Old age is a stage of life marked by the loss of bodily functions and issues with mental abilities. Medical technological advancements have also contributed to the rapid development of the world's 'Senior Citizens population. This has brought a slew of related issues ranging from physical care, security, engagement, social interactions, and mental health difficulties among the elderly.
The evaluation of history and clinical interviews continue to be the pillars of assessing geriatric patients with mental health problems. The clinician/therapist must ascertain that the patient understands the nature and aim of the clinical examination. When a patient is cognitively deficient, a family member or carer should provide an independent history. Identification facts (name, age, gender, and marital status), principal complaint, history of the current disease, history of past illnesses, personal history, and family history are all complete. The mental status assessment provides a cross-sectional perspective of a patient's thoughts, feelings, and behaviours during the examination. Symptoms raised by the history should be extensively examined using a mental status evaluation.
The patient's appearance, speech, physical activity, and attitude toward the doctor are all generic descriptions. Motor activity (bodily motions) should be monitored. Many persons with cognitive issues appear to be delayed in their speech and movement. In cognitive dysfunctions, the patient's speech may be strained. Tearfulness and open sobbing may also occur in depressed and cognitive illnesses, particularly if the patient is dissatisfied by his or her inability to answer any questions.
The mental health professional/therapist must assess patients' ability to retain independence and undertake daily tasks such as self-care, toileting, food preparation, clothing, grooming, and eating. The level of functional competence in their everyday actions is essential when developing a treatment strategy for these individuals.
The therapist should explicitly inquire about the patient's thoughts of self-harm, loneliness, and worthlessness. Anxiety and depression can also impair memory performance. An expansive or exuberant mood may indicate dementia. The tendency to invent puns and jokes and then laugh aloud at them is commonly caused by frontal lobe dysfunction of the brain. Flat, dulled, restricted, shallow, or incorrect affect can suggest a depressive condition, schizophrenia, or cognitive impairment. Dysprosody, or the inability to articulate emotional sentiments through speech intonation, is caused by dominant lobe malfunction.
Patients with cognitive impairment may experience hallucinations (perception without sensory stimulation in the environment) and illusions (misinterpretation of a sensory signal) due to diminished sensory acuity. The therapist must note if the patient needs clarification about the time or location. Cognitive diseases can result in perceptual abnormalities such as agnosia, which is the inability to perceive and evaluate the importance of sensory stimuli.
The therapist must evaluate language output. Aphasias, or problems in language production, are linked to organic brain lesions. Broca's aphasia is a kind of aphasia in which the patient's knowledge is intact, but his or her speaking ability is diminished.
In order to measure visuospatial function, the therapist may ask the patient to duplicate figures or a drawing. When visuospatial performance is affected, a thorough neuropsychological evaluation is required.
The therapist should evaluate any cognitive problems. The lack of abstract thinking (the capacity to grasp semantic subtleties) may be an early symptom of dementia. Phobias, obsessions, somatic preoccupations, and compulsions should be investigated in the content of one's thoughts. Suicide and homicide ideas should be explored. The examiner should look at delusions (fixed incorrect beliefs) and how they influence the patient's life.
Sensorium is concerned with the operation of the specific senses, whereas cognition is concerned with information processing and intelligence.
Consciousness − Altered consciousness is a sensitive sign of brain dysfunction in which the patient does not appear awake, has fluctuating degrees of awareness, or appears sluggish.
Orientation − Cognitive problems are related to difficulties orienting to time, location, and person. The examiner should assess the patient's orientation to place by asking him or her to describe his or her current location. By asking the person's name, you may determine his or her orientation. The patient's memory is evaluated by asking for the date, year, month, and day of the week.
Memory − Memory is often evaluated in terms of immediate, recent, and distant memory. Immediate retention and recall are assessed by asking the patient to repeat six numerals or days of the week, forward and backwards. The examiner should keep a record of the patient's memory capability. Unimpaired memory allows people to recall six numerals ahead and five or six digits backwards. Remote memory can be checked by querying the patient's age at marriage, the age of her eldest kid, and the names of her parents and children. Giving the patient the names of three things early in the interview and asking for recall later can be used to measure recent memory. The memory of recent events can also be checked by asking about the patient's address, including the street number; mode of transportation to the hospital; and some current events. Retention and recall can also be checked by having the patient recite a short tale or the names of three things mentioned previously.
Intellectual Tasks, Information, and Intelligence − Various intellectual activities assess the patient's general knowledge and cognitive functioning. To assess counting and to calculate, ask the patient to subtract seven from 100 and continue deducting seven from the result until the number 2 is achieved. Intelligence is connected to the patient's general knowledge fund. The patient may be asked to name the local elected leader at the village, sub-district, or district levels, the three neighbouring villages or cities close to his village and the distance between his village and the clinic. In evaluating the findings of several of these tests, the examiner must consider the patient's educational level, socioeconomic situation, and overall life experience.
Reading and Writing − To test for a reading or writing issue, the therapist may have the patient read a brief narrative aloud or write a short phrase.
Judgment − The ability to respond correctly in a variety of situations is referred to as judgement. Is the patient's judgement impaired? What would the patient do if he came upon stamped, sealed, and addressed mail on the street? What would the patient do if they smelled smoke at a movie theatre? Can the patient make a distinction? What is the distinction between a dwarf and a boy? Why is it necessary for couples to obtain a marriage licence?
A complete neuropsychological assessment involves a battery of tests that may be reproduced by many examiners and repeated over time to assess the progress of a specific disease. The Mini-Mental State Examination is the most extensively utilised measure of present cognitive functioning (MMSE). The Hindi variant of the HMSE evaluates orientation, attention, computation, immediate and short-term recall, language, and the ability to follow entire orders. The MMSE is used to diagnose deficits, track the progression of a disease, and assess the patient's reaction to treatment. It is not intended to be used to make a formal diagnosis. The highest possible MMSE score is 30. The MMSE measures cognitive performance, which is influenced by age and educational level.
Geriatric mental health is a neglected subject that receives little attention from health providers. These illnesses are linked to considerable impairment, poor quality of life, and a financial burden on families. There are several therapy techniques available, ranging from medication to supportive management. Early identification and management can significantly influence the outcome of various mental illnesses.
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