Transcript Seniors: What do you need to know?

SENIORS
WHAT DO YOU NEED TO KNOW?
Lynne Nash, MSW, RSW
Geriatric Mental Health Consultant
Geriatric Mental Health Consulting Services
Calgary Health Region
WHY DO WE NEED TO
KNOW ABOUT
SENIORS?
Between 2006 and 2026, the
number of seniors in Canada will
increase from 4.3 million to 8
million.
- www.alive.com, Oct/07 issue of Alive Magazine
In 1991, people aged 65 and older
made up 12% of the Canadian
population.
By 2011, this number will rise to
almost 22%.
By 2031, there will be approximately 9
million seniors, and they will account
for 25% of the total population.
Healthy Aging in Canada, p. 7
The average life span is increasing in
Canada – 100 years ago, the average
life span was 78.3 years.
It is now 84.2 years.
www.alive.com, Oct/07 issue of Alive Magazine
The 85+ group is growing 4x faster
than any other segment of the
population
From 1991 to 2001, the percentage
of Canadian seniors aged 80+
increased by 41% to 932,000.
By 2011, it is expected to have
increased another 43% to
1,300,000, the majority being
women.
Healthy Aging in Canada, p. 7
In the coming decades, seniors will comprise a larger share
of the Canadian population, growing from 3.5 million people
in 1996 to an estimated 6.9 million by 2021.
www.phac-aspc.gc.ca
By 2015, there will be more
Canadians aged 65 or older
than children under the
age of 15
Healthy Aging in Canada, p. 7
There are presently over 250,000
seniors with dementia in Canada
This number is expected to rise to
778,000 by 2031
There will be over 60,000 new cases of
dementia in Canada each year
until then
RNAO, 2003
“New diagnostic approaches which are
detecting Alzheimer’s disease at earlier stages,
the addition of the ‘baby boom’ numbers to
the aging population, and the increasing
incidence of the risk factors for Alzheimer’s
disease are causing a striking increase in the
number of younger people who are being
diagnosed with the disease.”
Alzheimer’s Society, 2006, p. 1
By 2011, almost 12,000 people in the
Calgary Health Region will require
access to services for dementiarelated concerns
This number exceeds the total
number of clients currently using
home care services
CHR
Although most seniors enjoy
good mental health, at least
20% suffer mild to severe
depression
National Advisory Council on Aging
Seniors have the highest suicide
rates of any age group
The highest suicide rate is among
single, white men aged 85 and
older and they are more likely to
succeed than females in the same
age group
Statistics Canada, 2002; RNAO, 2003
“Our civilization’s greatest
victory is that it has conquered
disease. Its greatest failure is
that it has not conquered fear
of aging.”
Jacques Seguela
HEALTHY AGING
AND
AGEISM
Healthy aging includes three components:
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Low risk of disease and disease-related
disability
High level of mental and physical functioning
An active interaction with life
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Maintaining close relationships with others
Continuing involvement in activities that have
personal meaning and purpose
Gall & Swabo, Psychosocial Aspects of Aging
“All persons confront age-specific
issues and obstacles that must be
surmounted if they are to
successfully cope with various life
stages.”
Gall & Swabo, Psychosocial Aspects of Aging
“Older Canadians are living longer and with
fewer disabilities than the generations before
them. At the same time, the majority of seniors
have at least one chronic disease or condition. . .
If [healthy aging is] left unaddressed, the aging of
the population will have far-reaching social,
economic and political impacts … that will far
outweigh the cost of investing in healthy aging
now.”
Healthy Aging in Canada, p. vi
“Older adults can live longer, healthier lives by
staying socially connected, increasing their levels
of physical activity, eating in a healthy way,
taking steps to minimize their risks for falls and
refraining from smoking. But there are real
environmental, systemic and social barriers to
adopting these healthy behaviours. Some relate
to inequities as a result of gender culture, ability,
income, geography, ageism and living situations.”
Healthy Aging in Canada, p. vii
“Ageism - discrimination based on age, especially
prejudice against older people - is common in all
societies. Ageism occurs when people believe that
enabling and promoting healthy living among seniors
is unimportant or too late to make a difference. For
example, it is widely recognized that promoting
activity is important for children and youth. There are
many initiatives designed to do just that. But there is
a prevailing attitude that it is not as important to be
physically active in later life - that it may be too late,
that the cost is prohibitive, and that the benefits aren't
as great at this stage of life. This prejudice reflects
our minimized expectations of older adulthood and
misconceptions about seniors' ongoing and future
participation and roles in society.”
Healthy Aging in Canada, p. 11
As an older adult ages, society’s
assumptions and stereotypes
greatly restrict the roles that
are available for that person.
Gall & Swabo, Psychosocial Aspects of Aging
Society’s beliefs regarding the
inevitability of decline in
health, functioning and mental
abilities as we age are
prevalent. Many older persons
themselves believe
aging = loss of “joie de vive”.
Gall & Swabo, Psychosocial Aspects of Aging
Ageism and the discrimination
it creates can increase the
vulnerability of older adults.
Assumptions about old age may
result in symptoms of trauma
being mistaken for age-related
illness.
HelpAge International, 2003
“It is time for a new vision on healthy aging – a
vision that:
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values and supports the contributions of older people;
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celebrates diversity, refutes ageism and reduces inequities; and
provides age-friendly environments and opportunities for older
Canadians to make healthy choices, which will enhance their
independence and quality of life.”
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Healthy Aging in Canada, p. vii
Why is it important that seniors stay as healthy as
possible?
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Some 69% of older Canadians provide one or more types of
assistance to spouses, children, grandchildren, friends and
neighbours
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Older Canadians make an important contribution to the
voluntary sector
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More than 300,000 Canadians 65 or older were in the labour
force in 2001
Healthy Aging in Canada, p. vi
Healthy aging can delay and minimize the
severity of chronic diseases and disabilities in
later life, thus saving health care costs and
reducing long-term care needs
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Not surprisingly, older people in vulnerable communities (Aboriginal,
economically disadvantaged groups) have the greatest chance of aging
poorly
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Chronic diseases are responsible for 67% of total direct costs in healthcare
and 60% of total indirect costs ($52 billion) as a result of early death, loss
of productivity and foregone income
Healthy Aging in Canada, p. vii
What does Canada’s older population look like?
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Canadian seniors are a highly diverse group
Men and women experience aging differently
There are huge differences between a 65-year-old and an
85-year-old, yet both are lumped into the same category
In 2001, almost 20% of the immigrant population of
Canada was over 65, significantly higher than the national
average
Although a relatively small proportion of Aboriginal
Canadians are seniors, the number is expected to rise
significantly by 2016
Healthy Aging in Canada, p. 2-3
What does Canada’s older population look like?
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More than 90% of seniors live independently in the
community and want to remain there
Only 7% of those over 65 live in long term care; this
number increases to 14% in the 75+ age group
Most seniors aged 80 or older are women, the majority of
whom live alone and are poor
Around 1/3 of Canadian seniors live alone
Healthy Aging in Canada, p. 2-3
www.phac-aspc.gc.ca
What is Healthy Aging?
“Healthy aging is ‘a lifelong process of optimizing
opportunities for improving and preserving health
and physical, social and mental wellness,
independence, quality of life and enhancing
successful life-course transitions’ (Health Canada,
2002). This definition takes a comprehensive
view of health that includes physical, mental,
social and spiritual well-being.”
Healthy Aging in Canada, p. 4
“Health is seen as a positive resource … not the
objective of living or the absence of disease”
Healthy Aging in Canada, p. 3
What is Healthy Aging?
“Promoting good mental health is increasingly recognized
as a priority in policy and program development for seniors.
By working to increase self-efficacy, self-esteem, coping
skills and social support, mental health promotion
empowers people and communities to interact with their
environments in ways that enhance emotional and spiritual
strength. It fosters individual resilience and mutual aid.
Mental health promotion also challenges discrimination
