Podcast
Questions and Answers
What age range does the WHO define as a child?
What age range does the WHO define as a child?
What percentage of people experience mental health conditions during their early life?
What percentage of people experience mental health conditions during their early life?
Mental illness occurs in isolation to other aspects of a child's life.
Mental illness occurs in isolation to other aspects of a child's life.
False
What are the most common mental health presentations in childhood?
What are the most common mental health presentations in childhood?
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What is a common negative impact of puberty on children?
What is a common negative impact of puberty on children?
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Which is a common risky behavior among young people?
Which is a common risky behavior among young people?
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What percentage of people over the age of 60 experience a mental disorder?
What percentage of people over the age of 60 experience a mental disorder?
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Schizophrenia is characterized by only positive symptoms.
Schizophrenia is characterized by only positive symptoms.
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What is a major risk factor for older adults related to medication?
What is a major risk factor for older adults related to medication?
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What is the primary cause of Alzheimer's Disease?
What is the primary cause of Alzheimer's Disease?
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Match the following mental health conditions with their characteristics:
Match the following mental health conditions with their characteristics:
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Older males are more likely to complete __________ than any other age group.
Older males are more likely to complete __________ than any other age group.
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What should be considered when communicating with older patients?
What should be considered when communicating with older patients?
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What age range defines a child according to the WHO?
What age range defines a child according to the WHO?
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What percentage of people experience mental health conditions during their early life?
What percentage of people experience mental health conditions during their early life?
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Which of the following are common presentations of mental illness in children? (Select all that apply)
Which of the following are common presentations of mental illness in children? (Select all that apply)
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Puberty does not impact a child's ability to regulate their emotions.
Puberty does not impact a child's ability to regulate their emotions.
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What are some common risk-taking behaviors in young people?
What are some common risk-taking behaviors in young people?
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What is a primary risk factor for poor mental health in older adults?
What is a primary risk factor for poor mental health in older adults?
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Older males are more likely to complete __________ than any other age group.
Older males are more likely to complete __________ than any other age group.
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Cognitive impairment is the same as Dementia.
Cognitive impairment is the same as Dementia.
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Match the following mental conditions with their characteristics:
Match the following mental conditions with their characteristics:
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What is a common life change that may lead to depression in older adults?
What is a common life change that may lead to depression in older adults?
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Engaging family in care planning is crucial for patients with cognitive impairments.
Engaging family in care planning is crucial for patients with cognitive impairments.
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What age range does the WHO classify as 'children'?
What age range does the WHO classify as 'children'?
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What are the most common mental health presentations in older adults? (Select all that apply)
What are the most common mental health presentations in older adults? (Select all that apply)
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Mental illness occurs in isolation to other aspects of a child's life.
Mental illness occurs in isolation to other aspects of a child's life.
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Which of the following is a common impact of puberty on a child's emotional regulation? (Select all that apply)
Which of the following is a common impact of puberty on a child's emotional regulation? (Select all that apply)
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The duration and intensity of adverse emotions can be indicators of potential mental health struggles in children.
The duration and intensity of adverse emotions can be indicators of potential mental health struggles in children.
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What is 70% of dementia diagnoses attributed to?
What is 70% of dementia diagnoses attributed to?
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Match the following mental health conditions with their characteristics:
Match the following mental health conditions with their characteristics:
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Older males are more likely to complete suicide than any other age group.
Older males are more likely to complete suicide than any other age group.
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What are some common medication-related risks in older adults?
What are some common medication-related risks in older adults?
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How does dementia affect communication abilities?
How does dementia affect communication abilities?
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Cognitive impairment is noted by poor performance on objective cognitive assessments that indicate a decline in ______.
Cognitive impairment is noted by poor performance on objective cognitive assessments that indicate a decline in ______.
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What is the age range defined by the WHO for a child?
What is the age range defined by the WHO for a child?
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What percentage of people are predicted to experience mental health conditions during their early life?
What percentage of people are predicted to experience mental health conditions during their early life?
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Anxiety, Depression, and Self-harm are considered common presentations in children.
Anxiety, Depression, and Self-harm are considered common presentations in children.
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What are common indicators of potential mental health struggles in children? (Select all that apply)
What are common indicators of potential mental health struggles in children? (Select all that apply)
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What impact does puberty have on a child's emotional regulation?
What impact does puberty have on a child's emotional regulation?
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What percentage of people over 60 experience a mental disorder?
What percentage of people over 60 experience a mental disorder?
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Match the following mental health disorders with their descriptions:
Match the following mental health disorders with their descriptions:
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Cognitive impairment and Dementia are the same.
Cognitive impairment and Dementia are the same.
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What is a common cause of depression in older adults?
What is a common cause of depression in older adults?
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What risk is associated with schizophrenia in older adults concerning medication?
What risk is associated with schizophrenia in older adults concerning medication?
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Which of the following outcomes is associated with communication impairment in dementia? (Select all that apply)
Which of the following outcomes is associated with communication impairment in dementia? (Select all that apply)
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A diagnosis of Dementia is supported by evidence of significant difficulties in daily life caused by cognitive __________.
A diagnosis of Dementia is supported by evidence of significant difficulties in daily life caused by cognitive __________.
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What age range does the WHO define as childhood?
