Management of Psycho geriatric

Problems
Ronny T Wirasto
Program Studi Pendidikan Dokter
FMIPA
Universitas Tadulako
2011
 Topik

Definisi
Gangguan
Diagnosis
Terapi
 Normal Aging
Factors associated with normal aging include:
-Decreased muscle mass/ increase fat
-Decrease brain wt/ enlarged ventricles & sulci
-Impaired vision & hearing
-Minor forgetfulness (benign senescent forgetfulness)
PROGRESSIVE REGRESSION
DEVELOPT AGING
INVOLUTION

INFANT ADULT ELDERLY

Social activity
Ageism
Counter transference
Socio economic
Retirement
Sexual activity
Long tem care
 What Kinds Of Changes
Learn slowly
To adapt with difficulty to new situations
To persevere with old habit of thought
fail to remember recent event

5
 Old People Suffer From

Nutritive deficiencies that result chiefly

from economic psychological or
physical problems

6
 What reversible
How
- irreversible
- to manage
- to prevent
many kind of elderly
Why
- Biological Emotional Cognitive
- Sociocultur behavior change
- Physiological
- Psychosocial in elderly
Who
aware the condition
Where doctor family
-they must seeking

7
 Stages of Dying

***Normal emotional response when facing death or loss of body part

include:
-Denial
-Anger (blaming others for illness)
-Bargaining(ex. Ill never smoke or drink again if my cancer is cured)
-Depression
-Acceptance

***May be experienced in any order or may occur simultaneously

 Major Depression
-common in geriatric population
-Elderly are twice as likely to commit suicide as general population
-15% of nursing home residents
-Symptoms of major depression in elderly often include problems with
memory & cognitive functioning, termed Pseudo Dementia, so we have to
work up an elderly patient for major depression when presents with
memory loss
Depressive symptoms include:
-sleep disturbances (early morning awakening).
-decrease appetite and weight loss.
-feeling of worthlessness and suicidal ideation.
-lack of energy and diminished interest in activities.
 Pseudo Dementia
-The presence of apparent cognitive deficits in patients with major depression
i.e. DEMENTIA + DEPRESSION

-Because of depression symptoms, patient may appear demented and it is not

true!!

-Demented pts are more likely to confabulate ( guess) when they dont know
an answer, whereas depressed pts will just say they dont know and when
you pressed for an answer, depressed pts will often give the correct one.
 Dementia Pseudo Dementia
( Depression )
Insidious onset More acute onset

Delights in accomplishments Emphasizes failure

Sun downing Common Uncommon

(increase confusion at night)
Guess at answer Often answer Dont Know
( confabulate )
Pt unaware of problem Pt is aware of problem
 TREATMENT
-Supportive psychotherapy
-Psychodynamic psychotherapy
-Low dose antidepressant (SSRIs)
-Electroconvulsive Therapy
-Mirtazapine: Sedative (good for insomnia)
-Methylphenidate: adjunct to antidepressant for psychomotor retardation
(DONT give in late afternoon or evening, lead to insomnia)
 Bereavement
-Elderly are more likely to experience losses of
lovers, relatives & friends.
-Its important to distinguish b/w normal grief
rxn from pathological ones (depression).
 Normal grief rxn
INVOLVES:
-Feeling of guilt and sadness
-Mild sleep disturbance and wt loss
-Illusions (seeing the deceased person or hearing his/her voice)
-Attempts to resume daily activities & work
-Symptoms resolve within 1 yr (worst symptoms within 2 months)
 Abnormal grief (major depression)

INVOLVES:
-Feeling of sever guilt and worthlessness
-Significant sleep disturbance and wt loss
-Hallucinations and delusions
-No attempt to resume activity
-Suicidal ideation
-Symptoms persist >1 yr (worst symptoms >2 months)
 Sleep Disturbances
-Incidence increase with aging
-Difficulty sleeping, Daytime drowsiness & Daytime napping
-Causes:
*medical conditions.
*Environment.
*Medications.
*Normal changes associated with aging .
 Changes in Sleep Structure
***REM Sleep:
-Increase no. of REM episodes at night
-REM episodes are shorter than normal
-Total amount of REM sleep not changed

***Non-REM Sleep:
-Increase awakening after sleep onset
-Increase amount of stage 1 & 2 sleep
-Decrease amount of stage 3 & 4 sleep
 Tx of Sleep Disturbances
-Approaches should be tried first:
Alcohol cessation, Increased structure of daily routine, Elimination of daytime
naps & treatment of underlying medical conditions

-Sedative Hypnotics
Hydroxyzine (Vistaril) & Zolpidem (Ambien)
Important Note prefer not to be used due to their S/E in elderly like memory
impairment, ataxia, paradoxical excitement & rebound insomnia
 Elder Abuse
- -10% of all people >65 yrs underreported by victims
-Perpetrator is usually caregiver who lives with the victim
-Types:
Physical, Sexual, Psychological, neglect (withholding of care) & exploitation
(misuse of finance).
 Care for the elderly
-Restraints:
-Often overused in nursing homes & hospitals
-Always try alternatives such as closer monitoring & tilted chairs

-Nursing Homes:
-provide care and rehabilitation for chronically ill and impaired pts as well as
for pts who are in need of short term care before returning to their prior
living arrangement
-50% stay permanently, 50% discharged after few months
 Cont,,, Elder Care
-Old Age Home:
Elderly can live for the rest of their lives with no attempt to rehabilitate.

-medications:
Many older people on multiple medications, they suffer from more side
effects because of decreased lean body mass and impaired liver and
kidney function.
Selesai