314 - final

Question 1

aging population

• 1956, 2006, 2056 projections
• aging tsunami
• accomplishment
• other factors

Answer 1

• 1956: pyramid (lots at bottom, little at top)
• 2006: fewer ppl being born recently (looks like house)
• 2056 projections: turn into bean pole shape thing (vase shape)
• aging tsunami: there are more seniors (64+) than there are children (0-14)&raquo_space; increased disease incidence in old age (cancer, CVD, etc)&raquo_space; gonna bankrupt the medical system
• it is a societal accomplishment&raquo_space; living longer, healthier lives (reduces burden on healthcare)
• there is WAY too high of a role for sES, age, gender, ethnicity despite the fact that we have a public healthcare system

Question 2

decline in cognition

• independence
• control
• wellbeing paradox

Answer 2

• ppl want to maintain independence and they dont want to ‘lose it’ &raquo_space; overall trajectory of cog decreases over the age of 60
• perceived control decreases with old age (health challenges, no longer living independently)&raquo_space; personal control can have a powerful effect on health and psychological condition

wellbeing paradox: older adults increase their positive experience with life&raquo_space; low at 30, then increases!&raquo_space; goes well until 4th stage (very old)
- still true even with increasing physical and cognitive decline

Question 3

models of successful aging

• goals (definition + 3)
• problem

Answer 3

People are active agents that navigate through life by setting and pursuing goals&raquo_space; moving closer to goals is good for your well-being

Goals: cognitive representations of the self in the future

• Guide behavior over time
• individual reference standard
• linked to stress (unable to reach goals) and well-being

Problem: what if health limits goal pursuit → physical in capability → not enough strength

Question 4

Goal adjustment and well-being

• disengagement and management
• farmer example
• changing themes
• generativity (3)
• symbolic immortality

Answer 4

• disengagement and management → how can they just goal → something challenging and meaningful to pursue without experiencing failure

Eg. farmer aging → must pass on Farm to kids → instead, grow a vegetable garden → gets even older → switch to potted plants → breaking things down into sub goals that are manageable
Let go of goals that are too challenging and ALSO look for an alternative

Goals reflect changing themes of life
Eg. middle-age = work goals, uni = academic goals

older adulthood: generativity ( leaving a legacy/ legacy, contribution)

• guiding the Next Generation
• taking responsibility for well-being of others
• passing on knowledge

symbolic immortality: a sense of continuity of one’s life beyond death&raquo_space; associated with enhanced meaning as people confront their own mortality

Question 5

the experience corps program

• win-win
• training
• results (6)
• adherance

Answer 5

• International volunteer-based tutoring program to support reading in elementary school-age children
• win-win: fostering literacy skills in disadvantaged children while promoting Health cognitive skills and social engagement and older adult volunteers ( over retirement but still fit)
• even the first trial showed results → older adults and program walk more flights of stairs, walk more overall, watch no TV during work hours (decreased sedentary time and increased physical activity), reduction in falls, more social support (meet others also doing intervention), more self-esteem and executive functioning
• 80% adherence to program (very high!)&raquo_space; more likely to get up and go on a rainy day (aches and pains) to see a cute 9yo (promised to meet) rather than some aerobics class

Question 6

experience corps intervention:

• primal pathways (3)
• mechanisms (functional, physiological, and cognitive parameters)
• outcomes (5)

Answer 6

primal pathways: physical activity, social engagement, cognitive stimulation

mechanisms:
- functional parameters: inc strength/balance, dec falls
- physiological parameters: dec insulin resistance, dec BP
- cognitive parameters: inc cognitive reserve, changes in brain structure and function

outcomes: physical function (mobility), global function, quality of life, cognitive function, healthcare costs

Question 7

old age has many faces

• third stage
• fourth stage
• start of decline?

Answer 7

“third” vs “fourth” stage
- “old age” is not a uniform experience&raquo_space; extends over multiple decades

good news: third stage = “young old” (60-85)

• relatively good health and subjective wellbeing
• substantial latent potential and reserve capacities
• effective strategies to attain goals

not-so-good news: fourth stage = “oldest old” (85+)

• sizable losses in cog potential
• inc in chronic disease burden
• sizeable prevalence of dementia and frailty
• social losses

*above age 70, life satisfaction states declining&raquo_space; close to death, life satisfaction declines rapidly

Question 8

adding life to years

- compression of morbidity (present vs life extension vs compression)

Answer 8

• pushing back chronic disease to reduce time spent under “fourth age” conditions (ill health/impaired quality of life)
• how can we add life to years, rather than years to life

present: early short slope, then death
life extension: long slope, then death&raquo_space; keeping people alive longer is just prolonging the time spent in chronic illness
compression of morbidity: late short slope, then death&raquo_space; want to extend life but also decrease time spent in morbidity (prevention and healthy lifestyles)

Question 9

how to compress morbidity

• inactivity/obesity
• inflammation association
• society
• healthcare system

Answer 9

• combat inactivity and obesity&raquo_space; if you were obese and completely sedentary, risk of chronic diseases is the same level as someone 12 years older who exceeds physical activity guidelines (significant!! especially in old age &laquo_space;affects age of onset)
• inactivity and obesity lead to inflammation&raquo_space; associated with diabetes, CVD, cancer and diseases affecting the CNS
• society: Manages health care expenditures
• Health care system: Need to focus on prevention

Question 10

runner study

• age, controls, time period
• research question
• results

Answer 10

• comparing 50+ yo runners with matched controls (matched age, status, gender and health&raquo_space; started at the same place) over 21 yr period
• does phys activity push back chronic disease in midlife sample growing older
• on avg, ppl from runners club developed same disability level (physical/cognitive&raquo_space; unable to walk up stairs/around block, manage their own finances) more than 12 years after community controls (enjoyed better quality of life&raquo_space; advantage became more pronounced over time (21yrs)

*aging is a different process for diff ppl!

Question 11

Who uses health services?

- health risks, age, gender, sES

Answer 11

• those with health risks (obsesity, high stress)
• age: young (children&raquo_space; vaccinations, checkups) and old&raquo_space; more vulnerable, chronic diseases
• gender: women more likely (pregnancy, childbirth); men less likely to admit to having symptoms
• socioeconomic factors: who can take time off (flexible work schedule&raquo_space; may not seek help if they can’t get time off); indigenous ppl and immigrants use a lot less (low income areas less likely to have a doctor, language barriers)

Question 12

factors affecting symptom recognition

- age, culture, situation, personality, mood

Answer 12

1. age: young adults feel invulnerable
2. cultural differences: comfort to bring up issues (eg. talking about private areas)
3. situational factors: busy = less aware
4. indiv differences in personality: some ppl are more likely to notice symptoms (neuroticism, contentiousness&raquo_space; more likely to be careful if there are people in your family with illness)
5. mood:
   - positive: less access to illness-related memories
   - negative: rumination abt symptoms, perception to be vulnerable to future illness

Question 13

interpretation of symptoms

• prior experience (2)
• lay referral work
• third one :)

Answer 13

1. prior experience: interpretation of a symptom is heavily influenced by prior experiences
   - expectations: ignore symptoms that arent expected, amplify symptoms that are
   - seriousness of symptoms: more likely to seek treatment if it causes pain
2. lay referral network: an informal network of family and friends who offer an interpretation of symptoms, give advice on seeking medical attention, remedies, or consulting another lay person
   eg. sanctioning = social trigger&raquo_space; someone insists they go get treatment
3. internet, talk shows (unreliable)

Question 14

Treatment delay

• definition
• problems (3)
• emotional factors (4)

Answer 14

time between recognition of symptom and obtaining treatment&raquo_space; an indiv is aware of the need to seek treatment but puts off doing so

Problems:

• recognition (should I get checked?)
• decision (im too busy)
• waitlists (Canada has great healthcare but HUGE waitlists&raquo_space; if you need a specialist it could take weeks/months)

emotional factors:

• ppl already depressed tend to delay getting med care&raquo_space; cannot mobilize energy to see it
• ppl more frightened more likely to seek treatment quickly
• if they think treatment will be painful they are less likely
• embarrassment may delay (turns out to be nothing, embarrassing symptoms)
• men believe getting care is a sign of weakness

Question 15

Delay behaviour

1. appraisal delay
2. illness delay
3. utilization delay

Answer 15

1. appraisal delay: (sensory experience) time it takes a person to decide that a symptom is serious (symptom happens over and over again, severity of symptoms)
2. illness delay: (thoughts on symptom) time btwn recognizing that a symptom implies an illness (symptom not going away) and the decision to seek treatment
3. utilization delay: (benefits and barriers) time btwn deciding to seek treatment and actually receiving appropriate care (waitlists)

Question 16

treatment non-adherence

• range
• adherence highest for?
• non-adherence highest for? reasons? (2)
• general low regimen adherence (4)
• religion

Answer 16

• non-adherence ranges from 15-93% (avg = 50%)
• adherence highest for HIV, arthritis, cancer, gastro-intestinal diseases (IBS)
• non-adherence highest in pulmonary diseases (eg. COPD), diabetes (can result in blindness from blood clots!) and sleep disorders
• adherence is variable and low in lifestyle change recommendations (stop smoking, change diet, etc)
• ppl may not adhere because of cost, duration of treatment (chronic)
• adherence generally low when the regimen is complex, must be followed for a long time, requires changes in the person’s lifestyle, and is designed to prevent rather than cure illness (eg. diabetes regimens)
• religion: doctors cannot superimpose&raquo_space; must be patient&raquo_space; don’t force, be accommodating but also keep best interests of patients

Question 17

Factors impacting adherence (8)

Answer 17

• pain (eg. HBP doesn’t have, many cancers dont either)
• perceived seriousness (education factor)
• duration
• age/life phase
• visibility of symptoms
• complexity of treatment (length, dose)
• side effects (approved meds weigh intended and unintended consequences)
• mental health (cognitive decline)

Question 18

creative/rational non-adherence (5)

Answer 18

involves modifying a prescribed treatment regimen

• patient does not know precisely the consequences of changing meds, confusion about when/how much to take
• patient beliefs and private theories (is there a diff btwn taking 1 or 2 pills? is the illness still there? stop and check)
• don’t have money for refill, forget to take meds
• believe medication isnt helping
• side effects are unpleasant, worrisome or reducing quality of life

Question 19

antibiotics non-adherence

• used when?
• why non-adherence?
• consequence

Answer 19

• for acute conditions
• prescriptions are usually very clear, but ppl “already felt better” or “had bad side effects” so they stopped early
• sub-optimum antibiotic concentrations&raquo_space; bacteria can become resistant (serious consequences)

Question 20

patient-provider communication

• unspecific symptom
• medical office and communication (2)
• provider problems (5)
• poor communication (4)

Answer 20

• pain is the most unspecific symptom (80% reason for physician visits)
• the medical office is an unlikely setting for effective communication
• the person who is ill&raquo_space; high temp, hard to articulate, private things
• the provider&raquo_space; time pressure (7 mins per visit), derailed convos, difficult to tell patient, depersonalization, burnout (physical/emotional exhaustion from chronic stress, feeling inadequate), reactance (patient’s angry responses when they feel controlled/lack freedom)

Poor communication: need to give patient time to process diagnosis; wait until they are ready to hear it, have more empathy&raquo_space; patient should bring someone with them for testing (to hear news for them/take notes)

Question 21

Problems with communication

- jargon (4), not listening, baby talk, stereotypes (2)

Answer 21

1. use of jargon&raquo_space; patients dont understand many terms that providers use&raquo_space; may be purposely used to…
   - keep patient from asking too many questions
   - keep patient from discovering provider is uncertain abt problem
   - used as carryover from technical training
   - resort to when it is difficult to tell the patient bad news
2. not listening: both sides&raquo_space; patients are not at their best, don’t listen to doctors questions and just keep repeating the same thing
3. baby talk: especially to elders&raquo_space; providers underestimate what patient can understand&raquo_space; undermines self-esteem&raquo_space; can forestall questions
4. stereotypes: gender, ethnicity, low SES, older adults, acute vs chronic (chronic requires a relationship&raquo_space; long term)
   - easiest to speak with ppl who share something in common with you
   eg. hard for young trans asian girl to talk to an old cis white guy

Question 22

Patient factors

• anxiety
• ESL

Answer 22

• 1/3 of patients cannot repeat diagnosis within minutes of discussing it&raquo_space; anxiety impairs info retention
• ESL&raquo_space; new terms (first time hearing it&raquo_space; should ask for clarification!)

