Psychotropic Medication and the Elderly

Psychotropic Medication and the Elderly


Psychotropic Medication and the Elderly
I’m Nicole Miller I’m Stacy Thomas and I’m Kathy Scott Marble. Our
presentation will cover Section One is the DSM-5 changes to delirium and
dementia. Section Two the state of psychosocial interventions for elderly
clients. Section Three Pharmacological treatment of dementia from the twentieth
century and into the 21st century. Section Four commonly prescribed
psychotropic medications in elderly population. Section Five aging and
assisted living. Section Six side effects peculiar to the elderly then we will
have a counseling session and then referrals and then our references The
new old age people today are living longer and better and this is in
tributed in part to better education health care and nutrition. Fifty is
called the new forty. A common marketing play to sell methods to live a higher
quality of life through pharmaceutical models and tests are based on aspiring
oldsters that are not representative of the population of mental health
professionals. Old age seems to be culturally defined as a degenerative
process of the body and mind, but in most developed countries age 65 is defined as
being elderly. I’m covering section one the DSM-5 changes to the delirium and
dementia the American Psychological Psychiatric Association has made several
changes. Moving from attributing causation to dimensional perspective now
highlighting the developmental and lifespan issues that include
gender race and culture. Incorporating the latest research and clinical
expertise is an exploration of bio-markers
discussed with etiology and genetic testing. The differential
diagnoses are distinguished comparatively. Neurocognitive disorders
are a new addition to categories of the DSM-5. They were previously referred to
as delirium, dementia, amnestic and other cognitive disorders. NCD is a
preferred term to dementia. It distinguishes dementia not associated with
degenerative aging such as impairment secondary to a medical disorder. Major and
mild NCDs The definition of dementia is Latin for madness. The dsm-5 tried to
reduce the stigma replacing dementia with major in the mild NCD. No single
disease is called dementia. This may arise from Alzheimer’s disease,
Parkinson’s disease, Huntington’s chorea, and Pick”s disorder. The primary
characteristic is declining cognitive function and not a deficit. It is separated
from neurodevelopmental disorders. The cognitive deficit proves at present
birth are developmentally impairing. It is possible that an NCD
could be present with an ND, and we know more about NCD etiology than any other
DSM disorder. There are major and mild NCDs. The major NCDs are more severe
impairments and severity of impairment of independence than the mild NCDs and
they’re essentially dementia or an aesthetic disorder. The mild NCDs main
purpose for mild NCD category is debated for non-medical mental health
professionals. The interest is in detecting
early detection and intervention of NCDs like mild in NCDs maybe the early stage
of later major in NCDs. The hope is to maintain and improve and stave off the
decline so that therapy can help people make the most of the time that they have
suffering from the major NCDs. The mild in CDs may be normal aging for some
people and for these people medication can only deliver side effects.
The etiological subtypes major NCD and mild NCDs include: that is
Alzheimer’s disease, Parkinson’s disease, Lewy body disease, Huntington’s,
Huntington’s disease, vascular disease, traumatic brain injury, HIV infection,
Prion disease (bovine spongy form disorder), frontotemporal lobe degeneration,
substance or medical induced dementia, and other causes. Alzheimer’s disease
the major majority of the medication for dementia is for Alzheimer’s which is
abbreviated AD. The most common type of AD is cortical dementia and progressive
that your neurodegenerative diseases. This involves an irreversible loss of
cholinergic neurons. There’s two variations. There is an early onset
familiar form that seems mostly genetic, and then there is a late onset form that
is far more common and less rooted in genetics. And 2013 the cost of the United
States was over two hundred billion dollars annually. The predominant problem are thought to
be neurotic senile plaques (NSP) and their neurofibrillary tangles NFT. The NSPs are composed of beta amyloid deposits key to neuron
death. NF Ts or the modified tau protein. Amyloid the Amyloid Cascade Hypotheses
This is the most popular theory for the last 20 years, and it suggests that the
beta amyloid accumulates and the problem is production and removal of the beta
amyloid. The main alternative hypothesis centers on the tau protein. AD
medication, the ultimate strategy of the ad medication is to develop
neuroprotective agents that modifies effects of the beta amyloid or
medication that flushes before it fills to dangerous levels up in the system.
