Nursing 407 - Geriatric Healthcare
Chapter 7 – Cognitive and Psychosocial Wellness
Cognitive decline is not necessarily inevitable
- Cognitive abilities vary from person to person
- Cognitive ability is affected by multiple factors
- Various cognitive abilities of the older adult can vary:
- Declining ability,
- Maintenance of ability, and
- Improvement of ability
Intelligence
- Fluid
- Integration, reasoning, abstract thinking
- Allows problem solving and adaptive thinking
- Crystallized
- Vocabulary, information, verbal comprehension
- Acquired through culture, education, life experiences
Wisdom
- Crystallized intelligence is associated with wisdom, judgment, and life experiences.
- Wisdom is associated with a person’s sense of well-being
- A resource during times of challenge
Memory
- Short Term
- Short duration, small capacity
- Can be transferred to long term storage
- Long Term
- Greater than seconds or moments
- Needed for storage and retrieval
Age related changes
- Decreased number of neurons
- Decrease in brain size
- Decreased brain blood flow
- Decrease in short term memory
- Increased pain threshold
- Increased reaction time
- Decreased sensation to touch, pain
Cognitive function in the elderly adult
- Short-term, primary memory remains stable
- Language skills remain intact
- Vocabulary skills improve
- Accumulation of practical experience continues
- Influenced by:
- Education
- Pulmonary health
- General health
- Activity level
- Ageism and diminished expectations of older adults
Cognitive wellness in the older adult
- Sociocultural influences
- Nutrition
- Physical activity
- Vision and hearing impairments
- Medication
Other drug effects on mental status
- Antihypertensives, antipsychotics—decreased cerebral blood flow
- Central nervous system depressants—respiratory depression
- Diuretics, alcohol, laxatives—F&E alterations
- Alcohol, psychotropics, narcotics—changes in thermo-regulation
- Diuretics, alcohol, nicotinic acid—acidosis
- Hypoglycemics, alcohol, propranolol—hypoglycemia
- Thyroid extract, corticosteroids—hormonal disturbances
Age related cognitive changes…
- Do not decline in healthy older adults
- Earliest changes that do occur are due to decreased perceptual speed
- Changes occur gradually
- Cognitive reserve develops with intellectual stimulation and higher levels of education
Coping with changes in cognition
- Make lists
- Memory training and techniques
- Playing computer games with hand/eye coordination
- Challenge mind
- Use assistive devices, habit
- Find support from others
- Keep sense of humor
Adjusting to changes
- Most adults adjust successfully
- A life of continuous adjustment makes it easier in the future
- Inability to adjust can be frustrating and/or depressing
- Assess for signs of depression with every life challenge
Rigidity and excess cautiousness
- Not a normal age related change!
- Experiences, values, and expectations no longer congruent with current ideas
- Out of their “comfort zone”
- Method of adjustment influenced by underlying personality
Maladaptation to stress in the elderly
- Sleep problems
- Chronic high anxiety
- Substance use/abuse
- Irritability
- New onset HTN
- Depression
- Chronic fatigue
- Chronic pain, discomfort
Mild cognitive impairment
- A state between normal aging and dementia
- Can remain stable, resolve, or progress
- Increases the risk of developing dementia
- Diagnosis not precise
- Based on:
- Clinical judgment
- Functional assessment
- Neuropsychological testing
Promoting cognitive wellness
- Correct misinformation, myths
- Provide information regarding age-related changes
- Establish positive expectations
- Provide information regarding how to enhance cognitive abilities, such as….
Psychosocial wellness
- Ageism
- Retirement
- Relocation
- Functional Impairment
- Chronic Illness
- Driving decisions
- Widowhood
- Death/Loss
Ageism
- Negative stereotypes of older adults
- Can also be self-imposed attitudes in the elderly
Retirement
- Employment is equated with productivity, contribution
- Retirement brings a change in social status
- Especially difficult if self-esteem is based on work status
- Less negative effect on psychological wellness if
- Person retires voluntarily
- Participate in volunteer work
- Transition from work gradually
- Have established leisure activities
Chronic illness and functional impairment
- Significant cognitive, mobility, or visual impairments associated with:
- Increased dependence
- Altered self-esteem, self-concept
- Lifestyle change
- Uncertainty of one’s abilities
- Increased financial burden
- Frequent health-care visits
- Adverse medication effects
- Increased vulnerability to, fear of crime
Adjustment to loss or life events
- Grief lasting up to 2 years is “normal”
- Duration of grief affected by
- Meaning associated with the person who has died
- Health of the survivor
- Survivor’s belief system
- Existence of substance abuse
- Cause, suddenness of death
Coping in older adults
- Younger adults tend to cope by modifying events, situations
- Older adults tend to cope by managing thoughts and feelings
- Coping more effective in those with religious support, significant family and friend relationships
- Past effective coping predicts future effective coping
- Due to life experiences, older adults are more adept at doping adaptively
Risk factors affecting psychosocial function
- Poor physical health
- Impaired physical function
- Weak social supports
- Lack of economic stability
- Poor social development
- Limited coping skills
- Unanticipated events
- Complex daily events
- Major life events converging
Personality disorders and psychoses
- Incidence of most personality disorders decline with age
- Schizophrenia rarely occurs initially in old age
- Most common form of psychosis in the elderly is paranoia
- Hearing loss
- Social isolation
- Cognitive impairment
- Delirium
- Underlying personality disorder
Alcohol abuse in the elderly
- 7-14% older adults report alcohol abuse, dependence, binge drinking
- Some are long-term users, others are late-onset users
Potential reasons for alcohol abuse in the elderly
- Boredom
- Loneliness
- Stress
- Continuation of long-term patterns
- Pain management
- Sleep problems
Consider alcohol problems if:
- Memory problems
- Frequent falls
- Changes in sleep patterns
- Irritability, sadness, depression
- Trouble concentrating
- Chronic pain
- Smell of alcohol
- Isolation
Nursing diagnoses related to psychosocial function
- Situational low self-esteem
- Social isolation
- Impaired social interaction
- Ineffective coping
- Chronic sorrow
- Grieving
- Relocation stress syndrome
- Spiritual distress
- Stress overload
- Readiness for enhanced spiritual well-being
A sense of control
- Promotes better physical, cognitive, and psychological health
- Involve the patient in decision making
- Involve the patient in organizing care activities
- Provide the patient information about his plan of care
- Include addressing factors regarding perceived control:
- Privacy
- Loss of individuality
Other methods to promote
psychosocial wellness
- Discuss role loss
- Volunteer work
- Encourage life review, reminiscences
- Promote social support
- May suggest group settings
- Referral to community resources
- Discuss spiritual needs openly
- Offer if patient is receptive
- Do not be afraid to minister
- Turn control back to patient and offer to participate