What age range does the WHO define as childhood?
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What percentage of people is predicted to experience mental health conditions during their early life?
What percentage of people is predicted to experience mental health conditions during their early life?
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Which of the following are common presentations of mental health issues in childhood? (Select all that apply)
Which of the following are common presentations of mental health issues in childhood? (Select all that apply)
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Puberty has no impact on a child's ability to regulate their emotions.
Puberty has no impact on a child's ability to regulate their emotions.
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What is the most common risky behavior among young people?
What is the most common risky behavior among young people?
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Match the following mental health struggles with their indicators:
Match the following mental health struggles with their indicators:
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What percentage of people over 60 experience a mental disorder?
What percentage of people over 60 experience a mental disorder?
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Which of the following are common mental health presentations in older adults? (Select all that apply)
Which of the following are common mental health presentations in older adults? (Select all that apply)
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What characterizes bipolar affective disorder?
What characterizes bipolar affective disorder?
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_______ is noted by poor performance on cognitive assessments indicating a decline.
_______ is noted by poor performance on cognitive assessments indicating a decline.
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What is the main cause of Alzheimer's Disease?
What is the main cause of Alzheimer's Disease?
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Which of the following symptoms is NOT typically associated with dementia?
Which of the following symptoms is NOT typically associated with dementia?
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Study Notes
Childhood Mental Health
- The World Health Organisation (WHO) defines a child as someone between 10 and 19 years old, but many mental health services include ages 0-25.
- 10-20% of people experience mental health conditions during early life.
- Mental health conditions are not isolated and require a holistic assessment approach.
- Anxiety, depression, and self-harm are common presentations.
- Healthcare workers need to understand developmental milestones for age-appropriate engagement.
Childhood: Impact of Development
- Puberty influences a child's emotional regulation.
- Increased independence and decision-making can lead to social isolation.
- Schooling pressures, peer pressure, and risk-taking behavior can impact mental health.
Childhood: Risk Taking
- Risk-taking is often a part of young people exploring their identity.
- Common risk behaviors include binge drinking, reckless driving, smoking, illicit substance use, and risky sexual activity.
- Risk-taking can be harmful for those with predisposing genetic factors and can become a maladaptive coping mechanism for emotional distress.
Indicators of Potential Mental Health Struggles
- Duration and intensity of adverse emotions
- Functional impairment
- Sudden changes in behavior
- Isolation and withdrawal
- Extreme reactions
- Regression
- Persistent fear or worry
- Tics or repetitive behaviors
- School refusal
- Self-harm or suicidal thoughts
- Excessive concern about appearance
- Perfectionism
Childhood: Impact of Technology
- 9 out of 10 teenagers between 14 and 17 own a mobile phone.
- Benefits include social connectedness.
- Risks include cyberbullying, peer pressure, and overdependency on being "liked".
Older Adults
- Typically considered anyone over 65 years old.
- Referrals come from the community, care facilities, or intra-hospital transfers.
- Can be more complex due to declining independence.
Older Adults: Mental Health Conditions
- 15% of people over 60 experience a mental disorder.
- Comorbidities like pain, loss of independence, and social isolation are linked to poorer mental health.
- Common presentations include schizophrenia/schizoaffective disorder, bipolar affective disorder, depression and anxiety, and cognitive impairments including dementia.
Older Adults: Schizophrenia
- Schizophrenia is a severe psychiatric condition characterized by positive and negative symptoms.
- Positive symptoms include delusions and hallucinations.
- Negative symptoms include social withdrawal, impaired motivation, and poor sleep.
- Presentation is often similar to younger adults.
- Special considerations include the long-term impact of antipsychotics on physical health, including an increased risk of stroke and cardiac illness.
Older Adults: Bipolar Affective Disorder (BPAD)
- BPAD is a mood disorder characterized by extreme mood changes, with periods of depression and mania.
- Long-term use of mood stabilizers can result in decreased kidney function, especially with prolonged lithium use.
Older Adults: Depression, Anxiety, and Suicidal Ideation
- Often related to grief or a sense of despair.
- Experiences of loss, such as loss of health, loved ones, physical mobility, and independence can trigger depression.
- Major life changes, including retirement, changes in financial status, and transitions into care facilities can also contribute.
Older Adults: Risks
- Older males are more likely to complete suicide than any other age group.
- Suicide completion rate is higher in older adults (1 in 3 attempts) compared to youth (1 in 200 attempts).
Older Adults: Medication-Related Risks
- Long-term side effects of medications are a concern.
- Medication processing ability needs to be monitored (considering impaired liver function, etc.)
- Increased sedation can increase the risk of falls.
Cognitive Impairment vs Dementia
- Cognitive impairment is characterized by poor performance on objective cognitive assessments, indicating declining performance.
- Dementia is diagnosed when cognitive impairment leads to significant difficulties in daily life that interfere with independence.
Alzheimer's Disease
- Accounts for 70% of dementia diagnoses.
- Caused by brain cell death in the outer layer, impacting memory, language, and judgment.
- Progressive symptoms include:
- Apraxia (difficulty with movements)
- Aphasia (difficulty with language - speech)
- Anomia (difficulty finding words)
- Agnosia (difficulty identifying people or objects)
- Amnesia (difficulty with memory)
Impact on Communication
- Dementia negatively impacts communication.
