Geriatric psychiatry „Old age” psychiatry

Содержание

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Geriatric psychiatry What is „Geriatric”? Physical, mental and social aspects Mental

Geriatric psychiatry

What is „Geriatric”?
Physical, mental and social aspects
Mental disorders in general
Different

disorders in the elderly
Psychiatric therapies in the elderly
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psychogeriatry Medical Definition of psychogeriatry: a branch of psychiatry concerned with

psychogeriatry

Medical Definition of psychogeriatry: 
a branch of psychiatry concerned with behavioral and emotional

disorders among the elderly
Medical Definition of US
The branch of healthcare concerned with mental illness and disturbance in elderly people, particularly those who have suffered distress as a result of moving into an institution.
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Aging In America www.census.gov

Aging In America

www.census.gov

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„Old age”? Gladys Burrill 92 y Honolulu Marathon 2010 Fauja Singh

„Old age”?

Gladys Burrill 92 y
Honolulu Marathon 2010
Fauja Singh 100 y
Toronto Marathon

2011
(Guinness record)
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Psychogeriatric care Psychogeriatric care is care in which the primary clinical

Psychogeriatric care

Psychogeriatric care is care in which the primary clinical purpose

or treatment goal is improvement in the functional status, behaviour and/or quality of life for an older patient with significant psychiatric or behavioural disturbance. The disturbance is caused by mental illness, age related organic brain impairment or a physical condition.
Psychogeriatric care is always:
1. delivered under the management of or informed by a clinician with specialised expertise in psychogeriatric care, and
2. evidenced by an individualised multidisciplinary management plan which is documented in the patient's medical record. The plan must cover the physical, psychological, emotional and social needs of the patient, as well as include the negotiated goals within indicative time frames and formal assessment of functional ability.
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Getting older v. living longer Mental changes Personality amplification of character

Getting older v. living longer

Mental changes
Personality
amplification of character traits
Cognition, memory
mental slowing
transformed

memory structure
summerised experiences
Emotional changes
Emotional maturity
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Getting older v. living longer Social changes Retirement (financial difficulties) Decrease

Getting older v. living longer

Social changes
Retirement (financial difficulties)
Decrease in social status
Facing

somatic and mental disfunctioning
Somatic diseases
Grief (loss of spouse, brothers or sisters, friends)
Social isolation
Moving to nursing/residential home
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What are the differences between older and younger persons with mental

What are the differences between older and younger persons with mental

illness?

Assessment is different: e.g., cognitive assessment needed, recognize sensory impairments, allow more time

Symptoms of disorders may be different: e.g., different symptoms in depression

Treatment is different: e.g., different doses of meds, different psychotherapeutic approaches

Outcome may be different: e.g., psychopathology in schizophrenia may improve with age

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Estimated Prevalence of Major Psychiatric Disorders by Age Group Jeste, Alexopoulus, Bartels, et al., 1999

Estimated Prevalence of Major Psychiatric Disorders by Age Group

Jeste, Alexopoulus, Bartels,

et al., 1999
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depression movement disorders psychosis dementia Depression with dementia (“pseudodementia”) Dementia with

depression

movement
disorders

psychosis

dementia

Depression with dementia (“pseudodementia”)

Dementia with depression

PD with depression

PDD, LBD, AD

with movement sx

PDD, LBD, AD, VaD with psychotic sx

Psychotic depression

Schizophrenia with depression

Schizophrenia with cognitive deficits

Schizophrenia with movement disorders

PDD, LBD, PD+ with cognitive deficits

med conditions & drugs

OVERVIEW: Consider main syndrome & comorbid conditions

Vascular depression with mild cognitive impairment

MCI with depression

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Mental disorders in general Biological, psychological, social factors (bio-psycho-social model) Internal

Mental disorders in general

Biological, psychological, social factors (bio-psycho-social model)
Internal medical, neurological,

psychiatric aspects
Multidimensonal approach
Polimorbidity!
Syndromatology (atypical) – etiology
Cross-sectional –long term course
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Mental disorders in the elderly Dementia Other „organic mental disorders” Affective

Mental disorders in the elderly

Dementia
Other „organic mental disorders”
Affective disorders (depression)
Delirium
Delusional disorders

(psychosis)
Anxiety disorders
Substance abuse disorders
Psychiatric patients getting old
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Dementia - Syndromatology Chronic course (10% above 65 y, 16-25% above

Dementia - Syndromatology

Chronic course (10% above 65 y, 16-25% above 85

y)
Multiple cognitive deficits incl. memory impairment (intelligence, learning, language, orientation, perception, attention, judgement, problem solving, social functioning)
No impairment of consciousness
Behavioural and psychological symptoms of dementia (BPSD)
Progressive - static
Reversible (15%) - irreversible
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Dementia - Classification Severity Mild cognitive impairment (MCI) Mild dementia Moderate

Dementia - Classification

Severity
Mild cognitive impairment (MCI)
Mild dementia
Moderate dementia
Severe dementia
Localization
Cortical
Subcortical
Etiology

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Dementia -Etiology Alzheimers disease (60-70%) Vascular dementia (10-20%) Neurodegenerative disorders (Pick,

Dementia -Etiology

Alzheimers disease (60-70%)
Vascular dementia (10-20%)
Neurodegenerative disorders (Pick, Lewy body dis,

Parkinson, Huntington, etc.)
Drugs and toxins
Intracranial masses
Anoxia
Trauma
Infections (JCD, HIV, etc)
Nutrition
Metabolic
Pseudodementia
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Memory impairment; and one of the following four items: Apraxia Aphasia

Memory impairment; and one of the following four items:
Apraxia
Aphasia
Agnosia
Abstraction and

other executive functioning
plus
Absence of clouding of consciousness
Ability to function is impaired

“MA6” Mnemonic for Dementia

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Prevalence: about 10% of those in aged 70-79 to nearly 20% aged 80-89

Prevalence: about 10% of those in aged 70-79
to nearly

20% aged 80-89
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Neuropsychiatric Symptoms of MCI (Lyketsos et al, 2002; Geda et al,

Neuropsychiatric Symptoms of MCI (Lyketsos et al, 2002; Geda et al, 2008)

Depression:

20% to 27% (1/4)
Apathy: 15 to 19% (1/6)
Irritability: 15 to 19% (1/6)
Psychosis: 5% (1/20)

Movement Disorders and MCI(Aarsland et al, 2009)
20% of PD patients have MCI (1/5)
(twice normal group)