Question 23

distinguishing symptoms

• pain
• embarrassment

Answer 23

• patients focus on pain&raquo_space; not helpful to distinguish problem/diagnosis&raquo_space; providers concerned with underlying illness
• embarrassment may lead patients to give faulty cues abt health history and practices (eg. broken arm vs hemorrhoids)

Question 24

social relationships and health

• types of measures (2)
• marital relationship

Answer 24

• social relations matter for health, morbidity, mortality etc

Measures:

• count number of ties ppl have&raquo_space; linked to better outcomes
• focus on quality of exchange/social support effect on stress

marital relationship: stakes in e/o health&raquo_space; first line of defense (social support)&raquo_space; exposed to same stressors (live together)

Question 25

• “it takes 2 to tango”
• couples dynamics
• change
• indiv
• coordination
• adjustments

Answer 25

• couples dynamics: if one slips, entire dynamic affected
• changes over time (not static)&raquo_space; difficult to learn
• depends on indiv characteristics and how well they work together
• must coordinate&raquo_space; hard&raquo_space; complimentary behav = help them do well as a unit
• even experienced dancers must adjust to health problems (doesn’t mean they stop dancing!)

Question 26

Marriage and health balance

- dyadic coping

Answer 26

• pooling resources/strategies in partnerships&raquo_space; collaborative problem-solving and dyadic coping (dealing w stressors together)
• stressor is not an isolated experience&raquo_space; impacts others&raquo_space; starts out indiv, then gets transmitted (happens in shared env)

Question 27

couples coping w chronic diseases

• common elements (6)
• disease specific elements (5)

Answer 27

Common elements:

• wake up call&raquo_space; look at life differently
• stressful&raquo_space; for indiv and close others (can they still play same role in fam?)
• complex adjustments eg. diabetes&raquo_space; can’t be sedentary, must eat healthy
• impacts close others (spouses, fam, friends)&raquo_space; stress abt future
• need support&raquo_space; caregiving
• long duration&raquo_space; significant adjustment

Disease specific elements:
- diabetes, cancer, arthritis&raquo_space; is it life threatening, debilitating, amount of pain, change needed, length (rest of life)?

Question 28

evidence: couples coping w chronic diseases
- most evidence based on what?
- need what?
- there is research on ____ and ____ but not what?

Answer 28

• almost everything is based on samples of unrelated indiv&raquo_space; ask one spouse abt the other (observations, their thoughts/feelings)&raquo_space; does not take into account both spouses perspectives
• need to observe impact of BOTH patient AND spouse
• theres a lot of research on patient and some on spouse (for appraisal, coping and adjustment), but not a lot on how patient’s ACA AFFECTS spouses and vice versa (not dyadic)

Question 29

Sample Case: diabetes

• requires
• stress (acute vs chronic)
• non-adherence

Answer 29

Requires:

• glucose control (glucose is dysregulated)
• complex behavioural modifications (life behaviours)

Stress:

• acute stress: life threatening&raquo_space; can lose consciousness (look drunk)
• chronic stress: elevated BS lv = damage nerves, CVD risk, blindness
• stress causes release of cortisol and epinephrine, which decreases insulin production (pancreas) and increases glucose production (liver); body decreases use of glucose
• problem focused coping better for diabetes than emotional focused

Non-adherence: can lead to severe acute/chronic health problems
- encourage patient to change without insulin meds&raquo_space; healthy diet, exercise

Question 30

spousal involvement in diabetes management

• eating
• help
• 3 types of involvement (which is best? which is worst)
• spousal appreciation

Answer 30

• difficult to do alone&raquo_space; eating is a very social behaviour&raquo_space; roles (groceries, cooking)&raquo_space; bigger struggle without support&raquo_space; spouse needs to know what you can’t eat!
• sometimes spouse does not know how to help patient adhere to diet&raquo_space; just stresses them out
• spousal support: smile, social support, buy healthy foods
• spousal persuasion: motivate (“you cant…” “I need you to…”)
• spousal pressure: criticism (“have you done…”)
• making them feel guilty does not always work&raquo_space; telling them off can make them start cheating the diet/stop listening
• only being supportive worked (compared to other 2)&raquo_space; pressure is a problem (stresses out patient by telling them what they already know is not working)
• spousal appreciation: spouse needs to be looked after as well
• when spouses helped a lot and saw patient smile because they did something for them resulted in positive affect increase (made them feel better)
• may feel negative affect, but being appreciated (positive experiences) can keep them going

Question 31

diabetes study

• sample size
• assessment (how often assessed, 4 assessments)
• mean age and relationship duration
• measures (3)
• covariates (5)

Answer 31

• 129 couples (one spouse with diabetes)
• repeated daily life assessment (24 days, once a day)&raquo_space; what they and their spouse did, how they felt, if they engaged in health behaviours, wrote diaries (much catch them in the moment to give critique) etc
• mean age @ baseline = 66 yrs, mean relationship duration = 38 yrs, 50% female patients

Measures:

• dietary adherence
• diabetes-specific stress
• diet-specific spousal support, persuasion and pressure

covariates: age, gender, ethnicity, comorbidities, severity of symptoms

Question 32

Sample Case: prostate cancer

• caused by?
• treatments
• common stressors
• support/coping

Answer 32

• uncontrolled cell proliferation (tumor)
• treatments: surgery, radiation, chemotherapy
• common stressors: incontinence (unable to hold pee), impotence = side effects&raquo_space; related directly to marriage
• spousal support and dyadic coping: benefits patient&raquo_space; huge diff in stress management/treatment

Question 33

prostate cancer study

• sample size
• mean age/duration
• recruitment
• measures (3 + covariates)
• effect of support (collab vs no collab&raquo_space; negative effect)
• distressed spouse

Answer 33

• 59 couples (one spouse w cancer)
• time sampling (everyday for 2 weeks)
• mean age = 68, mean relp duration: 38 yrs
• recruited within 6mo of diagnosis

Measures:
- number of daily stressors, collaborative coping, positive/negative effect, covariates: age

• working together and supporting each other makes a difference in how the patient does
• when they dont collab, there is a negative affect of husband, wife unrelated
• when they work together/support e/o negative affect is related to e/o&raquo_space; patient does what spouse wants them to do and spouse opens themselves up to negative affect&raquo_space; can take a toll on spouses emotions (vulnerable health)
• spouse may become too distressed (eg. depression) to provide support&raquo_space; affects patient (resources/support)

Question 34

Sample Case: Arthritis

• definition
• types (osteo, rheumatoid, fibro, gout)
• treatment

study

• sample size
• interview, questionnaires
• mean age/duration

measures:
- report
- CES-D
- covariates

Answer 34

arthritis: musculoskeletal disorders affecting the body’s muscles, joints, and connective tissues near the joints
- rest of life
- need high level of social support
- inc prev 75yo+, more women than men

types of arthritis:

• Osteoarthritis: joints degenerate (wear n tear)&raquo_space; most common
• Rheumatoid arthritis: most serious&raquo_space; inflammation of joints, debilitating pain, depressive symptoms
• Fibromyalgia: pain/stiffness in muscles/soft tissue
• Gout: too much uric acid&raquo_space; circulates in blood and leaves crystalline deposits at joints

treatment:

• anti-inflammatory meds
• maintain weight (every pound lost is 4 pounds off your knee)
• good sleep

Study:

• 133 couples (one spouse w arth)
• interviewed patient AND spouse (feelings, effect on life)
• each partner completed questionnaires 1 year apart
• Mean age = 62, Mean relationship duration = 31 yrs, 73% female patients

Measures: report feelings depressive symptoms, indiv characteristics, etc
- center for Epidemiological studies depression scale (CES-D) &laquo_space;list of symptoms&raquo_space; how often trouble sleeping, feeling down, physical limitations etc

Covariates: age, education, length of marriage, disease duration, employment

Question 35

RAIDAI

• spousal CES-D prediction
• why
• maladaptive strategies

Answer 35

RAIDAI patient reports: patients report feelings, pain, inflammation of every joint&raquo_space; very nuanced measure

spousal CES-D: spousal depression could predict disease activity a year later&raquo_space; ppl w spouses who had more depressive symptoms did worse in the long term

• sometimes spouse cannot/does not come through&raquo_space; depressed spouses are less likely to provide satisfactory support&raquo_space; they need to focus on themselves so it is harder to engage in coping strategies for patient
• sometimes spouse has maladaptive coping strategies&raquo_space; may even blame the patient

Question 36

Families coping with chronic disease: Adolescent diabetes (type 1)

• parental control
• switching to autonomy
• young vs teen
• pressure vs responsiveness

Answer 36

• parental involvement in diabetes management&raquo_space; parental control and responsive support
• complex process to switch from parental to indiv management (autonomy)&raquo_space; hard for parent to let go (severe consequences if kid does it wrong!)
• control is good when young, but too much when older can be detrimental
• parents who reported high control (pressure)&raquo_space; their kids did worse for treatment adherence
• parents who are responsive (“I am here for you”)&raquo_space; their kids did best

Question 37

Group medical visits study

• # patients
• indiv checkups
• quarterly educational sessions (7)
• primary outcomes (6)
• proof of concept
• spousal support
• acute vs chronic

Answer 37

• good for chronic illnesses&raquo_space; 5-6 patients
• check ups are only 8 minutes&raquo_space; hard to apply recommendations in an effective way
• quarterly educational sessions: 1 hour with 6 ppl instead of 8 min indiv&raquo_space; diabetes complications, principles of nutrition, personal habits and lifestyle changes, physical activity, glycemic control, self care, CV aspects

primary outcomes&raquo_space; knowledge of: diabetes, health behaviours, quality of life, body mass, glycosylated hemoglobin, lipids

proof of concept: ppl in group session study did better and had much better knowledge in management, improved health behaviours, know how to deal with situations/circumstances that make adherence hard, etc

• spousal support: bring them to appt&raquo_space; learn health habits needed&raquo_space; patient-doctor relationship also important
• healthcare originally meant for acute treatment&raquo_space; chronic diseases are becoming more prevalent

Question 38

healthcare spending

• problem
• why

Answer 38

• much higher than expected

- dealing with increased chronic diseases&raquo_space; prevention is important, rather than just management

Question 39

traditional vs contemporary

Answer 39

traditional view: quality measured in terms of “hard facts”&raquo_space; does not do justice to patient perceptions (psychological consequences ignored)

contemporary view: physical, psychological, vocational and social functioning&raquo_space; addresses additional disease or treatment related outcomes (psychological impact, engagement w others, ability to have a job, etc)

Question 40

Why study quality of life?