Drugs treat the symptoms not the underlying causes. Symptoms include
cognitive decline, behavioral disorders, movement difficulties, mood and anxiety
symptoms and radical personality changes. Cognitive functional and even physical
activity level deficits can be present in the early stages of AD. Can Altzheimer’s be Prevented? Studies suggest that with education, complexity of
occupation and engaged lifestyles can be productive effects. Exercise is
associated with the reduced risk linked to the vascular health. Vascular health
clinical trials or contradictory. There have been studies that have found the
use of antihypertensives are often after a cerebral vascular event are associated
with the reduction of cognitive impairment. And the recent studies though
show that people that are over 80 a reduction in the vascular problem
occurs but not in the cognitive impairment. Correlated with Alzheimer’s
risk there’s a lower level of education, physical inactivity, suffering from
depression, smoking, hypertension, sleep and disorder breathing. The influence of
diet is more controversial and this suggests that possibly omega-3 fatty
fatty acid or a Mediterranean Mediterranean diet
could reduce one’s risk of having Alzheimer’s. Several planned ongoing
prevention trials are happening and one is the Anti-amyloid treatment for
Asymptomatic AD trial for asymptomatic and pre-symptomatic individuals with
genetic factors, and drug the drugs in these studies have failed to show
improvement upon trial. The AChE inhibitors are the most common drugs to treat
Alzheimer’s disease efficacy. Then donepezil/Aricept the symptoms are not
the drug is not given until the symptoms are present so none of these drugs these
three drugs that are here are going to be considered to be prophylactic. The
rivastigimine or Exelon. The transdermal it has less side effects than the pills
so one of the side effects that is lessened is with nausea. The other one is
with there’s decreased caregiver burden and increased treatment adherence when
you use the transdermal. The galantamine or Razadyne is the third drug and these drugs bind to the enzyme AChE and break down the acetylcholine. The
side effects are: gastrointestinal distress, abdominal cramping and
sometimes anorexia. So the major implementation of these drugs that they
show – improvement at best. Tolerability is generally the guide that for which
drug to use so it depends on the side effect that the elderly person
might experience. The disease may overtake what the medication can do
and in in time if the patient lives long enough. Newer treatments – There is a new drug called memantine or
namenda that is a NMDA receptor antagonist that acts on the glutamate
system. There are more dropouts with the a CAG than there are with namenda.
Namenda shows more benefits if there are moderate to severe symptoms.
Parkinson’s disease is the other common neurodegenerative disease and it occurs
in 1% of 65 to 69 year-olds and that is worldwide. There is a progressive
loss of the dopamine neurons. We can only treat symptoms and disease that may
overtake the drugs. The primary drugs to treat Parkinson’s is to try to decrease
the dopamine neurons and the dopamine agonist. There are four drugs that
are used for Parkinson’s disease: levodopa/carbidopa is the most
common drug; apomorphine/apokan, lisuride/reveni; and paramipezole also called mirapex. Parkinson’s Disease Medications – These drugs partially reduce
the motor features of Parkinson. Parkinson’s affects the 5-HT and NE
neurotransmitters that may account for Parkinson’s related depression. As time
goes on each dose becomes less effective with this disorder. The COMT inhibitors
tolcapone/tasmar may lengthen effectiveness of the levodopa or
carbadopa. There are possible severe side effects on the liver however. A side effect of levodopa is induced
dyskinesias (the drug induced abnormal movements). The dyskinesias may be treated with a glutamate or adenosine receptor antagonist. Other drugs that have modest
effects on Parkinson’s are amantadine/symmetrel which is an
antiviral or memantine/namenda which is one of the new Alzheimer’s medications. Stimulates as a Dementia Treatment – There is cognitive
enhancement that is linked with stimulants as well as the AChE-I drugs. The 20th century to the present,
caffeine and and feta means have been used to treat all aspects of dementias.
