15% of US population is >65 and 80% have at least one chronic condition.
Signs that a psych issue may have organic etiology:
Onset > 40 yrs
Symptoms occur during major illness
Altered mental state
Eye abnormalities
Speech disturbances
Psychosis
Gait disturbances
Abnormal vital signs
Always remember to assess for safety: diet mobility clean clothes( diet, mobility, clean clothes ), fall risk bruising urination( fall risk, bruising, urination ), "meals on wheels" delivery poor eyesight driving( "meals on wheels" delivery, poor eyesight, driving ).
Drugs that can cause hallucinations or psychosis:
Levo-dopa
Procainamide
Estrogen
Steroids
ACE inhibitors
• Drugs that can cause agitation:
Neuroleptics and antibiotics
Benzodiazepines and ARBs
Bronchodilators and activating antidepressants
Drugs with extensive first pass effect may not be absorbed as well as those with phase II pathways in the elderly.
The following are which type of drugs? • Amiodarone • Diazempam • Chlodiazepoxide • Clonazepam • Lidocaine • Haloperidol
Hydrophilic drugs that build up in the leaner elderly.
Lipophilic drugs that get increased in with increased adipose tissue.
Protein-bound drugs that are increased in the elderly.
What is an issue with Lithium in elderly?
They don't like it.
Hydrophilic drugs have decreased distribution with decreased total body water.
They are too demented for it to have any effect.
It can cause delirium.
In prescribing SSRI's to the elderly, consider that:
They may disguise organic conditions.
They are only indicated for <65 years old.
Decreased fat:muscle ratio can result in serotonin syndrome.
Decreased plasma protein results in increased unbound, active drug.
Increased renal clearance changes elimination of drugs in elderly.
Risks of benzos with elderly:
Delirium risk
Self-neglect risk
Dementia risk
Fall risk
Greater risk of addiction
Common side effects of psychotropic drugs in elderly: o General: ❌ o Peripheral cholinergic blockade: ❌ o Central cholinergic blockade: ❌ o Alpha-adrenergic blockade and central pressor blockade: ❌ o Dopamine blockade: ❌
Benzodiazepines should be tapered very slowly in elderly clients, 10% per month for chronic users (> 1 month usage).
Types of reversible dementias:
Thyroid disorders
B12 deficiency
Neurosyphilis
Normal pressure hydrocephalus
Depression
Alcoholic and vascular dementias are irreversible.
Risk factors for dementia:
PPI or benzo use
Metabolic syndrome
Pesticide or degreasing agent exposure
PTSD
Treatments for Alzheimer’s disease: Cholinesterase inhibitors: ❌ NMDA receptor agonist: ❌