• patient
• morality
• example

Answer 40

• so patient is on board with recommendations of doc
• if theres no diff in mortality between active surveillance and immed treatment, then quality of life should be defining issue
  eg. getting dangerous surgery or watching and waiting&raquo_space; if danger is same, depends on patient’s wishes

Question 41

Emotional responses to chronic illness:
A. denial
- what is it
- effects

Answer 41

• defense mechanism&raquo_space; common early rxn to the diagnosis of chronic illness&raquo_space; serves as a protective fxn
• healthy response&raquo_space; protection from being overwhelmed&raquo_space; slowly digest/take it in
• during treatment/rehab (adherence), denial my have adverse effects&raquo_space; must get passed it before moving on

Question 42

Emotional responses to chronic illness:

B. anxiety

Answer 42

• very challenging
• common after diagnosis&raquo_space; increases when ppl have to wait a lot (waitlists, referrals), or anticipate substantial changes

Question 43

Emotional responses to chronic illness:

C. depression

Answer 43

• when the acute phase of chronic illness ends
• full implications sink in&raquo_space; assessing depression is challenging in the context of chronic illness&raquo_space; will have to make big life changes
• can interfere with adherence to treatment

Question 44

chronic disease challenges
- 2 main challenges

1. physical self
2. achieving self
3. social self
4. private self

Answer 44

• self concept
• self esteem

1. physical self: body image&raquo_space; perception and evaluation of ones physical functioning
   eg. invasive surgery (breast cancer)&raquo_space; lost a boob
   - can be restored, but takes time
2. achieving self: achievement is important to self esteem and self-concept
   eg. going out to eat for work&raquo_space; having to watch what you eat is an inconvenience
3. social self: rebuilding social life (esp when young)&raquo_space; interactions w fam/friends
   - fears abt withdrawal of support are common worries of the chronically ill
   - indiv w chronic disease often elicit ambivalence from acquaintances&raquo_space; young ppl think their invulnerable, so having someone close with cancer is hard for them&raquo_space; will distance themselves so they don’t have to think about being vulnerable
4. private self: major threats to self&raquo_space; illness creates a loss of independence (mobility loss, check ups, treatments)&raquo_space; adjustments to chronic illness involves exploring alternative routes to fulfillment

Question 45

Patient’s beliefs&raquo_space; control over illness

• no control
• smaller goals
• backfire

Answer 45

• if you feel you have no control (even if you do) it can result in depression (no longer in charge of life&raquo_space; sad to let go of things we value)
• important to find what aspects are still doable/controllable&raquo_space; pick smaller, still achievable goals to maintain sense of control&raquo_space; source of satisfaction in same life domain
• can backfire if actual control is low&raquo_space; they waste energy on uncontrollable things&raquo_space; frustration and sadness

Question 46

chronic illness: positive changes

Answer 46

• challenge in priorities&raquo_space; what is rlly important
• chronically ill ppl and their families render their priorities&raquo_space; find meaning in smaller activities of life
• changes in future time perspective affects social relationships (silver lining!)

Question 47

Motivational shifts: socioemotional selectivity theory

- perspective changes (3)

Answer 47

• motivational shift in line with anticipated future time horizons&raquo_space; reevaluate what important in life when life expectancy is cut short&raquo_space; how to spend life in an emotionally meaningful way

limited future time perspective

• greater value on emotional meaning
• preference for social interactions w close fam/friends
• appreciation for fragility and value of human life

Question 48

Heart disease

• stats
• congenital
• arrhythmia
• atherosclerosis
• congestive
• CHD
• symptoms of heart attack (4)

Answer 48

• 2nd leading cause of death, inc risk after 55yo, higher in males
• congenital (from birth) eg. valve/chamber issues
• arrhythmia: abnormal heartbeat
• atherosclerosis: plaques (made of fats/cholesterol buildup) cause narrowing of artery
• congestive heart failure: when heart’s capacity to pump can no longer meet the body’s needs, and the individuals become short of breath with little exertion (lungs become congested w fluid)
• coronary heart disease: narrowing and blocking of coronary arteries&raquo_space; most common heart disease&raquo_space; leads to lack of O2 flow (nourishment to heart)&raquo_space; can lead to angina (heart pain) and heart attack (myocardial infarction = complete blockage of flow to an area of heart&raquo_space; no O2 means area dies)

symptoms of heart attack:

• Uncomfortable pressure, fullness, squeezing, or pain in chest
• Pain/discomfort spreading to the shoulders, neck, jaw, or arms
• Shortness of breath
• Possible lightheadedness, fainting, sweating, or nausea

Question 49

can acute stress cause heart attack? (4)

Answer 49

yes.

• natural disasters: eg. earthquake&raquo_space; increased hospital admissions for heart attacks/cardiac deaths
• sporting events: increased risk of stroke/heart attack on day team lost (only men)
• 9/11: increased CVD in the 3 years following
• work deadlines, depression, anger (especially for heart attacks)

Question 50

biological mechanisms of MI

• reliability
• arrhythmia, thrombosis
• symptoms

Answer 50

• methods not entirely reliable&raquo_space; patient may overexaggerate report to find reason for MI
• arrhythmia (caused by fight/flight response&raquo_space; inflammatory&raquo_space; causes plaques to be disrupted and form blood clots (thrombosis) which block flow in heart muscle = MI
• increased BP, heart rate, vasoconstriction (lots of stress on heart)

Question 51

mental stress and vasoconstriction study

• sample size and disease
• test, measures
• men vs women
• high vs low vc
• low score means?

Answer 51

• 549 patients w stable CHD
• TSST&raquo_space; measured cortisol, vasoconstriction
• men had overall higher vasoconstriction than women
• overall, those w higher vc had significantly higher risk of adverse CV outcomes at 3 yr follow up (including cardiac death, MI, heart failure hospitalization, etc)
• low score = high vc&raquo_space; significantly greater

Question 52

MI triggers and management

• triggers (6)
• management (8)

Answer 52

triggers: physical exertion, anger, stress/heightened emotion, alcohol, cocaine use, infectious illness
management: exercise, anger management, stress management, coping behaviour therapy, medication, public health awareness, campaigns influenza vaccinations, antibiotic treatment

Question 53

high risk situations and management

• high risk situations (8)
• management (5)

Answer 53

high risk situations: festivals, public holidays, sporting vents, natural disasters, industrial/transport accidents, terrorist acts, anniversaries, significant dates

management: improve access to defibrillators, inc medical cover, public health awareness programs, emergency care, targeted social support

Question 54

can sexual activity trigger a heart attack?

• more likely when?
• relativity
• worse when?
• percentages, conditions of occurrence
• cumulative effect
• risk

Answer 54

yes.
heart attack more likely during sex with mistress
- after MI, ppl become fearful of sexual intercourse (can trigger)
- relative risk of having MI during sexual intercourse is about 2.7 times higher compared to not&raquo_space; sexual intercourse accounts for <1% of all MIs
- worse in sedentary vs physically active indiv
- not insignificant, but relatively small&raquo_space; 83-90% are men, and 75% of those were extramarital sex&raquo_space; usually younger partner, unfamiliar setting, excessive food/alc
- stable extramarital affairs predictive of major cardiac event over 4 year period (cumulative effect)
- small samples tho, very small real risk

Question 55

can you die of a broken heart?

• spouse/close friend, cause of death, exception
• long term
• carrie fisher example

Answer 55

yes.

• when spouse/close friend dies soon after&raquo_space; higher in spouse, of any cause, regardless of what spouse passed from (except for Alzheimer’s and Parkinson’s because they persist over several years&raquo_space; as disease progresses, caregiver responsibility increases)
• long term stress will take a toll&raquo_space; won’t have a significant increase in mortality (not a shock to the spouse like an aggressive cancer would be)
• eg. carrie fisher (princess lea)&raquo_space; had heart attack, her mom dies within days of an intracerebral hemorrhage due to hypertension (coincidence?)

Question 56

Widow(er) deaths

• highest risk time period
• causes of death (3)
• het men
• social support

Answer 56

Highest risk: within 3 months (2x higher in first week)
Widow(er)’s cause of death:
- cancer, CVD (inflammation)
- acute causes (infections/accidents due to not paying attention or not taking care of health)
- chronic illness (diabetes, COPD, colon cancer)&raquo_space; require careful management, but if they are depressed they won’t be taking care of themselves properly

• het men more likely to pass away when wife passes&raquo_space; women often encourage health behaviours&raquo_space; widowed men more affected
• ppl who lack social support more at risk

Question 57

CVD and depression studies

• type of study, length
• mortality risk (widow vs married; men vs women)
• health marker differences (3)

Answer 57

• 1332 couples
• prospective study (looked at mortality over 3 yrs)
• 593 lost spouse during study period
• risk of mortality in widowed men was significantly higher compared to married men/women AND widowed women&raquo_space; risk of mortality was LOWER in widowed women (health benefit, esp if woman had CVD&raquo_space; able to focus on themselves)

significant differences in a variety of health markers

• lower heart rate variability (variability is a good thing&raquo_space; protective) in bereaved ppl&raquo_space; prognostic for CVD
• higher levels of depression&raquo_space; significantly more likely when bereaved (most obvious&raquo_space; don’t take care of themselves, isolation, lack sleep, less phys activity)
• higher level of inflammatory markers in bereaved

Question 58

most reported chronic conditions (3)

• private vs collective dwellings
• home care

Answer 58

1. arthritis (ostio/rheumatoid)&raquo_space; 45% (more women)
2. HBP&raquo_space; 43%
3. diabetes&raquo_space; 18% (more men)
   * many older adults live with multiple chronic conditions (80% of 71-80yo live with 1+)

• almost all (92%) of 65+yo live in private dwellings (collective dwellings = retirement homes)
• older adults w chronic conditions have greatest need for home care&raquo_space; 40% receiving home care had unmet needs (mobile, fitness and social activities)

Question 59

Home care/health services (5)

Answer 59

• medical equipment/supplies
• nursing care (eg. dressing changes, meds prep)
• physio/occupational therapy (other healthcare services)
• transportation
• personal/home support (bathing, housekeeping, meal prep)

Question 60

Reablement

• idea
• definitions
• programs (availability, issues, aspects (5))

Answer 60

• not a new idea (1940s)&raquo_space; improve patients capacities for living as normal a life as possible after disablement
• diff definitions and populations: restorative care, function-focused care, reactivation

programs: available in Australia, Norway, UK and Canada&raquo_space; limited evidence, inconsistent, implementation details lacking&raquo_space; who delivered care, when, how, how much, etc&raquo_space; important for replication and determining effectiveness
- person-centered
- short term or time limited (6-9 weeks)
- home/community setting
- multidisciplinary&raquo_space; inc social connectivity, reduce ongoing support
- function focused, regain life skills, promote independence

Question 61

Shift from rehab to reablement mindset

- shift from passive to active

Answer 61

• rehab is more home/healthcare services (physical function), while reablement focuses more on biopsychosocial model and reintegration back into usual routines (doing what matters most to them)&raquo_space; re-enabling daily living skills (no accepted official definition)

passive to active:

eg. do not make them a meal, help them make their own
- goals are crucial
- working together on goal attainment
- identify resources
- health provider communication (and other comm!)