Several studies have concluded negative symptoms of apathy, motivation, and
persistence may be responsive to the methylphenidate also called
Ritalin. Front row temporal dementia and abnormal risk-taking has been treated by
Ritalin. It has been showed that coffee drinking may be a mild neuro protective
agent with reduced risk of Alzheimer’s and this may be related to caffeine or
antioxidant properties of the coffee. This study was done in 2010 that was
called Cardiovascular Risk Factors Aging and Incidence of Dementia. The
Cannabinoids – Many peer-reviewed studies have supported cannabinoids. They
say they have protective properties that can treat neurotoxicity and neuro
inflammation. They may limit the neurotic plaques and slow Alzheimer’s disease.
Studies show cannabinoids and synthetic cannabinoids prevent
brain death cell death after exposure to amyloid plaques and animals.
Biggest barrier to federal research is the criminalization of cannabis. As state
decriminalization expands and federal prohibition
will end allowing unfettered scientific research. okay now I’m Stacy and I’m going to pick
up where Kathy left off and I’m going to talk about some psychosocial
interventions for the elderly for elderly clients one of those one thing
is the functioning of the elderly can be affected by social and coping skills
so what psychosocial interventions does it is takes these experiences they have
and try to create interventions to deal with the social and the coping skills
utilizing psychosocial interventions along with medications have been proven
to support elderly patients and adjusting to factors that may be
associated with aging and as you know some of those factors can be mental
illness depression and cognitive impairment and it’s important to
properly assess assessment by clinician of these psychosocial experiences are
critical to creating interventions that will support them for helping them with
the social in coping skills major depressive disorder affects 20% of
individuals over the age of 65 so with this prevalence of the MBD in the
elderly population there has been a rise in completed suicides in this community
psychotropic medications such as hypnotics and benzodiazepine can
increase the risk of suicide in the elderly community there are also factors
to consider are comorbid disorders such as heart failure cancer diabetes also
create increased depressive symptoms as you know that when individuals have
chronic disease they are depressed so these things contribute to that all of
these factors should be considered when you’re looking at creating interventions
and elderly clients may not respond to the medications a lot but psychosocial
interventions can be used something to consider is as a clinician
making sure that you are a lot of times the elderly patients want you to
understand what they’re going through doing this when they’re depressed they
definitely want you to identify with that so one of the first types of
therapy that can be used psychosocial is the problem adaption therapy and it’s
called path it focuses on the client’s environment and integrates support from
individuals caregivers as an emotional support system while assisting the
client with tools to navigate their environment so it really focuses on
looking at their ecosystem to support them they’re going to look at the home
the caregiver and the client and it invites participation from caregivers
and supporting treatment if needed so some individuals may be in a different
situation so it can be used without if they may not have someone there’s going
to be helping them all the time and path is going to be conducted in their home
and it reduces the depressive symptoms that that are associated with aging and
it reduces disability and clients with cognitive impairments and one other
thing also is that it is it is very focused and it’s specific so that’s the
one thing it’s going to work on those specific things that they need to work
on and they say that it is a better treatment then it works better than
supportive therapy another intervention is interpersonal psychotherapy when it’s
called IPT it can be utilized as a treatment for depression in the elderly
and it’s often used to replace general general medical care and it increases
it’s been proven to increase mental and social functioning so it definitely
works on the interpersonal efficacy of the client of elderly clients the
techniques used would be communication building you’re going to identify those
symptoms so you’re going to look at what and you takes a close look at any
symptoms and really identifying what symptoms are attributed to the issues
that they’re presenting and then there is also interpersonal psychotherapy
formal impairment IPT MCI it is a modified
version of the IPT and it builds the relationship between the caregiver and
the client relationship allowing them to the caregiver to really understand
what’s going on with the client and helps support them and it supports
elderly clients who have severe cognitive and medical issues and also
elderly patients who have had adverse side effects to other medications there
is another intervention the problem-solving therapy for mild
executive dysfunction PST md this is a 12-week session for
