psychotherapy for elderly dementia patients?

[AlexanderN]

I'm a new nurse and I recently laughed at a strange consult for a patient I crossed by. An 88 year old male patient was brought in by his wife because he was being physically abusive and hitting her. He has advanced dementia, was medically cleared and for a Psych. consultation. I thought what the heck is the point of a psych. consult for an elderly dementia patient. I stated this same case to a fellow nurse and he described that he has worked on an acquired brain injury unit many years ago and he told me the story of a patient who got brained-damage after an accident and became very aggressive from his injuries. Long story short he informed me that psychotherapy can possibly reduce aggressive behaviour in patients with medical conditions that cause different unusual behaviors.

Does anyone have experiece with/knowledge about something similar to this. That is, using psychotherapy to reduce aggressive behavior in elderly dementia patients?

[SuesquatchRN, BSN, RN]

I think that you may be misinterpreting the use of a psych consult in this type of situation.

The patient will not be in psychotherapy. The practitioner is going to evaluate the symptoms and etiology and then prescribe appropraite medications and make suggetions for his care.

If I am wrong, I can't imagine how straight psychotherapy is going to benefit someone with organically induced behavioral and preceptual problems.

[S.N. Visit, BSN, RN]

Like SuesquatchRN said, the psych consult is to determine the level of aggressive and inappropriate behaviors that may be treated with a combination of psychotherapy, environmental modifications, and medication. Straight psychotherapy at this stage of dementia would probably create more adverse behaviors d/t frustration.

[statphleb SN]

My Grandma had severe dementia and I know when she had psych evals(usually annually) it was for med checks only---her family doctor said he wasn't comfortable giving her a specific Dx or putting her on meds he didn't deal with often. Hope this may help!

[casi, ASN, RN]

I second Sue that this is probably a consult for medication adjustments. They seem to be the best for adjusting medications for behaviors.

[AlexanderN]

oooohhh ok. Thank you so much! I probably should have done a little more research. Thanks for

clarifying this for me!

[BroadwayRN, ASN, RN]

I've seen many doctors order alot of tests on elderly patients with dementia, alzheimers, etc. Usually to r/o a CVA. I mean what is the purpose in that? Especially when the patient is already a DNR and unconscious? I think it's rather cruel. I wouldn't allow those tests to be done on my Grandmother and she would undoubtedly come back to haunt me if I did. We're talking EEG's, MRI's, etc...tests that are uncomfortable for the patient.

[Saifudin]

I agree with our colleagues, a psych assessment is required for a general evaluation of this patients state of dementia, need for appropriate meds and also if the wife is capable and/or willing to still care for this patient.

Physical abuse is common in dementia. The patient may be deluded and I wonder if he still recognizes his wife. If the abuse is severe enough the patient may require placement however, the fact he came from home indicates a likely highly committed wife and perhaps other factors such as their financial abilities for placement, quality of available nursing homes, etc. These situations can be quite complicated and requires an holistic approach. Even with medication, the aggressiveness may persist. And, of course, any confounding medical problems are important to know.

Final message, this a biopsychosocial and spiritual issue and a good lesson for you as a younger nurse. Learn well from it because some of us are not all that far behind from potential similar situations.

[lpnflorida]

I agree the psych consult is not for traditional pscyho therapy. The consult is for the conducting of such things as a testing to see if there is organicity versus say depression which might be causing the symptoms. Some of the testing is also used to get a base line so that further deterioration can be tracked. Behavioral plans are often developed as well as resources to help the spouse cope.

[nursemike, ASN, RN]

I've seen many doctors order alot of tests on elderly patients with dementia, alzheimers, etc. Usually to r/o a CVA. I mean what is the purpose in that? Especially when the patient is already a DNR and unconscious? I think it's rather cruel. I wouldn't allow those tests to be done on my Grandmother and she would undoubtedly come back to haunt me if I did. We're talking EEG's, MRI's, etc...tests that are uncomfortable for the patient.

DNR doesn't mean do not treat, and letting a patient with dementia go untreated for a CVA or seizures would leave a doctor and facility open to all sorts of liability. Granted, the tests are no fun. On the other hand, being unconcious would take a lot of the discomfort out of an MRI or CT, and an EEG really doesn't look so bad.

I'm sure the intention is not to be cruel, and I honestly doubt many docs would order these tests just to bill for them. I imagine there may be an element of CYA in some cases, but you kinda have to blame lawyers and families for that.

Still, if a patient with advanced Alzheimer's was complaining of chest pain, would you not get an EKG and enzymes?

[BroadwayRN, ASN, RN]

Still, if a patient with advanced Alzheimer's was complaining of chest pain, would you not get an EKG and enzymes?

As a physician I would have no choice but to do so, as a nurse if it were my Grandmother or Grandfather, no I would not want anything done other than pain meds.

[nursemike, ASN, RN]

As a physician I would have no choice but to do so, as a nurse if it were my Grandmother or Grandfather, no I would not want anything done other than pain meds.

Not really disagreeing with you. At least at some point, it does seem like it might be more merciful to go over something treatable, but quick, rather than letting a long, terminal illness run its course. But it isn't cut-and-dried, is it? I've had an inpatient being treated for pneumonia who was on hospice for something else, and it made sense, to me.

I see a fair number of patients, many of whom may be DNR, go through a variety of tests and treatments and wind up on Comfort Measures Only, but I don't feel like it's wasted effort. Guess it depends a lot on what their baseline quality of life is.

I imagine there may be times when a psych consult may help determine how well a pt with apparent dementia is able to know and express their own wishes.