Question 62

health action process approach (HAPA)

• motivation phase
• volition phase

Answer 62

1. motivation phase: self efficacy, outcome expectations, risk perception&raquo_space; INTENTION
2. volition (action-behaviour) phase: action/coping planning, self-efficacy&raquo_space; HABIT

Question 63

Behaviour change techniques (BCTs)

• active ingredient
• example
• 1, 2, and 7

Answer 63

• component of intervention designed to alter/redirect causal processes that regulate behaviour, aka “active ingredient”
  eg. inc phys activity in older adults

1. goals and planning (behavioural contracting): planning when, where, and with who you will perform the activity (action planning)
2. feedback and monitoring: track heartrate, steps, sleep, sedentary time (eg. w accelerometer)
3. associations: prompts, cues&raquo_space; do squats while brushing teeth

• lower levels of self efficacy/phys activity associated with setting goals, self-monitoring, coping planning and feedback&raquo_space; we don’t know exactly how goals were planned

Question 64

Physiotherapists

- which BCTs? (2)

Answer 64

asked via online survey what BCTs used to promote activity/adherence to non-treatment phys activity

• goals and planning most freq
• repetition and substitution (graded tasks&raquo_space; slowly inc difficulty)

Question 65

child poverty

Answer 65

C grade in Canada, esp BC!

• working without adequate pay
• in 2015 18.3% (1% above national avg)

Question 66

Promoting resilience and growth

• Broaden and Build theory
• the undoing hypothesis

Answer 66

• health psychologists are looking for positive experiences that keep ppl from developing illnesses and ward off adversity

Broaden and build theory:
positive emotions widen ppls outlook on life&raquo_space; broaden attention and thinking, repertoire of declared actions, and ​inc openness to new experiences&raquo_space; build up reserves of energy and social resources (optimism, ego resilience, mental health) that can be later used to adapt to adversities

the undoing hypothesis: positive emotions serve their adaptive role in stress by “undoing” or reversing the negative impact of stress

Question 67

waitlist control study on loving - kindness meditation

• sample size
• assessments
• results

Answer 67

• 202 middle-aged adults
• 9 weeks of daily life assessments, 6 meditation sessions

results:

• more daily positive emotions (joy, gratitude, contentment)
• more positive relations and social support, more purpose in life, fewer depressive symptoms, fewer health symptoms after 9 weeks

Question 68

Giving support during the pandemic

Answer 68

• social support
• providing emotional and tangible support benefits the recipient and it is also associated w elevations in positive affect and social satisfaction in the provider

Question 69

epigenetics - methylation

Answer 69

over the course of a lifetime, the methylation btwn MZ twins is distinguishable from e/o (start out identical, but change over time&raquo_space; env factors)

Question 70

Hospital services

• emergency care
• health promotion facilities

Answer 70

• emergency care, diagnostic testing, curative treatment, rehabilitation, and social services
• health promotion facilities (wellness centers/weight loss problems)

Question 71

Nursing homes

• who needs it, why
• outpatients, why (4)
• problem

Answer 71

relatively long-term medical and personal care, esp if patients or their families cannot provide this care
- older adults&raquo_space; frail/mobility problems&raquo_space; need help in day-to-day activities such as dressing and bathing themselves

• ppl are starting to use outpatient services&raquo_space; cheaper, more convenient for daily living, inc govt funding, technological advances (eg. pacemakers that regulate heartbeat and and insulin pumps that inject on a schedule)
• problem: lacking help from fam/friends, no transportation to check ups

Question 72

Medicare

• what is it
• variability
• low income
• universal health care
• US

Answer 72

publicly funded health care insurance program

• basic healthcare tenets, reasonable access to necessary health services without cost
• funded health services differ by province/territory (eg. abortion services)
• prescription drugs and dental care not included (paid privately or by employee insurance)
• low-income Canadians still experience significant financial barriers to health care and are often subject to longer wait times in hospitals and emergency rooms
• universal health care: similar to medicare, funded by taxes/payroll reductions (au, G, Italy, Neth, Swed, UK)
• US: larger privatized healthcare system&raquo_space; insurance provided by work place, private, or government programs&raquo_space; many americans do not have health insurance

Question 73

perceiving symptoms

• physiological self estimations
• external symptoms

1. individual differences
2. env stimuli
3. psychosocial influences
4. gender/sociocultural diff

Answer 73

• people are terrible at estimating their own heart rate, breathing, etc
• trouble perceiving external symptoms (hard to notice, differ between ppl)

1. individual differences: same registering of pain threshold for heat, but different levels of tolerance of pain; some ppl pay more attention to internal state (body sensitivity), not more accurate!&raquo_space; overestimate bodily changes, slower recovery (neuroticism associated)
2. competing environmental stimuli: when env is stimulating ppl are less likely to pay attention to internal sensations
3. psychosocial influences: perception of bodily sensations heavily influenced by cognitive, social and emotional factors (eg. placebos)
   - expectations can inc symptoms perceived (nocebo phenomenon&raquo_space; side effects that were def not caused by drug&raquo_space; “manufactured” based on negative expectations)
4. gender and sociocultural differences:
   - women feel discomfort at lower stimulus levels than men&raquo_space; ask to end it sooner (hormones, gender role beliefs)
   - difference in expression of pain/distress varies by culture

Question 74

placebo effect

• what is it
• examples (5)
• treatment causes what?
• affected by (4)

Answer 74

medical procedure or treatment produces a response due to the user’s beliefs and experiences about the intervention or pill rather than its actual physical or chemical properties.

• colour of pill (bright = stimulant, cool = tranquilizing)
• branded pills, higher price
• calling a placebo a stimulant causes inc HR/BP (verbal suggestions)
• injections have stronger placebo effect than pills
• larger # of pills/dosage
• treatment with placebo may decrease stress, which reduces pain experience; psychological process causes release of endorphins&raquo_space; classical conditioning and expectancies
• affected by negative emotions, vague physical sensations, cognitive factors exaggerate sensations, modelling of symptoms by others

Question 75

• medical student’s disease

- mass psychogenic illness

Answer 75

medical student’s disease: as they learn abt diseases they think they have one

mass psychogenic illness: widespread symptom perception even tho no medical basis&raquo_space; chain reaction (see someone sick, then feel sick)

Question 76

commonsense models

1. illness identity
2. causes
3. timeline
4. consequences

• prevalence

Answer 76

how people think about disease

1. Illness identity: name and symptoms of the disease
2. Causes and underlying pathology: ideas concerning how one gets the disease and what physiological events occur with it
3. Timeline: how long the disease takes to appear/lasts
4. Consequence: ideas about the seriousness, effects, and outcomes of an illness.

• prevalence: rare illnesses are seen as more serious
• after experience, fear can motivate health behaviour or maladaptive avoidance behaviours

Question 77

trust in practitioners

• iatrogenic conditions
• trust issues (2)

Answer 77

iatrogenic conditions: development of health problems as a result of medical treatment
- practitioner’s error, normal side effect/risk of treatment, technology error

trust issues:

• confidentiality (from parents, about sexuality)
• stigmas against minority groups/certain diagnoses (HIV/AIDS)

Question 78

health belief model

• initiation
  1. perceived threat (2)
  2. benefits - barriers

Answer 78

• symptoms initiate a decision-making process about seeking medical care
  1. perceived threat
• cues to action (symptoms, advice, mass media, symptom descriptions)
• perceived susceptibility/seriousness: modify concern cues arouse (threat intensified)
  2. do perceived benefits of treatment outweigh perceived barriers to doing so (if they think they can be cured by doc, go, but if they think there’s gonna be bad side effects, don’t go because it will be costly and painful

Question 79

complementary and alternative medicine (CAM)

• definitions
• learned through
• better?

1. Manipulative and body based
2. natural (3)
3. mind-body interventions
4. other (3)

Answer 79

complementary = used along w conventional treatments
alternative = replacement
- learned through religious/cultural backgrounds
- usually medical treatments yielded better results

1. Manipulative and body-based methods: move parts of the body (eg. chiropractors, massage therapy, reflexology&raquo_space; good for back pain)
2. Natural products: herbal products, vitamin and mineral supplements, and other dietary supplements
3. Mind-body interventions: enhancing mind’s ability to manage body function and symptoms (muscle relaxation/meditation/yoga)
4. Other CAM practices: energy fields (physical energies/magnetic fields), homeopathy (applying diluted substances that produce symptoms in healthy people like those the ill person has), and traditional Chinese medicine

Question 80

hypochondriasis

• somatic symptom disorder
• factitious disorder

Answer 80

worry excessively about health, monitor their bodily sensations closely, make frequent unfounded medical complaints, and believe they are ill despite reassurances by physicians that they are not (associated w neuroticism)

• when accompanied by perceived physical symptoms, it is called somatic symptom disorder
• repeatedly acting like you’re sick is called factitious disorder

Question 81

chronic fatigue syndrome (CFS)

• definition
• linked to
• detection

Answer 81

unexplained, persistent severe fatigue for at least six months, but other symptoms can include sore throat and headaches

• linked with high allostatic load and low blood pressure
• no medical tests to detect CFS (diagnosis based on ruling out)

Question 82

treatment styles

• doctor centered
• patient centered

Answer 82

doctor-centered: physician asks yes/no questions, focuses on first problem mentioned&raquo_space; don’t discuss other problems with patient, want to establish link without being sidetracked

patient-centered: less controlling, open-ended questions&raquo_space; more information and new facts mentioned, avoid jargon, allow patient participation

Question 83

Assessing adherence (3)

• pill/quantity counting
• medication recording dispensers
• biochemical tests

Answer 83

pill/quantity counting: remaining medication measured, compared against what should be remaining
medication-recording dispensers: count/record time of usage (expensive, but accurate)
biochemical tests: patient’s blood/urine&raquo_space; can test if it was used, but not amount/when&raquo_space; time consuming, expensive

*doesnt work if patient is not honest! (eg. discarding meds)

Question 84

kidney disease

• hemodialysis
• medication
• restrictions

Answer 84

requires:

• hemodialysis: blood filtered from artery and returned to vein
• lots of medication/vitamins
• severe dietary restrictions (sodium, potassium, phosphorus, protein)

Question 85

preventing non-adherence (7)

• reasons
• simplification
• written instructions
• repetition
• psychological enhancements
• records
• letters