against those with mental health problems and fosters
respect for culture, equity, social justice and personal
dignity.”
Healthy Aging in Canada, p. 3-4
Social Connectedness and Healthy
Aging
“Social connectedness has a positive effect on health.
People who remain actively engaged in life and connected
to those around them are generally happier, in better
physical and mental health, and more empowered to cope
effectively with change and life transitions. Distress,
isolation and social exclusion increase substantially the risk
of poor health and loneliness, and may even act as
predictors of death.”
Healthy Aging in Canada, p. 15
Social Connectedness and Healthy Aging
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Social Support
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usually provided by family, friends, neighbours and members of
supportive organizations such as a church group
is a critical part of staying healthy physically (i.e., others provide
encouragement and support to eat regularly) and mental health-wise
Positively influences self-perceptions of health
Healthy Aging in Canada, p. 15
Social Connectedness and Healthy Aging
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Social Networks
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Much smaller than the social networks of younger
adults, as many family and friends are deceased
As they age, some seniors start to avoid making new
social contacts, as the experience of more loss is too
painful
Declining health, decreased mobility, physical changes
and sensory loss can make it very difficult for older
adults to travel to or enjoy social outings
Social activity is also influenced by poor accessibility
to public transport, substance abuse, living in poverty,
language barriers and living geographically remote
areas or far away from family
Healthy Aging in Canada, p. 17
Social Connectedness and Healthy
Aging
“Studies have consistently found associations
between loneliness and poor health … However, the
relationship between loneliness and ill-health
remains ambiguous. It is unclear whether loneliness
occur as a result of poor health or if poor health is a
result of loneliness”
A recent study found that older women experiencing
psychological stress (anxiety, feeling worthless or
hopeless) were 60% more likely to die within eight
years than those with lower stress levels.
Healthy Aging in Canada, p. 19
Social Connectedness and Healthy
Aging
Although great strides have been made to reduce
poverty amongst Canada’s seniors, those that
remain poor are more likely to be women over the
age of 80, divorced or separated, and have
immigrated to Canada
On average, women have more social connections
than men, but older women are more likely to feel
lonely, perhaps because they often outlive their
spouse by several years
Healthy Aging in Canada, p. 19-20
Social Connectedness and Healthy
Aging
Research indicates that seniors that are socially
isolated and eat alone are more unlikely to have
unhealthy eating habits and poor nutrition
Poor nutrition, especially inadequate intake of B
vitamins, contributes to cognitive decline and
dementia
Healthy Aging in Canada, p. 29
Social Connectedness and Healthy
Aging
“Living alone (for both sexes) increases the
person’s vulnerability to financial difficulty,
chronic health problems and loneliness.
Such persons commonly are in need of
financial assistance and social services, and
they are at risk for premature
institutionalization.”
Gall & Swabo, Psychosocial Aspects of Aging
The majority of seniors live in urban areas
About 10% of Calgarians and Edmontonians are
seniors (18% of those living in Victoria)
www.phac-aspc.gc.ca
www.phac-aspc.gc.ca
Healthy aging in the senior
population is seriously affected by
the 3 D’s – Delirium, Dementia and
Depression
Yet all three are often unrecognized
due to their complexity and multifaceted nature
RNAO, 2003
Lack of recognition of
Delirium, Dementia and
Depression impacts the quality
of life, morbidity and mortality
of the older client
RNAO, 2003
DELIRIUM
What is Delirium?
Delirium involves a sudden change in
behaviour, attention and/or memory
Delirium usually develops over
several hours or days
Delirium is a medical emergency
What is Delirium?
DSM-IV diagnosis:
 disturbance of consciousness with a reduced
ability to focus, sustain or shift attention
 a change in cognition or the development of a
perceptual disturbance that is not better
accounted for by a pre-existing, established or
evolving dementia
 The disturbance evolves over a short period of
time (usually hours or days) and tends to
fluctuate during the course of the day
Who Gets Delirium?
Babies and children with high
temperatures
 Adults who are very ill
 Older adults – for a variety of
reasons, they can be very
susceptible to delirium
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CHR
Delirium - Prevalence
In hospital, as many as 50-65% of
older adults become delirious, for a
variety of reasons
 Certain groups are at high risk:
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Postcardiotomy – 35%
 Post hip fracture – 40-65%
 Geriatric/neuropsychiatric patients –
40-60%
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CHR
Delirium Issues
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Commonly under-diagnosed in the
elderly
Contributes significantly to morbidity and
mortality in the geriatric age group
Associated with increased length of
hospitalization and risk of placement
Often misdiagnosed as dementia
GMHCS
Delirium Consequences
Prolonged cognitive impairment
 Cognitively, most elderly people with
delirium never return to baseline
 The longer they are delirious, the
greater the chance there will be
irreversible cognitive changes
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GMHCS
Signs and Symptoms of Delirium
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Don’t make sense when they speak
Hallucinations and delusional thinking (dead babies,
pregnant, think they’re dead, kidnapped, transported
by aliens, conspiracy theory, etc.)
Don’t pay attention to or recognize family or friends
Don’t recognize everyday objects
Forget things they’ve recently been told
Forget where they are and think they are somewhere
else
Either restless and fidgety or sleepy and unresponsive
Signs and Symptoms of Delirium
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Believe someone is trying to harm them
Imagine things, people and events that never really
occurred
Try to get out of bed, crawling over bedrails
Try to pull tubing and IV lines out
Unable to control their bladder or bowel
Become either very withdrawn or may yell or scream
or be physically aggressive
CHR
Common Medical Causes of Delirium
in the Elderly
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Alcohol – intoxication,
withdrawal
Cardiovascular – MI,
cardiac arrhythnmia,
CHF, hypertensive
encephalopathy, TIA,
cerebral embolism
Infarction, acute CVA
Infection – pneumonia,
UTI, sepsis, cellulitis,
encephalitis, meningitis
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Medications – any
medication can cause
delirium, but in
particular antihistamines, anticholinergics,
psychotropics, anticonvulsants, sedatives,
digitalis, analgesics
(opiates)
Common Medical Causes of Delirium
in the Elderly
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Metabolic – renal, pancreatic or liver compromise, anemia (silent
bleed), COPD, carbon
monoxide poisoning,
hypo- or hyper-thyroidism, hypo- or hyperglycemia, hypo- or
hyper-parathyoid states,
Addisonian crisis,
vitamin deficiency
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Physiological – epilepsy
Post-anasthesia
Primary psychiatric –
manic delirium,
catatonic excitement
Trauma (fracture)
Tumor
Caine & Grossman, 1992
Common Non-Medical Causes of
Delirium in the Elderly
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Dehydration
Decreased oxygen
High temperature
Severe pain
Moving an elderly person from one place to another (i.e.,
home to the hospital, hospital to long term care, one room to
another in hospital)
Sensory overload/deprivation
Isolation
Use of restraints
Drinking grapefruit juice – interferes with how some
medications work
CHR
The rate of diagnosis
of delirium by
medical professionals
is 20%!
CHR
For the delirium to clear,
treatment must be aimed at the
cause of the problem. If there
is more than one cause for
delirium, all the problems
need to be treated.
CHR
Psychotropic medication is
not recommended for
delirium unless there is a
specific issue, such as
aggression, and should
only be used until the
delirium clears
CHR
Delirium at End of Life
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Occurs in about 80% of cases involving terminal
illness
But – 50% of the time, if it’s the first time they’ve
had delirium, the delirium is reversible
Second time having a delirium, 26% reversible
Physician and family need to discuss whether or not
diagnostic work-up and treatment is appropriate
CHR
Questions to ask
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Current year, month
Age, birth date
Are they married?
How many children, grandchildren?
Names of husband, children, grandchildren
Where are they?
What time of day is it (lunchtime, evening, etc.)
Count backwards from 20
Say the months of the year in reverse order
CHR
CAM –
Confusion Assessment Method Instrument
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Acute onset
