort of meaningful occupation
31:49giving them a purpose that's truly what
31:54they need you might have your giving
31:56direct care you might have to set up you
31:59know doing more structured mental health
32:03type treatment sessions so actually
32:07treating and helping with some
32:10strategies also making sure everything
32:14the caregiver education you know we can
32:18never stress enough how important it is
32:21to teach the caregivers because they are
32:25truly the ones that are helping keep
32:28this client on the right path helping
32:33with what you have taught them carrying
32:36over all of that information you know
32:40patient can never do it alone they need
32:43help and you can't always be there so
32:46you have to teach the caregivers you
32:48know if they're they do if your patient
32:50does this or your family member does
32:52this try and give them this remind them
32:55of this set them up with these
32:57strategies they have to value it just as
33:01well as your patient because they are
33:03the ones that are going to be in the
33:05trenches with the patient at two o'clock
33:08in the morning when they're having a
33:10crying spell
33:11or you know when you know they need to
33:14get up and go to the bathroom and they
33:15don't recognize where they are they need
33:19to pee just as prepared and equipped
33:22with how to handle things as you would
33:25give those things to your patient
33:31so hopefully again make sure you go back
33:34and read through the chapter it should
33:37be a fairly easy read like I've said
33:40everything should be kind of some sort
33:42or review and that is all

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