ambulatory elderly clients and what’s going to happen is in the first five
weeks the model is going to be taught so they teach the model within the first
five weeks the last seven sessions focuses on fine-tuning the model so it
goes back it looks at any questions that the patient may have the elderly patient
may have or any anything that they need to go over again making sure that they
understand what the goals are and then it supports again clients who have
severe cognitive and medical issues and as well as patients who’ve also had
adverse side effects to medication it also involves a five-step
problem-solving model so the model is the client sets a goal then they discuss
and out evaluate ways to reach their goals they’re going to create a plan and
evaluate how well that plan worked and the planning model creates helps
decrease depressive symptoms so it’s a very good model for a lot of times
issues are going to present in the elderly person’s life it’s a good step
for helping them start from the beginning to the end of solving the
problem to work through those issues of course we have cognitive behavioral
therapy another psychosocial intervention
CBT CBE is a psychosocial intervention it’s going to focus on changing and
challenging cognitive distortions and behaviors it’s effective for treating
depression in the elderly population it’s most effective as
it’s most effective after screening for specific cognitive impairments sensory
impairments and disabilities so that’s something that you want to definitely do
is make sure that you screen for those things first
so with CBT it takes those thoughts and those feelings and then you they just
kind of looked at their core beliefs and how it relates to them if those things
are true and about their future how they feel about their future and just really
looking at those thoughts that they have and changing those behaviors it’s really
good for other clients because they can be memory trained so a lot of repetition
helps and CBT can be used with the variety of issues with the elderly
modifications may be needed so it’s a good difference differentiation for
different issues that may be presenting okay we have group therapy as another
Sokol psychosocial intervention it’s definitely favorable for elderly
patients who don’t respond to psychotropic medications or individual
therapy one of the limitations could be accessibility because a lot of times
elderly patients are not able to get around or have someone to take them
somewhere so being able to get to group is can be an issue it does empower them
through sharing of related issues so being able to meet with other
individuals that are within the same age with them who may be having the same
issues is a good thing because they can talk about whatever issues they may have
and somebody else may have them and it just helps them work through those
things that’s another they also have music
group therapy it’s very popular it’s non-invasive and it’s inexpensive which
is definitely good because a lot of times elderly patients are on a fixed
income so they need and usually group therapy or music therapy would be free a
lot of recent research has showed that music the memory lasts longer music
memory lasts longer because you know you can remember a tune from when you were –
musical therapy reduces depressive symptoms it’s very calming it’s a
calming thing a lot of times you play music to calm down and it’s also shown
music therapy has also shown to delay cognitive
functioning and elderly patients some non for makalah some non pharmacological
interventions one is aromatherapy and it supports dementia and that’s of course
you know different fragrances a lot of people have the machines in their homes
and it helps support their mind with dementia reducing the cognitive issues
that may be presenting some multi saw one multi-sensory intervention is called
a pero robot and it was created it was started at intervention by a Japanese
person in Japan and it resembles a baby seal so what it does is it helps to
elevate the individual’s mood it picks it up and it’s used in place of live
animals so most often you know you see where animals are taken in to senior
care centers or different facilities treatment facilities to help animals are
known to pick up the mood for for individuals so that’s what it does the
parallel robot has five senses tactile light addition which is hearing
temperature and posture sensors it’s going to respond to blinking it responds
to tail wagging and voice commands so this at this time psychosocial
interventions are not commonly used for elderly patients but it’s one thing to
consider as a future clinician because it’s a you can use an integrative
approach to treating those elderly clients so it may be a little bit of the
medication Plus this or either/or but it’s something to consider okay so pharmacologic treatment of
dementia dementia is a decline in memory other mental abilities so there has been
an increase in psychotropic medications for the elderly but also increase in
overuse of these medications and facilities are with elderly clients most
psychotropic medications are used in institutions and it’s they are given to
women more often than men geriatric patients usually have
