Aging

Question 1

Normal aging

Universal to all members of a species

Answer 1

Primary aging

Question 2

Change associated w disease, disuse, or abuse

Answer 2

Secondary aging

Question 3

Rapid losses that occur shortly before death

Answer 3

Tertiary aging

Question 4

What are some qualities that emerge w aging?

Answer 4

more confidence
more empathy/generosity
improved reliability/organization
improved problem solving
improved emotional regulation
less anxiety/negative affect
more contentment

Question 5

As we age, our processing capacity (pattern comparison, letter rotation, etc) declines, while our world knowledge increases. What are 3 components that increase as we age?

Answer 5

shipley vocab
antonym vocab
synonym vocab

Question 6

Who prefers emotional ads, younger or older folks?

Answer 6

older

Question 7

Young people are more inclined to remember (blank)-related slogans. Old people, on the other hand, are more likely to remember (blank) meaningful slogans.

Answer 7

knowledge-related; emotionally

Question 8

Balance of emotional consequences and (blank) seems to be critical for healthy aging

Answer 8

resource allocation

*declines in resources (i.e. worse memory) can be compensated for by allocated resources differently

Question 9

What did the study on positive vs negative faces reveal about younger vs older populations?

Answer 9

older people recognized positive faces more frequently than younger people, and payed less attention to negative faces *positivity bias

Question 10

What are the upsides of the positivity bias in older folks?

Answer 10

greater contentment :)
calm -_-
more pleasure, less conflict in relationships :)

Question 11

Old people report lower levels of serious (blank)

Answer 11

psychological distress

*those ages 45-64 had the highest levels of psych distress, while those 65+ had much lower levels

Question 12

Characteristics of older couples vs younger couples?

Answer 12

older couples:
less conflict
better negotiation
more pleasure
~levels of mental/physical health
fewer gender differences in sources of pleasure
more ++ emotions
more empathetic listening
more patience/flexibility

Question 13

What is the downside of a positivity bias in older folks?

Answer 13

less likely to consider potential risks, and more likely to consider benefits
*can be a problem in financial decision making and health care decision making

Question 14

List some concerns of older adults

Answer 14

health/well-being of loved ones
staying independent
avoiding nursing homes
finances
enjoy a high quality life *even w chronic disease

Question 15

As pts live longer lives, they may be more susceptible to suffering additional yrs of long term illnesses. What is the goal w these pts?

Answer 15

Goal is “compression of morbidity,” or pushing back the initial onset of illness so that they are in a morbid condition for a shorter period of time

Question 16

So, there is a difference bw life extension and compression of morbidity. Discuss.

Answer 16

Extending life would simply increase the amount of time the pt must suffer from a morbid condition, while compression of morbidity would push back the initial onset of illness = less time living w disease

Question 17

Give an example of the two different morbidity trajectories

Answer 17

1. man has first fatal heart attack at 50 *early mortality, minimal morbidity
2. 95 yo woman dies asymptomatically in her sleep *late mortality, minimal morbidity

Question 18

What were the findings of the vigorous exercise, health and longevity study?

Answer 18

Regular running slows the effects of aging

Question 19

Who had a greater probability of survival, those in the runners club or those in community controls?

Answer 19

*runners club (woohoo)

Question 20

Who had slower progression of disability, those in the runners club or those in community controls?

Answer 20

*runners club, baby

Question 21

What are some factors from individual to individual that affect state of disability vs health?

Answer 21

lifestyle/behavioral changes in the face of disease
psychological attributes & coping
activity accommodations *choosing activities and how they are done to ensure that they are gratifying

Question 22

What is the greatest predictor of depression in older adults?

Answer 22

functional impairment related to disease *not disease diagnosis

Question 23

What are some psychological attributes that contribute to good health?

Answer 23

positive affect

spirituality

Question 24

Some aspects of the physician’s role in promoting quality of life?

Answer 24

listen *don't assume
respect choice and autonomy
become informed
promote behavioral health
respect and communicate w other providers

Question 25

T/F: You should never assume that an older pt is not competent to provide consent. Furthermore, involve the family ONLY w consent of the older person, unless a legal rep is authorized to make health care decisions.

Answer 25

True

Question 26

With older pts, should there be more emphasis on increasing healthy behaviors or reducing symptoms?

Answer 26

increasing healthy behaviors

Question 27

Something to consider w older pts is that several providers may be involved in their overall care. What should you be sure to do?

Answer 27

communicate w other providers seek information from them comply w requests for release of med info

Question 28

What is polypharmacy referring to in older pts?

Answer 28

a large % of pts 60yo+ are taking more than 5 medications

Question 29

What is the main concern w polypharmacy?