Answer 85

• explain reasons for treatment, emphasize key info
• simplify verbal instructions
• use written instructions for more complicated/long-term treatments (eg. multi phase/step treatments)
• have patient repeat instructions
• enhance self-efficacy, motivation and social support
• have patient keep adherence record (self-monitoring), with small rewards
• follow up letters stating importance of adherence and risks of non-adherence

Question 86

chronic care model

1. organization
2. information systems
3. deliveries
4. decision support
5. self-management
6. resources

Answer 86

chronic care model: secondary (try to reverse condition) or tertiary (try to slow progression) prevention

1. organization of care: priority to primary prevention (eg. identify smokers to help them quit)
2. clinical information systems: regularly update clients’ files
3. delivery-system design: mailings and counselling as preventative interventions
4. decision support: guidelines/training for staff to ID clients who need intervention
5. self-management support: info and referrals
6. community resources: self-help organizations

Question 87

Organization of hospitals
7 levels
1. board
2. admin
3. chief
4. physicians
5. other
6. nurses
7. orderlies

Answer 87

1. board of trustees: at the top&raquo_space; upper-lv business/professional ppl; long-range planning and fundraising
2. administrators and medical staff: admin in charge of day-to-day (equipment/supplies purchases, record keeping, etc) and medical staff are responsible for patient care
3. Chief of staff, aka medical director
4. attending physicians: residents (med school graduates) and full fledged physicians (supervise residents)
5. other (radiologists/pathologists)
6. nurses: care for patients and manage wards&raquo_space; coordinate patient’s care
7. orderlies, etc

Question 88

health hazards (3)

Answer 88

• chemical hazards
• errors (surgery on wrong patient/body part)
• disease-causing microorganisms (nosocomial infections: caught in the hospital setting)

Question 89

changes in hospital procedures (4)

Answer 89

• cost containment: hiring less nurses
• short stay hospitals (admission/discharges and avg length of stay have decreased after 1990)&raquo_space; patients released earlier
• more outpatient procedures
• medical procedures becoming more efficient

Question 90

coping

• 2 types
• blame (2)
• learned helplessness
• improvements

Answer 90

1. problem-focused coping: alter cause of stress (take meds to reduce pain, increase knowledge)
2. emotion-focused coping: regulate the emotional response to the situation (deny unpleasant facts, distract themselves, social support)

blame: poor adjustment
- self-blame: guilt, self-recrimination&raquo_space; difficulty adjusting to condition
- blame others: anger, bitterness&raquo_space; impair adjustment (worse)

learned helplessness: no effort to initiate change when control is possible&raquo_space; depressed

improvements:

• constructive suggestions during anesthesia
• psychological counselling
• roommate who already had the surgery

Question 91

anxiety and control

• preoperative anx
• types of control (3)

Answer 91

anxiety: people with high preoperative anxiety tend to report more pain, use more medication for pain, stay in the hospital longer, and report more anxiety and depression during their recovery than patients with less preoperative fear

types of control:

1. behavioural: reduce discomfort/promote recovery via actions (eg. special breathing)
2. cognitive control: focus on benefits, not unpleasant aspects of procedure
3. informational control: gain knowledge abt sensations during/after procedure

Question 92

cardiac catheterization

• how
• used for
• side effect
• control
• how to lessen anx

Answer 92

physician inserts a thin, hollow tube called a catheter into one of your blood vessels, gently threads it toward your heart, and then injects dye through the catheter

• tranquilizing medication and a local anesthetic
• “hot flashes” when dye is injected into the heart (scary but not painful)
• little to no behavioural control
• ppl who received cog/info control experienced less anx

Question 93

endoscopy

• used for
• how
• behavioural control
• informational control

Answer 93

• used in diagnosing ulcers and other disorders of the digestive tract
• tube must be passed through the patient’s mouth and down to the stomach and intestine, remains for 15-30 mins
• behavioural control: breathing/swallowing teaching (reduce gagging, reduces emotional behaviour)
• informational control (expected sensations)

Question 94

lamaze training

• what is it
• 3 types of control

Answer 94

• mother learns how to participate in childbirth and receives minimal medication
• informational: birthing procedures
• behavioural: breathing patterns
• cognitive: how to maintain concentration

Question 95

avoidance vs attention

• definitions
• avoidance better for
• matching needs
• repetition

Answer 95

avoidance: coping by denying threat, suppressing unpleasant thoughts, or refusing to hear threatening info
attention: seeking detailed info abt situation

• avoidance ppl better able to adjust emotionally to medical procedures
• best to match preparation for medical procedures to coping needs to indiv
• number of times patients are given the info also matters (less stress the more times they hear info)

Question 96

Hospitalization in childhood

• toddler years
• school-age

Answer 96

Toddler years: separation distress: young children’s normal reaction of being upset and crying when they are separated from their parents, particularly in unfamiliar surroundings
- returning from a hospital trip can be traumatic

School age: better coping than toddlers, but still distressed
- lack of personal control, worry about outcomes, social isolation, and embarrassment are difficult aspects of hospitalization for school age children

Question 97

informing children of medical procedures: factors

- age, experience, coping

Answer 97

1. age: below 7 benefitted from video presentation right before procedure, older children benefit better if presented to several days before
2. experience: informing makes younger children more anxious than older children if they had prior difficult experiences
3. coping: children who use avoidance coping benefit less from information than those who use attention strategies

Question 98

psychologist in hospitals (5)

Answer 98

• consult specialists&raquo_space; diagnostic and counselling services
• help with coping for stressful procedures
• help with adherence
• improv self-care skills/compliance after discharge
• rehab, help family adjust, help career decisions if needed

Question 99

CVD emotional adjustment

• common characteristics (2)
• diagnosing psychologically

Answer 99

• common to have depression and pessimism &raquo_space; slower recovery and likely to be rehospitalized
• anxiety and low personal control&raquo_space; inc risk of heart attack/arrhythmia
• use DSM-5 to diagnose via interview
• questionnaires are less time consuming and cheaper than interviews, but less accurate

Question 100

specialized tests

• MMPI (3 aspects)
• MBMD
• PAIS (health care thoughts, job, home, sexual relationships, family relationships, social env, psychological distress)

Answer 100

Minnesota Multiphasic Personality Inventory (MMPI):

• true/false format
• neurotic triad scales&raquo_space; high scores on all 3 means theyre prone to psychophysiological disorders (ulcers, headaches)
  1. hypochondriasis: complaining abt physical health
  2. depression: unhappiness/hopelessness
  3. hysteria: coping using avoidance and devel of physical symptoms

Millon Behavioral Medicine Diagnostic (MBMD): assesses decision-making issues
- coping style, negative health habits, stress moderators

Psychosocial Adjustment to Illness Scale (PAIS): 4 point scale, either questionnaire or interview, 7 psychosocial characteristics of patient’s life

• Health care orientation: patient’s attitudes about health care, expectancies abt treatment
• Vocational environment: impact on job performance
• Domestic environment: difficulties at home because of health problem
• Sexual relationships: modifications in sexual activity as a result of the health problem
• Extended family relationships: disruptions in relationships between the patient and family members outside of the immediate family
• Social environment: impact on socializing/leisure activities
• Psychological distress: self-esteem, feelings of depression, anxiety, and hostility

Question 101

patient satisfaction

• quality (2)
• autonomy
• coordination
• env

Answer 101

1. The technical quality of the treatment or care received
2. The quality of the interaction with the care provider(s), including communication (listening and explaining clearly)
3. A sense of autonomy and informed consent while receiving care.
4. coordination and communication among care providers, planning for leaving hospital (patient safety)
5. physical environment, food quality

Question 102

organic vs psychogenic pain

• somatic symptom disorder
• referred pain

Answer 102

organic: pain clearly linked to tissue pressure/damage

psychogenic pain: no tissue damage; discomfort involved in these pains could result from psychological processes&raquo_space; not experienced differently than organic pain (hurts!)

somatic symptom disorder: long-term pain as a part of excessive concerns for physical symptoms or health

referred pain: pains originating from internal organs are often perceived as coming from other parts of the body, usually near the surface of the skin (eg. heart attack pain felt in shoulders, pecs or arms)&raquo_space; same sensory pathway

Question 103

acute vs chronic pain (2)

• chronic recurrent
• chronic intractable benign
• chronic progressive

Answer 103

acute: less than 3 months, inc anx during pain, subsides after condition improves

chronic: high lv of anx long term, hopelessness; pain interferes w daily life
- benign (harmless) or malignant (injurious)
- continuous or episodes

1. chronic recurrent pain: benign causes, episodes of pain, (eg. headaches)
2. chronic intractable benign pain: pain present all the time, varying intensity, no underlying condition (eg. back pain)
3. chronic progressive pain: continuous, associated w malignant condition, increasingly intense as condition worsens (arthritis, cancer)

Question 104

Burns

• how are they measured?
• first degree
• second degree
• third degree

Answer 104

• severity measured by percentage of skin area affected and depth of burn
  1. First-degree: damage to outermost layer of skin (epidermis). The skin turns red, but does not blister (eg. sunburn)
  2. Second-degree: are those that include damage to the dermis, the layer below the epidermis. These burns are quite painful, often form blisters, and can result from scalding and fire
  3. Third-degree: destroy the epidermis and dermis down to the underlying layer of fat, and may extend to the muscle and bone. These burns usually result from fire. When third-degree burns damage nerve endings, there is generally no pain sensation in these regions initially.

Question 105

burn treatment phases

• emergency
• acute
• rehab

Answer 105

1. emergency phase: assess severity, prevent infection, balance fluids/electrolytes
2. acute phase: until burned area is covered w new skin (days to months), constant pain, esp 3rd when nerve endings regenerate
3. rehabilitation phase: until scar tissue has matured, pain subsided

Question 106

physiology of pain

• stimulation
• signal path
• types of fibres

Answer 106

• noxious stimulation triggers release of ST, histamine and bradykinin&raquo_space; promote immune system activity and cause inflammation
• signal carried to spinal cord, which carries it to brain (afferent nerve endings that respond to pain are called nociceptors)

Pain signals carried by:

a) A-delta fibres: coated w myelin (sharp localized pain)&raquo_space; motor/sensory areas&raquo_space; respond quick
b) C-fibres: transmit slower (dull, burning, aching)&raquo_space; brainstem/forebrain&raquo_space; emotional/motivational/mood states

Question 107

neuropathic pain
- definition

1. neuralgia
2. causalgia
3. phantom limb pain

Answer 107

pain with no current cause (no noxious stimulant)&raquo_space; result from current or past disease/damage in peripheral nerves&raquo_space; can be triggered by minor stimulants (touch)

1. neuralgia: intense shooting/stabbing pain along nerve after infection
2. causalgia: recurrent episodes of severe burning pain after serious wounds (gunshot/stabbing)
3. phantom limb pain: feels pain in limb that is no longer there or has no functioning nerves, can be severe, recurrent or continuous (shooting, burning or cramping)

Question 108

early theories of pain

• problem
• specificity theory&raquo_space; problem
• pattern theory&raquo_space; problem

Answer 108

early theories: not adequate; do not explain how psychological factors are involved

1. specificity theory: body has a separate sensory system for perceiving pain (like hearing/vision)&raquo_space; has its own receptors and nerves (FALSE)
2. pattern theory: no separate system&raquo_space; shared with touch&raquo_space; triggered by intense stimuli (cannot explain causalgia/neuralgia)

Question 109

inducing pain in lab research

1. cold pressor
   - self statements
2. muscle ischemia
   - safe until
   - measures what?