- Confusion, memory impairment, disorientation, and difficulty expressing needs are common.
- Aphasia is common in worsening Alzheimer's Disease.
- Inability to express needs can lead to frustration, aggression, fear, or embarrassment.
Getting to Know Your Patient
- A holistic understanding of the patient is crucial when they present with cognitive impairment.
- Involve family in care planning.
- Learn their preferences, including:
- Morning or afternoon showers
- Tea or coffee
- Favorite foods
- Likes and dislikes
- Ways they express themselves
Benefits of Knowing Your Patient
- Knowing the patient makes care easier.
- They are less likely to be fearful and frustrated.
- Building a trusting rapport becomes easier.
Verbal Communication
- Short, simple sentences are key when communicating with patients with cognitive impairment.
- Offering too many choices can lead to confusion.
- One person should speak at a time, giving clear directions.
- Be aware of tone of voice as patients can pick up on frustration.
Non-Verbal Communication
- Be aware of non-verbal communication, including body language and cues (hunger, thirst, toileting, pain).
- Touch is vital in the care of people living with cognitive impairments.
- It can be used for comfort, assistance with ADLs, and during crisis.
Environment
- New environments can be disorienting and distressing.
- Use familiar items in bed spaces.
- Reduce bed movement.
- Use color differences in furniture and flooring.
- Utilize dementia-friendly signage (large font and clear pictures).
Patient-Centered Care
- Goals of care should include end-of-life care or palliative care.
- Involve family in care planning.
- Involve the patient where appropriate and possible.
- Involve the current care facility.
Dementia, Delirium, and Depression
-
Dementia:
- Slow deterioration over time (months to years).
- Non-reversible cognitive decline.
- Symptoms include wandering, agitation, difficulty with word recall, and fluctuations in symptoms.
-
Delirium:
- Sudden onset (hours or days).
- Reversible when underlying cause is treated.
- Fluctuating and short duration.
- Symptoms include restlessness, agitation, fluctuations in appetite, hallucinations, mood changes, and disorganised thinking.
-
Depression:
- Mood changes over 2 weeks or more.
- Could be linked to a life event or loss of loved one.
- Reversible with treatment.
- Symptoms include withdrawal, hopelessness, concentration changes, and fluctuations in moods.
Older Adults: Delirium Screening
- Delirium is a medical emergency.
- Screening instruments can be used to assess risk and monitor for changes.
Importance of Age
- Mental illness was once considered taboo.
- Willingness to discuss thoughts and feelings can depend on age.
- Use age-appropriate language.
Tutorials
- Case studies can be valuable learning tools.
- Group work allows for collaborative learning and discussion.
Childhood
- The World Health Organization (WHO) defines a child as someone between 10-19 years old.
- Mental health services for young people often include ages 0-25.
- Mental health conditions are present in 10-20% of children during their early life.
- A holistic approach to assessment is vital as mental illness is often linked to other aspects of a child's life.
- Anxiety, Depression, and Self-Harm are common mental health presentations.
- Healthcare workers must understand developmental milestones to appropriately engage with children.
Childhood: Impact of Development
- Puberty impacts a child's ability to regulate their emotions.
- As independence and decision-making increase, so can social isolation.
- School pressures, peer pressure, and risk-taking are common for children.
Childhood: Risk-Taking
- Risk-taking is often seen as a normal part of young people exploring their self-identity.
- Binge-drinking, reckless driving, smoking, illicit substance use, and risky sexual activity are common forms of risk-taking.
- Risk-taking can be harmful for those with predisposing genetic factors and can become maladaptive coping strategies for those experiencing emotional distress.
Indicators of Potential Mental Health Struggles
- Duration and intensity of adverse emotions.
- Functional impairment.
- Sudden changes in behaviour.
- Isolation and withdrawal.
- Extreme reactions.
- Regression.
- Persistent fear or worry.
- Tics or repetitive behaviours.
- School refusal.
- Self-harm or suicidal thoughts.
- Excessive concern about appearance.
- Perfectionism.
Childhood: Impact of Technology
- 9/10 14 – 17-year-olds have a mobile phone.
- Mobile phones offer benefits like social connectedness but also risks like cyberbullying, peer pressure, and overdependency on being "liked".
Older Adults
- Typically considered anyone over the age of 65.
- Referrals for mental health services come from the community, care facilities, or intrahospital transfers.
- Mental health presentations in older adults can be more complex due to a decline in independence.
Older Adults
- 15% of people over 60 experience a mental disorder.
- Comorbidities (pain, loss of independence, social isolation) are linked to poor mental health.
- Common mental health presentations in older adults include:
- Schizophrenia/Schizoaffective disorder
- Bipolar Affective disorder
- Depression and anxiety
- Cognitive impairments - including Dementias
Older Adults - Schizophrenia
- Schizophrenia is a severe psychiatric diagnosis characterized by positive and negative symptoms.
- Positive symptoms include delusions and hallucinations.
- Negative symptoms include social withdrawal, impaired motivation, and poor sleep.
- The same presentation often appears in younger adults.
- Special considerations in older adults include:
- The long-term impact of antipsychotics on their physical health (increased risk of stroke and cardiac illness).
