Chapter 14 Flashcards
1
Q
Many people, especially after they reach mid-life, may find the idea that they are aging to be what? What is the reality?
A
> to be distressing,
> yet research shows that older adults experience more happiness than most other age groups
2
Q
Older adults represent what segment of the population in the US and Canada? How many are there in the US that over the age of 65?
A
> Older adults represent the fastest-growing segment of the US and Canadian populations, with the leading edge of the baby boomers turning 65 in 2011.
> Over 46 million adults in the United States are 65 years of age + with this portion increasing rapidly
3
Q
The prevalence of most types of disability (e.g., problems in mobility, agility, hearing, vision,
and pain) increases with age, with the highest rates occurring in what age?
A
> the highest rates occurring in those aged 75 and older.
4
Q
All conditions except which two increase across the lifespan?
A
> All conditions except obesity and asthma increase across the lifespan.
5
Q
By age 70, what percent of older adults will have hypertension and arthritis?
A
> 7% hypertension
55% arthritis
6
Q
What condition decreases as age increases? At what age is the rate the highest for this condition?
A
> obesity decrease as age increases, with obesity rates being the highest in adults 55 to 64 years old
7
Q
At the age of 75 and older, what percentage of the Canadian population will have CVD?
A
> 23 per cent of Canadians have cardiovascular disease
8
Q
What is dementia and what are some symptoms? What does it represent?
A
> Dementia, which refers to a variety of conditions that affect the brain (e.g., Alzheimer’s disease [AD])
> produce symptoms such as memory loss and impairments in language skills
represents a significant public health need in older populations.
9
Q
What percentage of older adults aged 74 to 85 years of age have a diagnosis of dementia? (Break it down by gender)
A
> 11.6 per cent of females and 10.4 of males
10
Q
What is the prevalence rates for males and females respectively aged over 85 years respectively for dementia? (for diagnosis of)
A
> 37.1 per cent and 28.1 per cent for females and males over 85 years respectively.
11
Q
The majority of people with dementia suffer from what specific condition under this umbrella term? How many people in the US experience this?
A
> AD (alzheimers disease)
In the United States, 5.4 million Americans are estimated to suffer from AD
12
Q
Health disparities reduce the ability to achieve what among which groups and how do they arise?
A
> reduce the ability to achieve the best health outcomes among minority groups, including people of colour + those with low education and income, + rural-dwelling individuals
> Health disparities arise due to poverty, poor access to health care, and educational differences.
13
Q
Lifespan and health are determined by both what influences? What percentage is largest between these two factors in terms of influence.
A
> by both genetic and environmental or lifestyle influences, with genetics accounting for roughly 35 per cent and health behaviours
14
Q
Can health behaviours be changed?
A
> health behaviours may be changed through culturally competent educational programs.
15
Q
Ability to decrease risk factors is important for health geropsychology, but what childhood + adulthood epidemic may affect this? What are they are increased risk for?
HD,T2D,HBP,S,O,RP,C
A
> the childhood and adult obesity epidemic threatens longevity and health for people as they grow older.
> Overweight individuals are at increased risk for heart disease, type 2 diabetes, high blood pressure, stroke, osteoarthritis, respiratory problems, and some cancers.
16
Q
Approximately 75 million people in the United States have what type of condition?
A
> have more than one chronic condition
17
Q
What health outcomes are associated with chronic illnessss?
IH,CMS,DMTS,CMA,ID,D
A
> increased hospitalizations,
complicated medication schedules,
duplicated medical tests,
conflict-ing medical advice,
increased disability,
death.
18
Q
Chronic conditions often are accompanied by what disorders? As a result, what intervention has been made?
A
> are accompanied by psychological disorders such as anxiety and depression
> this has led to the development of integrated health programs that combine mental health screening and services of medical care settings treating patients (called collaborative care)
19
Q
What is a collaborative care approach? (What does it entail)
A
> an approach in which physicians and mental health–care providers work together in an organized way to manage common mental disorders and chronic disease.
> These programs are practical and apply principles of chronic disease manage-ment
> supports systematic diagnosis and health or mental health outcomes tracking.