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Vascular Dementia Pure AD and VaD may be rare. AD is

Vascular Dementia

Pure AD and VaD may be rare.
AD is multifactorial.
Similar risk

factors: cholesterol, APOE4, DM, HTN.
Vascular pathology may contribute to cholinergic abnormalities in both disorders(cholinesterase inhibitors may help with both).

cholinergic deficits in cortex

Pure VaD

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Graphic representation of the proposed staging framework for preclinical AD

Graphic representation of the proposed staging framework for preclinical AD

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Major Neurocognitive Disorder: The DSM-5’s New Term for Dementia Major neurocognitive

Major Neurocognitive Disorder: The DSM-5’s New Term for Dementia

Major neurocognitive disorder

is a decline in mental ability severe enough to interfere with independence and daily life.
Dementia vs. Neurocognitive Disorder
The word "dementia" is related to a Latin word for "mad," or "insane." Because of this, the introduction of the term neurocognitive disorder attempts to help reduce the stigma associated with both the word dementia and the conditions that it refers to
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Symptoms of Alzheimer's Disease According to the DSM-5, there are three

Symptoms of Alzheimer's Disease

According to the DSM-5, there are three Criterion

for Alzheimer's Disease:
A. The diagnostic criteria for major or minor neurocognitive disorder is fulfilled,
B. Insidious onset and gradual decline of cognitive function in one or more areas for mild neurocognitive disorder, or two or more areas for major neurocognitive disorder, and
C. The diagnostic criteria for either possible or probable Alzheimer's Dementia are fulfilled, as defined by the following:
Presence of causal Alzheimer's Dementia genetic mutation based on family history or genetic testing.
The following three indicators are present:
1. Decline in memory or learning, and one other cognitive area, based on history or trials of neuropsychological testing
2. Steady cognitive decline, without periods of stability, and
3. No indicators of other psychological, neurological, or medical problems responsible for cognitive decline.
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Alzheimer's Disease Prevalence According to the DSM-5, the prevalence of Alzheimer's

Alzheimer's Disease

Prevalence
According to the DSM-5, the prevalence of Alzheimer's Disease is

5-10% in persons in their seventies, and 25% for those age 80 and over (American Psychiatric Association,
2013).
Comorbidity
The DSM-5 indicates that APD is comorbid with multiple medical problems (American Psychiatric Association, 2013). The comorbidity of Alzheimer's Disease with Down's Syndrome is 75% in individuals with Down Syndrome over age 65 (Alzheimer's Association, 2014a).
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Impact on Functioning Alzheimer's Disease will have a progressive major impact

Impact on Functioning
Alzheimer's Disease will have a progressive major impact on

most areas of functioning. It is inexorable and terminal. (American Psychiatric Association, 2013). The degree of impact will depend on what stage the disease process is in:
Stage 1: No impairment- no detectable cognitive impairment in an individual with risk factors for Alzheimer's Disease.
Stage 2: Very mild decline- subjective experience of occasional aphasia or STM (Short Term Memory) failure which cannot be objectively verified. This may me MCI instead of Alzheimer's Disease. (see note at the end of this section).
Stage 3: Mild decline- objective indicators of aphasia, STM impairment including problems with name recall, or concentration may be present.
Stage 4: Moderate decline- difficulty with Short term, recall, inability to perform serial seven's, impaired episodic LTM (Long Term Memory) recall, and difficulty successfully completing multi-step tasks.
Stage 5: Moderately severe decline- disoriented to time and place, difficulty dressing appropriately for weather and occasion, deeper episodic LTM deficits.
Stage 6: Severe decline- disoriented to person, time, place, more profound episodic LTM deficits, reversed sleep pattern, loss of bladder and bowel control, enhancement of previously suppressed personality characteristics, and paranoid delusions.
Stage 7: Very severe decline- unresponsive, loss of motor control, abnormal reflexes, difficulty swallowing, death. (Alzheimer's Association, 2014b)
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Physical Aggression: 42% Verbal Aggression/threats: 54% Restlessness:38% Wandering: 29% Sleep disturbances:38%

Physical Aggression: 42%
Verbal Aggression/threats: 54%
Restlessness:38%
Wandering: 29%
Sleep disturbances:38%
Apathy/Withdrawal: 27%
Hallucinations:24%
Delusions:50%
Paranoia/suspiciousness:30%
Emotional lability: 8%
Mood disturbances(depression,tearfulness):29%

Prevalence

of Neuropsychiatric Symptoms(i.e., Psychiatric and Behavioral Problems) in AD

About half

Psychoses: about half

About one-quarter

Cause of caregiver distress

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treatment Medications for Memory: Medications for early to moderate stages All

treatment

Medications for Memory:
Medications for early to moderate stages
All of the prescription

medications currently approved to treat Alzheimer's symptoms in early to moderate stages are from a class of drugs called cholinesterase inhibitors. Cholinesterase inhibitors are prescribed to treat symptoms related to memory, thinking, language, judgment and other thought processes.
Additionally, cholinesterase inhibitors:
•Prevent the breakdown of acetylcholine (a-SEA-til-KOH-lean), a chemical messenger important for learning and memory. This supports communication among nerve cells by keeping acetylcholine high.
•Delay or slow worsening of symptoms. Effectiveness varies from person to person.
•Are generally well-tolerated. If side effects occur, they commonly include nausea, vomiting, loss of appetite and increased frequency of bowel movements.
Three cholinesterase inhibitors are commonly prescribed:
•Donepezil (Aricept) is approved to treat all stages of Alzheimer's.
•Rivastigmate (Exelon) is approved to treat mild to moderate Alzheimer's.
•Galantamine (Razadyne) is approved to treat mild to moderate Alzheimer's.
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treatment Medications for moderate to severe stages Memantine (Namenda) and a

treatment

Medications for moderate to severe stages
Memantine (Namenda) and a combination of

memantine and donepezil (Namzaric) are approved by the FDA for treatment of moderate to severe Alzheimer’s.
Memantine is prescribed to improve memory, attention, reason, language and the ability to perform simple tasks. It can be used alone or with other Alzheimer’s disease treatments. There is some evidence that individuals with moderate to severe Alzheimer’s who are taking a cholinesterase inhibitor might benefit by also taking memantine. A medication that combines memantine and a cholinesterase inhibitor is available.
Memantine:
•Regulates the activity of glutamate, a chemical involved in information processing.
•Improves mental function and ability to perform daily activities for some people..
•Can cause side effects, including headache, constipation, confusion and dizziness.
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treatment Common changes in behavior Many people find the changes in