comorbid disorders along with mental illness and I stated that early it’s
something to really consider because sometimes they may have there may be
other issues that may have to be dealt with and sometimes they’re not so it’s
really making sure that you’re looking for those other existing cope you know
the comorbid disorders that may be presenting as well an appropriate
medication use in the elderly is a major functional and safety issue
so within treatment facilities we’re seeing that over medication over
medicating the elderly patients is becoming more common and a lot of that
is due to staff distress in working with patients and might be the cause of a lot
of the improper medication and medicating them and a lot of times they
have to say oh most often it or not you know they present a lot of problems
they’re agitated or irritated so they’re giving them the medication so they’ll
you know calm down and a lot of times they could be overworked and
overstressed and stressed one solution was to create a program called proper is
the solution to over medicating and it’s it stands for a prescription
optimization of psychotropic drugs and the elderly nursing home patients with
dementia it was a trial program that was created designed to educate pharmacists
physicians and nurses regarding medication the plan was to it involved
preparation in education then they were going to look at look at conduct and
evaluation and guidance and it was a good it was it was a trial plan it never
really came to be but it was it would be it was very good because it was looking
at the whole system of medicating individuals and facilities and it was
just a good plan because you always want to go back and look at how things are
working and what else that you can do and it was also like a checks and
balance to kind of help you so just a good thing to assist with keeping the
patient safe and keeping you out of trouble most importantly clinicians and
those in health care need to practice ethically so you always want to err on
the side of doing what’s right for the patient some other commonly prescribed
medications when we’re looking at depression it is a mood disorder that
causes persistent feelings of sadness and loss adults the age of 65 and older
have a suicide rate of 15 400,000 with males rate 30 to 400,000 and I discussed
that earlier there’s a highest suicide rate with depression and the elderly
population it needs to be an integrative approach to treating them so that would
be utilizing the primary care physician and a psychiatric professional so always
working with both of them because a lot of times elderly patients are more
comfortable with their primary care physician but they may need services
that are not the primary care physician may not be unable to offer so definitely
work with them to making sure that you’re giving them good quality care and
having proper inhibition interventions and medication you also need to consider
the risk and benefits when adding antidepressants to any any cognitive
enhancer so once again making sure that whatever you’re going to do is going to
benefit the client positive outcomes there has been positive outcomes using
lexapro and cymbalta for depression and the SSRIs are proven to increase fall
risk in elderly patients studies show that the morbidity rate for depression
increases with age while treatment helps the symptoms
there’s also a lot of treatment non-compliances health is happening as
well long term use of sort of these medications that I mentioned for a
depression can result in severe side effects they can induce cardiovascular
side effects seniors and I’m syndrome as well as other side effects and they may
also affect metabolism in risk of elevated plasma concentration of
psychotropic medication so making sure that you really understand what’s going
to happen if these medications are given because most times with them with the
elderly population they they present a lot of problems and this can increase
issues with all these problem another they as you know elderly people
have anxiety which is a fear characterized by behavior distortion
it’s a common problem for elderly as they age if you have many individuals
that you know parents or grandparents a lot of times anxiety that when their
anxiety is raised they start to get fearful and scared and you know things
can get out of control so that’s something to understand accent song lytx
such as benzodiazepine psychotropic medication is usually used for
depression in the elderly it is also correlated with higher rates
of suicides and Falls and is the number-one page for medication that is
used when they come into emergency rooms for the elderly
so we’ve noticed I think I mentioned before that there are issues with benzos
diazepam so why if they’re so problematic why are we still using them okay a lot of times patients use those
medications because it’s the only drugs they know they’ve been using them
forever so they just continue to use that specific drug a lot of times they
don’t know how to do the research on anything else and maybe caregivers or
they don’t have anyone to help them to see what else is out there and they may
you know just not they’re so comfortable they don’t want to ask about anything