> It also facilitates adjustment of treatments based on these outcomes
20
Q
What does the collaborative approach represents what kind of practice - particularly under what condition?
A
> Collaborative care represents best clinical practice, particularly given the multiple chronic conditions experienced by many older adults
21
Q
he National Hospice and Palliative Care Organization (2017) defines advance care planning as what?
A
as, “making decisions about the care you would want to receive if you become unable to speak for yourself.”
22
Q
Advance care planning includes what 4 elements?
A
(1) getting information on the types of life-sustaining treatments that are available;
(2) deciding what types of treatment you would or would not want should you be diagnosed with a life-limiting illness;
(3) sharing your personal values with your loved ones; and
(4) completing advance directives to put into writing what types of treatment you would or would not want should you be unable to speak for yourself.
23
Q
What are advance directives usually (how are they created)
A
> Advance directives usually are written documents designed to allow competent patients the opportunity to guide future health-care decisions in the event that they are unable to participate directly in medical decision making.
24
Q
In order to make the process of advance care planning, including advance directives, easier for individuals to complete, multiple methods have emerged. Provide some examples (3)
A
> Five Wishes and Making Your Wishes Known are two self-guided, web-based programs that provide individuals with documented end-of-life care goals.
> Respecting Choices® is a program designed and verified to improve advance care planning by training individuals to engage patients in these discussions.
25
Which groups are less likely to use advance directives?
> People from minority groups are disproportionately less likely to complete advance directives
26
Despite the many positive aspects of caregiving, providing care to an older family member with a chronic illness can be associated with what?
> psychological distress and and feelings of caregiver burden
27
Family caregivers of individuals approaching the end of life are at risk for what health outcomes? When are they especially at risk for these outcomes?
| S,D,+HP.
> are at risk for stress,
> depression,
> and health problems
* especially when there have not been previous discussions of the dying person’s wishes for medical care at the end of life.
28
What is more relevant in the health care of minority groups than advanced directives?
> In ethnic minority groups, inclusion of family in medical decision making is common; for example, among Hispanics and African Americans the use of family to communi-cate the wishes of the patient is often seen as more relevant than a written directive
29
What 4 family responses to illness management have been associated with negative patient outcomes?
| BC,BO,BC,BD
> Being critical,
> Being overprotective,
> Being controlling,
> and being distracting
30
The Caregiver Stress–Health Model (Monin & Schulz, 2009) suggests what about Geropsychology?
> suggests ways in which an older adult’s suffering may influence family members’ emotion regulation and, thus, provision of care.
31
What are the two possible family member response patterns as suggested by the caregiver-stress-health model?
> cognitive empathy and conditioned emotional responses.
32
What is cognitive empathy?
> Cognitive empathy refers to the shared or complementary emotional experience of the family member in response to the older adult’s physical and emotional suffering.
33
When do conditional emotional responses occur? What emotions do they create?
> occur when the family member has paired certain emotions with past experiences of the older person’s suffering (i.e., becoming angry when the older relative displays fatigue or pain)
> and can cause defensive emotions (e.g., denial, fatalism) and withdrawal from the older patient.
34
Chronic pain affects what cent of older adults who live in the community and what per cent of seniors who live in long-term care
> at least 50 percent of older adults who live in the community
> as many as 80 for those in LTC
35
Gauthier and Gagliese (2010) have discussed some of the issues specific to pain assessment for older adults and have pointed out what makes assessment for older adults harder to do?
> age-related changes may make it more difficult (I.e., changes in hearing / visual acuity)
36
What attitude is considered a complicating factor for older adults and health care?
> the idea that pain is an inevitable part of aging that must be endured = a false belief
37
Pain is not the result of aging per se, but the result of what mindset?
> but the result of pathology that ought to be treated irrespective of a person’s age.
> Beliefs that pain in old age is natural may make older persons less likely to seek assessment and treatment of their pain and contribute to the under-treatment of pain that is often seen in this population
38
The CBT methods used with older adults are similar to those employed with younger persons, although the focus is considered what?
> the focus may be different.
> For example, older adults often present with inaccurate beliefs about pain and aging such as the aforementioned idea that pain is inevitable in old age and must be endured.
