Assessment of Older Adults Flashcards
What are the major changes in older adult life?
- Relationship: due to retirement, assuming the caring role and adjusting to illness/death of a spouse
- Parenting: empty nest syndrome, assuming grandparent role, redefinition of the parenting role
- Health: adjusting to decreasing physical strength and health, cognition decline, awareness of mortality
- Social Relations: change in networks following retirement/relocation; loss of close friends
- Finances: change since welfare, financial planning for the remainder of life
What are Erikson’s psychosocial stages?
- Trust v mistrust
- Autonomy v Shame/Doubt
- Initiative v guilt
- Industry v inferiority
- Identity v role confusion
- Intimacy v isolation
- Generativity v stagnation
- Integrity v despair
Which of Erikson’s psychosocial stages occurs during infancy?
Trust v Mistrust
Which of Erikson’s psychosocial stages occurs during Early Childhood?
Autonomy v Shame/Doubt (Ages 1-3)
Which of Erikson’s psychosocial stages occurs during Preschool age?
Initiative v guilt (Ages 3-6)
Which of Erikson’s psychosocial stages occurs during School age?
Industry v inferiority (Ages 6-12)
Which of Erikson’s psychosocial stages occurs during Adolescence?
Identity v role confusion (Ages 12-18)
Which of Erikson’s psychosocial stages occurs during Young Adulthood?
Intimacy v isolation (Ages 18-35)
Which of Erikson’s psychosocial stages occurs during Middle Age?
Generativity v stagnation (Ages 35 -60)
Which of Erikson’s psychosocial stages occurs during Later Life?
Integrity v despair (Ages 60+)
According to Cohen’s developmental stages in the second half of life, what stage is ages 40s to 50s?
Midlife evaluation
- Quest to make life and work more gratifying and meaningful
According to Cohen’s developmental stages in the second half of life, what stage is ages 60s to early 70s?
Liberation
- experience new personal freedom
According to Cohen’s developmental stages in the second half of life, what stage is age 70 and over?
Summing up
- searching for meaning in life through looking back, summing up and giving back
According to Cohen’s developmental stages in the second half of life, what stage is age 80s and over?
Encore
- desire to make a final statement or take care of unfinished business
What is primary ageing?
- occurs due to the passage of time
- visual acuity
- lung capacity
What is secondary ageing?
- due to the process of disease
- Alzheimer’s disease
- Depression
At what age does memory peak?
early 20s with some loss each decade from then on
At what age is it normal for memory to begin slipping?
around 60 years
How many units can someone age 20 get in the Symbol Digit Modalities Test?
55
How many units can someone age 40 get in the Symbol Digit Modalities Test?
51
How many units can someone age 60 get in the Symbol Digit Modalities Test?
42
How many units can someone age 80 get in the Symbol Digit Modalities Test?
33
What is dementia?
an impairment of memory and other intellectual functions which goes beyond that expected by the normal ageing process and is usually progressive
What is required to satisfy DSM-5 Major Neurocognitive Disorder?
- Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition)
- The cognitive deficits interfere with independence in everyday activities
- The cognitive deficits do not occur exclusively in the context of delirium.
- The cognitive deficits are not better explained by another mental disorder
What are the trends in dementia prevalence?
great increase
What % of the population is projected to have dementia by 2050?
2.8
What are the common causes of dementia?
○ Alzheimer’s disease (AD) ○ Mixed AD and VaD ○ Vascular dementia (VaD) ○ Frontotemporal dementia ○ Dementia with Lewy Bodies
What are potentially reversible causes of dementia?
○ Benign tumours ○ Normal pressure hydrocephalus ○ Vitamin deficiency states e.g. B12 ○ Endocrine disease e.g. hypothyroidism ○ Limbic encephalitis
What is the most common form of dementia in Aus?
Alzheimer’s disease
What is Alzheimer’s disease?
is a gradual, progressive degenerative process defined by the presence of an extensive number of plaques and tangles in the brain
What % loss of brain volume each year is shown in Alzheimer’s disease patients?
2.8%
What is stage one of Alzheimer’s disease?
Mild Cognitive Impairment
What are the symptoms of Mild Cognitive Impairment of Alzheimer’s disease?
- complaint of poor memory
- episodic memory impairment
- largely intact general cognitive abilities
- able to perform activities of daily living
- a prodromal stage
What is stage two of Alzheimer’s disease?
Mild-to-moderate dementia
What are the symptoms of Mild-to-moderate dementia of Alzheimer’s disease?
- worsening memory and attention (patients retain little new info)
- disorientated and confused
- breakdown of semantic memory: word finding and vocabulary difficulty
- difficulty understanding complex sentences, performing tasks, recognising people and objects
What is stage three of Alzheimer’s disease?
