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PYB309: Individual Differences and Assessment > Assessment of Older Adults > Flashcards

Assessment of Older Adults Flashcards

1
Q

What are the major changes in older adult life?

A
  • 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
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2
Q

What are Erikson’s psychosocial stages?

A
  • 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
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3
Q

Which of Erikson’s psychosocial stages occurs during infancy?

A

Trust v Mistrust

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4
Q

Which of Erikson’s psychosocial stages occurs during Early Childhood?

A

Autonomy v Shame/Doubt (Ages 1-3)

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5
Q

Which of Erikson’s psychosocial stages occurs during Preschool age?

A

Initiative v guilt (Ages 3-6)

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6
Q

Which of Erikson’s psychosocial stages occurs during School age?

A

Industry v inferiority (Ages 6-12)

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7
Q

Which of Erikson’s psychosocial stages occurs during Adolescence?

A

Identity v role confusion (Ages 12-18)

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8
Q

Which of Erikson’s psychosocial stages occurs during Young Adulthood?

A

Intimacy v isolation (Ages 18-35)

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9
Q

Which of Erikson’s psychosocial stages occurs during Middle Age?

A

Generativity v stagnation (Ages 35 -60)

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10
Q

Which of Erikson’s psychosocial stages occurs during Later Life?

A

Integrity v despair (Ages 60+)

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11
Q

According to Cohen’s developmental stages in the second half of life, what stage is ages 40s to 50s?

A

Midlife evaluation

- Quest to make life and work more gratifying and meaningful

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12
Q

According to Cohen’s developmental stages in the second half of life, what stage is ages 60s to early 70s?

A

Liberation

- experience new personal freedom

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13
Q

According to Cohen’s developmental stages in the second half of life, what stage is age 70 and over?

A

Summing up

- searching for meaning in life through looking back, summing up and giving back

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14
Q

According to Cohen’s developmental stages in the second half of life, what stage is age 80s and over?

A

Encore

- desire to make a final statement or take care of unfinished business

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15
Q

What is primary ageing?

A
  • occurs due to the passage of time
  • visual acuity
  • lung capacity
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16
Q

What is secondary ageing?

A
  • due to the process of disease
  • Alzheimer’s disease
  • Depression
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17
Q

At what age does memory peak?

A

early 20s with some loss each decade from then on

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18
Q

At what age is it normal for memory to begin slipping?

A

around 60 years

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19
Q

How many units can someone age 20 get in the Symbol Digit Modalities Test?

A

55

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20
Q

How many units can someone age 40 get in the Symbol Digit Modalities Test?

A

51

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21
Q

How many units can someone age 60 get in the Symbol Digit Modalities Test?

A

42

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22
Q

How many units can someone age 80 get in the Symbol Digit Modalities Test?

A

33

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23
Q

What is dementia?

A

an impairment of memory and other intellectual functions which goes beyond that expected by the normal ageing process and is usually progressive

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24
Q

What is required to satisfy DSM-5 Major Neurocognitive Disorder?

A
  • 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
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25
Q

What are the trends in dementia prevalence?

A

great increase

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26
Q

What % of the population is projected to have dementia by 2050?

A

2.8

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27
Q

What are the common causes of dementia?

A 
○ Alzheimer’s disease (AD)
		○ Mixed AD and VaD
		○ Vascular dementia (VaD)
		○ Frontotemporal dementia
		○ Dementia with Lewy Bodies
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28
Q

What are potentially reversible causes of dementia?

A 
○ Benign tumours
		○ Normal pressure hydrocephalus
		○ Vitamin deficiency states e.g. B12
		○ Endocrine disease e.g. hypothyroidism
		○ Limbic encephalitis
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29
Q

What is the most common form of dementia in Aus?

A

Alzheimer’s disease

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30
Q

What is Alzheimer’s disease?

A

is a gradual, progressive degenerative process defined by the presence of an extensive number of plaques and tangles in the brain

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31
Q

What % loss of brain volume each year is shown in Alzheimer’s disease patients?

A

2.8%

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32
Q

What is stage one of Alzheimer’s disease?

A

Mild Cognitive Impairment

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33
Q

What are the symptoms of Mild Cognitive Impairment of Alzheimer’s disease?

A
  • complaint of poor memory
  • episodic memory impairment
  • largely intact general cognitive abilities
  • able to perform activities of daily living
  • a prodromal stage
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34
Q

What is stage two of Alzheimer’s disease?