treatment

Common changes in behavior
Many people find the changes in behavior caused

by Alzheimer's to be the most challenging and distressing effect of the disease. The chief cause of behavioral symptoms is the progressive deterioration of brain cells. However, medication, environmental influences and some medical conditions also can cause symptoms or make them worse.
In early stages, people may experience behavior and personality changes such as:
•Irritability
•Anxiety
•Depression
In later stages, other symptoms may occur including:
•Aggression and Anger
•Anxiety and Agitation
•General emotional distress
•Physical or verbal outbursts
•Restlessness, pacing, shredding paper or tissues
•Hallucinations (seeing, hearing or feeling things that are not really there)
•Delusions (firmly held belief in things that are not true)
•Sleep Issues and Sundowning
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treatment Concerns about alternative therapies Although some of these remedies may

treatment

Concerns about alternative therapies
Although some of these remedies may be valid

candidates for treatments, there are legitimate concerns about using these drugs as an alternative or in addition to physician-prescribed therapy:
•Effectiveness and safety are unknown. The rigorous scientific research required by the U.S. Food and Drug Administration (FDA) for the approval of a prescription drug is not required by law for the marketing of dietary supplements. The maker of a dietary supplement is not required to provide the FDA with the evidence on which it bases its claims for safety and effectiveness.
•Purity is unknown. The FDA has no authority over supplement production. It is a manufacturer’s responsibility to develop and enforce its own guidelines for ensuring that its products are safe and contain the ingredients listed on the label in the specified amounts.
•Dietary supplements can have serious interactions with prescribed
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vascular dementia A common form of dementia in older persons that

vascular dementia

A common form of dementia in older persons that is

due to cerebrovascular disease, usually with stepwise deterioration from a series of small strokes and a patchy distribution of neurologic deficits affecting some functions and not others. Symptoms include confusion, problems with recent memory, wandering or getting lost in familiar places, loss of bladder or bowel control (incontinence), emotional problems such as laughing or crying inappropriately, difficulty following instructions, and problems handling money. The damage is typically so slight that the change is noticeable only as a series of small steps
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vascular dementia DSM-IV criteria for the diagnosis of vascular dementia A.

vascular dementia

DSM-IV criteria for the diagnosis of vascular dementia
A. The development

of multiple cognitive deficits manifested by both:
Memory impairment (impaired ability to learn new information or to recall previously learned information)
One or more of the following cognitive disturbances: (a) aphasia (language disturbance)
(b) apraxia (impaired ability to carry out motor activities depite intact motor function)
(c) agnosia (failure to recognize or identify objects despite intact sensory function)
(d) disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)
B. The cognitive deficits in criteria A1 and A2 each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning.
C. Focal neurological signs and symptoms (e.g., exggeration of deep tendon reflexes, extensor plantar response, psuedobulbar palsy, gait abnormalities, weakness of an extremity) or laboratory evidence indicative of cerebrovascular disease (e.g., multiple infarctions involving cortex and underlyig white matter) that are judged to be etiologically related to the disturbance.
D. The deficits do not ocurr exclusively during the course of a delirium.
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Treatment and prevention of vascular dementia RISK FACTOR MANAGEMENT Antihypertensive drugs

Treatment and prevention of vascular dementia

RISK FACTOR MANAGEMENT
Antihypertensive drugs
Diabetes

management
Statins
Antiplatelet agents
Homocysteine lowering — Elevated homocysteine is an independent risk factor for vascular disease and may also be associated with risk of dementia
Healthy lifestyle — There is mounting evidence that certain modifiable health behaviors (eg, smoking, alcohol use, physical activity, and diet) are associated with cognitive function later in life, underscoring the importance of promoting a healthy lifestyle at all ages
Acetylcholinesterase inhibitors — Cholinergic dysfunction has been documented in VaD as well as Alzheimer disease (AD) Three acetylcholinesterase inhibitors approved for use in AD, donepezil,
galantamine, and rivastigmine, have also been studied in VaD
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Frontotemporal dementia Frontotemporal dementias (FTDs) are a group of clinically and

Frontotemporal dementia

Frontotemporal dementias (FTDs) are a group of clinically and neuropathologically

heterogeneous neurodegenerative disorders characterized by prominent changes in social behavior and personality or aphasia accompanied by degeneration of the frontal and/or temporal lobes. Some patients with FTD also develop a concomitant motor syndrome such as parkinsonism or motor neuron disease (MND). FTD is one of the more common causes of early-onset dementia, with an average age of symptom onset in the sixth decade
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Frontotemporal dementia Clinical presentation — Early behavioral changes of bvFTD include

Frontotemporal dementia

Clinical presentation — Early behavioral changes of bvFTD include the

following:, striatal and hypothalamic degeneration.
●Disinhibition – Examples of disinhibition or socially inappropriate behavior include touching or kissing strangers, public urination, and flatulence without concern. Patients may make offensive remarks or invade others' personal space. Patients with FTD may exhibit utilization behaviors, such as playing with objects in their surroundings or taking others' personal items.
●Apathy and loss of empathy – Apathy manifests as losing interest and/or motivation for activities and social relationships. Patients may participate less in conversations and grow passive. Apathy is mistaken frequently for depression, and patients are often referred for psychiatric treatment early in the disease course.
As patients lose empathy, caregivers may describe patients as cold or unfeeling towards others' emotions. Degeneration of right orbitofrontal and anterior temporal regions may drive the loss of sympathy and empathy
●Hyperorality – Hyperorality and dietary changes manifest as altered food preferences, such as carbohydrate cravings, particularly for sweet foods, and binge eating. Increased consumption of alcohol or tobacco may occur. Patients may eat beyond satiety or put excessive amounts of food in their mouths that cannot be chewed properly. They may attempt to consume inedible objects. This behavior correlates with right orbitofrontal, insularaviors such as hoarding, checking, or cleaning. Other behaviors traditionally associated with obsessive compulsive disorder, such as hand washing and germ phobias, are generally absent. Patients with FTD can develop a rigid personality, rigid food preferences, and inflexibility to changes in routine.
Compulsive behaviors – Perseverative, stereotyped, or compulsive ritualistic behaviors include stereotyped speech, simple repetitive movements, and complex ritualistic beh
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Frontotemporal dementia Currently, there is no cure for FTD. Treatments are