Inattention
Disorganized thinking
Altered level of consciousness
Disorientation
Memory impairment
Perceptual disturbances
Psychomotor agitation or retardation
Altered sleep/wake cycle
Inouye, et. al.
CAM –
Confusion Assessment Method Instrument
To have a positive CAM result, the person must display:
Presence of acute onset and fluctuating discourse
AND
Inattention
AND EITHER
Disorganized thinking
OR
Altered level of consciousness
Inouye, et. al.
DEPRESSION
Prevalence of Depression
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15-27% of those over 65 living in the community
have depressive symptoms
Only 1-3% actually diagnosed with major depression
Prevalence may be much higher than studies indicate,
especially in long term care centres (up to 47%)
46% of those with Parkinson’s disease suffer from
depression
60% of stroke patients develop depression
45% of hospitalized medically ill elderly are
depressed
25% of people with Alzheimer’s are depressed
GMHCS
Prevalence of Depression
Many seniors with undiagnosed and untreated
depression are admitted to long term care, bringing
their chronic depression with them
Survival rates for depressed long term residents are
10% less at six months and 15% less at one year,
compared to non-depressed residents
GMHCS
10-15% of seniors in the
community suffer from
depressive symptoms and/or
clinical depression
Healthy Aging in Canada, p. 6
Depression Risk Factors - Biological
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Female gender (2:1)
Possible genetic factors (twin studies)
Changes in neurotransmitter activity and metabolism
with aging
Dysregulation – thyroid, growth hormone, circadian
rhythm,
Overall physical and cognitive decline
Medical issues (pain, decreased mobility, respiratory
and cardiac issues)
Polypharmacy (lots of meds can cause depression)
GMHCS
Depression Risk Factors – Biological
Medical illnesses associated with depression:
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Metabolic – uremia, hypoxia, electrolyte imbalance,
dehydration, etc.
Endocrine – thyroid dysfunction, diabetes,
hyperparathyroidism, Cushing’s, Addison’s
Infections – UTI, pneumonia, TB, endocarditis, encephalitis
Cardiovascular – CHF, MI, angina
Pulmonary – COPD, malignancy
GI – malignancy (pancreas), irritable bowel syndrome, ulcer,
hepatitis
MSK – arthritis, osteoporosis, fractures
Neurological, stroke, TIA, dementia, tumors, Parkinson’s
Other – anemia, vitamin deficiencies, malignancy, sensory
loss, substance abuse
GMHCS
Depression Risk Factors – Biological
Medical illnesses associated with depression:
Vitamin D deficiency is common
among older adults
Vitamin D deficiency has been shown
to be associated with symptoms of
depression and poor cognitive
performance
Wilkins, et. al., 2006
Depression Risk Factors – Psychosocial
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Loss, loss, loss, loss – roles, financial, home
environment, bereavement (family, friends, pets),
independence, cognitive function, health
Social isolation
Previous history of depression
Cognitive distortions
GMHCS
What does depression in the elderly look like?
“Older persons with significant depression
may have fewer symptoms than the number
required by the
DSM-IV criteria”
Gallo & Rabins, 2005, p. 2
“Older adults who are physically ill are
especially at risk for inadequate treatment of
depression … depression may not be easy to
recognize”
Gallo & Rabins, 2005, p. 4
What does depression in the elderly look like?
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Irritability
Anxiety or worries
Psychomotor changes – slowing down or agitation,
complaints of having “bad nerves”
Sleep disturbance
Loss of interest in activities previously enjoyed
Lack of interest in personal care (dishevelled look)
Low energy and excessive fatigue
Difficulty concentrating and what may appear to be
cognitive impairment (misdiagnosed as dementia)
Feelings of hopelessness
What does depression in the elderly look like?
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Weepy
Loss of appetite, often accompanied with weight loss
Fixation on somatic complaints, such as digestion,
bowels, headaches, pain
Feelings of guilt or excessive preoccupation with
regrets of the past
Feeling punished
Suicidal ideation
Symptoms often coincide with life changes and have
an abrupt onset
GMHCS
What does depression in the elderly look like?
Seniors will commonly deny feelings of
sadness or feeling depressed
Although it is normal for a senior to think
about death on a regular basis, suicidal
ideation is not normal – watch for
statements such as “I might as well be
dead” or “what’s the use?”
Gallo & Rabins, 2005
Geriatric Depression Scale
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Are you basically satisfied with your life?
Have you dropped many of your activities and
interests?
Do you feel that your life is empty?
Do you often get bored?
Are you in good spirits most of the time?
Do you feel happy most of the time?
Do you often feel helpless?
Geriatric Depression Scale
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Do you prefer to stay at home, rather than
going out and doing new things?
Do you feel you have more problems with
memory than most?
Do you think it is wonderful to be alive now?
Do you feel full of energy?
Do you feel that your situation is hopeless?
Do you think that most people are better off
than you are?
Geriatric Depression Scale – Short Form
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Are you basically satisfied with your life?
Do you feel that your life is empty?
Are you afraid that something bad is going to
happen to you?
Do you feel happy most of the time?
Cornell Scale for Depression in
Dementia
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Anxiety (anxious
expression, worrying)
Sadness (sad voice,
fearfulness)
Lack of reactivity to
pleasant events
Irritability (easily
annoyed, short
tempered)
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Agitation (restlessness,
hand wringing, hair
pulling)
Slowed movements,
speech or reactions
Multiple physical
complaints
Loss of interest, less
involved in usual
activities
Cornell Scale for Depression in
Dementia
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Appetite loss, eating less
than usual
Weight loss
Lack of energy, fatigues
easily, unable to sustain
activities
Sleep difficulties – falling
asleep later, multiple
awakenings, early morning
awakening
Mood is worse in the
morning
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Feels life is not worth
living, death wishes or
suicide attempts
Poor self-esteem – selfblame, apologetic, feeling
like a failure, “I’m so
stupid”
Pessimism – anticipating the
worst
Delusions of poverty,
illness, loss
Questions to ask for Depression
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How’s your appetite?
How are you sleeping – do you have trouble falling asleep or
waking up during the night, do you feel rested in the morning?
How would you describe your mood?
Do you ever feel sad, anxious or depressed?
Do you worry about anything?
How’s your energy level, do you feel motivated to do the
things you used to enjoy or visit with others?
Do you feel guilty about anything, or as if you were being
punished?
Do you go to bed at night and wish you wouldn’t wake up in
the morning?
GMHCS
Stress can cause:
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Suppression of the immune system
Impaired decision making
Difficulty problem-solving
Hypervigilance and paranoia
Decreased perceptual and motor skills
Gall & Swabo, Psychosocial Aspects of Aging
A major sources of stress for seniors as
they age involves loss, such as loss of:
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Family, friends and pets through death
Social network due to sensory loss and/or mobility
issues
Primary control over decision-making regarding
health, mobility, living situation and finances
Occupational and/or role status
Income
Physical and sensory functioning
Home and sense of belonging
Gall & Swabo, Psychosocial Aspects of Aging
“Do not regret growing older.
It is a privilege denied to
many”
Anonymous
MEMORY –
WHEN TO WORRY!
MEMORY TEST #2
Memory problems can be due to:
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Illness
Dehydration
Poor diet
Lack of sleep
Medications
Depression
Thyroid problems
Vitamin deficiencies
Alcohol and drug abuse
Many other causes – most of which are treatable
But don’t panic – poor memory may
simply be due to:
Lack of focus (not paying attention)
 Trying to rush
 Being disorganized
 Being anxious
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Seven problems with memory
1. Transience
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“Use it or lose it”
Memories from the distant past fades
with time
Happens to most of us
Seven problems with memory
2. Absent-mindedness
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“Where are my flippin’ keys?”
“What was I just about to do?”
This is an attention problem, rather than a
memory problem – related to lack of
attention and superficial processing of
information
Seven problems with memory
3. Blocking
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Can’t remember a name or particular
word, but know “it’s on the tip of my
tongue!”
Temporarily can’t access the information
More common as we grow older
Usually nothing to worry about
Seven problems with memory
4. Misattribution