A

Mild-to-moderate dementia

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35
Q

What are the symptoms of Mild-to-moderate dementia of Alzheimer’s disease?

A
  • 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
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36
Q

What is stage three of Alzheimer’s disease?

A

Advanced Dementia

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37
Q

What are the symptoms of Advanced Dementia of Alzheimer’s disease?

A
  • global loss in all areas of intellectual functioning
  • progressive deterioration of personality
  • incontinence, poor social conduct, aggressive behaviour, wandering
  • difficulties eating and walking
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38
Q

How many people of age 65 have Alzheimer’s disease?

A

less than 5%

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39
Q

How many people of age 85 or over have Alzheimer’s disease?

A

nearly 50%

40
Q

How long does Alzheimer’s disease last for?

A

8-12 years

41
Q

What % of people have early onset (before age 65) Alzheimer’s disease?

A

5-10%

- typically rapid course

42
Q

Who is at greater risk of Alzheimer’s disease?

A

Women

43
Q

What is stage one of a neuropsychological assessment of dementia?

A

review of medical records and related documents

44
Q

What is stage two of a neuropsychological assessment of dementia?

A

Initial interview with patient

FEWMAPS - Family, Education, Work, Medical, Alcohol and drugs, Psychological, social

45
Q

What is stage three of a neuropsychological assessment of dementia?

A

Interview with significant other (collateral info)

46
Q

What is stage four of a neuropsychological assessment of dementia?

A

Behavioural and other qualitative observations

47
Q

What is stage five of a neuropsychological assessment of dementia?

A

Formal cognitive testing

48
Q

What are some general considerations of stage four of a neuropsychological assessment of dementia?

A
  • sensory impairments
  • ensuring adequate time available
  • pain or fatigue
  • appropriate age-based norms
  • likely premorbid intellectual ability
  • cultural factors
49
Q

What should the formal test assess in cognitive functions?

A

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

50
Q

What do the following tests measure?
Test of Premorbid Functioning
Wechsler Adult Intelligence Test Fourth Edition (WAIS IV)

A

General intellectual functioning

51
Q

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

A

Memory (verbal and visual)

52
Q

What do the following tests measure?
The Boston Naming Test
The Controlled Oral Word Association Test

A

Language

53
Q

What do the following tests measure?

Digit Span & Arithmetic (from WAIS IV)

A

Attention/concentration

54
Q

What do the following tests measure?
Trails A
Coding & Symbol Search (from WAIS IV)
Stroop Test (Word reading and colour naming trials)

A

Speed of Information Processing

55
Q 
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
A

Visuospatial and constructional abilities

56
Q 
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
A

Executive functioning

57
Q

What do the following tests measure?
The Geriatric Depression Scale
The Geriatric Anxiety Inventory

A

Mood and Anxiety

58
Q

What are some limitations Neuropsychological Assessment of dementia?

A
  • 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
59
Q

What is the memory clinic approach?

A
  • 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
60
Q

How can we control cognitive aging?

A
  1. Ensure you are well educated to boost cognitive reserve
  2. Ensure adequate intake of Omega 3 fatty acids (at least one meal of
    fatty fish per week or Omega 3 supplements)
  3. Ensure a diet rich in antioxidants (Vitamins B, C, E and folate)
  4. Maintain a socially active lifestyle
  5. Maintain a physically active lifestyle (walking for a least 30 minutes, 3
    times per week)
  6. Continue to engage in activities that are cognitively challenging
    (including at
  7. Develop and hold positive attitudes towards the ageing process
61
Q

What is the prevalence of Major Depressive Disorder in older adults?

A

1-5%

- lower than younger adults

62
Q

What is the prevalence of milder Depressive Disorder in older adults?

A

10-25%

- much higher

63
Q

What factors increase the risk of depression?

A

female sex, unmarried/widowed, stressful life events, low social support, medications, lack of education

64
Q

What are common co-existing medical conditions to depression in older adults?

A 
Thyroid disorders
Cancer
Cerebrovascular disease
Parkinson’s disease
Chronic obstructive pulmonary disease
65
Q

What side effects of depression are common amongst older adults?

A

loss of pleasure, problems with concentration, poor appetite, insomnia, poor energy

66
Q

What screening assessments for depression are used for older adults?

A

Cornell Scale for Depression
Hamilton Rating Scale for Depression
Beck Depression Inventory Second Edition (BDI II)
Geriatric Depression Scale (GDS)

67
Q

Why is Beck Depression Inventory Second Edition (BDI II) not ideal for older adults?

