Cognitive Functioning in Older People - Literature review Example

Literature synthesis Paper Student’s Name Institution’s Name Introduction Elderly people contain special healthcare requirements which can turn their medical care to be more complex. Over half of elderly aged 65 and above contain at least three medical issues. This paper will discuss cognitive functioning issues associated with old people. According to Qiu et al. (2007) cognitive function is an intelligent process by which a person develops awareness of, comprehends, or perceived ideas. It encompasses all remembering, reasoning, thinking, and perception aspects. It also involves judgment capacity and awareness. These aspects tend to be impaired as one advance in age. This may be due to age associated cognitive deterioration, the development of dementia, depression, or acute confusion also known as delirium. Best cognitive function is essential for continued individuality. Cognitive function issues lower independent level of the affected old and thus, they need to be addressed. Cognitive Function Disorders Cognition alterations happen in all individuals as thy advance in age. Ageing can cause alterations in remembering as well as thinking and is commonly known as age associated cognitive decline. Cognitive disorders can be contributed by a number of factors, among the accumulating modifiable risks evidence proposes that health behaviors for instance weight, diet, alcohol drinking, physical activity and smoking effect cognitive function significantly and in late life they can contribute to the development of dementia (Gorospe & Dave, 2007). As people ages, a number of them will suffer at least one of the three D’s: depression, dementia, and delirium. The most severe of the three is delirium. According to Mitchel & Kakkadasam (2011), delirium accounts for about 10 to 15% of the entire admissions to acute care sanatoriums. It has also been estimated that 10 to 30% of admitted patients age 65 and above have delirium episode during their hospital stay. Delirium is characterized by fluctuating consciousness level, global cognitive function impairment, and acute onset. There are various factors that may lead to delirium cognitive disorder. About 43 % of delirium in old is caused by infections, 20 to 40% by endocrine as well as prescribed medication, constipation, electrolyte and fluid imbalance. Despite this, the rates of non-detection ranges between 33 and 66%, which is quite high (Qui et al, 2007). There have also been cases of misdiagnosis of delirium. Although nurses’ notes only were established to hold enough information to assist in delirium diagnosis for about 85%, the information is rarely used in delirium diagnosis. Thus, the cases of misdiagnosis are quite high. Delirium symptoms can persist for weeks, hours, months or longer, a condition that may indicate poor prognosis, decline in future cognitive and severe underlying illness (Simard, n.d.). Dementia increase prevalence from about 0.7% of elderly aged between 60 and 64, doubles after every five years to about 40% in elderly aged between 90 and above. It is approximated that about 35 million of individuals in the world are suffering from dementia. The signs and the symptoms contain both features that are directly attributable to cognitive function defects as well as to non-cognitive features that include psychiatric symptoms for instance delusions and hallucinations, and also disturbed behaviors for instance eating disorder, wandering and aggression (Featherstone et al., 2010). Dementia can be initiated by a number of conditions. About 65% of dementia incidents are caused by Alzheimer’s diseases. Other common dementia causes in older people include drug intoxication, alcoholism, vascular dementia, and Parkinson’s disease. Other less contributors of dementia condition among elderly include degenerative disorders, chronic infections for instance HIV, endocrine abnormalities, and vitamin deficiencies. It is also known to occur in severe cases of depression or delirium (Peters et al., 2008) The depression prevalence among older adults living in the society is about 10 to 18%. This can significantly increase in hospital and residential settings. There many causes of depression in older adults. Most of these causes are associated with the life experience of an individual. A series of losses for instance death of friends, children, and spouses, dwindling financial resources, alterations in living situations, and diminished physical capabilities are some of the factors that contribute to depression (Qiu et al., 2007). Depression has also been related with other medical conditions. It is estimated that the chances of health elderly suffering from depression are between 20 to 30% while that of elderly with chronic diseases are approximated to be as high as 70% (Sprinks, 2011). Depression advancement has recently been associated with clinical care. According to Cherniack (2011) subclinical depression might raise the disability progression and illnesses worsening perception among the old, an aspect that acts as a suicide risk factor. Older adults have been found to contribute for 25% of total number of suicides that take place in the world. It has also been documented that 75% of older adults who commit suicide called their provider for primary care within a month before suicide, also between 30 and 50 percent within one week before their death. Ageing Theory that Relate to Cognitive Disorder Cognitive disorders can be investigated based on psychosocial theories of aging. This is a combination of psychological and social theories of aging. Psychological ageing is primarily characterized by changes of behavior while sociological alterations refer to alterations that associate to the environmental effects that contribute to and influence aging people. Cognitive disorder refers to mental related disorders. They can easily be understood when one understand the psychosocial theories that exist regarding the older people. According to the theory, the mental condition of a person changes depending with the social experience encountered during the past as well as in the present situation (Givens et al., 2009). These are some of the factors that have been mentioned in a number of literatures to contribute to depression as well as other mental related problems. Psychological theory states that as people become order, their activities, social interactions and behavior changes. This creates a good base for research on cognitive disorder, for the researcher is made to understand that some condition happens involuntarily even without other externally causes for instance diseases. It also enlighten the practice