Question

Discuss the following cognitive concerns for the aging population including possible causes and nursing care for each:

-Cerebrovascular accident

-Depression

-Insomnia

-Paranoid thinking.

Answer 1

Cerebrovascular accident is when there is a sudden blockage in the blood flow to a certain part of the brain maybe due to a rupture in the blood vessel. They are commonly called stroke and have a very high chance to occur in the older population. It is said that after the age of 55 years, the chances of getting a stroke doubles in every 10 years. Prevalence of other medical consitions like diabetes, hypertension or peripheral artery disease etc are related with the high risk of stroke in the elderly population. Also with age blood vessels of our body weakens and the chances of stroke further increases.

Monitoring vital physiologic parameters of the patient and maintenance of homeostasis which is setting of an optimal functioning of different body system is a very important aspect of nursing care for a stroke patient.

Depression can be simply defined as a mood disorder that causes a person with a constant feeling of sadness, hopelessness and loss of interest in doing anything and even the things that they once loved to do. Incidence of depression are higher in older population as compared to the general population. This is because with age, a person start loosing his friends, family members, life partner, beloved pets which causes a big void of loneliness in their life. Often their childrens akso move to other cities and get busy with their life. So there is no one to consistently look after them. Additionally there is also a fear of dealth, chronic health condtion and economic crisis. These all conditions increase the risk of developing a condition of depression in th elderly.

A mixture of cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapy is used according to the condition of the patient to cure the condition of depression. It is a lengthy process and adequate patience and efforts are required. In a older patient with depression, a nurse must assist them with self-care and educate and help them to maintain personal hygiene. Healthy and good food is very important for such patient and hence the nurse should encourage the patient to eat. The nurse should also teach the patient with techniques of improving sleep. Day to day activities should be planned for the  patient' to keep him occupied and happy.

A condition of insomnia is very common in elder popultaion. This is because they carry a lot of respiratory problems which make it difficult for them to breath while sleeping, physical disability like falls or hip fracture, constant pain due to chronic conditions and most of the time a poor health condition. Additional lack of physical activities also reduces the urge to sleep and in addition, there are drugs like beta blockers, glucocorticoids, NSAIDs, decongestants, and many others that contributes to the condition of insomnia.

To treat the condition of insomnia in the elderly, the nurse must use a variety of cognitive behavioral therapy which include strong sleep hygiene likeoptimal bedroom environment for better sleep and regular physical activities that promote quality sleeping habit, relaxation techniques to pause constant ongoing thoughts in the mind that interrupts sleep pattern, sleep restriction, and stimulus control.

Paranoid thinking can be defined as a mental condition where a person develops an irrational and unrealistic suspicion or mistrust for others and develops a feeling of being persecuted. In older people it can be seen by their accusation on their caregivers about theft or cheating. They also show unkind, impolite and rude behavior to their caregivers. The biggest causes of these behavior and paranoid thinking are condition of mental confusion, emotional disruption, medication side effects, presence of mental disorder, depression and dementia.

For a patient with paranoid thinking, it is better for a nurse to reduce the environmental stimuli as low as possible that triggers the paranoid behavior of the individual. The caregiver should avoid arguements and try to be all ears for the patient and help them in getting calm. Timely administration of PRN medication as prescribed and whenever appropriate. Nurse should encourage patient to comply and closely monitor the sign and symptoms of the client and their response towards the drug therapy.