Answer 109

1. cold-pressor procedure: forearm in ice water (2 degrees C)&raquo_space; aching/crushing pain
   - people who were taught self-statements and explanations for when to use them experienced less pain (beliefs affect pain)
2. muscle-ischemia procedure:
   ischemia = insufficient blood flow&raquo_space; to arm (using cuff of sphygmomanometer)&raquo_space; pain without damage (50 mins safe)
   - can also be used to measure pain threshold (much higher threshold for ppl watching comedy show/practicing relaxation)

Question 110

Gate-control theory

• built on
• what is it
• output control (fibres (2) and brain)
• periaqueductal grey

Answer 110

• earlier theories + physiological mechanism that psychological factors can affect ppls experience of pain
• neutral “gate” can be opened/closed in varying degrees&raquo_space; modulate pain signals (in spinal cord)&raquo_space; must pass critical level to perceive pain

output control:

1. activity of pain fibres (A-delta and C)&raquo_space; opens gate (stronger stimulus = more active fibres)
2. activity of other peripheral fibres (A-beta) carry info abt harmless stimuli (close gate)
   - why massages dec pain
3. messages that descend from the brain (anx/excitement impact)&raquo_space; open (negative emotions, injuries, boredom) or close (positive emotions, medication, counterstimulation, concentration/distraction)
   - why env can distract from pain

periaqueductal grey: area in brain when stimulated with electrodes can induce analgesia&raquo_space; causes release of endorphins&raquo_space; enables pain regulation

Question 111

pain behaviours

1. expressions of distress
2. distorted walking
3. irritable
4. activity avoidance

• reinforcement

Answer 111

1. Facial or audible expression of distress: clench teeth, moan, or grimace.
2. Distorted ambulation or posture: such as moving in a guarded or protective fashion, stooping while walking, or rubbing or holding the painful area
3. Negative affect: irritable
4. Avoidance of activity: lie down frequently, stay home from work, or refrain from motor or strenuous behaviour

• reinforced via operant conditioning (getting out of something annoying is rewarding, high levels of help/attention)

Question 112

pain thresholds

• thresholds vs reaction
• cold pressor
• sES
• negative emotions

Answer 112

• men and women have similar thresholds, but differ in their reaction to pain
• women give higher ratings than men for cold-pressor tests
• lower sES experience more pain
• negative emotions (eg. anxiety) increase pain expectations and memory of experience

Question 113

models of pain

• social communication model of pain
• communal coping model of pain

Answer 113

social communication model of pain: importance of social factors in both acute and chronic pain experiences (interpersonal context)
eg. patient and caregiver dynamic influences pain experience&raquo_space; contextual factors

communal coping model of pain: focuses on deleterious pain response of catastrophizing (magnifying and dwelling on one’s pain) which worsens pain intensity and feelings of helpless in pain management (may occur due to trying to get attention/sympathy&raquo_space; social network)&raquo_space; affected by others’ responses

Question 114

pain coping strategies

• overt
• covert
• acceptance

Answer 114

1. overt behavioural coping: getting rest, using relaxation methods, and taking medication
2. covert coping: hoping or praying the pain will get better, saying calming words to oneself, and diverting one’s attention
3. pain acceptance: being inclined to engage in activities despite the pain and disinclined to control or avoid the pain (pay less attention to pain, more self-efficacy, function better, use less pain meds)

Question 115

ways to measure pain

• self report (3)
• MPQ (2)
• behavioural assessment approaches (2)
• psychophysiological measures (3)

Answer 115

self-report: describe their own discomfort (questionnaire or rating scale)

• interviews
• pain diaries
• rating scales&raquo_space; visual analogue scale (line with ends labelled), numeric rating scale (range), verbal rating scale (never, sometimes, often, always)

McGill pain questionnaire (MPQ): determines degree of pain by using words with varying reflections of pain (series of verbal rating scales)

• affective (emotional-motivational), sensory and evaluative dimensions
• limited use with ppl below age 12/have poor English skills

behavioural assessment approaches:

a) clinical sessions: nurses use pain behaviour scale&raquo_space; rate 10 pain behaviours on a 3 pt scale
b) everyday activities: spouse makes list of behaviours that signal pain&raquo_space; assessor trained to watch for signals&raquo_space; used to determine impact on daily life&raquo_space; children under 5 usually assessed this way

psychophysiological measures: pain has sensory and emotional components&raquo_space; these are best used as supplements to self-report and behavioural assessment approaches

a) autonomic activity: heart rate, skin conductance (not as useful), occurs in the absence of pain (eg. stress)
b) EEG: measures evoked potentials of the brain&raquo_space; amplitude of peaks increases with stimulus intensity
c) EMG: (measures muscle tension)&raquo_space; associated w pain

Question 116

crisis theory

• what is it
  1. illness related factors
  2. personal factors
  3. env factors

Answer 116

• 3 types of factors that influence how ppl adjust/cope&raquo_space; coping process (cognitive appraisal, adaptive tasks, coping skills)&raquo_space; outcome of crisis
  1. illness-related factors: greater illness threat = harder to cope (eg. pain, disfigurement, life-threatening, embarrassment)
  2. background and personal factors: personality, self-esteem, age, gender, social class, religion, emotional maturity, timing of illness, fitting in, self-blame (cope poorly if they think it is their fault they got illness, more depressed), rumination, catastrophizing
  3. physical and social environmental factors: hospital env, home env, social support

Question 117

coping process

• 3 steps
• tasks/skills (illness, psychosocial)

Answer 117

1. cognitive appraisal of significance of health problem in life
2. adaptive tasks
3. coping skills of adaptive tasks

Tasks/skills:

a) tasks related to illness/treatment: learning to cope w symptoms, adjust to hospital env/procedures, maintain good relations with practitioners
b) tasks related to general psychosocial functioning: control negative feelings, positive outlook, maintain self-image/competence, preserve relationships w friends/fam, prepare for uncertain future

Question 118

coping strategies

• denial
• information
• self-administration
• goals
• support
• consider future
• purpose

Answer 118

• denying or minimizing seriousness of situation (only beneficial early, safe from overwhelming)
• seeking information abt problem and treatment
• learning to provide own medical care (self-administered insulin)
• setting concrete, limited goals
• recruiting instrumental/emotional support
• considering possible future events&raquo_space; be prepared for difficulties
• gaining manageable perspective on problem/treatment&raquo_space; long term “purpose”

Question 119

asthma

• prevalence
• what happens?
• heredity
• triggers (4)
• regimens (4)

Answer 119

chronic respiratory problem&raquo_space; prevalence higher in children

• episodes of impaired breathing when airways are obstructed&raquo_space; immune system is stimulated to react in allergic manner&raquo_space; releases histamine&raquo_space; irritates tissues in bronchial tube
• heredity plays a role, can be passed on (if received transplant)

triggers:

• personal factors (anger, anx)
• environmental conditions (air pollution, pollen)
• physical activities (exercise)
• suggestion (placebos can trigger)

regimens:

• avoid triggers
• use bronchodilators (open restricted airways)
• anti-inflammatories&raquo_space; reduce sensitivity/inflammation
• avoiding exercise makes condition worse

Question 120

epilepsy

• cause
• tonic-clonic
• aura
• how to help (5)
• regimens (2)

Answer 120

• recurrent, sudden seizures that results from electrical disturbances of the cerebral cortex&raquo_space; stigmatized, emotional arousal (eg. anx) increases risk
• tonic-clonic: brief “tonic” phase&raquo_space; lose consciousness and body is rigid; longer “clonic” phase&raquo_space; 2-3 mins of spasms/twitching
  aura: unexplained sounds, smells, or other sensations&raquo_space; occurs before a seizure

how to help:

• prevent injury from falling/flailing
• do NOT put anything in person’s mouth, loosen clothing around neck, turn body on side
• do NOT restrain person, move nearby objects and make space
• call an ambulance if still seizing after 5 mins
• after person wakes up describe what happened, ask if they need help

regimens:

• anticonvulsant drugs&raquo_space; taken regularly to maintain conc
• if medication does not work, there are other methods

Question 121

spinal cord injury

• causes, damage severity
• rehab progression

Answer 121

neurological damage in the spine that results in the loss of motor control, sensation, and reflexes in associated body areas&raquo_space; damage is permanent if cord is badly torn/severed because little/no nerve tissue will regenerate

rehab: (if cord is not severed) start with independent functioning (bladder/bowel control, range of movement), then move on to muscle control

Question 122

diabetes mellitus

• hyperglycemia
• pancreas
• prevalence

Answer 122

• too much glucose in blood for long period of time (hyperglycemia)
• accumulation because pancreas is not producing enough insulin or body no longer responds normally to insulin
• prevalence higher in men, increases greatly with age, varies across ethnic groups

Question 123

types of diabetes

• type 1, type 2, gestational
• heredity
• self-management (4)

Answer 123

type I: develops in childhood/adolescence (5-10% of cases)

• autoimmune processes have destroyed insulin producing cells in pancreas
• need insulin injections

type II: pancreas is producing at least some insulin, can manage with good diet and medicine
- usually after age 40, overweight, more than normal amt insulin (insensitivity, resistance)

gestational: when pregnant (temporary); inc risk of mother/child getting diabetes later
- heredity plays a role in dec insulin production&raquo_space; inc susceptibility to effects of environmental conditions

self-management:

• self-monitoring blood glucose (finger prick)
• taking insulin/meds (too much insulin can cause hypoglycemia)
• diet (limit high risk foods and calorie intake)
• exercise (uses glucose)

Question 124

side effects of diabetes

• direct cause
• neuropathy
• blood glucose inc effects (5)

Answer 124

• death (direct cause)
• neuropathy (nerve disease): high blood glucose destroys myelin&raquo_space; lose sensation in area/pain
• inc blood glucose thickens arterial walls (atherosclerosis)&raquo_space; kidney failure, heart disease, stroke, gangrene (requires amputation), if occurs in eyes can cause blindness

Question 125

alzheimer’s disease

• dementia
• alzheimers
• causes (2)
• associations (7)
• caregivers&raquo_space; pros and cons

Answer 125

dementia: progressive loss of cognitive functions that often occurs in old age
alzheimers: most common form of dementia&raquo_space; deterioration of attention, memory, and personality (does not happen all at once)
causes: lesions in brain (gnarled and tangles nerve and protein fibres), genetic defects (hereditary)

associations:
- low education
- prior strokes
- alcohol use
- sedentary lifestyle
- obesity
- hypertension
- high cholesterol

caregivers: studies show they have lower immune function, poorer overall health, higher stress hormones, and higher mortality rates
- taking care of loved ones can be deeply rewarding, but watching them deteriorate can be painful, exhausting and stressful

Question 126

adjustment problems

1. physical
2. vocational
3. self-concept
4. social
5. emotional
6. compliance

Answer 126

1. Physical: being unable to cope with disability or pain
2. Vocational: difficulty revising educational and career plans or finding a new job
3. Self-concept: being unable to accept one’s changed body image, self-esteem, and level of achievement or competence.
4. Social: difficulty of losing enjoyable activities or finding new ones and coping with changed relationships with family, friends, and sexual partners.
5. Emotional: experiencing high levels of denial, anxiety, or depression.
6. Compliance: failing to adhere to the rehabilitation regimen.