Older Adults – Bipolar Affective Disorder (BPAD)
- Bipolar affective disorder is a mood disorder characterized by extreme changes in mood, with phases of depression and mania.
- Long-term use of mood stabilizers (Lithium) can lead to decreased kidney function.
Older Adults: Depression, Anxiety, and Suicidal Ideation
- Often related to grief or a sense of despair.
- Experiences of loss (health, loved ones, physical mobility, and independence) are common.
- Major life changes (retirement, change in financial status, transitioning into care facilities) can contribute to mental health difficulties.
Older Adults: Risks
- Older males are more likely to complete suicide than any other age group.
- Youth: 1 in every 200 suicide attempts result in death.
- Older adults: 1 in every 3 attempts result in death.
Older Adults: Risks
- Medication-related risks are common.
- Long-term side effects of medications.
- The patient's body's ability to process medications (consider impaired liver functioning).
- Increased sedation increases the risk of falls.
Cognitive Impairment vs Dementia
- Cognitive impairment is indicated by poor performance on objective cognitive assessments that reveal a decline in performance.
- A dementia diagnosis is supported by evidence of significant difficulties in daily life that interfere with independence caused by cognitive impairment.
Cognitive Impairment vs Dementia: Alzheimer's Disease
- Alzheimer's Disease accounts for 70% of Dementia diagnoses.
- Caused by the death of brain cells in the outer layer of the brain responsible for memory, language, and judgment.
- Progressive symptoms include:
- Apraxia - difficulty with movements.
- Aphasia - difficulty with language (speech).
- Anomia - difficulty finding the words to use.
- Agnosia - difficulty identifying people or objects.
- Amnesia - difficulty with memory.
Impact on Communication
- Dementia negatively impacts a person's communication abilities.
- Confusion/memory impairment.
- Disorientation to time, place, and person.
- Inability to express their needs.
- Aphasia (common in worsening Alzheimer's Disease).
- When someone cannot express their needs, they often become:
- Frustrated and at times aggressive.
- Fearful or embarrassed.
Getting to know your patient
- Understanding your patient's background and preferences is crucial.
- Involve their family in care planning.
- Learn about their preferences (shower time, beverage choices, favorite foods, likes/dislikes, ways they express themselves).
Getting to know your patient
- Knowing a patient makes providing care easier and reduces fear and frustration.
- Building a trusting rapport becomes easier.
Verbal Communication
- When communicating with patients living with cognitive impairment:
- Short simple sentences are key.
- Offering too many choices can cause further confusion.
- Allow one person to speak at a time, providing clear directions.
- Be aware of your tone of voice, as patients can pick up on frustration.
Non-Verbal Communication
- Be aware of your patient's non-verbal communication.
- Body language.
- Cues (hunger, thirst, toileting, pain) - knowing your patient is important.
- Unlike other mental health settings, touch is vital in the care of people living with cognitive impairments.
- Assisting with activities of daily living (ADL's).
- Comforting them in times of crisis.
Environment
- New environments can be disorientating and distressing.
- Use familiar items in bed space to reduce bed movement.
- Differentiate furniture and flooring with color.
- Utilize dementia-friendly signage (large font and clear pictures).
Patient Centred Care
- Goals of care can vary depending on the individual's needs (end-of-life care/palliative care).
- Involve family members in the care process.
- Include the patient in care decisions where appropriate and possible.
- Collaborate with the patient's current care facility.
Older Adults: Dementia, Delirium, and Depression
| Features | Dementia | Delirium | Depression |
|---|---|---|---|
| Onset & | Slow deterioration over time | Sudden onset (hours/days) | Mood change over 2 |
| Duration | Months to years | weeks (linked to life | |
| events/loss) | |||
| Course/ | Slow and progressive | Sudden, short and | Fluctuations |
| Progression | Cognitive decline (non- | Fluctuating (reversible | (reversible with |
| reversible) | when underlying cause is | correct treatment) | |
| treated) | |||
| Signs & | Wandering, agitation, | Restlessness, fluctuations | Withdrawn, |
| Symptoms | Difficulty with word recall, | in agitation, appetite, and | hopelessness, |
| Fluctuations in symptoms | Hallucinations and mood | concentration | |
| changes, disorganized | changes | ||
| thinking |
Older Adults: Delirium Screening
- Delirium screening is crucial to identify and manage delirium.
Importance of Age
- Mental illness was once more taboo, so consider this when interacting with people.
- Willingness to discuss thoughts and feelings can depend on age.
- Use language appropriate for the person you are interacting with.
Tutorials
- Utilize case studies and group work to enhance learning and understanding.
Childhood
- Individuals aged 10-19 years old are considered children by the WHO.
- Many mental health services extend their services to young people aged 0-25.
- Mental health conditions affect approximately 10-20% of individuals during childhood.
- Mental health conditions are complex and cannot be isolated from other aspects of a child's life.
- Holistic assessments are crucial for understanding the child's situation.
- Anxiety, depression, and self-harm are the most prevalent presentations.
- Healthcare workers must understand developmental milestones to effectively engage with children.
Childhood: Impact of Development
- Puberty influences a child's emotional regulation.
- As independence and decision-making increase, so does the risk of social isolation.
