314 - final Flashcards

Question

- "it takes 2 to tango" - couples dynamics - change - indiv - coordination - adjustments

Answer 1

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

Answer 2

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

Answer 3

Common elements: - wake up call >> look at life differently - stressful >> for indiv and close others (can they still play same role in fam?) - complex adjustments eg. diabetes >> can't be sedentary, must eat healthy - impacts close others (spouses, fam, friends) >> stress abt future - need support >> caregiving - long duration >> significant adjustment Disease specific elements: - diabetes, cancer, arthritis >> is it life threatening, debilitating, amount of pain, change needed, length (rest of life)?

Answer 4

- almost everything is based on samples of unrelated indiv >> ask one spouse abt the other (observations, their thoughts/feelings) >> 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)

Answer 5

Requires: - glucose control (glucose is dysregulated) - complex behavioural modifications (life behaviours) Stress: - acute stress: life threatening >> 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 >> healthy diet, exercise

Answer 6

- difficult to do alone >> eating is a very social behaviour >> roles (groceries, cooking) >> bigger struggle without support >> spouse needs to know what you can't eat! - sometimes spouse does not know how to help patient adhere to diet >> 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 >> telling them off can make them start cheating the diet/stop listening - only being supportive worked (compared to other 2) >> 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

Answer 7

- 129 couples (one spouse with diabetes) - repeated daily life assessment (24 days, once a day) >> 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

Answer 8

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

Answer 9

- 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 >> patient does what spouse wants them to do and spouse opens themselves up to negative affect >> can take a toll on spouses emotions (vulnerable health) - spouse may become too distressed (eg. depression) to provide support >> affects patient (resources/support)

Answer 10

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) >> most common - Rheumatoid arthritis: most serious >> inflammation of joints, debilitating pain, depressive symptoms - Fibromyalgia: pain/stiffness in muscles/soft tissue - Gout: too much uric acid >> 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) << list of symptoms >> how often trouble sleeping, feeling down, physical limitations etc Covariates: age, education, length of marriage, disease duration, employment

Answer 11

RAIDAI patient reports: patients report feelings, pain, inflammation of every joint >> very nuanced measure spousal CES-D: spousal depression could predict disease activity a year later >> ppl w spouses who had more depressive symptoms did worse in the long term - sometimes spouse cannot/does not come through >> depressed spouses are less likely to provide satisfactory support >> they need to focus on themselves so it is harder to engage in coping strategies for patient - sometimes spouse has maladaptive coping strategies >> may even blame the patient

Answer 12

- parental involvement in diabetes management >> parental control and responsive support - complex process to switch from parental to indiv management (autonomy) >> 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) >> their kids did worse for treatment adherence - parents who are responsive ("I am here for you") >> their kids did best

Answer 13

- good for chronic illnesses >> 5-6 patients - check ups are only 8 minutes >> hard to apply recommendations in an effective way - quarterly educational sessions: 1 hour with 6 ppl instead of 8 min indiv >> diabetes complications, principles of nutrition, personal habits and lifestyle changes, physical activity, glycemic control, self care, CV aspects primary outcomes >> 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 >> learn health habits needed >> patient-doctor relationship also important * healthcare originally meant for acute treatment >> chronic diseases are becoming more prevalent

Answer 14

- much higher than expected | - dealing with increased chronic diseases >> prevention is important, rather than just management

Answer 15

traditional view: quality measured in terms of "hard facts" >> does not do justice to patient perceptions (psychological consequences ignored) contemporary view: physical, psychological, vocational and social functioning >> addresses additional disease or treatment related outcomes (psychological impact, engagement w others, ability to have a job, etc)

Answer 16

- 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 >> if danger is same, depends on patient's wishes

Answer 17

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

Answer 18

- very challenging - common after diagnosis >> increases when ppl have to wait a lot (waitlists, referrals), or anticipate substantial changes

Answer 19

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

Answer 20

- self concept - self esteem 1. physical self: body image >> perception and evaluation of ones physical functioning eg. invasive surgery (breast cancer) >> 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 >> having to watch what you eat is an inconvenience 3. social self: rebuilding social life (esp when young) >> 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 >> young ppl think their invulnerable, so having someone close with cancer is hard for them >> will distance themselves so they don't have to think about being vulnerable 4. private self: major threats to self >> illness creates a loss of independence (mobility loss, check ups, treatments) >> adjustments to chronic illness involves exploring alternative routes to fulfillment

