Blinkist Study

Question 1

A decline in cognitive function that interferes with daily life, most commonly caused by neurodegenerative diseases

Answer 1

Dementia

Question 2

The 8 A’s of Dementia

Answer 2

Attentional deficit
Anosognosia
Agnosia
Aphasia
Apraxia
Altered perception
Amnesia
Apathy

Question 3

a neuropsychiatric condition in which one is in denial–unconsciously–and unaware of an apparent disability or deficit.

Answer 3

Anosognosia

Question 4

is a rare disorder whereby a patient is unable to recognize and identify objects, persons, or sounds using one or more of their senses despite otherwise normally functioning senses.

Answer 4

Agnosia

Question 5

is a disorder of the brain and nervous system in which a person is unable to perform tasks or movements when asked,

Answer 5

Apraxia

Question 6

is a disorder that affects how you communicate

Answer 6

Aphasia

Question 7

Alzheimer’s Disease
Vascular Dementia
Lewy body dementia
Frontotemporal dementia
Mixed

Answer 7

Types of Dementia

Question 8

Improving and maintain a positive quality of life and reducing the risks of harm associated with the condition

Answer 8

Management of dementia

Question 9

Medications, cognitive interventions, memory training, behavioural management, support for ADLs, psychosocial support, physical activity

Answer 9

Management of dementia

Question 10

Cognitive decline
Memory loss
Language deficits
Issues with spacial awareness
Behavioural changes
Anxiety, depression, personality changes
Difficulty with ADLs

Answer 10

Dementia Characteristics in the Elderly

Question 11

MMSE
MOCA
Clock drawing test
ADL assessment
IADL assessment
Geriatric depression scale
Fall risk assessment
Comprehensive geriatric assessment

Answer 11

Diagnostic assessments of dementia

Question 12

Management for ________ individuals
Similar to in elderly, however interventions need to be tailered to each individual
Special support groups for people to create sense of belonging and community

Answer 12

younger

Question 13

Presentation: younger vs older
__________
Younger - loss of executive functioning first; older - memory loss first

Answer 13

Cognitive

Question 14

Presentation: younger vs older
__________
Younger - impulsivity, mood swings, aggression; older - confusion, social withdrawal

Answer 14

Behaviour

Question 15

Presentation: younger vs older
___________
Younger - faster progression; older - slower progression

Answer 15

Progression

Question 16

Presentation: younger vs older
______-
Younger - traumatic injury, genetics, infection/disease; older - age related

Answer 16

Causes

Question 17

In the elderly population, __________ can present as hallucinations, delusions, disorganized thought and speech patterns, and disorganized behaviours. Negative symptoms like catatonia are also more likely to present in older populations.

Answer 17

psychosis

Question 18

Client observation & interview
Family interview & lab results
Consistent vs irregular?
First occurrence?
Delirium ruled out?
MSE
Medical & med history - substance use
Med interactions
MRI
CT scan

Answer 18

Psychosis assessments in elderly

Question 19

Somatic & visual hallucinations & delusions
Visual hallucinations vs poor vision
Tinnitus vs auditory hallucinations
Somatic delusions vs actual pain / strain (extended healing time)
Delusions of theft vs misplacing item

Answer 19

Psychosis presentation difference from from younger individual & implications

Question 20

Typical antipsychotics (EPS risk)
Atypical antipsychotics (metabolic changes and Anticholinergic effects) Meds titrated
Re-evaluation of the psychosis as well as individual risk assessment, goal setting, and care planning would be beneficial for management of the condition

Answer 20

Psychosis management

Question 21

½ dose is prescribed for medication initially due to metabolism of elderly adults
Monitoring for cardiac and metabolic events
If clozapine is prescribed, monitor for WBC count, infections, and sepsis

Answer 21

Management in elderly vs young (differences)

Question 22

Older folks routinely experience polypharmacy. (Polypharmacy)
As medical conditions begin to show up in response to an aging body, numerous doctors and increased contact with the health care system leads to an increase in prescribed medication use.
- As we age, changes in the body result in alterations to the pharmacokinetics of medications (Metabolic Decline)
- decreased renal capacity causes decreased excretion, decreased liver size and function leads to a slower metabolism leading to a longer drug half life.
- Medication adherence may decline as vision impairment, cognitive decline and complicated medications regimes come into effect through polypharmacy (Neurological Decline)
- Prescribed medications to manage chronic pain or sleep difficulties can also cause substance dependence and complications similar to those of alcohol misuse in seniors. Colonna, C., 2019. Summary: Guidelines for Comprehensive Mental Health Services for Older Adults in, Mental Health Commission of Canada.
Canada. (Substance Use)

Answer 22

Medication in elderly

Question 23

Comprehensive medication review of all medications
Tapering expectations R/T medication efficacy.
- Comprehensive health history
- Family involvement w/ consent, in case of questionable historians.
Increased routine screening of medication side effects, kidney function, and liver function.

Answer 23

Age appropriate assessment for meds

Question 24

Yes, younger individuals are able to take a wider variety of medications allowing for more aggressive treatment of health conditions. Older folks on the other hand, are impacted by their aging body and are not able to metabolize medications as easily, altering the half life of medications making some medications unsafe with increased risk of side effects, and medical conditions that are not as adequately treated. The implications of this are that younger individuals have a wider variety of treatment options, faster recovery with fewer side effects compared to that of older folks.
(Metabolic Decline)
Older adults experience higher rates of cognitive decline than their younger counterparts. This condition may impact their ability to adhere to medication schedules. This, combined with the fact that older adults often have more complicated medication schedules due to polypharmacy, creates unique challenges for this age group. (Neurological Decline)
Due to the prevalence of polypharmacy in older adults, medication use is often associated with greater financial burden than their younger counterparts. This, combined with the fact that many older adults are retired or earning less than they did when they were younger, creates unique economic challenges for this age group. (Socioeconomic Strain)

Answer 24

Younger vs older med use

Question 25

• For folks who have poor med adherence, using tools such as a pill organizer, may aid the individual in remembering their medications. Such tools will also help in ensuring folks don’t accidentally double-dose themselves.
  Long acting/depot medications to increase adherence?
• Some medications may no longer be necessary as people naturally age.
Through the assessment of a comprehensive medication review, there may be medications of the same class that are no longer necessary
• BEERS assessment
  The beers criteria assesses medication regimes and provides recommendations for avoiding possible inappropriate medications (PIMs). It evaluates medications in 5 main categories: drugs to avoid, drugs to use with caution, drug-drug interactions, medications to avoid in particular clinical situations and dosage according to kidney
  function(https://www.ncbi.nlm.nih.gov/books/NBK585118/)
• Trying to reduce the number of medications and over the counter medications through education and implementing other non medication treatment options when applicable.
Providing education about the medication and encouraging the use of the pharmacist as a great resource.

Answer 25

Med Management in Elderly

Question 26

To some extent yes, although we should be encouraging non medication forms of treatment regardless of age and providing the necessary information regarding the medication. However, the BEERS criteria does not apply to younger individuals as their body is able to metabolize medications at a normal rate, and there is less of a concern regarding kidney and liver function; although that depends on the medication.

Answer 26

Younger vs Older management