The memory is present, but we attribute it to the
wrong thing, person, place, etc.
We remember the general picture of what happened,
but fill in the details
“I remember the night we met – you wore a red dress
and had your hair cut short”
“No I didn’t – I had long hair and wore a green
dress!”
Confabulation – the “time” and “source” tags fall off
the memories, so you’re not making things up, just
misattributing them
Seven problems with memory
5. Suggestibility



We incorporate information from other
people into our memories
“Remember I told you” ruse – someone
insists they told you something, you
assume you forgot what they said and end
up taking the blame - “I guess I forgot”
More common with age
Seven problems with memory
6. Bias


Pre-existing knowledge/beliefs/feelings
influence our recall
See a group of teenage boys walking
down the street and assume they’re up to
no good - “I remember they had an angry
looks on their faces and I just knew they
were going to do something”
Seven problems with memory
7. Persistence






Can’t forget
Chronic fears, PTSD
“I remember every little detail of what
happened as if it was yesterday”
Memory works better, we remember more
detail, when we’re scared
Emotional arousal makes for stronger recall
“Natural selection” – we gain an evolutionary
advantage by remembering the things that
scare us
How to improve your memory





Pay attention!
Write it down
Repeat it out loud
Have a set spot in your home (by the door) for
items such as keys
Use word association to help remember facts
How do you know if memory issues
are becoming a problem?



They’re noticeable to others
They make it difficult for someone to manage
their daily activities
They come on after a serious illness (stroke,
head injury, heart attack), etc.
Remember
Significant memory loss is not an
inevitable result of aging. In fact, the
brain is capable of producing new brain
cells and learning new things at any age.
Recent research indicates the brain is like any
other muscle in the body: use it or lose it

Both mental stimulation and physical exercise are necessary to
keep your mind fit as you age

The more the brain is involved in new learning, the better it
works to gain, process and retain information

Seniors who walk regularly have less chance of cognitive
decline, especially executive functioning (planning, organizing
and the ability to juggle more than one task at once)

Runners can look forward to having better long-term memory
Alive Magazine, 2007
To keep the brain fit, the key
principles are:




Novelty
Variety
Constant challenge
Some of the best ways to keep fit are reading,
doing puzzles, playing cards or board games,
playing a musical instrument or painting
Alive Magazine, 2007
Harvard Medical School’s 12 tips for
keeping the brain (and memory) healthy







Get mental stimulation
Get physical exercise
Improve your diet
Improve your blood pressure
Improve your blood sugar levels
Improve your cholesterol
Consider taking a low dose of aspirin daily
Harvard Men’s Health Watch, 2006
Harvard Medical School’s 12 tips for
keeping the brain (and memory) healthy





Avoid tobacco
Don’t abuse alcohol
Maintain good mental health
Protect your head
Build social networks
Harvard Men’s Health Watch, 2006
Dementia
It is estimated that 750,000 Canadians
will have dementia by 2031
“Some people, no matter how
old they get, never lose their
beauty – they merely move it
from their faces into their
hearts”
Martin Buxbaum
Dementia - Definition

An acquired impairment in intellectual functioning in
at least two spheres:







Language
Visuospacial
Memory
Executive function
Ability to do routine tasks, recognition
Abstraction, calculation
Symptoms usually progress slowly and/or are
relatively stable over a few years, unlike delirium
Richardson, 1995
Prevalence of Dementia




5% of those aged 65
Prevalence increases significantly with age
By age 85, about 35% of individuals suffer
from dementia
By age 95, the prevalence is about 45%
GMHCS
Prevalence of Dementia
Today, one out of every 20 Canadians over the
age of 65 has Alzheimer’s disease.
Over the age of 85, the chances of having
Alzheimer’s increases to one in four.
Alzheimer Society of Canada, 2006
Types of Dementia



Alzheimer’s disease
 up until recently, thought to be the most common
type - 45-50%
 Insidious onset, progressive deterioration
Vascular dementia
 pure vascular quite rare – 5-10%
 Often a step-wise progression related to CVA’s or
TIA’s
 Often positive neuroimaging findings
 Treatable risk factors
Mixed (Alzheimer’s and vascular dementias)

now recognized as being the most common form of
dementia – 50-60%
GMHCS
Types of Dementia

Dementia with Lewy bodies



5-15% prevalence, likely underdiagnosed
Memory problems may not be an early feature
Must have two of the following early in the course
of the disease: Parkinson’s features, fluctuation
cognition, psychotic features (usually
hallucinations)
GMHCS
Types of Dementia

Pick’s disease/frontotemporal dementia








5-10% prevalence
Onset often before the age of 65
Usually only mild memory loss
Progressive behavioural change
Early loss of social judgement and empathy
Impulsivity
Loss of insight early in course
Language problems may be prominent early and
predate the dementia
GMHCS
Types of Dementia


Other – 5% (i.e., Parkinson’s disease, alcoholinduced, normal pressure hydrocephalus, MS,
HIV-related dementia, Creutzfeldt Jakob
disease, thyroid disease)
Less than 5% are reversible
GMHCS
Diagnosing Alzheimer’s disease and other
dementias





Postmortem examination of the brain to detect plaques and
tangles is the only way to identify Alzheimer’s disease with
certainty
A number of psychological and memory tests have been
developed which quite accurately (90-95%) allow a diagnosis
of Alzheimer’s disease (or other dementia) to be made
Psychological and memory testing, medical examination and
gathering of collateral information helps to identify the
appropriate dementia(s)
CAT scans and brain imaging techniques such as Magnetic
Resonance Imaging (MRI) are used to more accurately
identify what type of changes occur in the brain
Genetic testing for the “Alzheimer’s gene” is now available,
but not widely undertaken in Canada at present
- Alzheimer’s Society of Canada, 2006
The Brain
Limbic System
8
Alzheimer’s Society
9
Alzheimer’s Society
Brain Changes that Occur with
Alzheimer’s Disease