- School-related pressures impact mental health.
- Peer pressure and risky behaviors are prevalent during childhood.
Childhood: Risk Taking
- Risk-taking is a typical aspect of young people exploring their identity.
- Common risky behaviors include binge-drinking, reckless driving, smoking, illicit substance use, and risky sexual activity.
- Individuals with predisposing genetic factors may experience detrimental consequences from risk-taking.
- Risk-taking can develop into maladaptive coping mechanisms for those experiencing emotional distress.
Indicators of Potential Mental Health Struggles
- Prolonged and intense negative emotions.
- Functional impairment.
- Sudden behavior changes.
- Social withdrawal.
- Extreme reactions to events.
- Regression to earlier developmental stages.
- Persistent fear or anxiety.
- Tics or repetitive behaviors.
- School refusal.
- Self-harm or suicidal ideation.
- Excessive concern about appearance.
- Perfectionism.
Childhood: Impact of Technology
- 90% of 14-17-year-olds own a mobile phone.
- Technology offers benefits such as social connectedness.
- Risks associated with technology include cyberbullying, excessive peer pressure, and overreliance on social acceptance.
Older Adults
- Individuals over 65 years old are typically considered older adults.
- Referrals for older adults often originate from community settings, care facilities, or intrahospital transfers.
- Older adult patients may present with more complex needs due to decline in independence.
Older Adults Mental Health
- Approximately 15% of individuals over 60 experience a mental health disorder.
- Comorbidities, such as pain, loss of independence, or social isolation, are common in older adults and contribute to poor mental health.
- The most common mental health presentations in older adults include:
- Schizophrenia/Schizoaffective disorder
- Bipolar affective disorder
- Depression and anxiety
- Cognitive impairments, including dementias.
Older Adults - Schizophrenia
- Schizophrenia is a severe psychiatric diagnosis characterized by positive (delusions, hallucinations) and negative (social withdrawal, impaired motivation, poor sleep) symptoms.
- The presentation of schizophrenia in older adults often mirrors that of younger populations.
- Special considerations for older adults with schizophrenia:
- Long-term antipsychotic treatment impacts physical health, increasing the risk of stroke and cardiac illness.
Older Adults – Bipolar Affective Disorder (BPAD)
- BPAD is a mood disorder characterized by extreme mood swings, with alternating phases of depression and mania.
- Individuals with BPAD often require long-term mood stabilizers.
- Prolonged lithium use can lead to kidney dysfunction.
Older Adults: Depression, Anxiety, and Suicidal Ideation
- Depression in older adults is frequently linked to grief or despair.
- Loss experiences, such as loss of health, loved ones, physical mobility, and independence contribute to depression.
- Major life transitions, including retirement, financial changes, and moving to care facilities, can trigger depression.
Older Adults: Risks
- Older men have a higher suicide completion rate compared to other age groups.
- The suicide completion rate for youth is 1 in every 200 attempts, while it's 1 in every 3 attempts for older adults.
- Medication-related risks include long-term side effects, altered medication processing due to factors like impaired liver function, and increased sedation leading to falls.
Cognitive Impairment vs Dementia
- Cognitive impairment is characterized by poor performance on cognitive assessments, indicating a decline in mental function.
- A dementia diagnosis is supported by evidence of significant difficulties in daily life that interfere with independence and are caused by cognitive impairment.
Alzheimer's Disease
- The majority (70%) of dementia diagnoses are attributed to Alzheimer's disease.
- Alzheimer's is caused by brain cell death in the outer layers of the brain, affecting memory, language, and judgment.
- Progressive symptoms include:
- Apraxia (difficulty with movements)
- Aphasia (difficulty with language)
- Anomia (difficulty finding words)
- Agnosia (difficulty identifying people or objects)
- Amnesia (difficulty with memory)
Impact on Communication
- Dementia negatively impacts communication abilities.
- People with dementia often experience:
- Confusion and memory impairment.
- Disorientation to time, place, and person.
- Inability to express their needs.
- Aphasia (common in worsening Alzheimer's).
- Inability to communicate needs can lead to frustration, aggression, fear, and embarrassment.
Getting to know your patient
- Understanding the individual with cognitive impairment requires a holistic approach.
- Involve family members in care planning.
- Learn the patient's preferences (morning/afternoon shower, tea/coffee, favorite foods, likes/dislikes, communication style).
Getting to know your patient
- Knowing the patient facilitates easier care provision.
- It reduces fear and frustration, creating a sense of safety for the patient.
- Building trust is more attainable when you know the patient.
Verbal Communication
- When communicating with patients with cognitive impairment:
- Use short, simple sentences.
- Avoid overwhelming choices, as they may lead to confusion.
- Ensure one person speaks at a time and provide clear directions.
- Be mindful of your tone of voice as patients can sense frustration.
Non-Verbal Communication
- Be attentive to your patient's non-verbal communication:
- Body language
- Cues (hunger, thirst, need for toileting, pain)
- Touch is vital in the care of individuals with cognitive impairments.
- Provide comfort during times of distress.
- Assist with activities of daily living (ADLs).
Environment
- New environments can be disorienting and distressing for people with cognitive impairment.
- Use familiar items in the patient's bed space to create familiarity.
