Drug-related confusion in the elderly: the role of the mental health nurse.

The mental health problems of the elderly are frequently overlooked, misdiagnosed and mistreated. Australia's growing aged population experiences higher rates of drug usage and adverse reactions than younger people. Delirium and disturbances in cognitive functioning have multiple origins and the associated behavioural disturbances are often treated with medications that have the potential to predispose or precipitate further confusion. The use of psychoactive medications in the treatment of psychotic and affective disorders may be complicated by behavioural and somatic adverse reactions. Age-related physiological changes and the use of commonly prescribed medications to treat somatic illnesses can be factors in the differential response and side effect profiles of psychoactive medications. This paper reviews the context and physiology of drug-related confusion in the elderly, specifically the effects of neuroleptic medications, as well as the related roles of the mental health nurse. Models of mental health nursing that acknowledge the personal, social, and environmental responses of the elderly and recognize the role of pathophysiology and psychopharmacology are supported. It is argued that the role of the mental health nurse is enhanced by the availability of psychogeriatric nursing, psychiatric, and pharmacological literature.