6 - Psychological and Cognitive Function

Gerontological Nursing
Fourth Edition
Chapter 7
Psychological and Cognitive
Function
Copyright © 2019, 2014, 2010 Pearson Education, Inc. All Rights Reserved
Normal Changes in Aging
• Normally, an older person’s mental health and cognition remain relatively
stable.
• Severe changes and sudden loss of cognitive function are usually symptoms
of a physical or mental illness, such as Alzheimer’s disease, stroke, or serious
depression.
Mental Health: Themes
• Mental health is fundamental to health.
• Mental illnesses are real health problems.
• The efficacy of mental health treatments is well documented.
• Mind and body are inseparable.
• There is a serious shortage of trained mental health professionals to meet the
need for services.
• Stigma is a major obstacle preventing older people from getting help.
Cultural Considerations
• The older population is highly heterogeneous and includes a diverse mix of
immigrants, refugees, and multigenerational Americans with vastly different
histories, languages, spiritual practices, demographic patterns, and cultures.
Personality and Self-Concept
• An older person’s self-concept can be eroded or enhanced over time as a
result of circumstance and life experiences.
• An older person’s personality influences self-concept and adaptation to role
transitions, such as widowhood or retirement.
Life Satisfaction and Life Events
• Life satisfaction is an attitude toward one’s own life; it may be defined as a
reflection of feelings about the past, present, and future.
• Life satisfaction and morale are closely related to well-being.
• Recent studies document that life satisfaction increases until about the age of
65 and then begins to decrease.
Stress and Coping
• Excessive and persistent stress has been linked to the development of illness.
• Gerontological nurses should recognize and understand stress and its
influence on older persons.
Personality Disorders (1 of 2)
• Psychiatric symptoms that should be investigated and not written off as
normal changes of aging include:
– Memory and intellectual difficulties
– Change in sleep patterns
– Changes in sexual interest and capacity
– Fear of death
– Delusions‫االوهام‬
– Hallucinations
– Disordered thinking
– Problems with emotional expression
Psychotic and Adjustment Disorders
• The most common form of psychosis in later years is paranoia.
• The most common stressor that leads to adjustment disorder in later life is
physical illness.
Alcohol Abuse/Substance Abuse (1 of 2)
• Nursing actions that may be appropriate include teaching the patient to:
– Review all medications and instructions for use on a routine basis.
– Urge older persons not to drink alcohol if they are taking medications for
sleep, pain, anxiety, or depression.
• Nursing actions (teaching the patient), continued:
– Keep track of all side effects or changes in cognition or function
(especially when new medications are started).
– Clean out the medicine cabinet every year.
– Conduct a medication reconciliation and review all medications at least
once a year.
Bereavement‫الفجيعه‬
• Factors that can affect the duration and course of grieving include:
– Centrality of the loss
– Health of the survivor
– Survivor’s religious or spiritual-belief system
– History of substance abuse
– Nature of the death
Depression
• Depression is the mental health problem of greatest frequency and magnitude
in the older population.
• Depression in older adults is often undetected and untreated.
Nursing Assessment of Depression
• Various instruments are used to assess depression in the older adult.
– Each instrument has advantages and limitations.
• The Geriatric Depression Scale (GDS) is a screening instrument used in
many clinical settings to assess depression in older people.
Symptoms of Mania ‫هوس‬in Bipolar Depression
• Abnormal or excessive elation‫الغبطه‬
• Unusual irritability, high levels of energy and activity
• Decreased need for sleep
• Grandiose notions‫مفاهيم عظيمة‬
• Increased talking
• Racing ‫سباق‬thoughts
• Increased sexual desire
• Markedly increased energy
• Poor judgment, going on spending spree, using recreational drugs
• Inappropriate social behavior
Basic Principles for Psychological Assessment
• The gerontological nurse may be the first to notice:
– signs and symptoms of psychological change
– recommend the referral to the geriatric mental health specialist.
Nursing Interventions
• Treatment of mental health problems in the older person can use:
– nonpharmacological approaches
– pharmacological approaches
– a combination of the two.
Patient and Family Teaching
• Educating older adults and families is critical so that nurses can interpret
scientific data and individualize the nursing care plan.

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