- Minimize bed movement.
- Employ distinct colors in furniture and flooring for better orientation.
- Utilize dementia-friendly signage with large fonts and clear pictures.
Patient-Centred Care
- The goals of care should consider end-of-life care or palliative care needs.
- Engage the family and patient (when appropriate) in care planning.
- Collaborate with current care facilities.
Older Adults: Dementia, Delirium, and Depression
| Feature | Dementia | Delirium | Depression |
|---|---|---|---|
| Onset | Slow deterioration (months to years) | Sudden onset (hours or days) | Mood change over 2 weeks (may be linked to life event) |
| Duration | Progressive | Short and fluctuating (reversible) | Fluctuations (reversible with appropriate treatment) |
| Course/Progression | Slow cognitive decline (non-reversible) | Sudden, fluctuating (reversible when underlying cause is treated) | Reversible with correct treatment |
| Signs and Symptoms | Wandering, agitation, difficulty recalling words, fluctuating symptoms | Restlessness, fluctuating agitation, appetite and mood changes, disorganized thinking, hallucinations | Withdrawn, hopelessness, concentration changes |
Older Adults: Delirium Screening
- CAM (Confusion Assessment Method): A tool used to screen for delirium.
Importance of Age
- Mental illness has historically been considered taboo.
- Discussing thoughts and feelings can vary based on age.
- Use age-appropriate language when communicating with patients.
Tutorials, Case Studies, and Group Work
- These are valuable learning tools that supplement general knowledge.
Childhood Mental Health
- The World Health Organisation defines a child as someone between the ages of 10-19.
- Many mental health services, however, include ages 0-25 in their definition of "young people."
- 10-20% of people experience mental health conditions during early life.
- Mental health conditions do not occur in isolation.
- It is vital to be holistic in assessment style.
- Anxiety, Depression, and Self-Harm are the most common presentations.
- Healthcare workers need to understand developmental milestones in order to engage with a child at an appropriate level.
Childhood: Impact of Development
- Puberty impacts a child's ability to regulate emotions.
- Independence and decision-making can lead to social isolation.
- School pressures contribute to mental health challenges.
- Peer pressure and risk-taking are common in childhood.
Childhood: Risk-Taking
- Risk taking is often a normal part of exploring self-identity.
- Binge-drinking, reckless driving, smoking, illicit substance use, and risky sexual activity are common.
- Risk-taking can be harmful to those with predisposing genetic factors.
- Risky behavior can become a maladaptive coping strategy for those experiencing emotional distress.
Indicators of Potential Mental Health Issues
- Duration and Intensity of Adverse Emotions: How long and how strong are the negative emotions.
- Functional Impairment: Difficulty completing daily tasks.
- Sudden Changes: Noticeable shifts in behavior or mood.
- Isolation and Withdrawal: Avoiding social interactions.
- Extreme Reactions: Overreacting to typical situations.
- Regression: Returning to earlier behaviors or coping mechanisms.
- Persistent Fear or Worry: Excessive and ongoing anxiety.
- Tics or Repetitive Behaviors: Uncontrollable movements or actions.
- School Refusal: Avoiding school due to mental health concerns.
- Self-Harm or Suicidal Thoughts: Engaging in behaviors that harm oneself or contemplating suicide.
- Excessive Concern About Appearance: Unhealthy preoccupation with physical appearance.
- Perfectionism: Setting unrealistic standards for oneself.
Childhood: Impact of Technology
- 9 out of 10 14-17 year olds have a mobile phone.
- Mobile phones can be beneficial for social connectedness.
- Risks associated with technology include cyberbullying, peer pressure, and overdependency on social media validation.
Older Adults
- Anyone over 65 is typically considered an older adult.
- Referrals for older adults often come from the community, care facilities, or hospital transfers.
- Older adults may present with more complex cases due to declining independence.
Older Adults: Mental Health
- 15% of people over 60 experience a mental disorder.
- Poor mental health in older adults is linked to comorbidities such as pain, loss of independence, and social isolation.
- Common mental health presentations in older adults include:
- Schizophrenia/Schizoaffective disorder
- Bipolar Affective Disorder
- Depression & Anxiety
- Cognitive impairments (including Dementias)
Older Adults: Schizophrenia
- Schizophrenia is a severe psychiatric diagnosis characterized by positive and negative symptoms.
- Positive Symptoms: Delusions and Hallucinations.
- Negative Symptoms: Social withdrawal, impaired motivation, and poor sleep.
- Schizophrenia often presents similarly in both younger and older adults.
- Special considerations for older adults with Schizophrenia:
- Long-term impact of antipsychotics on physical health: Increased risk of stroke and cardiac illness.
Older Adults: Bipolar Affective Disorder (BPAD)
- Bipolar Affective Disorder is characterized by extreme mood changes:
- Depression: Low mood, fatigue, loss of interest.
- Mania: Elevated mood, racing thoughts, impulsivity.
- Long-term use of mood stabilizers, especially lithium, can lead to decreased kidney function in older adults.
Older Adults: Depression, Anxiety, and Suicidal Ideation
- Depression and anxiety in older adults are often related to grief or despair.
- Experiences of loss, such as loss of health, loved ones, physical mobility, and independence, can contribute to depression.