Frontotemporal dementia

Currently, there is no cure for FTD. Treatments are available

to manage the behavioral symptoms. Disinhibition and compulsive behaviors can be controlled by selective serotonin reuptake inhibitors (SSRIs).[24][25] Although Alzheimer's and FTD share certain symptoms, they cannot be treated with the same pharmacological agents because the cholinergic systems are not affected in FTD.[4]
Because FTD often occurs in younger people (i.e. in their 40's or 50's), it can severely affect families. Patients often still have children living in the home. Financially, it can be devastating as the disease strikes at the time of life that often includes the top wage-earning years.
Personality changes in individuals with FTD are involuntary. Managing the disease is unique to each individual, as different patients with FTD will display different symptoms, sometimes of rebellious nature.
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criteria for the clinical diagnosis of probable and possible dementia with

criteria for the clinical diagnosis of probable and possible dementia with Lewy

bodies (DLB

Essential for a diagnosis of DLB is dementia, defined as a progressive cognitive decline of
sufficient magnitude to interfere with normal social or occupational functions, or with usual daily
activities. Prominent or persistent memory impairment may not necessarily occur in the early
stages but is usually evident with progression. Deficits on tests of attention, executive function,
and visuoperceptual ability may be especially prominent and occur early.
Core clinical features (The first 3 typically occur early and may persist throughout the course.)
Fluctuating cognition with pronounced variations in attention and alertness.
Recurrent visual hallucinations that are typically well formed and detailed.
REM sleep behavior disorder, which may precede cognitive decline.
One or more spontaneous cardinal features of parkinsonism: these are bradykinesia (defined as
slowness of movement and decrement in amplitude or speed), rest tremor, or rigidi
Supportive clinical features
Severe sensitivity to antipsychotic agents; postural instability; repeated falls; syncope or other
transient episodes of unresponsiveness; severe autonomic dysfunction, e.g., constipation,
orthostatic hypotension, urinary incontinence; hypersomnia; hyposmia; hallucinations in other
modalities; systematized delusions; apathy, anxiety, and depression

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criteria for the clinical diagnosis of probable and possible dementia with

criteria for the clinical diagnosis of probable and possible dementia with Lewy

bodies (DLB

Indicative biomarkers
Reduced dopamine transporter uptake in basal ganglia demonstrated by SPECT or PET.
Abnormal (low uptake) 123iodine-MIBG myocardial scintigraphy.
Polysomnographic confirmation of REM sleep without atonia
a. Two or more core clinical features of DLB are present, with or without the presence of
indicative biomarkers, or
b. Only one core clinical feature is present, but with one or more indicative biomarkers.
Probable DLB should not be diagnosed on the basis of biomarkers alone.
Possible DLB can be diagnosed if:
a. Only one core clinical feature of DLB is present, with no indicative biomarker evidence, or
b. One or more indicative biomarkers is present but there are no core clinical features.

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Treatment of LBD A palliative care approach to LBD entails comprehensive

Treatment of LBD

A palliative care approach to LBD entails comprehensive symptom

management to maximize quality of life for the person with LBD and the family caregiver. In addition to pharmacological treatments, physical, occupational, and speech therapy may also be helpful.
•Early and aggressive treatment of cognitive symptoms with cholinesterase inhibitors is supported by research data suggesting that LBD patients (specifically those with dementia with Lewy bodies) may respond better than AD patients. Cholinesterase inhibitors may help reduce psychosis and should be part of a long term treatment strategy. If additional intervention is needed, cautious trial of quetiepine or clozapine for psychosis may be warranted. There is less evidence to support the use of memantine in LBD.
•Treating all sleep disorders is necessary for optimal cognitive function. Melatonin and clonzepam are suggested for treatment of REM sleep behavior disorder.
•Levodopa may provide some improvement in motor function and is the safest of the dopaminergic drugs. Dopamine agonists are more likely to cause psychiatric and behavioral side effects.
IMPORTANT NOTE: Traditional, or typical, antipsychotics, such as haloperidol, fluphenazine or thioridazine should be avoided. About 60% of LBD patients experience increased Parkinson symptoms, sedation, or neuroleptic malignant syndrome (NMS). NMS is a life-threatening condition characterized by fever, generalized rigidity and muscle breakdown following exposure to traditional antipsychotics.
.
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Dementia due to Creutzfeldt-Jakob disease - Clinical symptoms typical of syndrome

Dementia due to Creutzfeldt-Jakob disease

- Clinical symptoms typical of syndrome

of dementia
Symptoms also include involuntary movements, muscle rigidity, and ataxia
Onset of symptoms typically occurs between ages 40 and 60 years; course is extremely rapid, with progressive deterioration and death within 1 year
Etiology is thought to be a transmissible agent known as a “slow virus.” There is a genetic component in 5 to 15 percent.
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Gerstmann–Sträussler–Scheinker syndrome Gerstmann–Sträussler–Scheinker syndrome (GSS) is an extremely rare, usually familial,

Gerstmann–Sträussler–Scheinker syndrome

Gerstmann–Sträussler–Scheinker syndrome (GSS) is an extremely rare, usually familial, fatal

neurodegenerative disease that affects patients from 20 to 60 years in age. It is exclusively heritable, and is found in only a few families all over the world
It is, however, classified with the transmissible spongiform encephalopathies (TSE) due to the causative role played by PRNP, the human prion protein
Symptoms start with slowly developing dysarthria (difficulty speaking) and cerebellar truncal ataxia (unsteadiness) and then the progressive dementia becomes more evident. Loss of memory can be the first symptom of GSS.[6] Extrapyramidal and pyramidal symptoms and signs may occur and the disease may mimic spinocerebellar ataxias in the beginning stages. Myoclonus (spasmodic muscle contraction) is less frequently seen than in Creutzfeldt–Jakob disease. Many patients also exhibit nystagmus (involuntary movement of the eyes), visual disturbances, and even blindness or deafness.[7] The neuropathological findings of GSS include widespread deposition of amyloid plaques composed of abnormally folded prion protein
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Gerstmann–Sträussler–Scheinker syndrome GSS can be identified through genetic testing.[7] Testing for