Advanced Dementia
What are the symptoms of Advanced Dementia of Alzheimer’s disease?
- global loss in all areas of intellectual functioning
- progressive deterioration of personality
- incontinence, poor social conduct, aggressive behaviour, wandering
- difficulties eating and walking
How many people of age 65 have Alzheimer’s disease?
less than 5%
How many people of age 85 or over have Alzheimer’s disease?
nearly 50%
How long does Alzheimer’s disease last for?
8-12 years
What % of people have early onset (before age 65) Alzheimer’s disease?
5-10%
- typically rapid course
Who is at greater risk of Alzheimer’s disease?
Women
What is stage one of a neuropsychological assessment of dementia?
review of medical records and related documents
What is stage two of a neuropsychological assessment of dementia?
Initial interview with patient
FEWMAPS - Family, Education, Work, Medical, Alcohol and drugs, Psychological, social
What is stage three of a neuropsychological assessment of dementia?
Interview with significant other (collateral info)
What is stage four of a neuropsychological assessment of dementia?
Behavioural and other qualitative observations
What is stage five of a neuropsychological assessment of dementia?
Formal cognitive testing
What are some general considerations of stage four of a neuropsychological assessment of dementia?
- sensory impairments
- ensuring adequate time available
- pain or fatigue
- appropriate age-based norms
- likely premorbid intellectual ability
- cultural factors
What should the formal test assess in cognitive functions?
General intellectual functioning
Memory (verbal and visual)
Language (particularly word finding ability)
Attention & concentration
Speed of information processing
Visuospatial and constructional abilities
Executive functioning (planning, self awareness,
problem solving, flexibility of thinking)
Mood and anxiety
What do the following tests measure?
Test of Premorbid Functioning
Wechsler Adult Intelligence Test Fourth Edition (WAIS IV)
General intellectual functioning
What do the following tests measure?
The Wechsler Memory Scales Fourth Edition (WMS IV)
The Rey Auditory Verbal Learning Test
The Rey Complex Figure Test
Memory (verbal and visual)
What do the following tests measure?
The Boston Naming Test
The Controlled Oral Word Association Test
Language
What do the following tests measure?
Digit Span & Arithmetic (from WAIS IV)
Attention/concentration
What do the following tests measure?
Trails A
Coding & Symbol Search (from WAIS IV)
Stroop Test (Word reading and colour naming trials)
Speed of Information Processing
What do the following tests measure? Block Design, Matrix Reasoning, Visual Puzzles (from WAIS IV) The Judgment of Line Orientation Rey Complex Figure Test (Copy trial) The Clock Drawing Test
Visuospatial and constructional abilities
What do the following tests measure? Trails B Similarities (from WAIS IV) Stroop Test (Interference Task) The Tower of London Test The Wisconsin Card Sorting Test
Executive functioning
What do the following tests measure?
The Geriatric Depression Scale
The Geriatric Anxiety Inventory
Mood and Anxiety
What are some limitations Neuropsychological Assessment of dementia?
- limited assessment of important cognitive domains
- often too brief to determine the specific cause of the dementia
- fail to detect subtle deficits in cognitive ability
- do not have age or education-based norms
What is the memory clinic approach?
- hospital-based
- consists of geriatrician, neurologist, psychiatrist, neuropsychologist, social worker
- patient reviewed by medical specialist team
- team meeting facilitates discussion between multiple disciplines to reach diagnosis
- patient informed of outcome
How can we control cognitive aging?
- Ensure you are well educated to boost cognitive reserve
- Ensure adequate intake of Omega 3 fatty acids (at least one meal of
fatty fish per week or Omega 3 supplements) - Ensure a diet rich in antioxidants (Vitamins B, C, E and folate)
- Maintain a socially active lifestyle
- Maintain a physically active lifestyle (walking for a least 30 minutes, 3
times per week) - Continue to engage in activities that are cognitively challenging
(including at - Develop and hold positive attitudes towards the ageing process
What is the prevalence of Major Depressive Disorder in older adults?
1-5%
- lower than younger adults
What is the prevalence of milder Depressive Disorder in older adults?
10-25%
- much higher
What factors increase the risk of depression?
female sex, unmarried/widowed, stressful life events, low social support, medications, lack of education
What are common co-existing medical conditions to depression in older adults?
Thyroid disorders Cancer Cerebrovascular disease Parkinson’s disease Chronic obstructive pulmonary disease
What side effects of depression are common amongst older adults?
loss of pleasure, problems with concentration, poor appetite, insomnia, poor energy
What screening assessments for depression are used for older adults?
Cornell Scale for Depression
Hamilton Rating Scale for Depression
Beck Depression Inventory Second Edition (BDI II)
Geriatric Depression Scale (GDS)
Why is Beck Depression Inventory Second Edition (BDI II) not ideal for older adults?