Answer 21

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

Answer 22

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

Answer 23

- motivational shift in line with anticipated future time horizons >> reevaluate what important in life when life expectancy is cut short >> 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

Answer 24

- 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 >> most common heart disease >> leads to lack of O2 flow (nourishment to heart) >> can lead to angina (heart pain) and heart attack (myocardial infarction = complete blockage of flow to an area of heart >> 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

Answer 25

yes. - natural disasters: eg. earthquake >> 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)

Answer 26

- methods not entirely reliable >> patient may overexaggerate report to find reason for MI - arrhythmia (caused by fight/flight response >> inflammatory >> 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)

Answer 27

- 549 patients w stable CHD - TSST >> 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 >> significantly greater

Answer 28

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

Answer 29

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

Answer 30

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 >> sexual intercourse accounts for <1% of all MIs - worse in sedentary vs physically active indiv - not insignificant, but relatively small >> 83-90% are men, and 75% of those were extramarital sex >> 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

Answer 31

yes. - when spouse/close friend dies soon after >> 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 >> as disease progresses, caregiver responsibility increases) - long term stress will take a toll >> 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) >> had heart attack, her mom dies within days of an intracerebral hemorrhage due to hypertension (coincidence?)

Answer 32

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) >> 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 >> women often encourage health behaviours >> widowed men more affected - ppl who lack social support more at risk

Answer 33

- 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 >> risk of mortality was LOWER in widowed women (health benefit, esp if woman had CVD >> able to focus on themselves) significant differences in a variety of health markers - lower heart rate variability (variability is a good thing >> protective) in bereaved ppl >> prognostic for CVD - higher levels of depression >> significantly more likely when bereaved (most obvious >> don't take care of themselves, isolation, lack sleep, less phys activity) - higher level of inflammatory markers in bereaved

Answer 34

1. arthritis (ostio/rheumatoid) >> 45% (more women) 2. HBP >> 43% 3. diabetes >> 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 >> 40% receiving home care had unmet needs (mobile, fitness and social activities)

Answer 35

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

Answer 36

- not a new idea (1940s) >> 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 >> limited evidence, inconsistent, implementation details lacking >> who delivered care, when, how, how much, etc >> important for replication and determining effectiveness - person-centered - short term or time limited (6-9 weeks) - home/community setting - multidisciplinary >> inc social connectivity, reduce ongoing support - function focused, regain life skills, promote independence

Answer 37

- 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) >> 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!)

Answer 38

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

Answer 39

- 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) 7. associations: prompts, cues >> do squats while brushing teeth - lower levels of self efficacy/phys activity associated with setting goals, self-monitoring, coping planning and feedback >> we don't know exactly how goals were planned

Answer 40

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 >> slowly inc difficulty)

Answer 41

C grade in Canada, esp BC! - working without adequate pay - in 2015 18.3% (1% above national avg)

Answer 42

- 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 >> broaden attention and thinking, repertoire of declared actions, and inc openness to new experiences >> 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

Answer 43

- 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

Answer 44

- 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

Answer 45

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

Answer 46

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

Answer 47

relatively long-term medical and personal care, esp if patients or their families cannot provide this care - older adults >> frail/mobility problems >> need help in day-to-day activities such as dressing and bathing themselves - ppl are starting to use outpatient services >> 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

Answer 48

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 >> insurance provided by work place, private, or government programs >> many americans do not have health insurance

Answer 49

- 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! >> 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 >> side effects that were def not caused by drug >> "manufactured" based on negative expectations) 4. gender and sociocultural differences: - women feel discomfort at lower stimulus levels than men >> ask to end it sooner (hormones, gender role beliefs) - difference in expression of pain/distress varies by culture

Answer 50

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 >> classical conditioning and expectancies - affected by negative emotions, vague physical sensations, cognitive factors exaggerate sensations, modelling of symptoms by others

Answer 51

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 >> chain reaction (see someone sick, then feel sick)

Answer 52

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

Answer 53

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)

Answer 54

- 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

Answer 55

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 >> 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

Answer 56

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

Answer 57

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)

Answer 58

doctor-centered: physician asks yes/no questions, focuses on first problem mentioned >> don't discuss other problems with patient, want to establish link without being sidetracked patient-centered: less controlling, open-ended questions >> more information and new facts mentioned, avoid jargon, allow patient participation