Gerstmann–Sträussler–Scheinker syndrome

GSS can be identified through genetic testing.[7] Testing for GSS

involves a blood and DNA examination in order to attempt to detect the mutated gene at certain codons. If the genetic mutation is present, the patient will eventually be afflicted by GSS, and, due to the genetic nature of the disease, the offspring of the patient are predisposed to a higher risk of inheriting the mutation
Duration of illness can range from 3 months to 13 years with an average duration of 5 or 6 years
There is no cure for GSS, nor is there any known treatment to slow the progression of the disease. However, therapies and medication are aimed at treating or slowing down the effects of the symptoms. Their goal is to try to improve the patient's quality of life as much as possible.
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Dementia due to other medical conditions Endocrine disorders Pulmonary disease Hepatic

Dementia due to other medical conditions

Endocrine disorders
Pulmonary disease
Hepatic

or renal failure
Cardiopulmonary insufficiency
Fluid and electrolyte imbalance
Nutritional deficiencies
Frontal lobe or temporal lobe lesions
CNS or systemic infection
Uncontrolled epilepsy or other neurological conditions
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Substance-induced persisting dementia Related to the persistent effects of abuse of

Substance-induced persisting dementia

Related to the persistent effects
of abuse of

substances such as:
Alcohol
Inhalants
Sedatives, hypnotics, and anxiolytics
Medications (e.g., anticonvulsants, intrathecal
methotrexate)
Toxins (e.g., lead, mercury, carbon monoxide,
organophosphate insecticides, industrial solvents)
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Normal Pressure Hydrocephalus Normal pressure hydrocephalus (NPH) is a clinical symptom

Normal Pressure Hydrocephalus

Normal pressure hydrocephalus (NPH) is a clinical symptom complex

caused by the build-up of cerebrospinal fluid. This condition is characterized by abnormal gait, urinary incontinence, and (potentially reversible) dementia
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depression Depression is the most frequent cause of emotional suffering in

depression

Depression is the most frequent cause of emotional suffering in later

life and frequently diminishes quality of life.
A key feature of depression in later life is COMORBIDITY---
e.g., with physical illness such as stroke, myocardial infarcts, diabetes, and cognitive disorders (possibly bi-directional causality)
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depression Predisposing risk factors for depression include: • Female sex. •

depression

Predisposing risk factors for depression include:
• Female sex.
• Widowed or divorced

status.
• Previous depression.
• Brain changes due to vascular problems.
• Major physical and chronic disabling illnesses.
• Polypharmacy.
• Excessive alcohol use.
• Social disadvantage and low social support.
• Caregiving responsibilities for person with a major disease (e.g., de­men­tia).
• Personality type (e.g., relationship or dependence problems).
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depression Precipitating risk factors for de­pression should also be considered. These

depression

Precipitating risk factors for de­pression should also be considered. These include:
•

Recent bereavement.
• Move from home to another place (e.g., nursing home).
• Adverse life events (e.g., loss, separation, financial crisis).
• Chronic stress caused by declining health, family, or marital problems.
• Social isolation.
• Persistent sleep difficulties.
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depression Prevalence of depression among older persons in various settings: Medically

depression

Prevalence of depression among older persons in various settings:
Medically and surgically

hospitalized persons—major depression 10-12% and an additional 23% experiencing significant depressive symptoms.
Primary Care Physicians: 5-10% have major depression and another 15% have minor or subsyndromal depression.
PCPs may not be aggressively identifying and treating depression
Long-Term Care Facilities: 12% major depression , another 15% have minor depression. Only half were recognized.
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Major Depression Similar across lifespan but there may be some differences.

Major Depression

Similar across lifespan but there may be some differences. Among

older adults:
Psychomotor disturbances more prominent (either agitation or retardation),
Higher levels of melancholia(symptoms of non-interactiveness, psychological motor retardation or agitation, weight loss)
Tendency to talk more about bodily symptoms
Loss of interest is more common
Social withdrawal is more common
Irritability is more common
Somatization (emotional issues expressed through bodily complaints)is more common
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Major Depression Emphasis should be: less on dysphoria(depressed mood) and guilt

Major Depression

Emphasis should be:
less on dysphoria(depressed mood) and guilt

more on fatigue, sleep and appetite changes, vague GI complaints , somatic worries, memory or concentration problems, anxiety, irritability, apathy, withdrawal.
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Normal grief reaction versus Major Depression Suggestive Symptoms Guilt about things

Normal grief reaction versus Major Depression Suggestive Symptoms

Guilt about things other

actions taken at time of death
Thoughts of death other survivor feelings
Morbid preoccupation with worthlessness
Marked psychomotor retardation
Hallucinations other than transient voices or images of dead person
Prolonged & marked functional impairment
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Pseudodementia—“depression with reversible dementia” syndrome: dementia develops during depressive episode but

Pseudodementia—“depression with reversible dementia” syndrome: dementia develops during depressive episode but

subsides after remission of depression.
Mild cognitive impairment in depression ranges from 25% to 50%, and cognitive impairment often persists 1 year after depression clears.
Слайд 57

Treatment of Depression in Older Adults Use same antidepressants as younger

Treatment of Depression in Older Adults

Use same antidepressants as younger patients—however,

start low, go slow, keep going higher, and allow more time(if some response has been achieved, may allow up to 10-14 weeks before switching meds).
Older patients may have a shorter interval to recurrence than younger patients. Thus, they may need longer maintenance of medication.
Data are not clear if the elderly are more prone to relapse.
Слайд 58

Treatment of Depression in Older Adults Principles of treatment When selecting

Treatment of Depression in Older Adults

Principles of treatment
When selecting an

antidepressant it is important to consider the elderly pa­tient’s previous response to treatment, the type of depression, the patient’s other medical problems, the patient’s other medications, and the potential risk of overdose. Psychotic depression will likely not respond to antidepressant monotherapy, while bipolar depression will require a mood stabilizer.
Antidepressants are effective in treating depression in the face of medical illnesses, although caution is required so that antidepressant therapy does not worsen the medical condition or cause adverse events
For example, dementia, cardiovascular problems, diabetes, and Parkinson disease, which are common in the elderly, can worsen with highly anticholinergic drugs
Such drugs can cause postural hypotension and cardiac conduction abnormalities. It is also important to minimize drug-drug interactions, especially given the number of medications elderly pa­tients are often taking. Tricyclic antidepressants are lethal in overdose and are avoided for this reason.
Слайд 59

Treatment of Depression in Older Adults The selective serotonin reuptake inhibitors

