Understanding Psychosis in Older Adults

Feb 7th, 2017

 

 

Memory loss caused by Alzheimer’s can be shocking to many caregivers, but there are other behavioral side effects, like psychosis, that can be just as frightening.

The onset of psychosis is quite common among patients with Alzheimer’s Disease. A recent meta-analysis showed that more than 40 percent had psychotic symptoms, which led to faster functional impairment and increased mortality risk. Here are three defining factors to understand and share while educating caregivers and staff:

1. Psychotic Symptoms

The American Geriatric Society (AGS) suggests that psychosis occurring for the first time in later life is often due to dementia or neurologic conditions such Parkinson’s disease or stroke, as opposed to a primary psychotic disorder, such as schizophrenia.  Delirium that occurs as a result of dehydration, medication toxicity or pain is a common cause of abrupt behavioral health challenges in patients with dementia, and must be considered as part of the evaluation process.

Symptoms of psychosis

  • Visual or auditory hallucinations that have been present for one month or longer – seen in about 20% of Alzheimer’s patients
    • Hallucinations occur in about 11% of patients with psychotic symptoms, and are more commonly visual
  • Delusions that are fixed, idiosyncratic or false perceptions or beliefs with little, if any, basis in reality and are not the result of religious or cultural norms
    • Examples include belief that people are stealing things, spouse is unfaithful, etc.
  • Symptoms not continuously present before the onset of dementia

 2. Older Adult Psychosis Risk Factors

Discerning and managing psychotic symptoms among elderly patients and residents can be challenging for healthcare professionals and accelerate caregiver burnout.  Knowing whether the warning signs are related to Alzheimer’s or dementia, a medication reaction or potential drug interaction, or even late-onset schizophrenia remains key in developing a comprehensive, safe treatment plan.

Here are the major risk factors for developing psychosis among elderly adults:

  • Chronic bed rest
  • Cognitive impairment
  • Female gender
  • Sensory impairment
  • Social isolation

3. Top Five Management Factors

  • Age-related pharmacokinetic and pharmacodynamic changes
  • Comorbidities and concurrent use of medications
  • Safety and efficacy issues of pharmacological treatments, such as FDA black box warnings and limited efficacy
  • Cost factors and lack of studies with adequate control group and duration of exposure for nonpharmacological interventions
  • Regulatory issues for institutionalized patients

Staff Education Tip:

The month of February highlights Alzheimer’s and dementia caregiver education, recognizing the importance of sharing warning signs, symptoms and risk factors for psychosis with behavioral health staff. Since identifying and effectively managing the neuropsychiatric symptoms of dementia requires careful and comprehensive evaluation, consider dedicating time to talk with and educate staff about the issues of late onset psychosis outlined in this article. Use the American Geriatric Society’s helpful guide and remember to anchor discussions around the following five areas: 

1. The patient’s symptoms,

2. The patient’s comfort,

3. The care environment,

4. The needs of the caregiver(s), and

5. The degree of distress of all those involved in the patient’s life.

For questions and concerns about patients or residents showing signs on psychosis, call Oceans for support.  We can help with multipronged strategies that safely and effectively optimize care for patients and their support network. 

 

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