Mental & Psychological Problems
in Older Persons
王春波醫生 Dr WONG Chun Por JP
Specialist in Geriatric Medicine
MBBS(HKU) FHKCP FHKAM(Medicine) MHA(UNSW)
MRCP(UK) FRCP(London) FRCP(Edinburgh) FRCP(Glasgow)
Outline
 Normal Ageing of the Brain
 Dementia
 Depression
 Delirium
 Anxiety
 Tips
Normal Ageing of the Brain
 Decreased hippocampal, frontal and temporal lobe
volumes – normal
 Neurotransmitters and myelin sheath degenerated
 Atherosclerosis of blood vessels
 Degenerative plaques and tangles
Cognitive Functions
 Impaired Visual and verbal memory, visuo-spatial
abilities, immediate memory or the ability to generate
words or name objects – normal
 Impaired Control and maintenance of attention and
immediate memory – normal
 Memory best at 16-18 of age
 Vocabulary and verbal reasoning even better at 60
Dementia 認知障礙症
 Alzheimer’s Disease 阿爾茲海默氏症 63%
 Vascular Dementia 20%
 Other degenerative diseases
 Parkinson’s Disease with Dementia
 B12 deficiency
 Alcohol
 Brain Tumor
Prevalence of Dementia
100,000 cases now
Alzheimer’s Disease
 Dr Alois Alzheimer
 (1864-1915)
 1906 first case
Mild Cognitive Impairment
 A slight but noticeable and measurable decline in
cognitive abilities, including memory and thinking
skills.
 Changes that are serious enough to be noticed by the
individuals experiencing them or to other people.
 But not severe enough to interfere with daily life or
independent function.
Cognitive Deficit
 Executive function
 Language
 Working (immediate) memory
 Spatial memory
 Verbal memory
 Impairment in Social Function
 Impairment in Independent Living
Independent Living
 Shopping
 Managing finance
 Household duties
 Appropriate social behavior
Symptoms to watch for
 Getting lost in familiar
places
 Decline in planning and
organization
 Repetitive questioning
 Changes in diet/eating
habits
 Odd or inappropriate
behaviors
 Forgetfulness of recent
events
 Repeated falls or loss of
balance
 Personality changes
 Changes in hygiene
 Increased apathy
 Changes in language
abilities, including
comprehension
Later Stage
 Inappropriate outbursts of anger
 Problems recognizing friends and family members
 Restlessness, agitation, anxiety, tearfulness,
wandering—especially in the late afternoon or at night
 Hallucinations, delusions, suspiciousness or paranoia,
irritability
 Loss of impulse control (shown through undressing at
inappropriate times or places or vulgar language)
V Late Stage
 Weight loss
 Seizures
 Skin infections
 Difficulty swallowing
 Groaning, moaning, or grunting
 Increased sleeping
 Lack of bladder and bowel control
Drugs
 Aricept
 Exelon (oral and patch)
 Ebixa
 Reminyl
Behavioral Problem
 Quetiapine
 Olanzapine
 Risperidone
Risk Factors
 High blood pressure, diabetes, poor nutrition and social
isolation are associated with a higher probability of
developing a neurodegenerative condition
 Heart disease
 Family history of dementia
 Psychological factors such as stress and depression also
negatively affect the healthy aging process
Tips to prevent
 Treat Hypertension, High Cholesterol, Heart Disease
 Exercise your body
 Stop smoking, reduce drinking
 Healthy Diet
 Extensive Social Network
Tips for care
 Keep patient safe from accident
 No arguments
 Keep in comfort
 Reminiscing
Depression
In the Elderly
Outline
 Depression and Ageing
 Common Diseases in Elderly
 Depression affecting Diseases
 Diseases affecting Depression
Elderly suicide
Decreasing rate
Prevalence of elderly depression
in different care settings
Care setting
Prevalence of
depressive
symptoms
Community
15%
Prevalence of
major
depressive
disorder
1-3%
Primary care
20%
10-12%
Acute hospital
20-25%
10-15%
Long term care
30-40%
16%
Risk factors for depression
in general
 female gender
 low education
 loss of partner
 cognitive decline
 somatic diseases
 functional impairment or disability
High Risk Groups with diseases
 Current alcohol /substance-use disorder
 Specific comorbid conditions: dementia, stroke, cancer,
arthritis, hip fracture, myocardial infarction, chronic
obstructive pulmonary disease, and Parkinson’s disease
 Functional disability (especially new functional loss)
 Widow/widowers
 Caregivers
 Social isolation/absence of social support
 Diminished perception of light in one's environment
Depression affecting Diseases
 amplification of pain and disability
 delayed recovery from illness and surgery
 worsening of drug side effects
 excess use of health services
 cognitive impairment
 Subnutrition
 increased suicide- and nonsuicide-related death.
