What's unique to geropsych patients?

[RN007]

I just recently started working full time in a geropsych unit. I like it very much and know I have a lot to learn. I continue to work prn in another hospital's emotional health unit where we mostly get CD detox and depression with a few geros thrown in the mix.

The other day, our MD d/c'ed a 99-yr-old pt's Lexapro. When I asked why, he explained that patients with 'fragile minds' -- like those with AD or other dementia -- may not respond well to antidepressants, that they can actually exacerbate the problem.

Are there other medication-related issues or anything else that's unique to gero pts I should know about? I'm eager to learn.

Thanks!

[Whispera, MSN, RN]

As with any medications, elders metabolize and excrete meds much differently than youngers. Often smaller doses are needed. They also seem to have more side effects. Drugs that make people sleepy can mean an elder will fall and break a hip too.

[SuesquatchRN, BSN, RN]

They perseverate more than other psych folks, generally about something they must do or find. A typical event will be distress and anxiety over finding their car. And don't account for the one thye can't find - they'll then have another. And another. Same with the baby, the puppy - and if they are ambulatory they won't be after they fall.

I have found that with agitated, hostile male patients that male caregivers - nurse, aide - can be a factor precipitating violence.

[RN007]

Oh, yes. They sure do. It's wonderful when they can be redirected but, otherwise, I'm glad God gave me patience. And you're right about the male thing, too.

[Mr Ian]

Quality of life is more important than anything.

Alleviate problems with the least interventions necessary and promote the good stuff as much as possible.

The little things matter and don't look for a long term curative prognosis.

And sneak some beer in once in a while.

(What? Well I'm gonna be old one day.. .that's what *I* want!)

[Whispera, MSN, RN]

I'd like to add...don't stand over them. Kneel or sit so you're eye-level. Smile. Touch on the arm or hand. Talk to rather than about. Ask what's needed. Ask what's wanted in foods, clothes, activities. Don't push a schedule that's convenient to you if it's not convenient to the elder. Move slowly and gently, not quickly and roughly. Wear bright colors. Think about pleasant smells. Ask the family to bring in familiar items and put them wear they can be seen and/or touched. Don't call "sweetie" or "honey". Address by name and use the respect you'd like your parents, grandparents, or self to have.

[VicksburgNurse]

I too work Gero Psych. You would be completely surprised to learn how much simple issues like UTI's, low iron, b12 lvl's or fliud volume can cause increased confusion or combative behavior. When ever I have a patient who has been a sweetie "turn to the dark side" that's where I start looking first.