Plaques and tangles develop in the brain, in a sense choking
the cells of the brain to death. Messages in the brain cannot
get past the damaged cells and therefore cannot get from one
part of the brain to another (i.e., the back muscles send a
message to the brain that they are in pain, but the message
cannot get through to the part of the brain that deciphers the
message, so the person is unable to identify they are in pain;
rather, they become agitated “for no apparent cause” and will
even say “no” if asked if they do have pain.)
Inflammation of the brain – the body’s normal response to
trauma is to defend itself by intensifying an immune response,
unfortunately escalating the death of brain cells
Shrinkage and degeneration of nerve cells – originates in the
part of the brain responsible for thinking and memory and
eventually spreads to all parts of the brain
- Alzheimer’s Society of Canada, 2006
Alzheimer’s Disease - Early Stage






Memory loss
Time and spatial disorientation
Poor judgement
Personality changes
Withdrawal or depression
Perceptual disturbances
GMHCS
Alzheimer’s Disease – Mid-Stage









Recent and remote memory worsens
Increased aphasia (slowed speech and understanding)
Hyperorality
Apraxia (decreased ability to make the moves to do
routine tasks such as brushing teeth)
Disorientation to time and place
Restlessness or pacing
Perseveration
Irritability
Loss of impulse control
GMHCS
Alzheimer’s Disease – Late Stage










Incontinence of bladder and bowel
Loss of motor skills, rigidity
Decreased appetite and dysphagia
Agnosia (inability to recognize and identify objects)
Apraxia (can’t find the right words)
Communication severely impaired
May not recognize family members or self in mirror
Loss of most or all self-care abilities
Cognition severely impaired
Immune system depressed
GMHCS
Dementia – What to Watch For










Confabulation - making up the story or details as they go along
Minimizing and denying losses
Rambling speech
Perseveration - changing the subject continually to something
in particular
Difficulty with nouns
Difficulty with abstract word finding
Generally normal mood – can be “pleasantly confused” or can
become irritable when asked too many questions they can’t
answer
May be very suspicious as to why they are being asked
questions
“Mind your own business!”, “I’m not going to tell you”
“Yes, I know my age, but I’m not going to tell you”
GMHCS


Risk Factors for Alzheimer’s Disease
Age – with age comes a decline in the body’s
ability to repair any damage. This decline
occurs at different rates in different people.
Genetic risk factors – everyone has two sets of
genes, one from each parent. If a person gets
one “Alzheimer’s gene”, they are three times
more likely to develop Alzheimer’s. If they
carry both A. genes, they are ten times more
likely to develop Alzheimer’s.
- Alzheimer’s Society of Canada, 2006
Risk Factors for Alzheimer’s Disease

Diabetes – likely due to the blood vessel and heart
disorders, and sometimes obesity, that accompany
Type II diabetes. Also, glucose utilization is impaired
in the Alzheimer brain.
Current research is looking at new anti-diabetic drugs
used by those with Type II diabetes to help their
bodies respond to insulin, to see if they could also be
helpful in reducing the malfunctioning of the brain in
those people with Alzheimer’s disease who do not
have diabetes. There are encouraging indications that
memory and cognition could be enhanced.
- Alzheimer’s Society of Canada, 2006
Risk Factors for Alzheimer’s Disease







Mild cognitive impairment
Being female – twice as many
women than men get Alzheimer’s
(live longer, more prone to
diabetes and decline in estrogen
post-menopause)
Down’s syndrome (almost all who
live into their 40’s will develop
Alzheimer’s)
Chronic inflammatory conditions
History of clinical depression
Head injury
High cholesterol levels









Strokes or “ministrokes”
High blood pressure
Stress
Lack of physical exercise
Inadequate exercising of the brain
Unhealthy eating habits
Obesity
Low level of formal education
Low socio-economic status (these
last two may be indicative of
other risk factors in their
environment that have not yet
been identified)
- Alzheimer’s Society of Canada, 2006
The Good News
Research indicates that adopting a healthy
lifestyle is the best way to lower the
chances of developing Alzheimer’s.
Studies of identical twins have shown that
around 60% of the overall risk of
developing Alzheimer’s disease comes
from lifestyle, rather than genetic
susceptibility.
- Alzheimer’s Society of Canada, 2006
Recent research indicates that the frequent consumption of
fruit and vegetable juices may significantly reduce the risk of
Alzheimer’s disease

Seniors who consumed three or more glasses of fruit or vegetable juice per
week were 76% less likely to develop Alzheimer’s disease than those who
drank less than one glass per week

Scientists believe that antioxidants, found in high concentration in the skin
and peel of fruits and vegetables, may act to protect the brain from other
chemicals that can cause damage

Another study showed that drinking two glasses of apple juice per day
improves memory and prevents cognitive decline

Vitamins and minerals protect blood vessels from deterioration, ensuring
optimal blood flow to the brain (Alzheimer’s has been linked to poor blood
flow)
- www.alive.com, Oct/07 issue of Alive Magazine
Why is it so important to get accurate
diagnosis of dementia as soon as someone
exhibits possible signs and symptoms?
The sooner someone is diagnosed,
the sooner treatment can begin
↓
The sooner treatment can begin,
the greater the likelihood that cognitive and
memory decline can be slowed
Also, accurate diagnosis means that the most appropriate
treatment plan can be developed
Early diagnosis and treatment = ↑ quality of life
Treatment of Alzheimer’s Dementia



Aricept™ (donezipel) (cholinesterase inhibitor)
Exelon™ (rivastigmine) (cholinesterase inhibitor)
Reminyl™ (galantamine) (cholinesterase
inhibitor)


Ebixa® (memantine hydrochloride)
Basically, these medications help messages to
be conveyed from one nerve cell to the next, so
that messages have a better chance of getting
through to the right place
DIFFERENTIATING
BETWEEN DEMENTIA,
DEPRESSION AND
DELIRIUM
Is it depression or dementia?


Common disorders in the elderly
They may co-exist




Alzheimer’s disease – up to 25% experience
depression
Vascular dementia – an even higher prevalence of
depression than AD
Many symptoms overlap, making them
difficult to distinguish
Depression may cause reversible dementia
GMHCS
Is It Depression Or Dementia –
Common Symptoms

Eating changes


Dementia – usually gradual weight loss over years,
but may be a large weight increase due to
inactivity, hyperorality (frontotemporal dementia),
medications, etc.
Depression – subacute changes over weeks to
months, weight may increase or decrease
GMHCS
Is It Depression Or Dementia –
Common Symptoms

Sleep disturbance


Dementia – gradual loss of diurnal pattern over
years
Depression – subacute changes over weeks to
months


Often middle night awakening or early morning
awakening
May be excessive sleep
GMHCS
Is It Depression Or Dementia –
Common Symptoms

Mood

Dementia – may have early depressive mood; later,
mood fluctuates according to circumstances


Irritability fairly common
Depression – pervasive changes over weeks,
nearly every day



Sadness
Irritability
Loss of pleasure
GMHCS
Is It Depression Or Dementia –
Common Symptoms

Mood lability



Dementia – increases with time, often unrelated to
circumstances (laughing or crying anappropriately)
Depression – more crying, congruent with sadness
Apathy


Dementia – loss of interest and initiative without
sadness
Depression – subacute onset with sadness and
feelings of helplessness
GMHCS
Is It Depression Or Dementia –
Common Symptoms

