GERIA

• Mental health and emotional well-being are as important in older age as at any other time of life, according to WHO
• Neuropsychiatric disorders among the older adults account for 6.6% of the total disability for this age group, according to WHO
• Approximately 15% of adults aged 60 and over suffer from a mental disorder, according to WHO
• The most common neuropsychiatric disorders in this age group are depression and dementia, according to WHO
• Anxiety disorders affect 3.8% of the elderly population, according to WHO
• Substance use problems affect almost 1% and around a quarter of deaths from self-harm are among those aged 60 or above (often overlooked or misdiagnosed), according to WHO
• Risk Factors for mental health problems among older adults

  • Inability to live independently because of limited mobility
  • Chronic pain
  • Frailty
  • Experience events such as bereavement
  • A drop in socioeconomic status with retirement or a disability
• All of these factors can result in isolation, loss of independence, loneliness and psychological distress in older people
• Depression


  A clinical syndrome characterized by low mood tone, difficulty thinking, and somatic changes precipitated by feelings of loss or guilt
• Dysthymia


  Persistent mild feelings of sadness but doesn't meet the criteria for diagnosis of clinical depression
• Dysthymia keeps the elderly from functioning well or from enjoying life to the fullest, and elderly may benefit from increased socialization & involvement with others
• Emotional symptoms of depression


  • Sadness
  • Diminished ability to experience joy in life
  • Inability to concentrate
  • Recurrent thoughts of death
  • Excessive guilt over things that happened in the past
• Physical symptoms of depression

  • Body aches
  • Headaches
  • Pain
  • Fatigue
  • Change in sleep habits
  • Weight gain or loss
• Major Depression


  Manifestation of at least 5 of the following: Depressed mood, Sleep (insomnia or hypersomnia), Interest (diminished pleasure), Guilt, Energy (fatigability), Concentration, Appetite (change in weight), Psychomotor (retardation or agitation), Suicide (suicidal thoughts or attempts, or recurrent thoughts of or desire for death with or without a plan)
• Dementia is a syndrome characterized by chronic deterioration of memory and loss of other cognitive functions to the extent that it interferes with normal activities of daily living
• Differences between Dementia & Depression

  • Onset (Dementia - Slow, Depression - Rapid)
  • Duration (Dementia - Long, Depression - Short or Long)
  • Night Symptom (Dementia - Frequently worsens, Depression - Does not worsen)
  • Cognitive Functions (Dementia - Stable, Depression - Variable)
  • Mood (Dementia - Labile, Depression - Depressed)
  • Behavior (Dementia - Labile, Depression - Slowed thought & motor processes)
  • Physical Causes (Dementia - Rare, Depression - Possible)
  • Suicidal Ideation (Dementia - Rare, Depression - Common)
  • Low Self-Esteem (Dementia - Rare, Depression - Common)
• Validating therapy (VT)


  A new approach to dealing with clients with dementia, where validating means respecting the feelings of the person & confirming that, from the individual's perspective, the experience is true
• Purposes of Validation


  • To decrease stress
  • To promote self-esteem
  • To encourage communication
  • To reduce chemical & physical restraint usage
  • To sustain independent living for a longer period of time
• Alzheimer's Disease


  The most common form of dementia, a progressive, irreversible, degenerative disease attacking the brain & resulting in impaired thinking, behavior, movement coordination and memory
• Risk factors associated with Alzheimer's disease (AD)

  • Lack of education
  • Smoking
  • Lack of physical activity
  • Depression
  • High BP @ midlife
  • Diabetes
  • Obesity
• Etiology of Alzheimer's Disease


  Unknown, but it is believed that reduced level of certain brain chemicals cause degeneration of nerve cells in the part of the brain responsible for memory & other thought processes, which can be due to intrinsic causes like viruses/infections and genetics, or extrinsic causes like exposure to metals
• Clinical Manifestations of Alzheimer's Disease

  • Significant forgetfulness (problems with long & short term memory, inability to remember details of one's personal life)
  • Impaired cognitive functioning (persons with MCI have complaints and objective evidence of memory problems but do not have deficits in ADL and do not meet the criteria for dementia)
  • Difficulty in performing familiar tasks; misplacing objects constantly
  • Decline in social functions
• Stages of Alzheimer's Disease

