Senior Services

Mercy Jeannette Hospital

What are the primary psychiatric concerns for seniors?

• Dementia
• Depression
• Alzheimer's Disease

Dementia
Dementia is a common clinical syndrome characterized by decline in cognitive function that is sustained for months or years. Memory impairment is generally a prominent early symptom. Individuals with dementia have difficulty learning new material and may lose valuables, such as wallets and keys, or forget food cooking on the stove. In more severe dementia, individuals also forget previously learned material, including the names of loved ones. They may have difficulty with spatial tasks, such as navigating around the house or in the immediate neighborhood. Poor judgment and poor insight are common as well. Individuals may exhibit little or no awareness of memory loss or other cognitive abnormalities. To make a diagnosis of dementia, the cognitive deficits must be severe enough to impair the person's occupational or social functioning. Their decline in functioning must also be significant compared to previous levels of functioning.

People with dementia often:


• Make inappropriate jokes
• Neglect personal hygiene
• Exhibit undue familiarity with strangers or disregard conventional rules of social conduct
• Occasionally harm others by striking out
• Exhibit suicidal behavior
• Exhibit anxiety or have overwhelming emotional responses to a minor stress such as changes in routine or environment
• Exhibit a depressed mood
• Exhibit sleep disturbances independent of depression
• Have delusions, especially those involving themes of persecution (e.g., the belief that misplaced possessions have been stolen)
• Misidentify familiar people as unfamiliar (or vice versa)
• Have hallucinations (especially visual hallucinations)

Depression
Unfortunately, depression can be confused with or masked by other problems in addition to physical illness -- particularly dementia. "Pseudodementia" is a word used to describe depression in older people that often occurs following major life losses. Because its symptoms can mimic dementia (e.g., withdrawal, confusion, and memory loss), it is important to distinguish the two-a task that may require close observation over a period of time and/or professional assessment.

The American Psychiatric Association has identified the symptoms of depression. Criteria used by clinicians to diagnose a Major Depressive Episode may include the presence of five of the following symptoms during a two-week period:

• Depressed mood
• Diminished interest in activities
• Significant weight loss or gain
• Insomnia or oversleeping
• Psychosomatic agitation
• Fatigue or loss of energy
• Feelings of worthlessness, guilt or helplessness
• Difficulty in concentrating or making decisions
• Suicidal

Distinguishing clinical depression from depressive symptoms experienced as part of the normal grieving process can also be difficult. This table may be helpful in differentiating grief versus depression.

Alzheimer's Disease
Alois Alzheimer, a German physician, first described Alzheimer's disease as a disease of the brain causing memory loss and serious mental deterioration. It is the most common form of dementia. Alzheimer's disease is not just memory loss. People with Alzheimer's disease experience a decline in cognitive abilities, such as thinking and understanding, and changes in behavior. No one knows what causes Alzheimer's disease, although advances have been made in the treatment and care of people who are affected by it.

10 Warning Signs of Alzheimer's Disease
The Alzheimer's Association has developed a list of warning signs that include common symptoms of Alzheimer's disease. (Some also apply to other dementia.) If you or someone you know have several of these symptoms, contact a physician for a complete examination.

• Memory loss that affects job skills.
  It's normal to occasionally forget an assignment, deadline, or colleague's name but frequent forgetfulness or unexplainable confusion at home or in the workplace may signal that something is wrong.
  
  
• Difficulty performing familiar tasks.
  Busy people get distracted from time to time. For example, you might leave something on the stove too long or not remember to serve part of a meal. People with Alzheimer's might prepare a meal and not only forget to serve it but also forget they made it.
  
  
• Problems with language.
  Everyone has trouble finding the right word sometimes but a person with Alzheimer's disease may forget simple words or substitute inappropriate words, making his or her sentences difficult to understand.
  
  
• Disorientation to time and place.
  It is normal to momentarily forget the day of the week or what you need from the store. But people with Alzheimer's disease can become lost on their own street, not knowing where they are, how they got there or how to get back home.
  
  
• Poor or decreased judgment.
  Choosing not to bring a sweater or coat along on a chilly night is a common mistake. A person with Alzheimer's, however, may dress inappropriately in more noticeable ways, wearing a bathrobe to the store or several blouses on a hot day.
  
  
• Problems with abstract thinking.
  Balancing a checkbook can be challenging for many people, but for someone with Alzheimer's, recognizing numbers or performing basic calculation may be impossible.
  
  
• Misplacing things.
  Everyone temporarily misplaces a wallet or keys from time to time. A person with Alzheimer's disease may put these and other items in inappropriate places -- such as an iron in the freezer or a wristwatch in the sugar bowl -- and then not recall how they got there.
  
  
• Changes in mood or behavior.
  Everyone experiences a broad range of emotions -- it's part of being human. People with Alzheimer's tend to exhibit more rapid mood swings for no apparent reason.
  
  
• Changes in personality.
  People's personalities may change somewhat as they age. But a person with Alzheimer's can change dramatically, either suddenly or over a period of time. Someone who is generally easygoing may become angry, suspicious or fearful.
  
  
• Loss of initiative.
  It's normal to tire of housework, business activities, or social obligations, but most people retain or eventually regain their interest. The person with Alzheimer's disease may remain uninterested and uninvolved in many or all of his usual pursuits.

Behaviors of Alzheimer's Disease
Damage to the brain from Alzheimer's disease can cause the individual to act in different or unpredictable ways. Some with Alzheimer's become anxious or aggressive, while others repeat certain questions or gestures. Often these behaviors occur in combination, making it difficult to distinguish one from another. Behavioral problems do not always become apparent immediately after the onset of disease and often change as the disease progresses. Some of the most common problematic behaviors are:

• Agitation
• Aggression
• Combativeness
• Suspiciousness/paranoia
• Delusions
• Hallucinations
• Insomnia
• Wandering

Treatments of Alzheimer's Disease
Some behavioral symptoms are best modified without the use of medication, especially since some medications can induce further dementia symptoms. These treatments include:

• Family education and counseling. Learn what to expect from Alzheimer's disease. Turn to your local chapter of the Alzheimer's Association for educational materials, counseling and support.

• Modifying the environment. Modify the home environment. Environmental factors such as lighting, color, and noise can greatly affect behavior. Dim lighting, for example, makes some individuals uneasy, while loud or erratic noise often causes confusion and frustration.

• Planning activities. The individual should stay active for as long as he or she can and establish a routine. Daily routines such as bathing, dressing, cooking, cleaning, and laundry can be turned into productive activities. Other more creative leisure activities can include singing, playing a musical instrument, painting, walking, playing with a pet, or reading. Planned activities may relieve depression, agitation, and wandering.

Some severe behavioral symptoms may be best treated with medication. In some cases, drugs that are available for the treatment of cognitive symptoms also may improve behavioral problems. Drugs commonly used to treat behavioral symptoms, such as agitation, aggression, paranoia, delusions, or depression associated with Alzheimer's, include antipsychotics (neuroleptics), anxiolytics, and antidepressants.

The Behavioral Health Services for Seniors
In response to the unique needs of older adults, Mercy Jeannette Hospital offers a specialized behavioral health program for persons age 55 and older. The unit includes a 14-bed inpatient and acute area. Each patient has their own personalized therapy program, which includes a combination of group therapy, speech and physical therapies, medication education, wellness issues, coping skills, family therapy and stress management. To make a referral or for additional information, please call 724/527-9474. Someone is available 24 hours a day to answer questions.