Concentration

Dementia – usually intact until the late stages



slowly progressive changes
Person often unaware and unconcerned
Depression – subacute changes




often a major concern for the person
“Do I have dementia?”
Many “I don’t know” answers on testing
Give up easily
GMHCS
Is it depression or dementia?
Depression:
 Depressed senior exaggerates their disabilities: “I
can’t”, “I don’t know”
 Tests better than anticipated
 Inability to concentrate
 Insomnia, difficulty with
sleep onset/early morning
waking, hypersomnia
 Slow, sluggish speech
 Commonly have feelings of
guilt, worthlessness
 Ruminations common
 Suicidal ideation much more
common
Dementia:
 Senior with dementia
confabulates, minimizes and
denies losses
 Rambling speech, difficulty
with nouns
 Difficulty with abstract
word finding
 Generally normal mood
 Sleep is fragmented, often
awakens at night
GMHCS
Is it depression or
delirium?
Symptoms of depression may occur in delirium,
but depression cannot be diagnosed until the
delirium has cleared
One study showed that 42% of elderly people
sent to a psychiatric service for treatment of
depressive symptoms actually had delirium
GMHCS
What to Look for/Notice

Appearance








body frame
Size
personal hygiene
Dress
Psychomotor behaviour
Speech
Affect
Mood





Eye contact
Thought content
Perceptual disturbances
Person’s
description/percep-tion
of the problem
Cognitive state
(MMSE)
GMHCS
Differentiating Between the 3 D’s
Delirium
Dementia
Depression
Onset
Sudden/abrupt; depends
on cause; often at
twilight or in darkness
Insidious/slow and often
unrecognized; depends on
cause
Coincides with major life
changes; often abrupt, but
can be gradual
Duration
Hours to weeks
Months to years
At least 2 weeks, but can
be months to years
Alertness
Fluctuates, lethargic or
hypervigilant
Generally normal
Normal
Memory
Recent and immediate
impaired
Recent and remote
impaired
Selective or patchy
impairment, islands of
intact memory
Thinking
Disorganized, distorted,
fragment-ed, slow or
acceler-ated, incoherent
Difficulty with abstraction,
thoughts impoverished,
poor judgements, word
finding difficulty
Intact, but with themes of
hopelessness, helplessness
or self-deprecation
Perception
Distorted, delusions,
hallucinations, difficulty
distinguishing between
reality & misperceptions
Misperceptions uncommon
Intact
RNAO, 2003
MMSE (Mental Status Exam)



Needs to be administered and scored properly
When done on a regular basis, can indicate
progression of dementia
If there is a drastic change in a short period of
time and the person has not had a CVA, poor
score can indicate delirium
GMHCS
MMSE (Mental Status Exam)



Orientation: what is the year, season, month, date,
day of week, country, province, city, name of
building, room number
Registration/attention & short-term memory:
remember three words, spell “world” backwards
Language/spatial orientation & coordination: name a
pen and watch, repeat phrase, read a sentence, write a
sentence, copy a design, 3-part instruction
Molloy, 1989
MoCA (Montreal Cognitive Assessment)



Better assessment tool for mild dementia or
dementias such as frontotemporal, where
confusion and poor memory are not an issue
Picks up more subtle changes in cognition
May score 30/30 on the MMSE, yet score
poorly on the MoCA
GMHCS
WHAT ELSE DO WE NEED TO
KEEP IN MIND?
Sensory Loss


Gradual sensory loss is a “normal” part of
aging
Loss of vision, hearing, taste, smell and touch
can adversely affect a senior’s quality of life
Orzech, Social Work Today
Sensory Loss



Smell and taste play a key role in food
enjoyment and trigger feelings of hunger
Loss of smell and taste, and therefore
motivation to eat a variety of foods,
contributes to poor nutrition in the elderly
As a result of sensory loss, many seniors add
more salt and sugar to their food in order to try
to make the food taste better
Orzech, Social Work Today
Sensory Loss



Macular degeneration is the most common
age-related vision disorder affecting seniors.
People with macular degeneration are unable
to see things in the centre of their vision field
Diabetic retinopaty (blurry and fluctuating
vision) affects the sight of many seniors
Poor vision often leads to social isolation and
boredom, as it becomes impossible to read or
perform usual tasks
Orzech, Social Work Today
Sensory Loss


More than 25% of seniors over the age of 75
report problems with their eyesight, even when
wearing glasses
Poor vision often leads to social isolation and
boredom, as it becomes impossible to read or
perform usual tasks
Orzech, Social Work Today
Sensory Loss



Around 30% of seniors have significant
hearing loss
As with poor vision, hearing loss can result in
social isolation and boredom, as
communication with others, in person or over
the telephone, is so difficult
Some studies show a relationship between
hearing loss and depression, although not as
strong a connection as with vision loss
Orzech, Social Work Today
Sensory Loss
Many of those in the helping professions,
including social workers, are unaware of
the problems faced by seniors as a result
of sensory loss.
Social workers need to pay attention
when a client has a precursor such as
diabetes so that appropriate resource
information can be provided to the client.
Orzech, Social Work Today
Sensory Loss
“Nor are many social workers aware of
the connection between vision loss in
older adults and depression. Older people
with vision impairment are anywhere
from two to five times more likely to
suffer from depression than someone
without vision impairment. Between ¼
and 1/3 of visually impaired elders report
a significant number of depressive
symptoms.”
Orzech, Social Work Today, p. 21
Pain

Pain issues are reported by 25-50% of seniors
living in the community and 45-80% of longterm care residents
• Diagnosis of pain in the frail elderly can be
complicated by cognitive impairment due to
delirium or dementia, cultural barriers, vision
and hearing loss, and inaccurate beliefs (“pain
is an inevitable part of aging”)
Feldt, 2005
Pain
• Diagnosis in cognitively-impaired adults is further
complicated by the fact that when they are sitting
quietly, they may forget they have pain and appear to
be “just fine”
• Seniors with cognitive impairment (dementia or
delirium) are often unable to recognize or describe
their discomfort – in other words, they are unable to
recognize their discomposure as pain and, therefore,
may deny having pain or discomfort if asked, or they
may describe their discomfort as “I hurt all over”
Feldt, 2005
Pain

Studies have shown that, with cognitively impaired
seniors, aggression, agitation or resistance to care can
be related to untreated or poorly managed pain issues

New behaviours such as aggression or agitation in
seniors with dementia may indication an underlying
infection or other medical imbalance which is causing
discomfort (i.e., urinary tract infection, constipation,
cardiac changes or prolonged discomfort from a
fracture)
Feldt, 2005
Pain
• The cognitively-impaired senior may deny discomfort
and present with non-verbal symptoms such as:
•
•
•
•
•
•
•
•
•
facial movements (grimacing, frowning, raising cheeks)
Body movements (bracing, guarding, rubbing, touching)
Vocalizations (moans, groans, yelling, shouting)
Poor appetite
Sleep disturbance
Depressed mood
Agitated behaviour
Withdrawn
Weepy
Feldt, 2005
Pain
• If left untreated, pain issues can have serious
consequences, including depression, isolation,
sleep disturbance, impaired ambulation and
slowed healing
• Treatment includes treating underlying
medical issues, finding the right analgesic for
the type of pain and the correct dosage
Feldt, 2005
Sleep Issues


Sleep issues are a common complaint amongst
seniors, yet they are rarely diagnosed or treated, even
by geriatric specialists – despite the fact that sleep
disorders can have harmful effects on healthy aging
“Sleep disturbances among the elderly are associated
with significant morbidity and mortality and increase
the risk for nursing home placement”
McCall, 2004, p. 9
Sleep Issues


“Sleep disturbances in the elderly, and the subsequent
disruption of caregivers’ sleep, exact a toll on family
support. Insomnia has been cited as a primary factor
in caregivers’ decisions to institutionalize an elder,
with … 52% of admissions to long-term care directly
attributable to elderly sleep disturbance.”
“A survey of 1855 elderly urban residents found that
insomnia was the strongest predictor among males for
both mortality and nursing home placement”
McCall, 2004, p. 10
Sleep Issues

