Risk factors for psycho-emotional and cognitive challenges: genetics, family history; gender; living alone; physical illness or injury; medications, poverty, trauma
1. Dementia and Alzheimers disease:
Not just forgetfulness (where are keys vs what are keys for?)
Indicators: difficulty retaining new information or handling complex tasks; reasoning ability decreases (how to handle a plumbing issue); spatial orientation (getting lost); language (losing words, mixing up words); behavior (more passive or more aggressive; suspicious/paranoid; misinterpretation of visual and oral stimuli.
Medical diagnosis: MMSE, orientation x3, memory tests; self and proxy reports; not usually for a couple of years; sometimes hard to get a diagnosis of any kind because PWD can perform well under pressure often.
Stages: new way of approaching: MCI or dementia; not as many stages. MCI does not always develop to full-fledged dementia.
Different types: vascular, Parkinsonian, HIV/AIDS; concussion-related; Loewy-body; early onset (develops faster, more in steps than down-slope). Some good days, some bad days; three + caregivers; ten years on average until death.
2. Substance Abuse
What substances are we talking about?
Spotlight on alcohol: What is problem drinking?
Age-related; older adults process sugar differently.
Other illnesses and medications can mask drinking
Self reports: unreliable; usually under reporting
Early onset alcoholism: starts young; health issues and social issues (family and friends fall away), employment issues
Late onset: Usually related to a difficult transition. Denial is a greater issue.
Indicators: Falls, forgetfulness, sleeplessness; disheveled, hygiene, belligerence, falling asleep
Risks for alcoholism: runs in families; socio-cultural factors; isolation and depression; economics: access and spare income.
Race and ethnicity are related only in terms of socio-economic and education, not race and ethnicity as stand-alone factors
Long-term effects: liver, cognitive impairment; lungs; blood diseases; malnutrition.
Treatment approaches
Harm reduction vs abstinence
Approaches: Detox, rehab, in-patient/out-patient, individual counseling, 12-step, group, outward bound, etc.
3. Elder abuse
Definitions: abuse, neglect, self neglect
Most common types: neglect, then emotional/psychological, financial (stealing and exploitation), then one quarter of cases are physical abuse.
Abuse Symptoms: bruises, etc; change in behavior, self report; financial deficits.
Neglect: active and passive; by others or self.
Signs of neglect: lack of necessary care, malnutrition, unsanitary conditions, elder in poor condition but other household members are fine
Self neglect: inadequate self care and supports not in place.
Risk factors: family, poverty, stress.
Abusers: abused themselves; dependent on elder; substance abuse, mental illness.
Happens also in nursing homes; overworked staff need support, resources, self care.
Assessment: observation, interviewing alone, functioning.
Ethical dilemma: is the adult competent to make decisions about own care? Assess for competence: interview, family, doctor, legal component.
Who makes decisions is adult is no longer competent?