Question 127

biofeedback and progressive muscle relaxation

Answer 127

• biofeedback lets person know when changes occur
  eg. asthma&raquo_space; airflow in breathing
• progressive muscle relaxation allows asthma patients to learn how to control their breathing&raquo_space; reduce tension that could initiate asthma attack

Question 128

interpersonal therapy

Answer 128

interpersonal: help people change the way they interact with and perceive their social environments by gaining insights about their feelings and behaviour toward other people&raquo_space; esp good for anx&raquo_space; change self-concepts/relationships

Question 129

medical treatment of cardiac patients

• balloon angioplasty
• bypass surgery
• heart attacks (3)

Answer 129

balloon angioplasty: tiny balloon inserted into blocked artery to permanently keep vessel open
bypass surgery: directs blood flow around diseased portion of artery with a healthy vessel taken from another part of the body

heart attacks:

• limit damage to myocardium&raquo_space; use clot dissolving thrombolytic drugs (works if within 3 hours)
• coronary care units (monitoring)&raquo_space; risk for second attack high
• excessive anxiety, denial depression can impair recovery

Question 130

cardiac invalidism

• social support
• spousal beliefs

Answer 130

social support is very important for recovery (marital satisfaction), but sometimes people with heart disease become increasingly dependent and helpless
- the beliefs a spouse has about the patient’s physical capabilities can aid or delay rehabilitation (positive beliefs, encouragement)

Question 131

stroke

• definition
• prevalence (2)
• ischemic vs hemorrhagic

Answer 131

damage occurs in an area of the brain when the blood supply to that area is disrupted, depriving it of oxygen

• high prevalence above middle age years, higher for men in canada (similar both worldwide)
• higher rates of stroke occur among Indigenous, Black, and South Asian Canadians

ischemic stroke: blood supply in a cerebral artery is sharply reduced or cut off (like a heart attack for brain)&raquo_space; slow damage
hemorrhagic stroke: a blood vessel ruptures and bleeds into the brain&raquo_space; immed damage

Question 132

symptoms (5) and risk factors (8) for stroke

Answer 132

symptoms:

• Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden, severe headache with no known cause

risk factors:

• High blood pressure
• Cigarette smoking
• CCD, diabetes, and their risk factors (high chol, obesity, physical inactivity)
• Family history
• Atrial fibrillation (heart arrhythmia)
• Drug/alcohol abuse
• “Mini-strokes” (transient ischemic attacks) that may occur one or more times before a full stroke
• negative emotions/depression

Question 133

stroke deficits and rehabilitation

• severity varies
• treatment
• rehab
• left hemi damage (2 types of aphasia, depression)
• right hemi damage (visual neglect, depth perception, interpretation (2))

Answer 133

• severity varies&raquo_space; some degree of motor, sensory, cognitive (learning, memory, perception, language or speech impairment) as a result of the brain damage
• drugs and surgery vary greatly
• can show improvement over time&raquo_space; rehab reduces disability (biofeedback and intensive physical therapy)
• left hemi controls right, right hemi controls left side of body

left hemi damage: language processes, including speech and writing

• aphasia: difficulty understanding (receptive aphasia) or producing (expressive aphasia) words, even if they can make component sounds
• degree of depression

right hemi damage: processes visual imagery, emotions, and the perception of patterns, such as melodies

• visual neglect: patients fail to process information on the left side of the normal visual field (can be taught to overcome by turning head/tracking objects)
• depth perception issues
• interpretation/expression of affect (emotional lability&raquo_space; laugh or cry with little provocation, then surprised why)
• unable to interpret other people’s emotions

Question 134

cancer

• neoplasm
• oncogenes
• metastasis
• direct death
• indirect death (2)
• 5 types of cancer (carcinomas, melanomas, lymphomas, sarcomas, leukemias)

Answer 134

neoplasm: tumor&raquo_space; unrestricted cell growth (can be benign or malignant)
oncogenes: regulate cell division&raquo_space; genetic processes and carcinogens an damage them
metastasis: migration of cancer cells&raquo_space; forms new neoplasms&raquo_space; gets its own blood supply (angiogenesis)
- cancer is number 1 cause of death in canada (1/4 die)

direct death: cancer spreads to vital organ (brain, liver, lungs)&raquo_space; takes organs nutrients, organ fails
indirect death:
a) disease weakens patient
b) disease/treatment impair appetite and ability to fight infection

5 types of cancer:

1. carcinomas: malignant neoplasms in cells of the skin and the lining of body organs, such as the digestive, respiratory, and reproductive tracts (85% of cancers)
2. melanomas: neoplasms of a special type of skin cell that produces the skin pigment called melanin.
3. Lymphomas: cancers of the lymphatic system.
4. Sarcomas: malignant neoplasms of the muscle, bone, or connective tissue.
5. Leukemias: cancers of the blood-forming organs, such as the bone marrow, that lead to an extreme proliferation of white blood cells

Question 135

causes of cancer

• env
• behavioural
• psychosocial
• error
• risk inc

Answer 135

environment: ultraviolet radiation, and household and worksite chemical hazards

Behavioural: smoking, diet, obesity, and physical activity

psychosocial: stress (compromises immune system)

• 2/3 cases of cancer may be due to random error during DNA replication
• risk increases with age, esp middle age+, higher in males - prostate cancer and breast cancer most prevalent

Question 136

main cancers
1. skin cancer
2. lung cancer
3. prostate cancer
4. colorectal cancer
warning signs (8)

Answer 136

1. skin cancer (melanoma): cure is almost assured w early detection if basal/squamous cell carcinomas, but melanomas are more serious&raquo_space; metastasize quickly (5 yr survival)
2. lung cancer: higher in males than females, (higher smoking rate), 5yr survival rate is 16%, metastasize when small (spread early)
3. prostate cancer: 5 year survival rate 96%
4. breast cancer: early detection = 99% 5 yr survival rate, drops if it has already spread (82% live 10 yrs)
5. colorectal cancer: 64% 5yr survival rate, 90 when detected early (not often)

warning signs:

• weird lumps
• sores not healing
• changes in shape, size, or colour of a mole or wart
• persistent cough, difficulty swallowing
• blood in urine, stool, or phlegm
• change in bladder or bowel habits; difficulty or pain urinating
• gastrointestinal problems (e.g., indigestion) or unexplained weight loss
• unexplained aches, pains, fever, or fatigue

Question 137

diagnosing (3) and treating cancer

• surgery (2)
• radiation (2)
• chemotherapy
• general side effects

Answer 137

Diagnosing

1. blood or urine tests (hormone/enzyme levels)
2. radiological imaging: X rays, MRI&raquo_space; see internal structure (tumor)
3. biopsy: analyze suspicious tissue

Treating

• surgery: preferred treatment from medical standpoint&raquo_space; can entirely remove or remove large clusters&raquo_space; remaining for rad/chemo
  a) mastectomy: removal of entire breast
  b) lumpectomy: just tumor removed + radiation treatment
• radiation: damages DNA of cells&raquo_space; malignant cells less likely to be able to repair, can have side effects (nausea, vomiting, appetite loss, sterility, reduced bone marrow function)
  a) external beam therapy: external beam
  b) internal radiation therapy: apply inside, near tumor (injection)
• chemotherapy: oral/injection&raquo_space; kills cells that divide rapidly&raquo_space; can also kill normal cells (adverse temporary side effects, such as reduced immune fxn, sores, hair loss, nausea/vomiting, damage to internal organs)
• general side effects: chronic pain, fatigue, nausea and vomiting (anticipatory nausea = classical conditioning, learned food aversion&raquo_space; use a scapegoat food before treatment!)
• systematic desensitization may help w anticipatory nausea

Question 138

better adaption (4)

Answer 138

• involved in treatment decisions
• high perceived control
• cope using active, problem-focused strategies
• find meaning in difficulties

Question 139

leukemia

• 5 yr survival rate
• treatment (2 steps)
• bone marrow transplant
• hair

Answer 139

• five-year survival rate for childhood leukemia is 83%
• the main form of treatment is chemotherapy&raquo_space; terrible
  1. induction
  2. maintenance
• may require bone marrow transplant (aspiration = large needle inserted to remove marrow for testing and replaced)
• losing hair is traumatic and embarrassing

Question 140

HIV/AIDS

• spread by?
• immune function
• encephalopathy
• ART

Answer 140

acquired immune deficiency syndrome: infectious&raquo_space; caused by HIV spread through contact of blood and semen (unsafe sex, sharing syringes, birth by infected mother)
- immune function impaired&raquo_space; helper T cells reduced&raquo_space; variety of recurrent symptoms, such as spiking fever, night sweats, diarrhea, fatigue, and swollen lymph glands

encephalopathy: when HIV invades CNS&raquo_space; gradually lose cognitive functions, become disoriented and confused, and eventually lapse into comas

ART: drug used to treat HIV&raquo_space; suppress HIV reproduction and reduce viral load dramatically
- no HIV in blood, cant transmit to others, reduces opportunistic diseases

Question 141

aging process

• gerontology
• primary (3) vs secondary aging

Answer 141

gerontology: study of aging

primary aging: caused by biological factors (molecular/cellular changes)

• cellular senescence: loss of cellular function/cell death due to cells losing stress/damage resistance as they mature&raquo_space; can no longer replicate
• damage to mitochondria, inflammation, oxidative stress, and the accumulation of toxic metabolic by-products
• telomeres (chromosome caps) shorten&raquo_space; inc risk of age-related diseases

secondary aging: caused by environmental factors&raquo_space; often controllable (exercise, diet, or disease)
- can accelerate, or decelerate primary aging

Question 142

age-related diseases (11)

Answer 142

• Cardiovascular diseases
• most types of cancer
• type 2 diabetes
• chronic obstructive pulmonary disease
• rheumatoid arthritis
• osteoarthritis
• Parkinson’s disease
• Alzheimer’s disease
• cataracts
• glaucoma
• presbycusis (hearing decline w aging)

Question 143

frailty syndrome and sarcopenia

• decline
• impact
• sarcopenia
• cause

Answer 143

significant decline in the ability to respond and adapt to stress, including stress of a relatively minor nature, accompanied by what appears to be a loss in physical reserves
- far greater impact of illness or disease, are more likely to experience a fall or other serious injury, are more likely to experience mobility issues, and have a greater chance of being hospitalized

sarcopenia: progressive loss of skeletal muscle mass, strength, and function
- results from chronic inflammation and impaired immune function

Question 144

cognitive decline

• fluid mental abilities
• cog decline causes
• crystalized abilities

Answer 144

fluid mental abilities: used when solving problems in real time
- memory failure, reduced capacity for working memory, reduced attentional span, impaired visuospatial ability, and/or difficulties making decisions, processing speed

crystallized abilities: the use of learned knowledge and experience&raquo_space; remain largely uncompromised as people get older