else there probably has been some benefits so that’s why they continue to
use it there’s always the issue of tolerance independence being tolerant
I’m having the dependence on the medication and sitting there you can’t
do anything else without it that’s what comes up with all types of medication
and a lot of times they prefer the benzodiazepine to SSRIs as
antidepressants they just prefer to use them studies show an extended use of
diazepam are associated with negative outcomes over a lot of an extended
period of time for the aging population so a lot of times they can cause
additional anxiety increase their anxiety mess with sleep psycho and
psycho motor impairment some recommendation
that were as well there were recommendations for new guidelines of
dealing with these medications with this particular medication one was to use it
for only 30 days or limit prescriptions so being able to go back to the doctor
and just see if it’s working and if not try something else but not just allowing
just writing prescription that allowed them to use it over an extended period
of time okay psychosis and agitation which is our common behavior and psycho
psychological symptoms of dementia BP SD which happens with aging of course
psycho poses an agitation you’ve seen it before we talk about it with anxiety it
happens a lot with elderly community these are always difficult for
caregivers because a lot of times it becomes they’re dealing with this all
the time so it’s hard for them to it just brings more stress on caregivers so
what they wanted to do was create they created the Omnibus Budget
Reconciliation act and it was created to combat the misuse of psychotropic
medications and protect long term care of patients and long term care and
nursing homes so what the act was going to do was just working with nursing
homes to make sure that their of medicating them properly and there’s
like a checks and balance atypical antipsychotics or use more than
neuroleptics neuroleptics are considered to be more problematic and in 2005 the
FDA issued a warning for a typical treatment for PTSD in the elderly
community then in 2012 they created their partnership to improve dementia
care was the initial Nate was initiated a training program a research program to
deal with bps D ethically so once again going back to that ethical thing making
sure that you’re doing what’s right for the patient to keep them safe you had a
trouble some ethical issues for the elderly being treated with psychotropic
tropic medications one is autonomy the medication provide more autonomy for
the client in May you may have to look at the family and the caregivers to see
if there if the patient is able to decide what they want to do talking with
them and seeing if it’s something that they want if it’s something they can do
on their own or if it’s something that they like that’s an issue
caregiving there straddles autonomy family centric so a lot of times there
are multiple relationships within the therapeutic relationships so the parent
it could be that the caregiver is closer with the doctor so there may be
encouraging them to do certain things so just as a clinician just making sure
that you monitor that elder abuse is an issue clinicians need to assess for that
and they need to really discuss those difficult situations with clients and
with caregivers because a lot of times we talked about the stress that comes
along with helping the elderly or helping an elderly parent or someone or
even if you’re just working for someone there’s a lot of stress because of all
of the issues that may be presenting so really helping them look at what’s going
on and finding resources to help combat their stress
según decision-making setting up ways to determine medical directives through
substituted judgment or advanced directives so working with your clients
to talk about if something happens that’s with anyone but a lot of times as
you get older there are issues that are going to present what do you want to
happen putting something in place to make sure that those decisions can be
made an end-of-life issues potentially making end-of-life wishes durable power
of attorneys saying what wants to happen especially as you get older this is
something to think about and as a clinician you want to really see how you
feel about these these issues because it can help drive it maybe driving how you
treat your clients okay and I’m going to pick up with various issues to consider
when working with the elderly population so in regard to aging and assisted
living Medicaid payments for state psychiatric hospitals and institutions
for the treatment of mental health was ended in the 1960s the
intended goal was twofold one to end the poor living kind of
conditions at these facilities and to remove the cost of data from the federal
government and basically put it on to the states the goal was to promote
better functioning and independence for these former patients and in order to
help them adopt a community living what ended up happening in reality was that
many patients with psychiatric disorders were placed into nursing homes and
geriatric units and placing them into this managed care system eventually came
