The Use Of Electroconvulsive Therapy In The Elderly

WHAT YOU SHOULD KNOW:

  • Electroconvulsive therapy, also called ECT, is a type of shock therapy that may be used in the elderly. An elderly person may be defined as someone who is 60 years of age or older. ECT is a treatment where a small electric shock is sent to your brain to make a seizure (convulsion). The seizure may increase blood flow and release chemicals in your brain. These effects may make the cells of your brain work better. ECT is used to treat certain conditions that do not get better after medicines or other therapies have been tried. It is also used when other treatments cannot be given. ECT may also be used when symptoms need to be treated quickly, such as not wanting to eat or drink.

  • ECT in the elderly is mainly used to treat depression (a very deep sadness). This includes depression with insomnia (trouble sleeping), weight changes, or thoughts of hurting or killing yourself (suicide) or others. The depression may be severe (very bad), last a very long time, or go away and then come back again. ECT may also be used to treat movement disorders, such as Parkinson Disease, or long-lasting pain. Mental disorders that affect the way a person thinks, acts, or talks with others may also be treated with ECT. ECT may be used with other treatments, such as medicines or therapy.

  • With ECT, a device produces an electric current that travels through two electrodes. The electrodes may be placed on each side of your head or with one on the crown (top) of your head. When and how often you get ECT, and the strength of the electric current depend on your condition. You may need ECT treatments several times a week, or less often. You may need fewer than 12 treatments, or treatments may continue for years. Your caregiver will tell you how many treatments are best for you, and when you should have them done. Over time, ECT may help you feel happier or calmer, or decrease other symptoms such as shaking or pain.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • Common problems after ECT include confusion (trouble thinking clearly) and trouble remembering things. Confusion may last for an hour or longer after an ECT treatment. Memory often gets better two weeks after the treatment, but some memories may be forgotten forever. You may have nausea (upset stomach), vomiting (throwing up), a headache, tooth, gum, or mouth injury, and muscle aches. Your blood pressure may increase, or the rhythm of your heartbeat may change. ECT may not help treat your condition, or you may need more sessions before you feel better. Your problems or symptoms may come back after having ECT treatments.

  • If you have certain medical problems, your risk of problems after treatment with ECT is higher. The risk for problems may be higher in older adults, and if your health is poor. If you use heart medicine, this can also increase your risk of problems. You should not have ECT if you have had a recent stroke or heart attack, or if you have certain kidney tumors. You may not have ECT if you have high pressure in your brain caused by a tumor or blockage. Talk with your caregiver if you are worried or have questions about your treatment, medicine, or care.

WHILE YOU ARE HERE:

Before your treatment:

  • Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • Gown: A hospital gown is used so that caregivers can easily check and treat you. Caregivers will show you how to put on your gown. When you feel better you may be able to wear your own gown or pajamas.

  • IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.

  • Care before your treatment: You will be given medicines right before your treatment. The medicines will relax your muscles and make you feel sleepy. You may also be given medicine to prevent a headache after the ECT treatment. You are taken to the room where your treatment will be done. You will lie down on a table or bed to have the treatment.

During your treatment:

  • You are given general anesthesia to keep you completely asleep. This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat to help you breathe better. You are hooked up to one or more machines that watch your heart beat, breathing, and other body functions. Restraints (ties) may be put on your arms and legs to hold them to the bed and keep them from moving. A device called a bite block is placed in your mouth. This will help protect your teeth and decrease the chance of you biting your tongue during the treatment.

  • Caregivers place the electrodes on your head. An electric current is sent from the device connected to the electrodes, and a shock is sent through them to create a seizure. The seizure usually lasts for 35 to 80 seconds (one-half of a minute, to one and one-half minutes). Your body will move very little, or may not move at all during the seizure. Caregivers watch your seizure and record how long it lasts. Caregivers may suction your mouth if you have a lot of saliva in it.

After your treatment:

You are taken to a room where you can rest. Oxygen is given to help you breathe. Your arms and legs may be held down to the bed with ties. Caregivers watch you closely and suction extra saliva from your mouth and nose if that is needed. When they see that you are OK, you may be allowed to go home. If you are staying in the hospital, you will be taken to your hospital room. Tell a caregiver if you have a headache, feel sick, or have other problems.

  • Activity: You may need to lie in bed for a few hours. Your caregiver will tell you when it is okay to get out of bed. If you feel weak or dizzy after getting up, sit or lie down right away. There is a greater chance of falling down after having ECT treatments. Ask someone to help you when you stand up or walk.

  • Mental status exam: Caregivers will ask you questions to check your memory and speech. They will ask you if you know where you are, and what time it is. How well you think, including math skills, judgement, and reasoning, will also be tested. This helps tell caregivers how your brain is working after ECT.

  • Monitoring:

    • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

    • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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