Question 145

male-female health survival paradox

Answer 145

despite living longer than men, women experience higher rates of disability and poor health
- in old age men have greater physical strength and activity (correlated with longevity) but they still die earlier

Question 146

anti-aging

Answer 146

interventions intended to slow, stop, and/or reverse aging-related phenomena

• some people have started saying that aging itself is a disease to be treated

Question 147

factors associated with physical (7) and cognitive decline (10)

Answer 147

Physical decline:

• Daily alcohol consumption/smoking
• Depression/loneliness
• Falls, days spent in hospital, number of doctor visits
• Living without spouse/partner in household
• Low income and education
• Low subjective (self-reported) health
• Number of diagnoses/conditions, number of medications

cognitive decline:

• chronic perceived stress, stressful life events
• consumption of alcohol/glucose
• less engagement in cognitive activities
• low consciousness and openness to experience
• low education
• low physical fitness
• low hippocampal volume
• lower intelligence (as measured by IQ) in childhood
• poor social support, low social activity
• retirement

Question 148

neuroplasticity and cognitive training

Answer 148

neuroplasticity: the brain continues to form and reorganize synaptic connections in response to learning and experience in later life

Cognitive training: any program or intervention that aims to improve short-term memory, perceptual speed, or problem-solving by asking users to engage in simple tasks or games&raquo_space; requires attention, perception, comprehension, memory, judging

Question 149

cognitive decline

• relationship factors
• social activity
• social network
• stressors

Answer 149

• relationship factors affecting cognitive decline include low social activity, small social network size, feelings of loneliness, and low emotional support
• social activity associated with executive functioning, working memory, visuospatial abilities, and processing speed, but not episodic memory, verbal fluency, reasoning, or attention
• social support/social network size associate with cog functioning in general, but not any specific functions (nature of relationship unknown)
• stressors can increase cognitive decline&raquo_space; chronic stress causes dysfunction of HPA axis&raquo_space; causes inflammation&raquo_space; accelerates cog decline (coping and stress management is important!)

Question 150

older adults and coping with stress

• appraisal
• coping methods (7)

Answer 150

• older adults use emotion-focused coping more than problem-focused coping&raquo_space; stress tends to be less controllable later in life
• tend to cope more effectively with stress, and have a more positive appraisal of stress

coping methods: social isolation, negotiation, acceptance, accommodation, support seeking, living in the moment, and seeking spiritual comfort

Question 151

stamina

- high vs low

Answer 151

similar to hardiness

• high stamina: triumphant, positive outlook during periods of adversity
• low stamina: negative outlook and feelings of helpless and hopeless in facing life events in old age

Question 152

social isolation vs loneliness

• each associated with…
• both associated with
• momentary solitude

Answer 152

social isolation: physical separation from other people, as in living alone or having a scarcity of social interactions
- associated with being older

loneliness: subjective unpleasant feeling based on the perception of being alone or separated
- associated with being younger (decreases with age for women only), living alone, marital status (single, divorced, or widowed), and lower education

• both associated with lower income, being male, more chronic conditions, functional impairment, and increased mortality from CVD, obesity, cognitive decline, depression, etc

Momentary solitude: objective state of being alone without social interaction (distinct from both social isolation and loneliness)&raquo_space; can have positive or negative effects

Question 153

ageism

• discrimination
• results from
• negative word exposure

Answer 153

discrimination and social oppression on the basis of a person’s age
- result from stereotypes of older adults (women more) as limited in physical and/or cognitive ability and therefore inferior to younger members of society

• increased exposure to negative stereotype words causes worse cognitive performance, disengagement from daily activities, increases CV stress, increases loneliness and dependency

Question 154

successful aging

• associated factors (5)
• biopsychosocial approach (3 criteria)
• primary control
• positive outcomes (3 ways to maximize)

Answer 154

Factors associated with successful aging: social well-being, psychological well-being, physical health, spirituality and transcendence, and environmental and economic security

biopsychosocial approach criteria for successful aging:

1. avoid disease and disability
2. high cognitive and physical functioning
3. engagement with life
   - criticism: static (ignores experiences)

maintenance of primary control: efforts aimed at managing and controlling one’s environment when possible throughout life&raquo_space; selection and compensation

maximization of positive outcomes model:

1. selection: selecting fewer and meaningful goals
2. optimization: optimizing existing abilities through practice and technology
3. compensation: compensating for loss of abilities by engaging in new strategies

Question 155

wisdom

Answer 155

the coordination of knowledge and experience to improve well-being, reflecting a person’s ability to apply what has been learned across the lifespan in order to effectively manage and respond to new challenges

Question 156

reminiscence

Answer 156

spontaneous recall of past life events&raquo_space; negative reminiscence predicts poor physical health, opposite for good

• can be a source of stress or enrich a person’s life
• can reduce anx before death

Question 157

coping with terminal illness

1. physical
2. restrictions
3. realization

Answer 157

1. cope with the physical effects of their worsening conditions, such as pain, difficulty breathing, sleeplessness, or loss of bowel control
2. cope with activity restrictions&raquo_space; conditions severely alter their styles of living, restricting their activity and making them highly dependent on others
3. cope with realizing end of life is near

Question 158

5 stages of accepting death

1. denial
2. anger
3. bargaining
4. depression
5. acceptance

Answer 158

1. Denial: first reaction to prognosis&raquo_space; give them time to mobilize coping strategies
2. anger: resent others who are healthy, outbursts, taking anger out on others
3. bargaining: negotiating with God
4. depression: feeling that time is running out, grieve for future missed, detachment from world
5. acceptance: no longer depressed, ready for death, quiet calm

Question 159

palliative care

Answer 159

focuses on reducing pain, anxiety, depression, and discomfort while improving quality of life of chronically or terminally ill patients&raquo_space; support the families and caregivers of dying patients

Question 160

hospice care

- essential elements (4)

Answer 160

a medical and social support system that adopts a palliative approach to provide an enriched quality of life—through physical, psychosocial, and spiritual care—for terminally ill people and their families

essential elements:

1. people dying should be in their place of choice
2. care given should maximize their potential
3. care should address all family members needs
4. follow up care is available for family members

Question 161

indigenous practices in the hospital

Answer 161

traditional approaches to health are not always accommodated within Canada’s mainstream health care system, often due to policies that inadvertently prevent such practices or due to infrastructural limitations of hospitals

Question 162

the right to die

• DNR
• doctor-assisted suicide vs euthanasia
• MAiD
• who can do this?

Answer 162

goes further than a “do not resuscitate”

• doctor-assisted suicide = self-administration by patient (drinkable solution) of a life ending drug
• euthanasia = direct involvement of doctor (injection of barbiturates&raquo_space; sedatives that cause coma then death)
• must meet a number of criteria (where it is legal) to be allowed to do this
• allowed in Canada 2016 (medical assistance in dying)
• any consenting, competent adults suffering intolerably from a grievous and irremediable medical condition had the right to die with medical assistance&raquo_space; given opportunity to withdraw from MAiD any time, must consent once again right before administration

Question 163

dignity

• 4 conditions
• reason for early death

Answer 163

depends on 4 conditions:

(1) lack of pain and suffering,
(2) independence (i.e., lack of dependence on others),
(3) control
(4) integrity

highly personal feeling&raquo_space; main reason for choosing early death were decreased ability to participate in pleasurable activities, loss of autonomy, and loss of dignity

Question 164

suicide contagion effect

Answer 164

increasing the number of non-assisted suicides after patients hear about others doing it (not supported by evidence tho)

Question 165

bereavement

Answer 165

Feelings of grief and the expression of these feelings in mourning

• process usually takes time (a year at least, usually)
• pressures early in the grieving process to “start living again” may be insensitive and unproductive

Question 166

adjustment patterns after trauma (most to least common)

1. resilient
2. recovered
3. chronic
4. delayed

• not showing distress
• child
• accidents

Answer 166

1. resilient: adjusting well
2. recovered: having difficulty in the first months, but improving thereafter
3. chronic: adjusting poorly throughout
4. delayed: having moderate difficulty initially, which worsens later on

• failing to feel or show distress is not an indication of maladjustment (ppl who express less negative emotions actually experience less grief over time)
• loss of child is worst loss
• adjustment is difficult when death is sudden (from accident)

Question 167

saying goodbye

- privacy, check, framing, awkwardness, commitment

Answer 167

1. choose time and place (privacy)
2. broaching the topic and checking for acceptance
3. frame goodbye as an appreciation of the relationship (show that they had an impact on your life)
4. address the possible awkwardness and emotion (allow them to regain composure)
5. ongoing commitment (make sure they dont feel abandoned

Question 168

complicated grief

• persistent complex bereavement disorder
• symptoms (4)

Answer 168

• resembles PTSD
• persistent complex bereavement disorder is characterized by persistent and debilitating symptoms of grief and despair (12mo+)
• Symptoms: intense yearning for the deceased person and persistent disbelief, bitterness, depression, and intrusive thoughts about the death

Question 169

healthcare provider grief

• diffusion
• debriefing

Answer 169

diffusion: informal discussion immediately following the death of a patient
debriefing: formal discussion of one’s actions and reactions after the death of a patient, 24–72 hours later

Question 170

telehealth

Answer 170

• two-way video and audio communication to individuals in numerous countries and inaccessible areas
• provides diagnostic and treatment services and advice on lifestyle changes

Question 171

cost-benefit ratio

Answer 171

the extent to which it saves more money in the long run than it costs (healthcare)
- health care organizations providing psychosocial interventions depends on efficacy and cost-benefit

Question 172

evidence-based treatments

Answer 172

interventions or techniques with strong efficacy that have clear support across many high-quality studies, particularly randomized controlled trials
- meta-analysis, clinical trials, clinical significance (if patients life will improve greatly), and follow-up assessments (durable results)

Question 173

effectiveness and translational research

Answer 173

effectiveness: how well they work in real-world health care settings
Translational research: tests interventions in real-world settings and methods for getting health care providers to adopt new evidence-based treatments in their usual practice

Question 174

health psychologist categories

Answer 174

1. clinical
2. public health/broader-scale intervention
3. academic research

Question 175

environment and health psychology

• env factors
• climate change
• ecological grief

Answer 175

overcrowding, pollution, tobacco/smoking, contamination, and how it affects stress and mental health

climate change: key factors include worsening air quality; heat-related morbidity and mortality; droughts, flooding, and extreme weather, (agriculture affected); and increasing risk of infectious disease

ecological grief: feelings of anxiety and hopelessness over the future, as well as climate-related grief resulting from experienced and expected losses

Question 176

quality-adjusted life years (QUALYs) scale

Answer 176

assess how long a person is likely to live after receiving the treatment, multiply each year by its quality of life, and total these data&raquo_space; rank the value of different treatments

Question 177

sandwich generation

Answer 177

having to support children while also supporting aged parents

Question 178

factors affecting health psychology’s future (4)

Answer 178

• financial support (govt)
• role in primary care
• education and training
• developments in medicine