Somatic Disease vs Disabilities
 Disability, especially disability regarding participation,
self-care, or social activities is strongly related to latelife depression.
 Somatic diseases in itself are less of a risk for
depression, except that somatic diseases are related to
disability.
 Relationship was stronger for people of 60-69 years old
than for those older than 70 years
Prevalence of depression
after major disease
 Depressive symptoms were prevalent in 38.3% of the
subjects during the post-event year; in about 19.1%,
symptoms were mild.
 Risk factors: age, smoking, poor general health, poor
well-being, and neuroticism.
Drugs & Depression
 Steroids
 Narcotics
 Sedative/hypnotics, Benzodiazepines
 Antihypertensives
 H2 antagonists
 Beta-blockers
 Antipsychotics
 Immunosuppressives, Cytotoxic agents
Geriatric depression scale
Count for symptoms
 Depressive symptoms
 Feelings of worthlessness/guilt
 Depressed or irritable mood,
frequent crying
 Suicidal thoughts or attempts,
hopelessness
 Loss of interest, pleasure (in
family, friends, hobbies, sex)
 Weight loss or gain (especially loss)
 Sleep disturbance (especially
insomnia)
 Fatigue/loss of energy
 Psychomotor slowing/agitation
 Diminished concentration
 Psychosis (i.e.,
delusional/paranoid thoughts,
hallucinations)
 History of depression, current
substance abuse (especially
alcohol), previous coping style
 Recent losses or crises (e.g.,
death of spouse, friend, pet;
retirement; anniversary dates;
move to another residence,
nursing home); change in physical
health status, relationships, roles
Treatment
 Drug Treatment
 Psychological Counseling
Delirium
In the Elderly
Confusion
 Acute brain failure associated with autonomic
dysfunction, motor dysfunction and homeostatic failure
 A disturbance of consciousness that is accompanied by a
change in cognition that cannot be better accounted for
by a pre-existing or evolving dementia
 = Acute Confusional State
Causes
 Infection
 Drugs
 Electrolytes
 Pain
Management
 Treat the precipitating cause
 Comfort the patient
 Avoid accidents
 Restraints
 Chemical Sedation
Anxiety
In the Elderly
Geriatric Giant
 Twice as common as dementia
 4-8 x as common as major depression
 Causing significant impact on the quality of life,
morbidity, and mortality of older adults
 10-15% of older adults
Types
 General Anxiety Disorders or specific phobia 90%
 Obsessive Compulsive Disorders, Post-traumatic stress
and Panic attacks 10%
Cognitive Symptoms
 Hyper-vigilance to threat
 Seeing oneself as vulnerable
 Perceiving the demands of life as exceeding the
available resources to cope
Risk Factors
 A lack of social supports
 A recent traumatic event
 Medical illnesses and medications
 Poor self-rated health
 Presence of another psychiatric illness (particularly
another anxiety disorder or depression)
 An early-onset anxiety disorder
 Female gender
Physical symptoms
 Restlessness
 Fatigue
 Muscle tension
 Insomnia that interfere with social or occupational
functioning
 Headaches, back pain, or a rapid heartbeat
 Short of breath, sweating, hot flushes, urine frequently
 Worry about everything
Phobias
 Persistent irrational fear of a situation, object, or
activity
 Desire to avoid the phobic situation
Drugs
 SSRI (Selective Serotonin Reuptake Inhibitors)
 Benzodiazepines
Cognitive Behavior Therapy
 For children and younger adults
Conclusion
 The brain is the most mysterious organ
 Complex, varied, inconsistent
 Need support from friends and family to persevere
 Tranquility, Serenity, Peace of Mind are the most wanted
gift of mankind