- Major life changes, such as retirement, changes in financial status, or transitions into care facilities, can trigger feelings of hopelessness and depression.
Older Adults: Suicide Risk
- Older males are more likely to complete suicide than any other age group.
- Suicide attempts are more likely to result in death for older adults than younger individuals.
- 1 in 3 suicide attempts by older adults result in death.
Older Adults: Medication Risks
- Long-term side effects of medications can pose risks for older adults.
- Older adults' bodies may not process medications as efficiently as younger individuals, increasing the risk of adverse reactions.
- Increased sedation from medications can lead to an increased risk of falls.
Cognitive Impairment vs. Dementia
- Cognitive Impairment: Poor performance on cognitive assessments, indicating a decline in cognitive function.
- Dementia: Significant difficulties with daily life, interfering with independence, caused by cognitive impairment.
Alzheimer's Disease
- Accounts for 70% of Dementia diagnoses.
- Caused by the death of brain cells in the outer layer of the brain, impacting memory, language, and judgment.
- Progressive symptoms include:
- Apraxia: Difficulty with movements.
- Aphasia: Difficulty with language (speech).
- Anomia: Difficulty finding words.
- Agnosia: Difficulty recognizing familiar people or objects.
- Amnesia: Difficulty with memory.
Impact of Dementia on Communication
- Dementia negatively impacts a person's ability to communicate.
- Confusion and memory impairment.
- Disorientation to time, place, and person.
- Inability to express their needs effectively.
- Aphasia (common in worsening Alzheimer's Disease).
- When someone is unable to communicate their needs effectively, they may become frustrated, aggressive, fearful, or embarrassed.
Getting to Know Your Patient
- When dealing with cognitive impairment, it is crucial to have a holistic understanding of the individual.
- Involve the patient's family in care planning.
- Learn their preferences:
- Morning or afternoon showers
- Tea or coffee
- Favorite foods
- Likes and dislikes
- Ways they express themselves
Patient-Centered Care
- The goal of care involves providing end-of-life care or palliative care.
- Involve the patient's family in care decisions.
- Involve the patient in care decisions when appropriate and possible.
- If applicable, involve the current care facility.
Dementia, Delirium, and Depression in Older Adults
| Feature | Dementia | Delirium | Depression |
|---|---|---|---|
| Onset | Slow deterioration (months to years) | Sudden (hours or days) | Gradual (over weeks or months) |
| Duration | Chronic & Progressive | Acute (reversible when underlying cause is treated) | Variable (can be chronic) |
| Course | Slow & Progressive Cognitive Decline (non-reversible) | Fluctuating (reversible with treatment) | Fluctuating (reversible with treatment) |
| Signs & Symptoms | Wandering, agitation, difficulty recalling words. Fluctuations in symptoms | Restlessness, fluctuations in agitation, appetite, and mood changes. Hallucinations and disorganised thinking. | Withdrawal, hopelessness, concentration changes, and changes in mood. |
Delirium Screening
- Assessment tools are available to help identify delirium.
- Early recognition and management of delirium are crucial.
Importance of Age
- Mental health was once considered more taboo, impacting how individuals discuss their experiences.
- Willingness to discuss thoughts and feelings varies depending on age.
- Language used should be appropriate for the individual's age and understanding.
Teaching Resources
- Case studies provide practical examples to explore different mental health presentations.
- Group work allows students to collaborate, share perspectives, and learn from each other.
Childhood Mental Health
- The WHO defines a child as someone between 10-19 years of age.
- However, many mental health services extend this age range to 0-25 years old.
- Mental health conditions are estimated to affect 10-20% of people in their early years.
- Mental health conditions are not isolated and require a holistic approach to assessment.
- Anxiety, depression, and self-harm are some of the most frequent presentations.
- Healthcare professionals need to be aware of developmental milestones to engage appropriately with children.
Childhood: Impact of Development
- Puberty influences a child's emotional regulation abilities.
- Increased independence and decision-making can lead to social isolation.
- School pressures, peer pressure, and risk-taking behaviors are common during childhood.
Childhood: Risk-Taking
- Risk-taking is often considered a normal part of exploring self-identity for young people.
- Common examples include binge-drinking, reckless driving, smoking, substance use, and risky sexual activity.
- Genetic predisposition can heighten the negative effects of risk-taking behavior.
- Maladaptive coping mechanisms may develop for those experiencing emotional distress.
Indicators of Potential Mental Health Struggles
- Duration and intensity of adverse emotions.
- Functional impairment: Sudden changes in behavior.
- Isolation and withdrawal.
- Extreme reactions to situations.
- Regression to earlier behaviors.
- Persistent fear or worry.
- Tics or repetitive behaviors.
- School refusal.
- Self-harm or suicidal thoughts.
- Excessive concern about appearance.
- Perfectionism.
Childhood: Impact of Technology
- Nine out of ten 14-17 year olds own a mobile phone.
- Benefits include social connectedness.
- Risks include cyberbullying, peer pressure, and overdependence on online validation.
Older Adults: Mental Health Conditions
- Generally, individuals over the age of 65 are considered older adults.
- Referrals come from the community, care facilities, or intrahospital transfers.
- The complexity of care increases due to potential decline in independence.