Sleep disturbance can contribute to cognitive
decline and, if unrecognized, becomes another
factor that can impair accurate diagnosis of
dementia (i.e., person gets a diagnosis of
dementia, rather than insomnia and the sleep
disorder goes unrecognized and untreated)

Staying asleep is more of an issue with older
adults than falling asleep
McCall, 2004
Sleep Issues

There are no guidelines regarding how much sleep is
appropriate for older adults

Even healthy seniors tend to spend more time resting
in bed then younger adults, with no more time spent
sleeping

Studies show that older adults often spend more time
in light sleep and less time in deep sleep than younger
adults
McCall, 2004
Sleep Issues


Insomnia is often a “side effect” of chronic
disease, poor physical health or psychosocial
issues
Sleep disturbance in the elderly is strongly
correlated with depression
McCall, 2004
Common Causes of Sleep Disturbance



Caffeine
Nicotine
Perscription drugs (beta
blockers, decongestants,
thyroid medications,
corticosteroids,
antidepressants,
chemotherapy,
benzodiazepenes

Sleep disorders (sleep
apnea, periodic limb
movement disorder,
nocturnal myoclonus,
restless legs syndrome,
circadian rhythm sleep
disorder, rapid eye
movement behavioural
disorder)
Common Causes of Sleep Disturbance





Pain
Neurological disease
(Parkinson’s,
Alzheimer’s)
Chronic medical illness
(arthritis, cardiovascular
disease, gastrointestinal
disease, asthma, COPD)
Thyrotoxicosis
Daytime napping








