Mental health in older people - Naomi Gallant

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I was privileged to be able to speak as part of a Lent series at St. Paul's and St. Peter's church, Great Missenden about Mental Health and Human Flourishing in aging.In summary I highlighted 3 key areas where mental ill-health can become a problem in aging: dementia, delirium and depression

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Mental health in older people
@naomi_gallant
www.DementiaCareResearch.com

Naomi Gallant - www.DementiaCareResearch.com

The 3Ds
Dementia Delirium Depression
Naomi Gallant - www.DementiaCareResearch.com

The 3D Quiz - Definitions
Progressive loss of brain cells… a terminal condition:
An acute or sudden onset:
A change in mood lasting at least 2 weeks:
Naomi Gallant - www.DementiaCareResearch.com
Dementia
Delirium
Depression

The 3D quiz - Duration
Years (usually 8-20):
Hours to months, dependant on speed of diagnosis:
At least 6 weeks, can last months to years if untreated:
Naomi Gallant - www.DementiaCareResearch.com
Dementia
Delirium
Depression

The 3D Quiz: Thinking
Fluctuates… distorted thinking, incoherent speech:
May be indecisive, highlight failures/hopelessness:
Gradual loss of cognition:
Naomi Gallant - www.DementiaCareResearch.com
Dementia
Delirium
Depression

The 3D Quiz: Mental status testing
Capable of giving correct answers:
Attempt to answer, not aware of mistakes:
Testing may vary dependant on fluctuating cognition:
Naomi Gallant - www.DementiaCareResearch.com
Dementia
Delirium
Depression

The 3D Quiz: Memory
Recent and past memory impairment:
Generally intact, highlights negativity:
Recent and immediate memory impairment:
Naomi Gallant - www.DementiaCareResearch.com
Dementia
Delirium
Depression

The 3D Quiz: Sleep-wake cycle
Disturbed, usually early morning awakening:
Disturbed, sleep-wake cycle often reversed:
May awaken often at night, may wander:
Naomi Gallant - www.DementiaCareResearch.com
Dementia
Delirium
Depression

The 3D Quiz: Hallucinations/delusions
Can be present. Usually guilty and negative to self:
Can be present, may misperceive:
Often frightening or paranoid:
Naomi Gallant - www.DementiaCareResearch.com
Dementia
Delirium
Depression

The 3D Quiz: Diagnosis
Usually diagnosed approx. 3 years after symptom onset:
Diagnosis based on rapid onset of fluctuating symptoms:
May notice symptoms before the person does:
Naomi Gallant - www.DementiaCareResearch.com
Dementia
Delirium
Depression

The 3D Quiz: Care approaches
Early recognition is key… find cause and treat quickly:
Identify symptoms early. Help person to follow treatment plan
and offer hope:
Maintain and enhance abilities the remain:
Naomi Gallant - www.DementiaCareResearch.com
Dementia
Delirium
Depression

The 3D Quiz: Prognosis
Treatable and reversible if caught early:
Treatable and reversible:
Progression can be slow but not reversible:
Naomi Gallant - www.DementiaCareResearch.com
Dementia
Delirium
Depression

The 3D Quiz: Treatment
Treat cause:
Antidepressants, ECT, cognitive therapy:
..slow the progression. Symptomatic treatment with
environmental and staff approaches:
Naomi Gallant - www.DementiaCareResearch.com
Dementia
Delirium
Depression

Dementia: some stats
• Dementia is non-discriminatory
• 1/3 older people will end their lives with dementia
• 2 million people by 2051
• There is no cure
• Dementia costs the UK £26.3billion a year
• 670 000 people in the UK act as primary, unpaid carers for
people with dementia.
Naomi Gallant - www.DementiaCareResearch.com

• Alzheimer’s
• Vascular
• Lewy Body
• Frontal
• Frontotemporal
• +100 more
Naomi Gallant - www.DementiaCareResearch.com

3 key principles (Dr Jennifer Bute)
There is always a reason behind the behaviour
Normal human responses to:
Confusion
Loss of control
Fear/anxiety
Tiredness
Expressing needs
(pain, hunger, toilet)
Sadness
Naomi Gallant - www.DementiaCareResearch.com

When facts are forgotten, feelings remain
“My yesterdays are disappearing, and my tomorrows are
uncertain, so what do I live for? I live for each day. I live in the
moment… I will forget today, but that doesn’t mean that today
doesn’t matter.”
― Lisa Genova, Still Alice
Naomi Gallant - www.DementiaCareResearch.com

Familiar patterns of behaviour continue
Naomi Gallant - www.DementiaCareResearch.com

Faith in Dementia
Romans 8 v 35, 37-39 – Nothing can separate us from God’s love.
Psalm 139 v 7-10 – We cannot go anywhere to escape God.
Romans 9 v 14 – 16 – Every day we are alive is an opportunity for
mercy.
Naomi Gallant - www.DementiaCareResearch.com

Beyond words…
• Make the most of every moment – feelings will continue
• Never forget the person behind the diagnosis or behaviour
• Explore the senses
Naomi Gallant - www.DementiaCareResearch.com

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