Answer 59

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 >> can test if it was used, but not amount/when >> time consuming, expensive *doesnt work if patient is not honest! (eg. discarding meds)

Answer 60

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

Answer 61

- 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

Answer 62

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

Answer 63

1. board of trustees: at the top >> 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 >> coordinate patient's care 7. orderlies, etc

Answer 64

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

Answer 65

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

Answer 66

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 >> difficulty adjusting to condition - blame others: anger, bitterness >> impair adjustment (worse) learned helplessness: no effort to initiate change when control is possible >> depressed improvements: - constructive suggestions during anesthesia - psychological counselling - roommate who already had the surgery

Answer 67

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

Answer 68

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

Answer 69

- 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)

Answer 70

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

Answer 71

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)

Answer 72

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

Answer 73

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

Answer 74

- consult specialists >> 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

Answer 75

- common to have depression and pessimism >> slower recovery and likely to be rehospitalized - anxiety and low personal control >> 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

Answer 76

Minnesota Multiphasic Personality Inventory (MMPI): - true/false format - neurotic triad scales >> 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

Answer 77

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

Answer 78

organic: pain clearly linked to tissue pressure/damage psychogenic pain: no tissue damage; discomfort involved in these pains could result from psychological processes >> 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) >> same sensory pathway

Answer 79

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)

Answer 80

- 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.

Answer 81

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

Answer 82

- noxious stimulation triggers release of ST, histamine and bradykinin >> 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) >> motor/sensory areas >> respond quick b) C-fibres: transmit slower (dull, burning, aching) >> brainstem/forebrain >> emotional/motivational/mood states

Answer 83

pain with no current cause (no noxious stimulant) >> result from current or past disease/damage in peripheral nerves >> 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)

Answer 84

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) >> has its own receptors and nerves (FALSE) 2. pattern theory: no separate system >> shared with touch >> triggered by intense stimuli (cannot explain causalgia/neuralgia)

Answer 85

1. cold-pressor procedure: forearm in ice water (2 degrees C) >> 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 >> to arm (using cuff of sphygmomanometer) >> pain without damage (50 mins safe) - can also be used to measure pain threshold (much higher threshold for ppl watching comedy show/practicing relaxation)

Answer 86

- earlier theories + physiological mechanism that psychological factors can affect ppls experience of pain - neutral "gate" can be opened/closed in varying degrees >> modulate pain signals (in spinal cord) >> must pass critical level to perceive pain output control: 1. activity of pain fibres (A-delta and C) >> 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) >> 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 >> causes release of endorphins >> enables pain regulation

Answer 87

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)

Answer 88

- 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

Answer 89

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 >> 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 >> social network) >> affected by others' responses

Answer 90

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)

Answer 91

self-report: describe their own discomfort (questionnaire or rating scale) - interviews - pain diaries - rating scales >> 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 >> rate 10 pain behaviours on a 3 pt scale b) everyday activities: spouse makes list of behaviours that signal pain >> assessor trained to watch for signals >> used to determine impact on daily life >> children under 5 usually assessed this way psychophysiological measures: pain has sensory and emotional components >> 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 >> amplitude of peaks increases with stimulus intensity c) EMG: (measures muscle tension) >> associated w pain

Answer 92

- 3 types of factors that influence how ppl adjust/cope >> coping process (cognitive appraisal, adaptive tasks, coping skills) >> 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

Answer 93

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

Answer 94

- 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 >> be prepared for difficulties - gaining manageable perspective on problem/treatment >> long term "purpose"

Answer 95

chronic respiratory problem >> prevalence higher in children - episodes of impaired breathing when airways are obstructed >> immune system is stimulated to react in allergic manner >> releases histamine >> 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 >> reduce sensitivity/inflammation - avoiding exercise makes condition worse

Answer 96

- recurrent, sudden seizures that results from electrical disturbances of the cerebral cortex >> stigmatized, emotional arousal (eg. anx) increases risk - tonic-clonic: brief "tonic" phase >> lose consciousness and body is rigid; longer "clonic" phase >> 2-3 mins of spasms/twitching aura: unexplained sounds, smells, or other sensations >> 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 >> taken regularly to maintain conc - if medication does not work, there are other methods

Answer 97

neurological damage in the spine that results in the loss of motor control, sensation, and reflexes in associated body areas >> 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

Answer 98

- 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

Answer 99

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 >> 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)

Answer 100

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

Answer 101

dementia: progressive loss of cognitive functions that often occurs in old age alzheimers: most common form of dementia >> 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

Answer 102

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.

