Psychiatry 精神病学 Wang Keqin Jining Medical College Jinig Medical College
13.Psychiatry of old age Jining Medical College
Knowledge needed to work effectively with elderly patients Normal aging:biological,psychological,and social changes Mental disorders predominantly observed in later life,including Alzheimer's disease, related dementias,late-onset psychoses Effects of age on other psychiatric disorders,including mood and anxiety disorders Adjusting psychiatric treatments for aging changes:dose and schedule of psychoactive medications,drug-drug interactions,format and pace of psychotherapy Managing social and physical problems of later life:bereavement,role loss,pain, sleep disturbance Interactions of psychiatric and medical-surgical illnesses and their treatments Jinin Medical College
Changes with ageing Clinical consequences CNS CNS reased risk of organic confusion high- neration Increased lens rigidity Anterior hom cell loss Dorsal column loss eity and ay and pak expiratory flow ve volume Reduced immune function Cardiovascular system Reduced elasticity of conduit/ Increased risk of postural 8re8sedhskofatnalftonlation Endocrine system function gee88ec6mpared Renal system RonalsYeitdbalance Increased risk of Gastrointestinal system aecnshalsystem Bones Bones Reduced bone mineral density Increased risk of osteoporotic fracture
ENVIRONMENTAL ENRICHMENT AGING PLASTICITY NEUROTROPHIC FACTORS CELLS AND SYNAPSES: NEUROTRANSMITTER neurogenesis SYSTEMS: gliogenesis synthesis cell survival release 、 dendritic branching receptors synaptogenesis transporters M NEURONAL CIRCUITRY ACTIVITY BEHAVIOUR learning and memory motor activity
13.1.Assessment ■History ■Investigation ■Social assessment ■Full blood count ■Examination ■Urea and electrolytes ■Blood sugar ■Liver function ■EEG ■CT Jining Medical College
Functional complaints common to elderly persons Complaint Comment Sleep disturbance Reduced total sleep time Increased sleep latency More frequent awakenings More time spent in bed Reduced sleep efficiency Reduced appetite Reduced energy expenditure Reduced activity Exacerbated by diminished taste and olfactory sensation, poor dentition,or unappealing diet Reduced energy, Exacerbated by chronic illness,especially obstructive lung fatigue disease and heart failure Also exacerbated by B-blockers,clonidine,a-methyldopa, anticonvulsants,and benzodiazepines Impaired Normal forgetfulness may be experienced as a symptom concentration and Exacerbated by sensory losses,especially diminished vision memory and hearing Exacerbated by medications with central anticholinergic effects
History Slow down the pace;Ensure the patient can hear. Establish the speed of onset of the illness. If the presentation is vague,perform a systematic enquiry ■Obtain full details of: all drugs,especially any recent prescriptions past medical history,even from many years previously ■usual function (a)Can the patient walk normally? (b)Has the patient noticed memory problems? (c)Can the patient perform all household tasks? Confirm information with a relative or carer and the general practitioner,particularly if the patient is confused or unable to communicate. Jining Medical College
Social assessment ■Home circumstances Living alone or with another. Activities of daily living (ADL) Tasks for which help is needed: domestic ADL:shopping,cooking,housework personal ADL:bathing,dressing,walking Informal help:relatives,friends,neighbours Formal social services:home help,meals on wheels ■Carer stress Jining Medical College
Examination Thorough to identify all comorbidities Tailored to the patient's stamina and ability to cooperate Includes functional status: ■cognitive function ■gait and balance ■utrition ■nearing and vision Jining Medical College