what different concerns such as inappropriate prescribing of
psychotropic drugs as Stacy was mentioning elder abuse social stigma and
as well as you know is essentially just a blanket effect for all these quiet
elderly clients instead of really assessing their unique needs and
considering the side effects of the psychotropic medications in a lot of
cases many managed care sites do not have enough adequately state trained
staff so as I mentioned before a lot of them do not have adequate least trans –
staff that studies show that between 35 to 53 percent of clients in assisted
living take one or more psychotropic medications and this study went on to
show that only 45% of nursing homes have appropriate psychiatric training another
issue is the ratio of properly trained staff to the amount of elderly clients usually there’s it’s too large of a
ratio there’s too many clients to the trained staff and that just serves to
increase the amount of caregiver burden that’s
placed on them and increases the risk of restraining them chemically which is
what Stacy was mentioning earlier a large risk with assisted care managed
care settings if there’s not enough direct care staff at a managed care
facility there’s a risk that adverse side effects to psychotropic medications
may go unnoticed when it comes to working with elderly clients it’s
important to recommend to remember that due to physiological aging that they
simply react differently to medications and they would to their younger
counterparts older adults may be prone to different side effects
studies show that individuals over seventy or three and a half times more
likely to be admitted to the hospital due to adverse side effects of
psychotropic medications Stacy mentioned earlier a lot of those include with the
metabolism with cardiovascular issues fall risk as well as various other side
effects and the number increases if they’re using several medications the
biggest concern with this age group is so with medic is which medications or
combinations of medications are causing the problems because simply because of
the huge amount of medications that are being prescribed there’s no way to
discern which one is resulting in what side effects alone or if it’s resulting
in side effects in combination with others and you know just adjusting to
the unique chemistry makeup of each person that makes it even more difficult
to discern so according to our text there are some interesting studies and
between the United States and other countries so
in the United States benzodiazepines are usually pointed to as the main culprit
and are more likely to be criticized for adverse side effects and other
psychotropics however in other countries particularly Europe they point to its a
combination of drugs not just than the diazepam that others as well and even
those that are not psychotropic some non psycho Jo books such as medic
antibiotics are also associated with adverse side effects such as false they
also pointed out that antidepressants anxiety except knotek’s and
antipsychotics we’re also associated with Falls and
fractures interestingly and men and women but not in men again that may be
because of physiological differences like women might be more prone to
osteoporosis and weakening of the bones compared to men but there’s still more
being looked at at that and another thing to keep in mind is that culture
also plays a role and what is considered acceptable in Europe it’s more socially
acceptable to drink so elderly clients you know if they don’t have a drinking
problem they just enjoy to drink socially in the United States they go
into managed care setting and all of a sudden they have reduced if not no
access to alcohol you know and that’s essentially changing an important part
of their livelihood versus they might have access to that in Europe so in
addition to those side effects there’s also dermatological side effects to
various psychotropic medications and these are referred to as adverse
cutaneous drug reactions or AC DRS which ranged from benign to life-threatening
so some exams examples include pruritus which is itching red macules which is
like a flat discolored area papules which are solid and discolored elevation
the skin Dudek area which are highs angioedema which is swelling under the
skin similar to hives but it’s good to have more of that pronounced elevation
but then alopecia which is hair loss fixed drug rope reaction it’s kind of
like what you see similar in the picture are lesions that appear shortly after
taking medication and the photo sensitivity of various psychotropics can
range that’s why if you look at the side effects I recommend not staying in the
Sun for extended periods of time so like Stacy was talking about earlier it is
important to integrate counseling with medication use this helps to mitigate
the risks of side effects as well as helping clients to understand what those
side effects are instead of just defaulting to a medication and also
helps with medication compliance psychotherapy has been shown to be
effective when used in conjunction with psychotherapy with pharmacology
cognitive behavioral therapy interpersonal psychotherapy and
problem-solving therapy are often utilized as first-line treatments for
