• 38th Annual GAPNA Conference

    October 3-5, 2019 at the Paris Hotel, Las Vegas, NV.

    Focused education; lasting connections, networking, free access to the GAPNA Online Library.

    Earn up to 21 contact hours (including pre-conference workshops).

    Get more information and register now!

  • 2019 Senior Report Senior Report: Older Americans have more options for home care, but still struggling.

    The United Health Foundation has released results of a sweeping new study benchmarking the health of older adults. The America's Health Rankings® Senior Report was created in partnership with GAPNA to improve the health of America's seniors.

    The data will help advanced practice nurses and other providers deliver quality care.

    Find out about it!

  • AwardNew for GAPNA members: MCM Education

    GAPNA has partnered with a MCM Education to offer an ongoing series of CNE programs available to GAPNA members. "Diagnosing and Managing Parkinson’s Disease in Older Adults," is the latest program offered.

    Parkinson’s disease (PD) is characterized by both motor and nonmotor symptoms. It is diagnosed based on the presence of two of four motor symptoms including rest tremor, bradykinesia, rigidity, and gait imbalance...

    Find out about it!

  • FREE continuing education credit is available for the following session:

    "Dementia Management Update"

    (session captured at the GAPNA 2018 Annual Conference)

    For September/October 2019 - Get Your Free CNE Now!


Psychosis in Older Adults

by Linda J. Keilman, DNP, GNP-BC, FAANP

Psychosis is the presence of delusions, disorganized thinking, disorganized or abnormal motor behavior, hallucinations, or negative symptoms (American Psychiatric Association, 2013).

Psychosis is a loss of connection to reality and is quite common in older adults, especially at the end of life or those living with dementia.

The etiology in older adults can also be related to a variety of conditions or diseases as well as prescribed or illicit drug use. Psychosis can be a primary diagnosis but 60% of the cases are secondary to neurologic or medical conditions (Morgan, 2017). Most often, the older adult will have changes in behavior before psychosis develops.

The APRN should be aware of the following early warning signs (National Institute of Mental Health, 2016):

  • Difficulty concentrating or thinking
  • Unease with others, suspiciousness, paranoid ideation
  • Disengagement/withdrawal
  • Apathy or hyperactivity with unfocused ideas or plans
  • Self-neglect related to hygiene and appearance
  • Difficulty differentiating fantasy from reality
  • Trouble communicating or confused speech

A thorough and careful history, along with a complete physical examination, should be implemented if older adult patients present with any of the above warning signs. Accurate assessment skills will help lead to early diagnosis and treatment of underlying conditions and prevention of psychosis.

Linda J. Keilman, DNP, GNP-BC, FAANP


  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  • Morgan, S. (2017). Psychotic and bipolar disorders: Behavioral disorders in dementia. FP Essentials, 455, 18-22.
  • National Institute of Mental Health. (2016). Fact sheet: Early warning signs of psychosis. Bethesda, MD: National Institutes of Health.