Treatment of Depression in Older Adults

The selective serotonin reuptake inhibitors (SSRIs)

and the newer antidepressants buproprion, mirtazapine, moclobemide, and venlafaxine (a selective norepinephrine reuptake inhibitor or SNRI) are all relatively safe in the elderly. They have lower anticholinergic effects than older antidepressants and are thus well tolerated by patients with cardiovascular disease.
Common side effects of SSRIs include nausea, dry mouth, insomnia, somnolence, agitation, diarrhea,ex­cessive sweating, and, less commonly, sexual dysfunction.[17] Owing to renal functioning associated with aging, there is also an increased risk of elderly patients de­veloping hyponatremia secondary to a syndrome of inappropriate antidiuretic hormone secre­tion. This is seen in approximately 10% of patients taking antidepressants, and is associated particularly with SSRIs and venlafaxine.[19]
It is important to check sodium levels 1 month after starting treatment on SSRIs, especially in patients taking other medications with a propensity to cause hyponatremia, such as diuretics. Of course it is also important to check sodium levels if symptoms of hyponatremia arise, such as fatigue, malaise, and delirium. There is also an increased risk of gastro­intestinal bleeding associated with SSRIs, particularly in higher-risk in­dividuals, such as those with peptic ulcer
disease or those taking anti-inflammatory medications.
Of the SSRIs, fluoxetine is generally not recommended for use in the elderly because of its long half-life and prolonged side effects. Paroxetine is also typically not recommended for use in the elderly as it has the greatest anticholinergic effect of all the SSRIs, similar to that of the tricyclics desi­pramine and nortriptyline
Слайд 60

Treatment of Depression in Older Adults SSRIs considered to have the

Treatment of Depression in Older Adults

SSRIs considered to have the best

safety profile in the elderly are citalopram, escitalopram, and sertraline. These have the lowest potential for drug-drug in­teractions based on their cyto­chrome P-450 interactions. Venlafaxine, mirtazapine, and bupropion are also considered to have a good safety profile in terms of drug-drug interactions
Tricyclic antidepressants are no longer considered first-line agents for older adults given their potential for side effects, including postural hypo­tension, which can contribute to falls and fractures, cardiac conduction ab­normalities, and anticholinergic effects. These last can include delirium, urinary retention, dry mouth, and constipation.
Many medical conditions seen in the elderly, such as dementia, Parkinson disease, and cardiovascular problems can be worsened by a tricyclic antidepressant. If a tricyclic is chosen as a second-line medication, then nortriptyline and desipramine are the best choices given that they are less anticholinergic
Слайд 61

Factors Possibly Associated with Reduced Antidepressant Response Older age(>75 yrs) Lesser

Factors Possibly Associated with Reduced Antidepressant Response

Older age(>75 yrs)
Lesser severity
Late onset(>60)
First

episode
Anxious depression
Executive dysfunction
Слайд 62

Psychotherapy Originally thought to be ineffective over 50, e.g., Freud Controlled

Psychotherapy

Originally thought to be ineffective over 50, e.g., Freud
Controlled trials indicated

useful for:
Major and minor depression
Recurrent depression, especially with meds
Prevent depression after stroke
Good evidence for Cognitive Behavior Therapy, Reminiscence and Life Review, Interpersonal Therapy, Problem Solving, Psychodynamic, Dialectical Behavioral Therapy (as adjunct to meds), Bibliotherapy (mild types) (Frazier et al, 2005)
Слайд 63

Depression in Older Adults and Health Care Costs Unutzer, et al., 1997; JAMA

Depression in Older Adults and Health Care Costs

Unutzer, et al.,

1997; JAMA
Слайд 64

Worse outcomes Hip fractures Myocardial infarction Cancer (Mossey 1990; Penninx et

Worse outcomes
Hip fractures
Myocardial infarction
Cancer (Mossey 1990; Penninx et al. 2001; Evans

1999)
Increased mortality rates
Myocardial Infarction (Frasure-Smith 1993, 1995)
Long term Care Residents (Katz 1989, Rovner 1991, Parmelee 1992; Ashby1991; Shah 1993, Samuels 1997)

Depression Associated with Worse Health Outcomes

Слайд 65

Suicide in Older Adults 65+: highest suicide rate of any age

Suicide in Older Adults

65+: highest suicide rate of any age group
85+:

2X the national average (CDC 1999)
Peak suicide rates:
Suicide rate goes up continuously for men
Peaks at midlife for women, then declines
1/3 of older men saw their primary care physician in the week before completing suicide; 70% within the prior month
Слайд 66

Suicide Rate by Age Per 100,000 Older people: 12.7% of 1999

Suicide Rate by Age Per 100,000

Older people: 12.7% of 1999 population,

but 18.8% of suicides. (Hoyert, 1999)
Слайд 67

Agitation and Aggression in the Elderly Agitation (increased verbal and/or motor

Agitation and Aggression in the Elderly

Agitation (increased verbal and/or motor activity

as well as restlessness, anxiety, tension, and fear) and aggression (self-assertive verbal or physical behavior arising from innate drives and/or a response to frustration that may manifest by cursing/threats and/or destructive and attacking behavior toward objects or people) are symptoms commonly present in patients with central nervous system (CNS) disorders

(Hoyert, 1999)

Слайд 68

Abuse of the elderly 1. Physical •Non-accidental use of force against

Abuse of the elderly
1. Physical
•Non-accidental use of force against an elderly

person that results in physical pain, injury, or impairment. Such abuse includes not only physical assaults such as hitting or shoving but the inappropriate use of drugs, restraints, or confinement.
2. Emotional (Verbal)
•Intimidation through yelling or threats.
•Humiliation and ridicule.
•Habitual blaming or scape-goating.
3. Psychological (Non-verbal)
•Ignoring the elderly person.
•Isolating an elder from friends or activities.
•Terrorizing or menacing the elderly person.
4. Neglect
•Failure to fulfill a caretaking obligation constitutes more than half of all reported cases of elder abuse. It can be active (intentional) or passive (unintentional, based on factors such as ignorance or denial that an elderly charge needs as much care as he or she does).
5. Fraud
•Misuse of an elder’s personal checks, credit cards, or accounts.
•Steal cash, income checks, or household goods.
•Forge the elder’s signature.
•Engage in identity theft.
6. Scams
•Announcements of a “prize” that the elderly person has won but must pay money to claim.
•Phony charities.
•Investment fraud.
Слайд 69

Delusional disorders (psychoses) Late onset schizophrenia (over 40 y) Very late

Delusional disorders (psychoses)

Late onset schizophrenia (over 40 y)
Very late onset schizophreniform

disorder (over 60 y)
Other delusional disorders
Organic delusional disorder
Delusional symptoms of dementia (BPSD)
Multiple etiology, multiple syndromatology (schizophreniform, persecutory, hallucinosis, coenaesthesias, etc.)
Слайд 70

Anxiety disorders High prevalence Atypical symptoms Somatoform/behavioural symptoms Psychosocial stressors Comorbidity somatic psychiatric

Anxiety disorders

High prevalence
Atypical symptoms
Somatoform/behavioural symptoms
Psychosocial stressors
Comorbidity
somatic
psychiatric

Слайд 71

Substance abuse Alcohol/medication abuse Common comorbidity somatic psychiatric (anxiety, depression, etc.)