39
With respect to CBT treatments, the psychologist will challenge what beliefs that have what kind of dialogue?
> beliefs with Socratic dialogue.
> In other words, the psychologist queries the client regarding the logic underlying inaccurate be-liefs about pain experienced by older adults
40
Are the types of stressors faced by older adults the same as those faced by younger adults?
> are different from those typically seen among younger persons
> (e.g., younger persons are concerned about their ability to perform the duties of their occupation whereas retired older persons are more likely to be preoccupied with such issues as widowhood and empty nest).
41
Lunde and colleagues (2009) found CBT to be moderately effective, with demonstrated benefit on what kind of pain for older adults? What has it not benefited?
> demonstrated benefit on self-reported pain
> but not on physical function, depression, or patterns of medication use
42
Have acceptance and commitment therapy (ACT) approaches been beneficial?
> Initial results have demonstrated promising findings with respect to number of days off from work, medical care utilization, illness-focused coping strategies, catastrophic think-ing, and global distress levels over time
> Further research has been promising
43
While pain tends to be under-treated in older adults in general (Herr, 2010), this under-treatment is an even more significant concern when focusing specifically on what population? What factor excaberates this?
> those that live in LTC
> There is evidence that older persons who live in LTC in both the United States and Canada suffer from unnecessary pain.
> One of the factors contributing to this under-treatment is the communication challenge associated with advanced dementia.
44
Advanced AD and other dementias are associated with major impairments in what? As a result, how does this affect older adults and getting proper health care?
> in judgement and language abilities. As a result, older adults with dementia often do not report their pain.
45
Health psychologists and other professionals have played an active role in trying to solve the problem of pain under-reporting by developing what assessment methods?
> by developing behavioural observation assessment methods, emphasizing non-verbal pain behaviours (e.g., vocalizations, grimaces).
> Such automatic, reflexive pain behaviours tend to be less affected by advanced dementia compared to self-report
46
One of the most effective standardized assessment tools for identifying pain in this population is what assessment tool?
> the Pain Assessment Checklist for Seniors with Limited Ability to Communicate
(PACSLAC) and the PACSLAC-II
47
What does the (PACSLAC) require?
> require health-care personnel to observe the patient and evaluate him or her for pain behaviours
48
Untreated pain in LTC can lead to what specifc outcome? What is this outcome misattributed to and as a result what does it lead to?
> behavioural disturbances (e.g., aggression, loud vocalizations),
> can easily be misattributed to psychiatric con-ditions
> as a result, it can lead to unnecessary and risky phar-macological therapies
49
Jane Fisher and her colleagues developed what intervention model? What does this model recognize?
| the FAMI
> developed the Functional Analytic Model of Intervention
> this model recognizes that all behaviours are influenced by a person’s psychological and physiological history and his or her current social and physical context.
> through appropriate assessment sources of distress are identified and managed through a variety of integrated approaches
50
What is one of the most frequent sources of painful injury among older adults? Approximately how many older people out of 3 exprience this a year and how many experience it more than once within the same year?
> Falls
> Approximately one in three older persons experiences a fall, with roughly half of these individ-uals falling more than once per year
51
What are falls a leading cause to? When do the rates double for falls?
> cause of injury and hospitalization, with hospitalization rates doubling in seniors above age 75
52
In an American study, Stevens, Mack, Paulozzi, & Bal-lesteros (2008) found what what percent of falls resulted in what?
> found that 31 per cent of falls reported over one year resulted in at least one med-ical visit and at least one day of restricted activity.
53
In a Canadian six-month longitudinal study involving 571 older adults over age 69, Hadjistavropoulos and colleagues found how many falls had occured at this time and what percentages of these falls were associated with pain/medical injury
> found that 199 falls occurred, with 50 per cent of these falls leading to significant injury and 22 per cent leading to pain lasting more than a few days. Moreover, 18 per cent of the falls resulted in seeking medical attention.
54
What 3 medical factors increase the risk of falling? Do any other factors increase the risk of falling?
> visual problems,
> significant orthopedic diagnosis,
> use of medications that affect balance
> BUT psychological factors ALSO increase the risk of falling.