Answer 103

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

Answer 104

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 >> esp good for anx >> change self-concepts/relationships

Answer 105

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 >> use clot dissolving thrombolytic drugs (works if within 3 hours) - coronary care units (monitoring) >> risk for second attack high - excessive anxiety, denial depression can impair recovery

Answer 106

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)

Answer 107

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) >> slow damage hemorrhagic stroke: a blood vessel ruptures and bleeds into the brain >> immed damage

Answer 108

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

Answer 109

- severity varies >> 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 >> 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 >> laugh or cry with little provocation, then surprised why) - unable to interpret other people's emotions

Answer 110

neoplasm: tumor >> unrestricted cell growth (can be benign or malignant) oncogenes: regulate cell division >> genetic processes and carcinogens an damage them metastasis: migration of cancer cells >> forms new neoplasms >> 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) >> 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

Answer 111

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

Answer 112

1. skin cancer (melanoma): cure is almost assured w early detection if basal/squamous cell carcinomas, but melanomas are more serious >> 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

Answer 113

Diagnosing 1. blood or urine tests (hormone/enzyme levels) 2. radiological imaging: X rays, MRI >> see internal structure (tumor) 3. biopsy: analyze suspicious tissue Treating - surgery: preferred treatment from medical standpoint >> can entirely remove or remove large clusters >> remaining for rad/chemo a) mastectomy: removal of entire breast b) lumpectomy: just tumor removed + radiation treatment - radiation: damages DNA of cells >> 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 >> kills cells that divide rapidly >> 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 >> use a scapegoat food before treatment!) - systematic desensitization may help w anticipatory nausea

Answer 114

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

Answer 115

- five-year survival rate for childhood leukemia is 83% - the main form of treatment is chemotherapy >> 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

Answer 116

acquired immune deficiency syndrome: infectious >> caused by HIV spread through contact of blood and semen (unsafe sex, sharing syringes, birth by infected mother) - immune function impaired >> helper T cells reduced >> variety of recurrent symptoms, such as spiking fever, night sweats, diarrhea, fatigue, and swollen lymph glands encephalopathy: when HIV invades CNS >> gradually lose cognitive functions, become disoriented and confused, and eventually lapse into comas ART: drug used to treat HIV >> suppress HIV reproduction and reduce viral load dramatically - no HIV in blood, cant transmit to others, reduces opportunistic diseases

Answer 117

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 >> can no longer replicate - damage to mitochondria, inflammation, oxidative stress, and the accumulation of toxic metabolic by-products - telomeres (chromosome caps) shorten >> inc risk of age-related diseases secondary aging: caused by environmental factors >> often controllable (exercise, diet, or disease) - can accelerate, or decelerate primary aging

Answer 118

- 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)

Answer 119

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

Answer 120

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 >> remain largely uncompromised as people get older

Answer 121

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

Answer 122

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

Answer 123

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

Answer 124

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 >> requires attention, perception, comprehension, memory, judging

Answer 125

- 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 >> chronic stress causes dysfunction of HPA axis >> causes inflammation >> accelerates cog decline (coping and stress management is important!)

Answer 126

- older adults use emotion-focused coping more than problem-focused coping >> 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

Answer 127

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

Answer 128

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) >> can have positive or negative effects

Answer 129

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

Answer 130

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 >> 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

Answer 131

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

Answer 132

spontaneous recall of past life events >> 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

Answer 133

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 >> 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

Answer 134

1. Denial: first reaction to prognosis >> 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

Answer 135

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

Answer 136

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

Answer 137

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

Answer 138

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 >> 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 >> given opportunity to withdraw from MAiD any time, must consent once again right before administration

Answer 139

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 >> main reason for choosing early death were decreased ability to participate in pleasurable activities, loss of autonomy, and loss of dignity

Answer 140

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

Answer 141

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

Answer 142

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)

Answer 143

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

Answer 144

- 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

Answer 145

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

Answer 146

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

Answer 147

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

Answer 148

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)

Answer 149

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

Answer 150

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

Answer 151

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

Answer 152

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 >> rank the value of different treatments

Answer 153

having to support children while also supporting aged parents

Answer 154

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