Depression
Anxiety
Life stressors
Bedtime worrying
Mania or hypomania
Environmental causes
Noise
Eating or exercise
before bedtime
Treatment of Sleep Disturbance
Studies have shown that the use of sleep
medications could be reduced by 74% if nonpharmacological sleep protocols are used on
a regular basis, such as:
 back rubs
 warm drink
 relaxation tapes, etc.
CHR
SAMPLE CASES
Case #1:
A 78-year-old widow presents with insomnia. Her medical
history includes hypertension, diabetes, possible Crohn’s
disease, recurrent urinary tract infections, cataracts and
bilateral knee replacement surgery a number of years ago. She
denies any psychiatric history.
Mrs. Smith lives alone in her own home. For the past five years,
she has cared for her ailing husband, until his death one month
ago. She admits that looking after him was a strain and, at
times, she “could hardly stand it”.
Since her husband’s death, she has stopped going to church and
no longer socializes with friends. She is alert and oriented, but
appears to be stressed. Her MMSE score is 25/30; she lost
points on orientation and concentration. She denies feeling
depressed, but scored 15/30 on the Geriatric Depression Scale.
Gall, Clinical Geriatrics
Case #2:
Mr. Johnson is a 90-year old gentleman who lives at home with
his wife. Mrs. Johnson has had health problems for many years
and he has been her main caregiver.
Mr. Johnson was admitted to hospital for further investigations
following a fall. While in hospital, he was confused, resistive to
care, rambling incoherently and did not recognize family
members. Family were reassured that this was his “dementia”.
Family were perplexed, as they had not noticed much confusion
or serious cognitive impairment prior to his hospitalization.
They were reassured that he had probably been “covering up”
his deficits for some time. Family were told that Mr. Johnson
was not safe to look after his wife. Therefore, the decision was
made for long term care.
Case #3:
An 82-year-old widow presents with memory problems and
symptoms consistent with major depressive disorder. She is
having difficulties with independent functioning, so admission to
hospital is arranged for further work-up and treatment.
Her medical issues include arthritis, hypothyroidism, glaucoma
and NIDDM. Two months ago, she had a fall, resulting in a
compression fracture, so Tylenol #3 is started for pain. Other
medications include Synthroid, multivitamin and Pilocarpine
eye drops. To treat the depressive features, an anti-depressant is
also started.
Not long after admission, she begins to complain of hearing
music. Confusion and distress is evident – she claims she is
about to give birth, blood is everywhere, the head is crowning.
She appears to be restless and is awake throughout the night.
GMHCS
Case #4:
Mr. Jones is an 87-year-old gentleman with mild dementia. He had been
through a difficult period of adjustment since his admission to the nursing
home several months earlier. He wa critical of staff, impatient with his
roommate and plagued by insomnia.
One night at 3:00 am, he woke up, put his clothes on over his pajamas and
went to the dining room for breakfast. When staff tried to orient him, he
exploded in anger and accused them of trying to make him look like a fool.
He refused to go back to bed and paced the halls until morning. Staff who
changed his sheets noticed that, for the first time since admission, he had been
incontinent of urine.
On reviewing his chart, it was noted he had been started on Oxazepam for
insomnia 5 days earlier. He was not cooperative with a physical exam and
refused to answer mental status questions, complaining bitterly that this was
an infringement of his rights.
The oxazepam was discontinued. Two weeks later, however, Mr. Jones had
deteriorated further. He appeared disheveled, swore at staff and shook his
fist at them whenever they tried to approach him. During the afternoon he
slept for hours and was difficult to rouse. He started complaining of bugs in
his room.
GMHCS
CONCLUSIONS –
WHAT TO KEEP IN MIND
WHEN YOUR CLIENT IS A
SENIOR
“Age is an issue of mind over
matter. If you don’t mind, it
doesn’t matter.”
Mark Twain
It is extremely important to obtain
an accurate picture
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You need to get an accurate sense of what this senior
was like before you met them so that you can
determine whether there has been a sudden change
While respecting privacy and confidentiality issues:
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gather collateral information from as many sources as
possible (i.e., medical history – do they have a history of
delirium, depression, UTI’s, etc.)
Talk to different sources - the client, family members,
supports in the community, etc.
If possible, visit their home to get a better idea of what their
day-to-day functioning is like
It is extremely important to obtain
an accurate picture
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Be aware of the potential for adverse cognitive
effects/change in behaviour from many
medications, infection, other medical
imbalance, pain, constipation, poor nutrition,
etc.
Consider the signs and symptoms you are
seeing in context with the senior’s history
Don’t jump to conclusions!
Create opportunities for
honest, sincere dialogue
Ask appropriate questions
Be aware of your biases and
society’s biases
Create opportunities for
honest, sincere dialogue
Ask appropriate questions
Be aware of your biases and
society’s biases
Most seniors – and their families –
don’t know where to go for help, who
to talk to or how to ask for help
They’re from a generation that
never asked for help for anything
They’re also ashamed to admit
they have a “problem”
Assess the capabilities of
their existing support system
Refer to an appropriate
professional for more
thorough assessment,
supportive counselling, etc.
Social workers can provide
appropriate and accurate
information to seniors and their
family so they can make informed
choices
Provide opportunities to
discuss the benefits and risks
of choices
You may encounter situations
where a senior obviously needs
help, yet refuses any type of
support
In such a situation, risk of harm (to self and
others) needs to be properly assessed.
It may be necessary to have a competency
assessment done.
If unsure what to do, discuss the
case with other qualified personnel
Health regions have ethics boards
and most are more than willing to
discuss a case
If risk of harm to self or others is
apparent, it may be necessary to
complete a Form 1 to have the person
committed to hospital or psychiatric
service for assessment
Find out what resources are
available for seniors in your
community
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Local Health Authority - Seniors’ Health
Family physician (should know who to refer to for
assessment, physician referral usually necessary for
geriatric &/or psychiatric assessment)
Alzheimer’s Society
Community support agencies
Grief support programs
Competency assessment teams
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Local Health Authority - Seniors’ Health
Family physician (should know who to refer to for assessment, physician referral usually
necessary for geriatric &/or Specialized Geriatric Services
There are a number of geriatric services available. Clients seen within these services are
typically frail, complex older adults who present with deterioration in their functional status.
This deterioration may either be on a physical, cognitive or a mental health basis, or a
combination of the three. These individuals generally have a number of underlying chronic
conditions. The client’s family and support system are often included in the services offered.
Components to the services include both inpatient and outpatient geriatric services.
Referrals to any of the following services is centralized though a One Line Referral Service.
Family physicians, Home Care Coordinators and others use a common referral form to access
any one of these services. Referrals are triaged by Seniors Health professional staff. General
information about these services is obtained by calling 267-2991 or 943-3453.
Geriatric Consultation Services
Substance Abuse in Later Life (SAILL)
Mental Health Geriatric Team
Alzheimer and Dementia Resource Clinic (ADRC)
Calgary Fall Prevention Clinic
Cognitive Assessment Clinic
Carewest Day Hospital
Carewest Comprehensive Community Care (C3)
Inpatient geriatric assessment and rehabilitation units
Inpatient geriatric consultation services
Alzheimer’s Society
Community support agencies
Grief support programs
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Mental Health & Addictions Services
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Geriatric Programs & Services
Access Mental Health
Calgary Health Region at Sunridge Mall
Community Geriatric Mental Health Services
Geriatric Mental Health Acute Inpatient, Unit 48 RGH
Geriatric Mental Health Consulting Service
Geriatric Mental Health Outreach Team
Geriatric Rehabilitation & Recovery Unit
South Calgary Health Centre
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Geriatric Services Educational Series
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For information on any of the services listed call
Access Mental Health @ 943-1500
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Mental Health & Addictions Services
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Rural Programs & Services
Access Mental Health
Airdrie Mental Health Clinic
Black Diamond Mental Health Clinic
Bow Valley Mental Health Clinic
Chestermere Mental Health Clinic
Claresholm Centre for Mental Health & Addictions
Claresholm Mental Health Clinic
Cochrane Mental Health Clinic
Didsbury Mental Health Clinic
High River Mental Health Clinic
Nanton Mental Health Clinic
Okotoks Mental Health Clinic
Shared Mental Health Care, Rural South
Strathmore Mental Health Clinic
Vulcan Mental Health Clinic
Rural South Community Mental Health Workshops
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For information on any services listed call Access Mental Health @ 943-1500
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Especially for Seniors
Programs & Services
Capital Health has published a guide listing the programs and services it
provides for seniors. For a copy of this pdf click here
As well, we've gathered resources and links relating to the health information
needs of seniors and their caregivers. Use the topic links below to browse for
health information that interests you. Or find out about programs and services
of interest to seniors by using the link to the right.
Information is available on topics such as keeping fit, eating to stay healthy,
and living safely at home. Additionally, there is information about some
disorders and conditions that you might have questions about.
Community Care Services provides an integrated system of health and
personal support services to clients based on assessed need. Our services are
provided in clients' homes, and through a variety of supportive living
environments and continuing care facilities.
Community Care Access
The first point of contact is to call Community Care Access (known formerly as
Information and Intake) at 496-1300. Community Care Access provides
telephone screening and needs assessment 24 hours a day, seven days a week.
Ensure you’re part of the solution,
not part of the problem:
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Deal with any issues presented by a senior, rather
than ignoring them
Be aware that seniors often feel disenfranchised,
ignored and of little value in today’s society
Talk about seniors and their plight whenever possible,
in order to battle society’s general lack of awareness,
lack of understanding, apathy, ambivalence and
tendency to “put blinders on” whenever the issues of
the elderly are mentioned
Remember:
The elderly, like all other human beings, deserve the
opportunity to live as comfortably and contentedly as
possible
They also have the right to take risks
Even those seniors with advanced dementia can have
their quality of life improved by proper care and
attention
Unlike younger adults, seniors are much more likely to
need your help to ensure their needs are met
Therapies, etc.
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Reminiscence therapy
Cognitive behavioural
Motivational interviewing
Solution-focused
Bibliography
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Alexopoulos, G.B., et. al., Cornell Scare for Depression in Dementia,
1988, pp. 271-284
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Brink, T.L., et. al., Screening Test for Geriatric Depression, Clinical
Gerontologist, Vol. 1, No. 1, 1982, pp. 37-43
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Caine & Grossman, Neuropsychiatric Assessment, in Birren, Sloane &
Cohen, eds., Handbook of Mental Health and Aging, 1992
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Gallo, J.J., et. al., Handbook of Geriatric Assessment, Gaithersburg, MD: Aspecn Publications, 1995
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Biological Psychiatry, Vol. 23,
Inouye, S.K., et. al., Clarifying Confusion: The Confusion Assessment Method – a
New Method for Detection of Delirium, Annual of Internal Medicine, Vol.
113, pp. 941-948
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McCall, W.V., Sleep Disturbance in the Elderly: Burden, Diagnosis, and
Treatment, Primary Care Companion, Journal of Clinical Psychiatry,
Vol. 6, No. 1, 2004, pp. 9-20.
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Molloy, W., Standardized Mini Mental State Examination, Ontario: New Grange Press, 1989
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Orzech, D., Sensory Loss in Aging, Social Work Today, Vol. 7, No. 1, p. 20
Bibliography
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www.aafp.org
American Academy of Family Physicians
Gallo, J.J. & Rabins, P.V., Depression Without Sadness:
Alternative Presentations of Depression in Late Life,
American Family Physician, September 1999
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www. ajgponline.org
American Journal of Geriatric Psychiatry
wilkins, C.H., et. al., Vitamin D Deficiency is Associated
with Low Mood and Worse Cognitive Performance in Older
Adults, Vol. 14, December 2006, pp. 1032-1040
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www.alive.com
Alive Magazine (October 2007)
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www.alzheimer.ca
Alzheimer’s Society of Canada
A Report on Alzheimer’s Disease and Current Research
(2006)
Bibliography
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www.calgaryhealthregion.ca
Calgary Health Region website
Mental Status Exam – learning module
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www.clinicalgeriatrics.com
Clinical Geriatric Journal
Gall, J.S. & Szwabo, P., Psychosocial Aspects of Aging
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www.health.harvard.edu
Harvard Medical School
Harvard Men’s Health Watch, Vol. 10, No. 10 (May 2006)
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www.mocatest.org
Montreal Cognitive Assessment Tool (MoCA)
Bibliography
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www.phac-aspc.gc.ca
Public Health Agency of Canada, Aging and Seniors
Statistics re seniors
Healthy Aging in Canada: A New Vision, A Vital
Investment, From Evidence to Action – A Background Paper
Prepared for the Federal, Provincial and Territorial
Committee of Officials (Seniors)
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www.rehabilitation-director.advanceweb.com
Advance Online Editions for Directors in Rehabilitation
Feldt, K.S., Pain in the Elderly, Issue date 10/3/2005
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www.rnao.org
Registered Nurses Association of Ontario
Screening for Delirium, Dementia and Depression in Older
Adults, Nursing Best Practice Guidelines, November 2003
Caregiving Strategies for Older Adults with Delirium,
Dementia and Depression in Older
Adults, Nursing Best
Practice Guidelines, November 2003