Substance abuse

Alcohol/medication abuse
Common comorbidity
somatic
psychiatric (anxiety, depression, etc.)

Слайд 72

Psychiatric patients getting old Schizophrenia / bipolar disorder Personality disorder Neurotic

Psychiatric patients getting old

Schizophrenia / bipolar disorder
Personality disorder
Neurotic disorders
anxiety, somatoform, etc.
Changes

in clinical picture, therapeutical response, etc.
Bio-psycho-social changes
Multidimensional approach
Слайд 73

Psychiatric therapies in the elderly Pharamcotherapy Other biological therapies (ECT) Psychotherapies

Psychiatric therapies in the elderly

Pharamcotherapy
Other biological therapies (ECT)
Psychotherapies –social therapies
Improving cognitive

functioning
Rehabilitation
Treating primary or associated mood-anxiety disorder
Слайд 74

Pharmacotherapy Aspects of pharmacotherapy Mental status, neurological/somatic status Social status Etiology

Pharmacotherapy

Aspects of pharmacotherapy
Mental status, neurological/somatic status
Social status
Etiology
Special aspects
Polimorbidity
Pharmacokinetics (interactions)
Dosage (low)
Side

effects (cognitive, other)
Слайд 75

Слайд 76

Organic Disorder

Organic Disorder

Слайд 77

Neuropsychiatry Biological psychiatry Cognitive neuroscience Neuropsychology (Neurology – Psychiatry) Neuropsychiatry

Neuropsychiatry

Biological psychiatry
Cognitive neuroscience
Neuropsychology
(Neurology – Psychiatry)
Neuropsychiatry

Слайд 78

DSM IV TR Delirium, dementia, amnestic disorders and other cognitive disorders.

DSM IV TR

Delirium, dementia, amnestic disorders and other cognitive disorders.
DSM

V: Major/mild neurocognitive disorder
Mental disorders due to a medical condition
Слайд 79

ICD 10 Organic and symptomatic mental disorders Dementia Organic amnestic syndrome

ICD 10

Organic and symptomatic mental disorders
Dementia
Organic amnestic syndrome
Delirium
Other mental disorders caused

by brain lesion and dysfunction or somatic disorder
Organic hallucinosis, organic catatonia, organic delusional disorder, organic mood disorder, organic anxiety disorder, etc.
Mental and behavioural disorders caused by psychoactive substances
Слайд 80

Etiology, causes, pathology Central nervous system Neurodegeneration Cerebrovascular origin Inflammation, tumor

Etiology, causes, pathology

Central nervous system
Neurodegeneration
Cerebrovascular origin
Inflammation, tumor
Demyelination
Epilepsy
Trauma
Other
Outside the central nervous system
Endocrine
Metabolic,

cardio-vascular diseases
Nutritional disturbance
Infection
Drug intoxication, drug withdrawal
Alcohol, illegal drugs, medication
Слайд 81

From neurological point of view… Cerebrovascular diseases Neurodegenerativ diseases Parkinson’s disease,

From neurological point of view…

Cerebrovascular diseases
Neurodegenerativ diseases
Parkinson’s disease, other movement

dis.
Epilepsy
Head trauma –brain injuries
Tumors
Neuroinfections
Neuroimmunology (multiple sclerosis)
Слайд 82

Classification of syndromatology Acute – chronic Diffuse (global) – focal (local)

Classification of syndromatology

Acute – chronic
Diffuse (global) – focal (local) - multifocal

brain disfunction
Lobe syndromes
FRONTAL
apathy, disinhibition, lack of iniciative and spontaneity, motivation, perseveration, impulsivity
TEMPORAL affective, agression, fear, explosion, psychosis, disorientation
PARIETAL gnostic and cognitive dysfunctions (alexia, acalculia, agraphia), apraxias
Слайд 83

Delirium - Syndromatology Acute course – (sudden onset, short episode) Impairment

Delirium - Syndromatology

Acute course – (sudden onset, short episode)
Impairment of consciousness
Global

impairment of cognitive functions (memory, attention, orientation, thinking, etc.)
Perceptual disturbance (multimodal illusions and hallucinations)
Behavioural changes (agitation)
Fluctuating course
Слайд 84

Delirium - Etiology Any cause, resulting in global dysfunction General medical

Delirium - Etiology

Any cause, resulting in global dysfunction
General medical condition (e.g.

infection, metabolic reasons, hypoxia)
Substance induced
Multiple cause
Therapy: Causal, symptomatological (BZD, NL)
Слайд 85

Etiology Etiological factors? Risk (predisposing) factors Trigger (precipitating) factors Hyperactive, hypoactive, mixed form

Etiology

Etiological factors?
Risk (predisposing) factors
Trigger (precipitating) factors
Hyperactive, hypoactive, mixed form

Слайд 86

Risk factors 1. Age: 65+ sex: male Dementia (+++), other cognitive

Risk factors 1.

Age: 65+ sex: male
Dementia (+++), other cognitive disorder
Depression
Vision-,

hearing impairment
Dehydration, malnutrition
Medication (multiple drugs, psychoactive drugs), alcohol
Immobility, pain, constipation
Sleep deprivation
Saxena et al, 2009.
Слайд 87

Risk factors 2. Somatic illnesses Severe illness Many illnesses Chronic liver

Risk factors 2.

Somatic illnesses
Severe illness
Many illnesses
Chronic liver or kidney failure
Stroke, other

neurological disorder
Metabolic disorder
Trauma, bone fracture
Terminal state
HIV infection
Saxena et al, 2009.
Слайд 88

Precipitating 1. Comorbid disorders Infection Hypoxia Severe acute disorder (pl. AMI)

Precipitating 1.

