lor tab jaise so lots of pain complaints but their victory they complaints of pain some of which you have to know if you laid in bed twelve hours a day there's an increase in cognitive symptoms with older adults older adults with depression complain of memory problems all over the place they also have difficulty making decisions page twelve page twelve is a geriatric depression scale i think the geriatric depression scale doesn't excellent job of measuring depression in older adults i'd also think it's useful to use this to get a baseline throw therapy at your patient for thirty or sixty days and then we measure but in order for this test to work you have got to administer this test the way that it was designed to be administered it was never ever designed to be administered that you would drop this a bedside tell the patient to fill it out you pick it up later it doesn't work that way older adults will read through these questions and they will answer these items in the non depressed way up to ten of these endorsed is normal i took this test the other day just for grins and giggles when i got an eight we've all got something i like myself every single day so not so much i have issues you know when you get some of the release courses you were one of my would suggest to you that they're reading through your questions and not giving you straight answers i think it goes to validity that the test is designed to be administered conversation with so you have the form in front of you you sat down with the patient and you say wanted to see how you do and wanted to see how you feel about being here you know any problems you have to report to me are you basically satisfied with your life are you in good spirits most of the time and you just asked these questions conversational e noting the answer okay you don't drop it at that site and have the patient fell about and i see that happening a lot of facilities in in a lot of nursing facilities that i go to we have at a person that's in charge of the social services called on ss d social services designate now the social services designee that i work with that i work with than their several of the are exhort they are absolutely excellent they are patient focused date work with families they do all the paperwork they act as a social worker and we have been doing the things that social workers normally do ait id anything that needs to be done that i don't want to do you dump it on a social worker right that shirt that you were a little ss desire social services designates they look a lot like a social worker but they had a little less training ss deeds are high school graduates that went to we can cram course in how to be a social worker and that's their background training they're wonderful people i'd agree to work with but they don't have the background and expertise to the social worker has so we tend to look at these people and say today i want you to do these twenty-two geriatric depression scales and do eleven a minimal status exams what picture job to do twenty-two geriatric depression scales you're going to be dropping at the bedside intel on the person to fill it out except that one of the few options you have so that's why i see this test misused a lot of the time questions about the pressure on you a reduced ability to maintain attention to external stimulator disorganized thinking and at least two of the following reduced levels of consciousness perceptual disturbances disturbances of sleep-wake cycle increased or decreased psychomotor activity disorientation to time place for a person memory impairment the detroit area very very important the clinical features develop over a short period opponent usually hours two days and they tend to fluctuate over the course of the day symptoms are all from the worse at night you know how people will look at someone some downing and say see some downing of so common with dementia soul so common with delirium you're working with a patient week after week every week the patient knows who you are knows what you talked about knows what's going on in the news you walk in to see them one day and they say hi are you from the church you say no i'm doctor tom i work with you every week now we're not with me you talk to the patient they cognitively fallen off the cliff so you go to the nursing you say this patient has cognitively fallen off a cliff here we need to figure out what's going on the nurses out i don't know she has an alzheimer's diagnosis you know they have good days and bad days so you probably just seen or always on a good day i've seen ur confused before delirium onset suddenly if your patient suddenly falls off a cliff cognitively that is not al tigris disease alzheimer's doesn't come on that plane it's slow insidious if they have cognitively fallen off a cliff over a period of a week the only type of dimension of this could be is a stroke if that's what they're trying to sell the you asked to see a ct scan that's got a new area been parked on it otherwise this is not dementia this physical area rapid on setting symptoms delirium okay and the e criteria evidence from the history physical exam or laboratory tests of a specific organic factor judge to be e logically related to the disturbance and in the absence of such evidence and ideological organic factor can be assumed to be there if there is no non organic mental disorder that would account for this behavior so does that mean that in some ways we have to become little nurses who will positions yes we do without practicing medicine it really is important for us to assess from the patient are their physical findings that would lead us to believe this patient has a delirium so you have to become estimate looking at a patient and saying when you go to the bathroom is there any burning do you have any coffee hacking cough anything like that in the areas of your body that have source on the might be infected you have to see is our symptomatology going on that would lead you to believe that this person is infected then you have to go to a lab sheets and you've got a become somewhat good reading those lab sheets it's not rocket science most emeryville marked eighteen allele so i'll tell you what's high and low invest in a cheap little book lab results for dummies they'll tell you put this is high you usually get these symptoms when this is 