  • Stage 1 - Normal (no objective nor subjective evidence of cognitive impairment, but subjective concern about memory loss)
  • Stage 2 - Forgetfulness (can do familiar tasks in familiar settings)
  • Stage 3 - Early confusional (decreased ability to perform in demanding employment and social interactions, deficit in memory and ability to concentrate)
  • Stage 4 - Late confusional (increasing difficulty in performing complex tasks of daily life including money management, can bathe, dress, & travel in familiar settings, trouble speaking may begin)
  • Stage 5 - Early dementia (no assistance required with eating or toileting, can recall own name and name of spouse & children, unable to recall phone number, difficulty choosing proper clothing, may require coaxing to bathe, difficulty subtracting 3's from 20)
  • Stage 6 - Mid dementia (more deliberate gait, smaller steps, progressive deficits in independent dressing, bathing, & toileting, eventual urinary and fecal incontinence)
  • Stage 7 - Late dementia (progressive loss of speech, locomotion, & consciousness)
• Medications for Alzheimer's Disease

  • Cholinesterase inhibitor
  • Antioxidants (Vit. E)
  • Conjugated estrogen (estradiol)
  • NSAIDs
  • Ginkgo Biloba
• Cholinesterase Inhibitor


  Increases the amount of acethylcholine which slows the mental decline in people with AD, does not prevent the disease from getting worse but may slow the progression of symptoms
• Antioxidants (Vitamin E)


  Helps prevent free radical damage to the brain which can produce oxidative stress and contribute to development of AD
• Conjugated Estrogen (Estradiol)


  Increases cerebral blood flow, has anti-inflammatory action, has antioxidant properties, and promotes the nonamyloidogenic metabolism of the amyloid precursor protein
• Caring for Clients with Alzheimer's Disease

  • Promote functional independence and self-care as long as possible
  • Provide a structured, predictable daily routine
  • Institute safety measures
  • Protect client from sources of infection
  • Guard against learned helplessness
• Elder Abuse


  Doing something or failing to do something that results in harm to an elderly person or puts a helpless older person at risk of harm, according to WHO
• Types of Elder Abuse

  • Unreasonable confinement or willful deprivation of services (medical care)
  • Failing to prevent injury
  • Verbal assault
  • Demand to perform demeaning tasks
  • Theft or mismanagement of older person's money or belongings
  • Passive neglect (misuse, theft or withholding of an elder adult money, property, or valuables by another, to the older adults disadvantage)
  • Sexual abuse (nonconsensual sexual contact of any kind with an older adult)
  • Neglect (the refusal or failure of a person to fulfill any part of his or her obligations or duties to an older adult)
  • Abandonment (the desertion of an older adult by an individual who has physical custody of the elder or by a person who has assumed responsibility for providing care to the elder)
  • Self-neglect (occurs when older adults who are mentally competent enough to understand the consequences of their own decisions engage in behaviors that threaten their own safety)
• Reasons for Older Adults Being Victimized

  • Vulnerability (society believes that older adults are weak & gullible)
  • Visibility (appearance advertises age, predictability of daily routines & movements)
  • Level of dependency (increased dependency causes a greater risk)
  • Diminished senses (inability to see well enough to recognize danger, may not be able to hear enough to understand what is being said)
  • Loss of physical strength (reduces the ability to fight back)
  • Loss of cognitive ability (less able to reason rationally)
• Almost 90% of the perpetrators of elder abuse are family members – adult child, spouse, grandchildren, siblings, etc.
• Victimization Rates


  • Higher in older men
  • Higher in ages 65 – 74 than ages 75 and up
  • Higher in older persons who are separated or divorced for all types of crimes
  • Higher in older persons residing in cities compared with sub-urban or rural older adults
• Recent studies show that elderly abuse is severely underreported
• The Philippines has introduced bills to protect old women from institutional, community and domestic and sexual assault, and to establish programs and activities to aid victims of elder abuse, and provide training to health and government professionals in the assistance of such victims
• Possible signs of elder abuse


  • Unexplained bruises, burns, and injuries
  • Bed sores and poor hygiene
  • Person may become withdrawn, agitated, and depressed
  • Sudden change in the person's financial situation
• Preventing elder abuse means listening to seniors and their caregivers, intervening when you suspect elder abuse, and educating others about how to recognize and report elder abuse
• Once elder mistreatment is suspected, it should be reported to adult protective services
• Health Literacy


  The degree to which individuals have the capacity to obtain, process & understand the health information needed to make appropriate health decisions
• RA 9994, Sec. 4, par. 6 - Privileges for Senior Citizens: educational assistance to senior citizens to pursue post secondary, tertiary, post tertiary, vocational and technical education, as well as short term courses for retooling in both public and private schools through provision of scholarships, grants, financial aids, subsides and other incentives to qualified senior citizens, including support for books, learning materials and uniform allowances to the extent feasible; provided, that senior citizens shall meet minimum admission requirements