Comorbid disorders
Infection
Hypoxia
Severe acute disorder (pl. AMI)
Liver, kidney disorder
Urinary retention, constipation
Anaemia
Fever
Shock
Saxena

et al, 2009.
Слайд 89

Precipitating factors 2. Iatrogenic complication Metabolic imbalance Neurological disease (head trauma)

Precipitating factors 2.

Iatrogenic complication
Metabolic imbalance
Neurological disease (head trauma)
Surgery
Medication
overdose, politherapy
sedatives, hypnotics,

anticholinergic drugs, antiepileptics
Eniviromental factors (ICU, phycical restraint, bladder catheters, multiple/invasive manipulations, emotional stress)
Pain
Saxena et al, 2009.
Слайд 90

Delirium Diagnostic Criteria A. A disturbance in attention (i.e., reduced ability

Delirium

Diagnostic Criteria
A.
A disturbance in attention (i.e., reduced ability to direct, focus,

sustain, and shift attention) and awareness (reduced orientation to the environment).
B.
The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day.
C.
An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception).
Слайд 91

Delirium Diagnostic Criteria D. The disturbances in Criteria A and C

Delirium

Diagnostic Criteria
D.
The disturbances in Criteria A and C are not better

explained by another preexisting, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as coma.
E.
There is evidence from the history, physical examination, or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e., due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple etiologies.
Слайд 92

Dementia - Syndromatology Chronic course (10% above 65 y, 16-25% above

Dementia - Syndromatology

Chronic course (10% above 65 y, 16-25% above 85

y)
Multiple cognitive deficits incl. memory impairment (intelligence, learning, language, orientation, perception, attention, judgement, problem solving, social functioning)
No impairment of consciousness
Behavioural and psychological symptoms of dementia (BPSD)
Progressive - static
Reversible (15%) - irreversible
Слайд 93

Mental disorders due to a General Medical Condition (DSM IV) Psychotic

Mental disorders due to a General Medical Condition (DSM IV)

Psychotic disorder

due to a general medical condition
Mood disorder
Anxiety disorder
Sexual disfunction
Sleep disorder
Catatonic disorder
Personality change
Слайд 94

Amnestic Disorders Amnestic disorders are characterized by an inability to Learn

Amnestic Disorders

Amnestic disorders are characterized by an inability to
Learn new information

despite normal attention
Recall previously learned
information
Symptoms
Disorientation to place and time (rarely to self)
Confabulation, the creation
of imaginary events to fill
in memory gapsDenial that a problem exists or acknowledgment that a problem exists, but with a lack of concern
Apathy, lack of initiative, and emotional blandness
Слайд 95

Amnestic Disorders Onset may be acute or insidious, depending on underlying

Amnestic Disorders

Onset may be acute or insidious, depending on underlying pathological

process.
Duration and course may be quite variable and are also correlated with extent and severity of the cause.
Слайд 96

Korsakoffs syndrom Korsakoff's syndrome, or Wernicke-Korsakoff syndrome, is a brain disorder

Korsakoffs syndrom

Korsakoff's syndrome, or Wernicke-Korsakoff syndrome, is a brain disorder caused

by extensive thiamine deficiency, a form of malnutrition which can be precipitated by over-consumption of alcohol and alcoholic beverages compared to other foods. It main symptoms are anterograde amnesia (inability to form new memories and to learn new information or tasks) and retrograde amnesia (severe loss of existing memories), confabulation (invented memories, which are then taken as true due to gaps in memory), meagre content in conversation, lack of insight and apathy.
Слайд 97

Therapy in neuropsychiatry Pharmacotherapy Psychotherapy, psycho-social treatment Improving cognitive abilities Rehabilitation

Therapy in neuropsychiatry

Pharmacotherapy
Psychotherapy, psycho-social treatment
Improving cognitive abilities
Rehabilitation
Treating affective and anxiety symptoms
Treating

other psychological symptoms
Слайд 98

Amnestic Disorder due to a General Medical Condition Head trauma Cerebrovascular

Amnestic Disorder due to a General Medical Condition

Head trauma
Cerebrovascular disease

Cerebral neoplastic disease
Cerebral anoxia
Herpes simplex virus–related encephalitis
Poorly controlled diabetes
Surgical intervention to the brain
Слайд 99

Substance-Induced Persisting Amnestic Disorder Related to Alcohol abuse Sedatives, hypnotics, and

Substance-Induced Persisting Amnestic Disorder Related to

Alcohol abuse
Sedatives, hypnotics,
and

anxiolytics
Medications (e.g., anticonvulsants,
intrathecal methotrexate)
Toxins (e.g., lead, mercury, carbon
monoxide, organophosphate insecticides,
industrial solvents)
Слайд 100

Pharmacotherapy in neuropsychiatry 1. Targets of pharmacotherapy Etiological background Progression Psychiatric

Pharmacotherapy in neuropsychiatry 1.

Targets of pharmacotherapy
Etiological background
Progression
Psychiatric symptoms
Target symptom:


Cognitive
Agitation/aggression
Mood
Psychotic
Other behavioural
Neurologic symptoms
Слайд 101

Pharmacotherapy in neuropsychiatry 2. Aspects of pharmacotherapy Mental status Neurological status

Pharmacotherapy in neuropsychiatry 2.

Aspects of pharmacotherapy
Mental status
Neurological status
Social status
Etiological background
Typical v.

atypical symptoms
Слайд 102

Pharmacotherapy in neuropsychiatry 3. Special aspects Age Polimorbidity Pharmacokinetics (interactions) Optimal

Pharmacotherapy in neuropsychiatry 3.

Special aspects
Age
Polimorbidity
Pharmacokinetics (interactions)
Optimal dosing ( +/-)
Side effects

(cognitive, other)
Слайд 103

COVID-19 and the consequences of isolating the elderly The COVID-19 pandemic

COVID-19 and the consequences of isolating the elderly

The COVID-19 pandemic is

impacting the global population in drastic ways. In many countries, older people are facing the most threats and challenges at this time
However, it is well known that social isolation among older adults is a “serious public health concern” because of their heightened risk of cardiovascular, autoimmune, neurocognitive, and mental health problems
Self-isolation will disproportionately affect elderly individuals whose only social contact is out of the home, such as at daycare venues, community centres, and places of worship. Those who do not have close family or friends, and rely on the support of voluntary services or social care, could be placed at additional risk, along with those who are already lonely, isolated, or secluded.
Although all age groups are at risk of contracting COVID-19, older people face significant risk of developing severe illness if they contract the disease due to physiological changes that come with ageing and potential underlying health conditions.
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