based nurses on what to expect while handling old people and thus, creating a good base for their care. However, nurses need to be careful so as not to generalize all cases even those that are not caused by age (Peacock et al., 2012). Assessment Tool Used Mini-Cog tool was used to assess cognitive disorder in older people. This tool was used to assess elderly patient for the presence of dementia. The tool was administered to test for the patient executive function, recall and registration. The tool is very essential in practiced based nursing for it does not only help in establishing presence or absence of dementia but also, in detecting its early stage of development. The tool is straight forward and can only be administered within 3 minutes. This tool is highly recommended for any dementia assessment at all categories of healthcare including younger people (Doerflinger, 2007). Discussion Cognitive disorders have in some cases been successfully managed by nurses. However in most cases, cognitive disorders have been misdiagnosed. This is because most nurses have taken notes regarding the patients with other health problem in mind rather than cognitive disorder. It has been established in a three years study in Mitchel & Kakkadasam (2011) that although nurses’ notebooks contain all it takes to correctly diagnoses dementia, they have still failed to diagnose it correctly. In addition, clinic attendance has been associated to the advancement of depression cases to a point of suicidal Gorosp and Dave (2007). It has also been noted that most patients develop cases of dementia when they are admitted. This is a clear indication that advance nursing practice has not been very efficient in handling cognitive related problems. Additionally, there are high chances that nurses hardly consider psychological welfare of the elderly patients in admission. Instead they only concentrate on the actual problems that were initially reported during admission. Cognitive disorders have also been known to be contributed by a number of medications. The analysis shows that chronically ill elderly patients have a higher chance of suffering from depression as compared to normal elderly individuals. The current condition associated with cognitive disorders and advance nursing is awful. However, proper application of cognitive assessment tool can easily aids in giving the right diagnosis and thus, ensuring earlier diagnosis of the problem prior to its advancement (Qiu et al., 2007). Nurses should always develop a habit of counter checking patients who seems to have noticeable cognitive related symptoms so as to enhance better chances of handling the situation. This way, the advanced nursing practice will be able to produce good practical results. Conclusion Elderly people suffer from a number of geriatric problems that involves physical, cognitive and/ or life quality assurance. However, cognitive geriatric is quite complex and go unnoticed in most cases, since it is not straight forwardly revealed as pain does through facial expression. Therefore, most individual have suffered in silence until the problem grows to advancement where everybody can notice the state of confusion, the loneliness or worse when an elderly person attempt to commit suicide. Although health caring unit has tried its best to handle this situation, the results are not good enough. A lot need to be done to eliminate the high development of cognitive disorders and especially when the patients are under medication or in the hands of healthcare unit. Table 1: Diagnosis of cognitive disorders Author Study Design Duration of Follow Up Sample Type N and Dx Baseline Age Baseline Measure of Effective Symptoms Measure of Cognitive Gorospe & Dave, 2007 Longitudinal Monitored for 3 weeks Hospitalized elderly population was employed 100 admitted patients suffering from other cases other than cognitive disorders Examined patients aged between 50-85 Observation of the patient behavior, interview and questionnaire filling Rectal examination, neurological examination completed blood count (CBC) serum/drug screening self-reported screening self-reported screening test geriatric depression scale mini-mental state examination (MMSE) functional and status questionnaire CLOX: an executive clock drawing task Peacock e al., 2012 Longitudinal Research was conducted for 1 week Nursing home Interviewed 14 medical assistances Best cognitive disorder recognition techniques were question Interviewed on cognitive disorder trigger observation and detection knowledge, close content effect care management change teamwork and communication Figure 2: Relation between other Disorders and cognitive disorder development or advancement Author Study Design Duration of Follow Up Sample Type N and Dx Baseline Age Baseline Measure of Effective Symptoms Measure of Cognitive Cherniack, 2011 Longitudinal Five weeks University hospital clinic 1000 patients admitted with other health issues rather than cognitive Used population aged between 61-92 Establishing relation between vitamin D level and cognitive disorder Mini-mental status examination, Serum 25-hydroxy vitamin D level short portable mental test questionnaire serum 25-hydroxy parathyroid hormone level testing attention and processing establishment that vitamin D is inversely proportional to cognitive disorder development Givens et al., 2009 Cohort 4 months Examined patient admitted in hospital 14 Psychiatric patients Examined old population aged between 61 and 76 Relation between coprophagia and cognitive disorder Folstein mini-mental status examination geriatric depression scale mood observation diagnostic impression Axis I, Axis II, and Axis III test. Coprophagia is directly proportional to cognitive disorder development Mitchel & Kakkadasam, 2011 Longitudinal 2 years Teaching hospital 731 Psychiatric patients 65 and above Relation between hip fracture and psychotic mortality rate Geriatric mental stat/AGECAT standardized mini-mental state examination physical examination Figure 3: Influence of Daily Life on Cognitive Function Author Sample Follow Up Period Predictor Outcome Confounders Adjustment Risk Estimate Peters et al., 2008 65 and above Mean 6.3 y (1500) Alcohol 1-2 times/week vs once per week AD S, H, A No Association Peters et al., 2008 55+, C 6000 2y (100) Never, current former smoker VaD, AD, D S, H AD:RR=2.3, D: RR=2.2 for never vs current smokers: VaD: no association. Peters et al., 2008 70-81, C, 8000 Mean 1.8 y Leisure time activity, Met- Week/Hour Cog S, H High expenditure of energy related with improved cognitive function (verbal memory composite, working memory composite, working memory category fluency, global) increased mark p Read More