- Mental health disorders affect approximately 15% of people over 60.
Older Adults: Common Mental Health Presentations
- Co-morbidities, such as pain, loss of independence, and social isolation, can impact mental health.
- Common mental health conditions:
- Schizophrenia/Schizoaffective disorder.
- Bipolar affective disorder.
- Depression and anxiety.
- Cognitive impairments, including dementia.
Older Adults: Schizophrenia
- Defined by positive (delusions, hallucinations) and negative (social withdrawal, impaired motivation) symptoms.
- Similar presentation to younger adults.
- Considerations for older adults:
- Potential long-term impact of antipsychotics on physical health.
- Increased risk of stroke and cardiac illness.
Older Adults: Bipolar Affective Disorder (BPAD)
- Characterized by extreme mood swings, including phases of depression and mania.
- Long-term mood stabilizer use can lead to decreased kidney function (e.g., Lithium).
Older Adults: Depression, Anxiety, and Suicidal Ideation
- Often linked to grief or a sense of despair.
- Experiences of loss, such as loss of health, loved ones, mobility, and independence.
- Major life transitions, including retirement, financial changes, and moving to care facilities.
Older Adults: Suicide Risk
- Older males have a higher suicide completion rate than any other age group.
- Youth: 1 in 200 attempts result in death.
- Older adults: 1 in 3 attempts result in death (American Association of Suicidology, 2014).
Older Adults: Medication-Related Risks
- Long-term side effects of medications.
- The body's ability to process medications (consider impaired liver function).
- Increased sedation raises the risk of falls.
Cognitive Impairment vs. Dementia
- Cognitive impairment exhibits poor performance on objective cognitive assessments indicating a decline.
- A dementia diagnosis is supported by evidence of significant daily life difficulties impacting independence due to cognitive impairment.
Alzheimer's Disease
- Accounts for approximately 70% of dementia diagnoses.
- Caused by brain cell death in the outer layer responsible for memory, language, and judgment.
- Progressive symptoms:
- Apraxia: Difficulty with movements.
- Aphasia: Difficulty with language (speech).
- Anomia: Difficulty finding words.
- Agnosia: Difficulty identifying people or objects.
- Amnesia: Difficulty with memory.
Impact on Communication
- Dementia negatively affects communication abilities.
- Confusion/memory impairment.
- Disorientation to time, place, and person.
- Inability to express needs.
- Aphasia (common in worsening Alzheimer's Disease).
- When unable to express needs, individuals may become:
- Frustrated and aggressive.
- Fearful or embarrassed.
Getting to Know Your Patient
- A holistic understanding of the person is crucial when experiencing any cognitive impairment.
- Involve the family in care planning.
- Learn their preferences:
- Shower time, beverage preference, favorite foods, likes and dislikes, communication style.
Importance of Knowing your Patient
- Knowing your patient makes care easier.
- Reduces fear and frustration due to a sense of safety.
- Facilitates building a trusting rapport.
Verbal Communication
- Key considerations for patients with cognitive impairments*
- Use short, simple sentences.
- Avoid offering too many choices to prevent confusion.
- One person talks at a time, providing clear directions.
- Be mindful of tone of voice as patients can pick up on frustration.
Non-Verbal Communication
- Be attentive to a patient's non-verbal communication:
- Body language.
- Cues (hunger, thirst, toileting, pain) - Importance of knowing your patient.
- Touch is essential in caring for people with cognitive impairments, unlike other mental health settings:
- Comfort during crisis.
- Assistance with daily living activities.
Environment
- New environments can be distressing and disorienting.
- Use familiar items in the patient's bed space.
- Minimize bed movement.
- Create color contrasts between furniture and flooring.
- Use dementia-friendly signage (large font and clear pictures).
Patient-Centered Care
- Care goals: End-of-life care/palliative care.
- Involve the family.
- Involve the patient whenever appropriate.
- Coordinate with the current care facility.
Dementia, Delirium, and Depression: Key Features
| Feature | Dementia | Delirium | Depression |
|---|---|---|---|
| Onset and Duration | Slow deterioration (months to years) | Sudden onset (hours or days) | Mood change over 2 weeks, possibly related to a life event or loss |
| Course/Progression | Slow and progressive cognitive decline (non-reversible) | Sudden, short, and fluctuating (reversible when underlying cause is treated) | Fluctuations (reversible with correct treatment) |
| Signs and Symptoms | Wandering, agitation, difficulty with word recall. Fluctuations in symptoms. | Restlessness, fluctuations in agitation. Appetite and mood changes, disorganized thinking, hallucinations. | Withdrawn, hopelessness, concentration changes. |
Delirium Screening
- Delirium screening tools are available to assess delirium in older adults.
Importance of Age
- Mental illness was once more stigmatized, which should be considered when interacting with individuals.
- Willingness to discuss thoughts and feelings is influenced by age and the individual's comfort level.
- Adapt language to be appropriate for the individual's age.
Tutorials
- Utilizing case studies and group work can enhance learning.
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Description
This quiz explores key aspects of childhood mental health, including common conditions such as anxiety and depression. It emphasizes the importance of understanding developmental milestones and risk-taking behaviors during adolescence. Gain insights into how these factors affect emotional regulation and overall well-being.