elderly clients and as state stacy mentioned earlier they are very
efficacious they are effective what that said they may be limited in their effect
with clients that are in advanced stages of neurocognitive disorders like
Alzheimer’s or dementia they may not have the cognitive capacity to be able
to fully benefit and participate in these forms of therapy and that’s why
screening is important for these clients art therapy may be more effective it has
been shown effective at reducing depression and anxiety symptoms and
because it’s because it’s engaging the client creatively it’s
activating different parts of the brain that may not be as effective fight but
as affected by the Alzheimer’s or the other dementia related disorders so as a
result it may be more valuable than other forms of psychotherapy studies
suggest that one medication treatments are combined with group integrated
psychotherapy dropout rates are significantly reduced some things to
keep in mind with elderly as well as with their caregivers as the counselor
it is our duty to take into consideration different factors and when
bringing up the medications studies show that psycho education in
particular is hopeful not only for the clients before their caregivers as well
to inform them about the medications being consumed about their side effects
and these studies also show that this serves to reduce caregivers but in
somewhat and as we mentioned earlier caregiver burden is a real issue and as
has the counselors we need to be willing to bring it up because as a parent
burden depending on the nature of it mainly to
increased risk of elder abuse for less effective care for the client it’s
crucial to discuss the pros and cons of medications and how they will affect the
livelihood of the individual and to make them more aware not to chemically
restrain the client so much as it is to help improve their livelihood medication
should be used in conjunction with with the treatment not instead of
psychosocial treatment so as Stacy mentioned earlier there are ethical
considerations that we need to keep in mind to degree can elderly clients be
autonomous with their medication treatment you know if they want to be
non-compliant well affects their stability will that effect you know the fact like to what extent
will it affect how they will be able to live you know and are they being
non-compliant because they don’t like the side effects are they being
non-compliant because of the symptom ology of their disorder you know there’s
a lot of things to keep in mind and it’s a careful balance medication should be
used to improve their well-being not to chemically restrain them as we’ve
mentioned earlier that has this that’s associated with a higher risk of over
medicating and that in and of itself is associated with more adverse side
effects does medication maintain their safety and independence this goes in
with autonomy and is the medication wore for the side effects
as a counselor one must keep an eye for red flag signal a caregiver burden and
elder abuse so where do we go from here in order to increase the quality of
services utilized by all early clients we need to put an emphasis on quality of
life concerns first instead of you know focusing like it’s getting caught up in
the moment and over medicating them because we understand underfunded can’t
you know it feels like maybe they feel overwhelmed can’t do anything except to
medically calm them that’s just barely putting a band-aid over the issue and
not really addressing it instead of focusing on what the caregiver may or
may not be able to do focused ethically on the client what it is that they want
what it is that their caregivers want to accomplish this it’s necessary to be
aware of what psychotropic drugs are are not capable of doing they’re not a
miracle drug and the first step to this is to enable funding
and energy for complimentary services in order to provide an optimal quality of
life in conclusion living longer means dealing with more physiological issues
the field of geriatric psychiatry though in its infancy focuses almost
exclusively on pharmacological interventions and not a much of an
emphasis on psychosocial option and you know we’ve discussed the pros and cons
of how that’s been addressed with an increase in the population of older
adults and corresponding mental health concerns there is a need for a complex
set of solution that one-size-fits-all approach
embraced by the pharmaceutical industry is simply not sufficient or adequate to
address the demographic shifts and the complexity of this issue so here we have
our referral list both in the local Stephenville area as well as going into
the Fort Worth area so in Stephenville we have the pecan Valley mental health
mental retardation we have their website provided as well as their various
locations there is the Stephenville medical and
surgical clinic we have their website provided as well
the MSS Springs hospital which is in Fort Worth the Mental Health Association
of Tarrant County also in Fort Worth and then the MHMR of Tarrant County also
Fort Worth and then here are all of our references so we would all like to thank
you thank you thank you you

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