After Mrs. B™s delirium had cleared and the symptoms of her major depressive disorder with psychotic features continue

After Mrs. B’s delirium had cleared and the symptoms of her major depressive disorder with psychotic features continued to improve; cognitive and functional assessment revealed only mild deficits in short and long-term memory and instrumental activities of daily living.

 Mrs B’s ability to bathe, dress, use the toilet and eat meals remained steady at the level of requiring some assistance with planning and organising (motivating?) while able to complete the fine and gross motor tasks (praxis) without physical assistance.

Mrs B. is planning to go home to the hostel (“low care aged care facility”) section of the retirement community where she had previously had an assisted living apartment.  Her constipation, dehydration and poor nutrition resolved in hospital. Her cognition improved now scoring 26/30 on the MMSE with mild deficits in short term recall, orientation for date and a couple of minor  errors in the language tests. Her hypothyroidism was corrected.  Her BP was stable in hospital, so her antihypertensive was ceased (she hadn’t been taking it regularly when she was unwell at home). She responded well to anti-psychotic and anti-depressant medication. 

Over time Mrs B gradually became more responsive and more engaged with recreational pursuits with some encouragement. She expressed no more thoughts of dying and was perplexed (embarrassed?) when asked about her previous expression of these thoughts. Her appetite and sleep stabilised. Episodes of anxiety were less frequent.

  1. Using the ISBAR format, what information should be communicated to the Aged Care Facility prior to discharge and include any information that might help them manage Mrs B in the future (for example, Mrs B’s mental health relapse indicators).

http://www.safetyandquality.gov.au/our-work/clinical-communications/clinical-handover/national-clinical-handover-initiative-pilot-program/isbar-revisited-identifying-and-solving-barriers-to-effective-handover-in-interhospital-transfer/

  1. Describe the indication, clinical use, adverse effects, potential interactions and nursing implications of one psychoactive medications for the older person. Consider one of Mrs B’s medications from the case study: Quetiapine, Sodium Valproate, Sertraline, Venlafaxine, Aripiprazole or Lorazepam.
  2. Discuss briefly a personal model of successful ageing incorporating at least 2 theories of aging from the readings or text. In your answer explain the potential changing roles of a person as they reach old age and potential associated life problems.
Addit info

Essential readings

There are a substantial number of essential readings in this module. This is a module which is intended to be studied over two weeks. The readings are of a factual reference nature and are mostly reviews and summaries. readings.

General

  • Byrne, G., & Neville, C. (2010). Community Mental Health for Older People. Sydney: Elsevier. Chapter 30. (course textbook)
  • Holbeach, E., & Yates, P. (2010). Prescribing in the elderly. Australian Family Physician 39(10), 728-733 
  • Lindsey, P. L. (2009). Psychotropic medication use among older adults: what all nurses need to know. Journal of Gerontological Nursing, 35(9), 28-38 
  • Morgan, T. K. (2012). A national census of medicines use: a 24-hour snapshot of Australians aged 50 years and older. Medical Journal of Australia 196: 50-53. 

Antipsychotics

  • Hall, R. C. W., et al. (2006). Neuroleptic Malignant Syndrome in the Elderly: Diagnostic Criteria, Incidence, Risk Factors, Pathophysiology, and Treatment. Clinical Geriatrics 14(5): 39-46. 
  • Maust, D.T., Kim, H., Seyfried, L.S., & et al. (2015). Antipsychotics, other psychotropics, and the risk of death in patients with dementia: Number needed to harm.JAMA Psychiatry, 72(5): 438-445. 
  • Rado, J., & Janicak, P. G. (2012). Pharmacological and Clinical Profile of Recently Approved Second-Generation Antipsychotics Implications for Treatment of Schizophrenia in Older Patients. Drugs & Aging 29(10), 783-791. 

Mood stabilizers

  • Shulman, K. I. (2010). Lithium for older adults with bipolar disorder: should it still be considered a first-line agent? Drugs & Aging 27(8): 607-615. 
  • Meyer, R., & Schuyler, D. (2015). Calming the Agitated Demented Patient. The Primary Care Companion For CNS Disorders17(1). doi: 10.4088/PCC.15f01779.

Anti-depressants

  • Frank, C. (2008). Recognition and treatment of serotonin syndrome. Canadian Family Physician 54(7): 988-992. 
  • Howland, R. H. (2008). Understanding the clinical profile of a drug on the basis of it’s pharmacology: Mirtazapine as an example. Journal of Psychosocial Nursing 46(12): 19-23. 
  • Smith, J. (2010). Clinical implications of treating depressed older adults with SSRIs: possible risk of hyponatremia. Journal of Gerontological Nursing 36(4): 22-29. 

Benzodiazepines

  • Assem-Hilger, E., et al. (2009). Benzodiazepine use in the elderly: an indicator for inappropriately treated geriatric depression? International Journal of Geriatric Psychiatry 24(6): 563-569. 
  • Peisah, C. C. D. K. Y. M., R., Kurrle,S.E., Reutens,S.G. (2011). Practical guidelines for the acute emergency sedation of the severely agitated older patient. Internal Medicine Journal: 651-657. 

Cholinesterase Inhibitors

  • Schwarz, S., et al. (2012). Pharmacological treatment of dementia. Current Opinion in Psychiatry 25(6): 542-550. 


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