Care of older persons

with Dementia and

Depression
 Progressive change in personality
 Two or more areas of cognition (e.g
memory)
 One or more of the ff:
.. language, calculation, visual/spatial
perception, judgment and
abstraction MANIFESTATIONS
THAT SHOULD NOT BE
IGNORED
Alzheimer's disease
 -progressive, irreversible,degenerative
disease attacking the brain and
resulting in impaired:
 a. thinking
 b. behaviour
 c. memory
Degeneration is attributed by the
following factors:
 INTRINSIC factors

 believe to be due to regional differences in

blood flow to the brain caused by defective
blood-brain barrier

 immunologic factors- e. g herpes simplex,

measles, polio

 Genetics- believed to have one and two

chances of carrying genes that predispose to
the development of the condition
 Extrinsic factors

 Exposure to metals aluminum

content in their blood
 Significant other/ caregivers
main concern:

 is how to reduce the impact of the

disease so clients can lead a normal
life

 For the family : demands of

caregiving can be overwhelming
Clinical manifestations of AD
 1. significant forgetfulness
problems with long term and short term
 2. Impaired cognitive functioning
either impaired executive judgment
(difficulty in abstract thinking) or
higher cortical functions
e.g
aphasia-problem expressing speech
apraxia- inability to transform
thoughts into action
agnosia- inability to recognize objects
 3. Difficulty in performing familiar
tasks; misplacing objects constantly

 4. Decline in social functions

Caring for clients with
Alzheimer's diasease
 Total care of client can be illustrated
in the ff. diagram:

Physiological and Psychosocial needs

physical needs

Limiting and managing Caregivers needs

complications
Meeting physiologic and physical
needs
 1. Keep client ambulatory as long as
possible and maintain daily
exercise program
 2. Maintain optimal
nutritional/vitamin status

 3. Protect from sources of infection

 4. maintain bladder and bowel elimination
thru routine consistent toileting
◦ -do not used catheters
◦ -anticipate elimination needs
◦ Encourage to empty bladder/bowel at scheduled
time
◦ Limit fluid intake at nightime (decrease
nocturnal incontinence)

 5. Institute safety measures

◦ Decreased mobility
◦ Floors should be free of spills
◦ Remove harful objects
◦ Do not allow to go alone or leave the house
◦ Not allowed to be alone in the kitchen
Meeting the psychosocial needs
 1. Provide cognitive stimuli to enhance
memory and orientation
 2. Use reality orientation and reality
testing skills
 3. Provide regular social interaction
 4. Maintain self-esteem through
involvement in ADL skills
 5. Maintain a structured milieu or
social environment
 6. Pay particular attention to the use
of nonverbal communication
techniques as well as verbal cues to
maintain effective communication
patterns
 7. Use behavior modification
techniques to modify negative
behavior
 8. Conduct assessment and evaluation
of the need for medications
Limiting managing
complications
 1. Difficulty in communicating with
patient especially during the advanced
stages of Alzheimer's disease

 2. Difficulty in managing the patients

behavior especially when the
environment is misperceived and
appears threatening
Caring for the caregivers
 Stages in reaction to illness
(Eliopoulos)
 1. denial
 2. over-involvement
 3. Anger
 4. guilt
 5. acceptance
exercises:
 Mr. Alfonso,a 94 year old male, has been residing
in the Hospicio de San Jose for the past ten years.
He was found wondering alone in the streets before
he was brought to the institution. He speaks only
english, though sometime he is unintelligible,
according to the caregivers, he sometimes wonders
around the neighborhood but is usually brought
back to them since he can tell his address. He
usually has interrupted sleep and will wake up at
the middle of the night, shouting: I’m late for work,
It is already nine o clock! He cannot perform his
activities of daily living, except feeding himself.
Questions:
 1. Mr. Alfonso is on what stage of
Alzheimer's disease? Support your
answer.
 2. What will be you plan of care? State
specific activities for each goal of care.
 3. What is the greatest challenge to Mr.
Alfonso’s family, given the above
situation?
 4. How can you help ease the burden of
care for the family? Give specific
strategies.
DEPRESSION
 Depression in old age is a result of a
network of multiple causes with
internal and external origins

 Characterized by : sadness , poor

appetite , sleep disturbance,
psychomotor retardation or
agitation, loss of energy
 Feelings of hopelessness,
worthlessness and guilt
accompany by above
symptoms suicidal ideation
 George (1991) identified 3 social
environmental factors contributing to
increased social stressors and decreased
social support:

 1. life events (e.g. loss of spouse)

 2. chronic stress (e.g. threat to general well
being)
 3. daily hassles (e.g. unpleasant
interaction with neighbors)
If symptoms are observed:
 Consult a physician in order to
complete the diagnostic process and
rule out the problems
Caring for clients with
depression

Goal mgt:

 1. alleviating contributory factors

a. alleviate signs and symptoms of
existing disease
b. prevent or minimize complications
or disability
c. for drugs and meds: stop
2. Alleviating depressing
symptoms
a. strong social support-treat
functional member

b. expand social circle

c. If above interventions is not

working refer to a medical
doctor
3. Improve coping skills
a. Verbalization of how client feels

b. Encourage to engage in activities he

or that she likes most

c. Place in an exercise program

4. Providing safety
 a. avoid harm to self and others
 b. comply with medications
Activity :
 Mrs. Ramos is a 75 –year old grandmother.
She was admitted to the hospital due to
extreme dizziness and intermittent vomiting.
She was found to have malignant tumor on
her left breast. In the hospital she manifested
agitation and seemed to be distracted and
confused. Not only did she not know where
she was or what time it was, she was also
unable to remember recent events, like who
just visited her. She complains of hearing
people chattering over her.
questions:
 1. Does Mrs. Ramos have dementia,
delirium or depression?
Support your answer

 2. How can you prevent depression

from occurring in an older
woman like Mrs. Santos?

 3. What are the most important

strategies for coping with
depression among older
persons?