Gerontological Nursing

Psychological and Cognitive Function

Mokthar, Hayefah
Macmod, Ommayah
 Incidence of Diagnosable Psychiatric
Disorders in Older People

• Mental disorders occur less for older

• adults than any other age group
• •
• 20% of older persons suffer from mental
• health problems
• •
• Rate of suicide highest among older adults
• compared to other age groups
Normal Age-Related Changes

• Decline in speed of information processing

• Decreased ability to divide attention between
two tasks
• Difficulty in switching attention rapidly from
one auditory input to another
 Normal Age-Related Changes

• Difficulty with

• Sustained attention

• Filtering out irrelevant information

• Performing certain tasks such as visuospatial

• Short word finding

• Use of abstracting

• Maintaining mental flexibility

 Long-Term or Secondary Memory

• Exhibits more substantial age-related changes

• Decline is greater for recall than for
recognition
 Intellectual Abilities

• Decline greatest in individuals

• experiencing physiological disorders
 Personality

• Increasingly stable in the older adult

 Depression
• A clinical syndrome characterized by low mood tone, difficulty
thinking, and somatic changes

• Depressive symptoms are seen in 13% of community-dwelling

older adults (meaning those who are not in assisted living or
nursing homes)
• 43% of institutionalized elderly adults may exhibit depressive
symptoms

• Symptoms may be emotional and physical

 Depression

• Experienced twice as often in men as women

• Symptoms may be caused by medications
 Nursing Assessment of Depression

• Geriatric Depression Scale (GDS)

• Mini-Mental State Examination (MMSE)

• Cornell Depression Scale (CDS)

 Methods for coping with age-associated
cognitive changes
• Making lists
• Memory training and memory enhancement
techniques
• Playing computer games emphasizing eye/hand
coordination and memory
• Keeping the mind challenged and mentally active
• Use of assistive devices
• Seeking support from others
• Staying positive
 Examples of Common Events Requiring
Psychological Adjustments

• Widowhood (The condition or period of being

a widow)
• Confronting negative attitudes of aging
• Retirement
• Chronic illness
• Functional impairments
• Decisions about driving a car
• Death of friends and family
 Examples of Common Events Requiring
Psychological Adjustments

• Relocation from home to assisted living or

long-term care
• The longer a person lives, the more likely
events will occur that require coping and
adaptation
 Risk factors that influence psychosocial
functioning
• High levels of stress and poor coping
• Impaired mental health
 Risk Factors For High Levels Of Stress And
Poor Coping
• Diminished economic resources
• Unanticipated events, such as the death of a
spouse
• Many daily hassles at the same time in one
day
• Many major life events occurring in a short
period of time
• Unrealistic appraisals of situations
 Depression Associated with

• Stroke
• Heart disease
• Parkinson disease
• Endocrine disorders
• Cancer
• Epilepsy
• B12 deficiency
• Chronic pain
• Viral illness
• Serious losses
• Difficult relationships
• Changes in social roles
• Retirement
• Widowhood
• Loneliness
• Depression Associated with
• Poverty
• Unplanned moves, such as a move to assisted living or long-
term care
• Medication side effects
 Minorities at Greater Risk of Poor
Mental Health

• Increased segregation (isolation)

• Poverty
• Poor quality education
• Discrimination
• Healthcare disparities
 Cognitive Impairment Associated
with

• Chronic pain • Physical illness

• Viral illness
• Psychosocial factors
• Serious or multiple losses
• Difficult relationships
• Changes in social roles
• Loneliness
• Poverty
• Unplanned moves
• Stroke
• Heart disease
• Parkinson disease
• Endocrine disorders
• Cancers
• Epilepsy
• B12 deficiencies
• Medication side effects
 Nursing Actions

• Assisting older persons in identifying stressors

and rating their levels of stress
• Educating the older person and family about
stress theory and the stress cycle
• Helping the older person identify successful
coping mechanisms used in the past during
periods of high stress
 Nursing Actions

• Assisting the older person in examining

current coping mechanisms and behaviors and
altering or eliminating negative or
maladaptive mechanisms

• Reinforcing and strengthening positive coping

mechanisms
 Nursing Actions
• Investigating community resources, support
groups, stress-reduction clinics, and other
stress relievers that may be appropriate and
useful to the older person.
 Stress-Reducing Techniques
• Listening to music

• Reading a book

• Watching a movie

• Exercises such as yoga, tai chi, and walking

 Nursing Interventions
• Suicide self-restraint contracts(The patient
signed a suicide prevention contract)
• Encourage appropriate self-care behaviors
• Identify and encourage effective coping
strategies
• Encourage hopeful attitudes
 Fostering Healthy Aging and Social
Interaction

• Support groups
• Alzheimer’s Association
• American Cancer Society
• Other groups focused on specific illnesses
(cardiac, arthritis, lung, etc.)
• Grief and bereavement groups
• Travel with senior citizen groups
• Outside activities
 Fostering Healthy Aging and Social
Interaction

• Taking classes
• Elder hostels
• Volunteer work
• Regular exercise
• Hobbies and crafts
• Increased family involvement
 Ways to Decrease Depression Risk

• Alternative and complementary therapies

1. Relaxation techniques
2. Massage
3. Acupuncture
4. Yoga
Ways to Decrease Depression Risk
• Light therapy for SAD

• Seasonal Affective Disorder (SAD), also known

as winter depressionor winter blues, is a mood
disorder in which people who have normal
mental health throughout most of the year
experience depressive symptoms in the winter
or, less frequently, in the summer, spring or
autumn, repeatedly, year after year.
 Electroconvulsive therapy (ECT)

• Support groups such as AA and bereavement

groups