55
What factors can predict future falls?
> depression and excessive fear of fall-ing can predict future falls
> It is often assumed that fear of falling leads to excessive avoidance of activity, which in turn leads to loss of muscle tone and fitness, which then leads to falls
> what is actually the case = older people walk in a less stable way when they become anxious (there is a change in gait)
56
What method treats falls in older adults? What does it specifically allow an older adult to do? What do therapists put an emphasis on with respect to CBT?
> CBT
> reduces the fear of falling + recurrent falls, especially when it is combined with an appropriately supervised physical exercise program
> Allows patients to get a sense of control over falling
> An emphasis is also placed on correcting misconceptions about falls/fall risk + setting realistic goals for safely increasing physical activity + changing the home environ-ment to reduce risk
57
Transition to any residential care may result in what? What are the rates for this condition for those that are in residental care?
> may result in depression and loneliness
> 6-25% have a diagnosis of major depression
> 12-25% suffer from mild depressive disorders,
> and 30-50% display significant depressive symptoms
58
Transitions to LTC often are pre-cipitated by what?
> increasing physical or cognitive impairments, which are associated with decreased quality of life in multiple domains, such as privacy, individuality, relationship, and mood
59
Passage of the Nursing Home Reform Act as part of the Omnibus Budget Reconciliation Act of 1987 in the United States mandated what?
> mandated adequate care in skilled nursing facilities include psychosocial and quality-of-life assessments and required certified LTC facilities to employ activities per-sonnel
60
he Brief Behavioural Activation Treatment for Depression (BATD) focuses on what?
> focuses on unique environmental contingencies that maintain depressed behaviour across settings.
> he intervention seeks to increase participation in meaningful events through goal setting and ac-tivity planning.
> A modified version of BATD with inpatients in a geropsychiatric facility involving eight sessions over a four-week period improved depression in patients
61
Animal-assisted therapy in LTC has health benefits. It can improve what states including what?
> It can improve psychological states
> including self-worth, and increase morale
62
What outcomes (improvments) have occurred for older adults that take care of a canary? What 3 factors did they also expeirence decreases in compared to the controls?
| PF,SC,D/A,CF,SF,LS.
> WITH CANARY = have demonstrated improvements in:
> physical functioning,
> self-care,
> depression/anxiety,
> cognitive functioning,
> social functioning,
> and life satisfaction
> the canary group also demonstrated significant decreases in somatic complaints + significant decreases in anxiety and psy-chotic symptoms
63
Depressed residents are less likely to engage in what kind of activities at a LTC?
> informal spontaneous activities and may benefit from more structured activitie
64
he American Psychological Association (APA, 2005) defines end of life as what period?
> defines end of life as the period when health-care providers would not be surprised if death occurred within six months.
65
The APA ad-hoc committee on end-of-life issues identified four time periods when psychologists can contribute to end-of-life care: what are the four time periods?
(1) before illness strikes;
(2) after illness is diag-nosed;
(3) during advanced illness and the dying process; and
(4) after the death of the patient with bereaved caregivers.
66
Palliative care is defined by the World Health Organization (2017) as what?
> as an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identi-fication and impeccable assessment and treatment of pain and other physical, psychosocial, and spiritual problems
67
What does hospice require? Where can it be provided?
> Hospice requires a prognosis of six months or less with focus on physical and emotional comfort, not curing illness.
> It can be provided in the patient’s home, in freestanding hospice centres, hospitals, nursing homes, and other LTC facilities
68
Is all palliative care hospice care? What about vice versa?
> Patients receiving palliative care can be receiving curative therapy; therefore, all hospice care is palliative care, but not all pal-liative care is hospice care.
69
In order to meet goals of improved quality of life, what approach is adopted?
> the team approach is employed and often includes psychologists as well as social workers, chaplains, complementary and alternative practitioners (massage therapists, music therapists, art therapists, etc) in addition to physicians and nurses.
70
One of the most familiar models of grief is the work of Elisabeth Kübler-Ross, which describes five stages of grief: what are they?
| DABDA
> denial, anger, bargaining, depression, and acceptance
71
In contrast to the five stages of grief suggested by Kubler-ross, how is grief now conceptualized?