Answer 29

it increases the risk of adverse events *drug interactions that result in an unwanted effect

Question 30

What are estimates of medication nonadherence rates in elderly?

Answer 30

30-60%

Question 31

Adherence becomes less likely as number of (blank) increases

Answer 31

medications

Question 32

What are some strategies for increasing adherence?

Answer 32

minimize meds written instructions link taking meds w daily events (i.e. after getting the mail) utilize resources (i.e. geriatric pharm med review services)

Question 33

What are the priorities when caring for an elderly pt w dimentia whose deterioration/death is inevitable?

Answer 33

prevent, detect, reduce excess disability provide safe and effective care respond to challenging behaviors using "restraint free" methods

Question 34

When does this occur: | Premature reduction in behaviors that will inevitably be lost due to the disease process

Answer 34

in neurodegenerative dementias

Question 35

What is this considered: | When impairment in functioning exceeds what is expected due to disease

Answer 35

excess disability

Question 36

What are some self-stigmatizing behaviors that occur in the early phase of dementia?

Answer 36

metamemory *increasingly monitoring performance social interactions become anxiety provoking leads to social withdrawal and isolation depression

Question 37

What % of pts w early phase dementia are depressed?

Answer 37

30%

Question 38

What are some ways that other people stigmatize pts w dementia?

Answer 38

people are uncomfortable when interacting w them give corrective feedback during conversation assume all behavior is due to the dementia

Question 39

What begins to happen in middle and late phase dementia?

Answer 39

environment becomes increasingly confusing less environmental control of behavior (?) emergence of behavioral disturbances

Question 40

What are some behavioral disturbances associated w the middle/late stages of dementia?

Answer 40

aggression disruptive vocalizations wandering paranoia

Question 41

Is there a cure for dementia? So how do you go about treating it?

Answer 41

no cure :( there are 5 meds out currently that slow the progression but do not stop it *meds have side effects, like nausea, headache

Question 42

In treating pts w behavioral symptoms (i.e. wandering) there is an overemphasis on (blank) approaches

Answer 42

restraint-based | *behavioral symptoms are "eliminated" by meds and mechanical restraint :(

Question 43

According to the FDA, elderly people using conventional antipsych meds had higher (blank) than those receiving a placebo

Answer 43

death rates | *there is a nationwide effort being made to reduce use of antipsych drugs among dementia pts in nursing homes

Question 44

What kinds of negative effects can psychotropic interventions have on older pts?

Answer 44

``` sedation increased cognitive impairment incontinence increased risk of falls delirium ***higher mortality rate ```

Question 45

Do pts receiving long term antipsych meds have an increased mortality rate?

Answer 45

yes

Question 46

So how should you treat these pts if meds are so bad?

Answer 46

promote quality of life maintain skills for as long as possible prevent EXCESS disability prevent (NOT ELIMINATE) behavioral disturbances

Question 47

T/F: It's important to support family caregivers of the disabled elderly, and assess whether or not the caregiver is providing quality care. If not, refer them to some services.

Answer 47

True

Question 48

``` “Any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult” (NCEA, 2007) Includes infliction of : Pain Injury or Mental anguish on an older person Deprivation of : Food Shelter Clothing or services necessary to maintain physical or mental health ```

Answer 48

elder abuse

Question 49

What are the categories of elder abuse?

Answer 49

``` physical psychological neglect of basic needs self-neglect exploitation isolation ```

Question 50

What are these: Inadequately explained bruises, cuts or injuries Dehydration or malnutrition Overly medicated or extremely sedated Unusual confinement (Closed off in a room, tied to furniture) Lack of cleanliness, grooming Fear of speaking for oneself in the presences of the family or caretaker; anxious to please Anxiety, confusion, withdrawal, depression Shame, fear, embarrassment Sudden change in financial activity

Answer 50

Signs of abuse in the elderly

Question 51

What % of older adults are at risk of some type of abuse? What % of cases occur w/i families? What % of nursing homes are cited for abuse?

Answer 51

1/4; 95%; 30%

Question 52

What is the most commonly reported form of abuse?

Answer 52

neglect

Question 53

What's this? someone who is required by Nevada Law to notify a particular state or local agency when the person, in his/her professional or occupational capacity, knows or has reason to believe that a person 60 years or older is being abused, neglected or exploited.

Answer 53

mandated reporter

Question 54

Who can be a mandated reporter?

Answer 54

``` physician dentist eye doc medical examiner social worker police EMT etc ```

Question 55

Should you report any concerns regarding elder abuse/neglect to EPS even if you are unsure if abuse is occurring?

Answer 55

yes