A
  • 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
68
Q

Why is the Geriatric Depression Scale (GDS) recommended for older adults?

A
  • Yes/No format easy to understand
  • Places more emphasis on cognitive rather than somatic complaints
  • Relatively quick to complete
69
Q

What is the design of the Geriatric Depression Scale (GDS)?

A
  • has 30-item, 15-item and 5-item versions
70
Q

What do scores indicate in the 30-item version of the Geriatric Depression Scale (GDS)?

A

scores 10-19 indicate mild depression

scores 20-30 indicate severe depression

71
Q

What do scores indicate in the 15-item version of the Geriatric Depression Scale (GDS)?

A

scores 5-9 indicate possible depression

scores 10-15 indicate probable depression

72
Q

In what population is the prevalence of suicide most frequent?

A

older adults

- similar for women across age groups

73
Q

up to what % of older adults who committed suicide visited their G.P. within a month of their suicide?

A

75%

74
Q

What are treatment options for depression in older adults?

A
  • treatment produces very good outcomes
  • effectiveness of CBT and IPT
  • support for combination of antidepressant medication and psychological approaches
75
Q

What are the trends of anxiety disorder in older adults?

A
  • more prevalent in older adults with chronic health conditions
  • more in females than males
  • unusual for anxiety disorder to begin later in life
76
Q

What are the most prevalent anxiety disorders in older adults?

A

specific phobia and generalised anxiety disorder (GAD)

77
Q

What is the least common anxiety disorders in older adults?

A

Panic disorders

78
Q

What are risk factors for anxiety disorders in older adults?

A

co-morbid depression, lack of social support,

poor physical health, functional and/or cognitive impairment

79
Q

Why is it hard to diagnose anxiety in older adults?

A
  • 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
80
Q

What are some screening instruments for assessing anxiety?

A

Beck Anxiety Inventory (BAI)
Stait Trait Anxiety Inventory
Short Anxiety Screening Test
Geriatric Anxiety Inventory (GAI)

81
Q

What are the benefits of the Geriatric Anxiety Inventory (GAI) in assessing anxiety in older adults?

(Pachana et al., 2007)

A
  • 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
82
Q

What psychometric properties are present in the Geriatric Anxiety Inventory (GAI)?

A
  • Internal consistency: 0.91 0.93
  • Excellent inter rater and test retest reliability
  • Specificity 83%, sensitivity 75%
83
Q

What results have been found for treatment options for anxiety in older adults?

A
  • 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
84
Q

What are signs of caregiver burnout?

A

Exhaustion, guilt, anger, anxiety, social withdrawal and isolation, impaired sleep and concentration, increased health problems, and a decline in
caregiving

85
Q

What are the Practical impacts of caregiving?

A

helping patient with cooking, cleaning, feeding, bathing

86
Q

What are the Behavioural impacts of caregiving?

A

Dealing with incontinence, abusiveness, repetition,

wandering, loss of own sleep and self care time

87
Q

What are the Interpersonal impacts of caregiving?

A

Sadness, grief at change in patient, loss of closeness

and intimacy

88
Q

What are the Social impacts of caregiving?

A

Restrictions on getting out, times constraints, resentment

towards relatives and friends

89
Q

What are the carer stresses in the early stages?

A
  • anger/frustration at the patients confusion and vagueness
  • strong sense of grief/anxiety
  • depression due to loss of normal interaction
90
Q

What are the carer stresses in the middle stages?

A
  • Physical demands become more evident
  • Distress due to more rapid progress of intellectual and personality deterioration
  • Challenges/frustration associated with wandering and aggression
91
Q

What are the carer stresses in the later stages?

A
  • 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
92
Q

What is the degree of stress for a carer related to?

A
  • The degree of behavioural difficulty exhibited by the patient
  • The severity of depression in the patient
93
Q

What are the health effects of caregiving?

A
  • more visits to doctors
  • more prescribed medications
  • higher blood pressure
  • increased tendency to clot
  • higher noradrenaline levels
94
Q

What is the most widely used scale of caregiver burden?

A

The Zarit Burden Interview

95
Q

What is the Zarit Burden Interview?

A
  • 22 items rated on a 5-point scale according to frequency
96
Q

What does a higher score indicate with the max. = 88?

A

higher scores indicate higher levels of carer burden

97
Q

What are the six E’s used by psychologists in assisting carers?

A

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)

PYB309: Individual Differences and Assessment (12 decks)

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