Aging, Health and Mental Health CSWESAGESW Faculty Development Institute

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Aging, Health andMental Health
CSWE/SAGE-SWFaculty Development Institute
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HEALTH

• Elderly Mortality
• Health Conditions
• Medication Problems

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Leading Causes of Death Among the Elderly

• Heart Disease
• Cancer
• CAD-Stroke
• Pneumonia/Influenza
• Chronic Obstructive Lung Disease
• National Center for Health Statistics 1991

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Patient Reported Conditions

• Arthritis
• Hypertension
• Hearing Impairment
• Heart Disease
• Chronic Sinusitis

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Reported Conditions (Contd)

• Cataracts
• Orthopedic Conditions
• Osteoarthritis
• Osteoporosis
• Diabetes
• Visual Impairment
• Tinnitus

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Medication Problems

• Critical health care issuenations other drug
  problem
• Inspector GeneralDHHS
• Elderly Over-medication is epidemic
• Harvard Health Newsletter

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System Factors Contributing to Problem

• MD Inadequate Geriatric Training
• Wrong Drug and Dosage
• Inadequate Drug Tests
• Inadequate Labeling
• Polymedicine

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Additional Factors

• Polypharmacy
• Pharmacokinetics
• Absorption
• Distribution
• Excretion
• Elder Abuse and Misuse

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Extent of Problem

• 12 of Population 25 of Prescriptions
• Persons Over age 60, 40 of Adverse Drug
  Reaction
• 1/6 of age 70 hospital admissions due to
  medications

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Extent of Problem (Contd.)

• Over age 60, 15 times more likely medication
  admission
• 1986 613 million prescriptions at retail
  pharmacies (15.5 Rxs per person 40 of Rxs
  (outside of institutions)

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Most Frequently Used Prescriptions

• Heart heart related diseases
• 40 of all Rxs Over -treatment for
  hypertensionincrease in depression
• Analgesics for pain
• Implicated as possible cause for depression,
  psychosis, delirium and hallucinations
  pseudo dementia
• Tranquilizers, sleeping pills, anti- psychotic
  drugs and anti-depressants
• Most Likely to victimize elderly

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Need for Knowledge and Concern

• Physicians
• Drug Manufacturer
• Pharmacists
• Patients
• Families
• Direct Practitioners

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Practitioner Roles

• Education
• Counseling
• Monitoring Effects of Medications

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Symptoms of Adverse Reactions

• Confusion
• Forgetfulness
• Tremor
• Constipation or Diarrhea
• Loss of Appetite

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Adverse Reactions (Contd)

• Depression
• Impaired Mental Abilities
• Urinary Retention
• Dizziness
• Falling
• Weakness
• Lethargy

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Barriers to Detection

• MD sole responsibility
• Socialization of elders, family, workers
• Trust/reliance supreme in physician/patient
  relationship

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Mental Health

• Common Psychiatric Disorders
• Cognitive Disorders

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Common Psychiatric Disorders

• Depression
• Anxiety
• Somatoform Disorders
• Alcoholism and Drug Abuse
• Paranoia
• Psychosis

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Cognitive Disorders

• Delirium
• Dementia
• Possible Reversible
• Causes of Cognitive Impairment

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Features of Delirium

• Disorders of consciousness
• Disorders of perception
• Disturbances of thinking
• Disturbances of affect
• Abnormalities of movement
• Autonomic dysfunction Wells, C.E., 1976

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Components of Comprehensive Assessment

• Social
• Economic
• Physical Health
• Activities of Daily Living
• Mental Health
• Environment