- Multiple choice format confusing
- Patients may have difficulty remembering the alternate responses and thus become frustrated
- Many items assess somatic complaints which may be related to medical conditions or even normal age-related changes
Why is the Geriatric Depression Scale (GDS) recommended for older adults?
- Yes/No format easy to understand
- Places more emphasis on cognitive rather than somatic complaints
- Relatively quick to complete
What is the design of the Geriatric Depression Scale (GDS)?
- has 30-item, 15-item and 5-item versions
What do scores indicate in the 30-item version of the Geriatric Depression Scale (GDS)?
scores 10-19 indicate mild depression
scores 20-30 indicate severe depression
What do scores indicate in the 15-item version of the Geriatric Depression Scale (GDS)?
scores 5-9 indicate possible depression
scores 10-15 indicate probable depression
In what population is the prevalence of suicide most frequent?
older adults
- similar for women across age groups
up to what % of older adults who committed suicide visited their G.P. within a month of their suicide?
75%
What are treatment options for depression in older adults?
- treatment produces very good outcomes
- effectiveness of CBT and IPT
- support for combination of antidepressant medication and psychological approaches
What are the trends of anxiety disorder in older adults?
- more prevalent in older adults with chronic health conditions
- more in females than males
- unusual for anxiety disorder to begin later in life
What are the most prevalent anxiety disorders in older adults?
specific phobia and generalised anxiety disorder (GAD)
What is the least common anxiety disorders in older adults?
Panic disorders
What are risk factors for anxiety disorders in older adults?
co-morbid depression, lack of social support,
poor physical health, functional and/or cognitive impairment
Why is it hard to diagnose anxiety in older adults?
- High comorbidity with depressive disorders
- Symptoms can mirror the neurocognitive changes associated with dementia
- Somatic rather than cognitive symptoms are typically reported which overlap with medical illnesses
What are some screening instruments for assessing anxiety?
Beck Anxiety Inventory (BAI)
Stait Trait Anxiety Inventory
Short Anxiety Screening Test
Geriatric Anxiety Inventory (GAI)
What are the benefits of the Geriatric Anxiety Inventory (GAI) in assessing anxiety in older adults?
(Pachana et al., 2007)
- Effective for detecting anxiety, particularly GAD, in adults over age 60
- Relative brevity (20 items) to minimise fatigue
- Dichotomous response format
- Minimal inclusion of somatic symptoms
What psychometric properties are present in the Geriatric Anxiety Inventory (GAI)?
- Internal consistency: 0.91 0.93
- Excellent inter rater and test retest reliability
- Specificity 83%, sensitivity 75%
What results have been found for treatment options for anxiety in older adults?
- Effectiveness of CBT in older adults has been demonstrated for panic disorder, GAD
- Adjustments to psychological therapies may be necessary
- Efficacy of a range of medications have been demonstrated to be useful
What are signs of caregiver burnout?
Exhaustion, guilt, anger, anxiety, social withdrawal and isolation, impaired sleep and concentration, increased health problems, and a decline in
caregiving
What are the Practical impacts of caregiving?
helping patient with cooking, cleaning, feeding, bathing
What are the Behavioural impacts of caregiving?
Dealing with incontinence, abusiveness, repetition,
wandering, loss of own sleep and self care time
What are the Interpersonal impacts of caregiving?
Sadness, grief at change in patient, loss of closeness
and intimacy
What are the Social impacts of caregiving?
Restrictions on getting out, times constraints, resentment
towards relatives and friends
What are the carer stresses in the early stages?
- anger/frustration at the patients confusion and vagueness
- strong sense of grief/anxiety
- depression due to loss of normal interaction
What are the carer stresses in the middle stages?
- Physical demands become more evident
- Distress due to more rapid progress of intellectual and personality deterioration
- Challenges/frustration associated with wandering and aggression
What are the carer stresses in the later stages?
- Difficult for carer to observe gross neurological disability (e.g. rigidity, tremor, body wasting)
- Sense of guilt and stress associated with finding appropriate nursing home care, when required
What is the degree of stress for a carer related to?
- The degree of behavioural difficulty exhibited by the patient
- The severity of depression in the patient
What are the health effects of caregiving?
- more visits to doctors
- more prescribed medications
- higher blood pressure
- increased tendency to clot
- higher noradrenaline levels
What is the most widely used scale of caregiver burden?
The Zarit Burden Interview
What is the Zarit Burden Interview?
- 22 items rated on a 5-point scale according to frequency
What does a higher score indicate with the max. = 88?
higher scores indicate higher levels of carer burden
What are the six E’s used by psychologists in assisting carers?
Educate
Empower
Environment
Engage (both carer and patient in comfortable, stimulating activities)
Energise (providing respite time)
End points (realistic attitudes and proactive towards long-term placement options)