> grief has been conceptualized as a life process that varies in intensity (Wessel & Garon, 2005) rather than a single experience or series of stages as described by Kübler-Ross.
72
he Fraser Health Hospice Psychosocial Care Guidelines (2006) describe that grief work is not so much acceptance but what instead? As a result, what do they reccomend a grieving person to do? What do they note is an important part of grief work?
> it is about exploring and adjusting to life without the person who has died.
> They recommend that healing is about taking on:
> the changes the loss has created,
> developing a new sense of self,
> investing in new roles and relationships.
> They also describe normalizing and validating the grief process as an important part of grief work.
73
Of note, what per cent of individuals are resilient and experience emotional recovery following the loss of a loved one? What does this not mean though?
> 75%
> but that does not mean they do not experience sadness and emotional pain
74
What are risk factors for persistent complex bereavement disorders?
> sudden and unexpected death;
> loss of a child;
> death after a lengthy illness;
> death that the mourner perceives as having been preventable;
> a relationship with the deceased that was markedly angry, ambivalent, or dependent;
> multiple losses (past or present) or additional stressors;
> mental health concerns;
> and a mourner’s perception of lack of support
75
Although older adults experience declines in episodic memory with advancing age (Radvansky, 2011), considerable evidence demonstrates that what methods are popular in reducing depression in older age populations? What else improves?
> demonstrates that life review and reminiscence interventions are effective in reducing symptoms of depression in this population
> + improving social interaction, quality of life, and aspects of well-being and assisting in the in-tegration, maintenance, or development of the self
76
Haber (2006) clearly differentiates reminiscence (the universal, passive recall of memories) from life review: what is the difference?
> Life review describes a structured, potentially multi-session interview focused around one or more life themes such as family, work, major turning points, the impact of historical events, the arts, aging, dying and death, and socialization issues such as meaning, values, and purpose in life.
77
We discuss reminiscence therapy in relation to three different populations: which 3?
> older adults in community, LTC residents, and persons in palliative care settings.
> Notably, across settings, incorporation of volunteer-delivered interventions incorporating schoolchildren, a folklor-ist/oral historian, or same-aged peer may be effective means of improving accessibility of reminiscence interventions to older adults with chronic illness
78
Reminiscence has received support as an evidence-based treatment for depression among community-dwelling older adults. What is the evidence proving so?
> Using coding criteria suggested by the APA, Scogin and colleagues found the life review to be one of six treatments that are beneficial in reducing geriatric depression, and it is the only intervention developed specifically for older adults.
79
In 28 studies, published between 1990 and 2003, using life review with nursing home patients with mild to moderate dementia, benefits were found in what areas?
| SE,SI,QOL,MOPB
> benefits were found in self-esteem and self-integration, quality of life, and modification of problematic behaviour
80
In 28 studies, published between 1990 and 2003, using life review with nursing home patients with mild to moderate dementia, which group benefited the most?
> Specifically, the individuals with mild to moderate dementia appeared to benefit most in the five interventions that targeted self-integration
81
What were the features for the interventions used for enhanced sense of identity in the 28 studies published between 1990 and 2003 were what three elements?
> the features of the interventions associated with an enhanced sense of identity were:
(1) a thorough and encompassing treatment of the individual’s life story;
(2) the translation of the life story into care interactions with nursing home staff (e.g., mutual reminis-cence); and
(3) active encouragement of the residents’ meaningful activity.
82
Kitwood (1997) has argued that the emphasis on what two factors in dementia care is in the process of being adopted as a best practice within LTC? What other approach has received emphasis from this researcher?
| PH+S, HE has recieved an empasis
> has argued that the emphasis on personhood and subjectivity is a best practice within LTC,
> also, a humanistic emphasis on seeing the person with dementia as a person capable of having experiences within physical, social, and cultural con-texts.
83
Moos and Björn (2006) note several methodological problems within life-review studies, including what?
> inadequate information on the staging of dementia,
> limitations of personalized content as a result of group sessions,
> and poor documentation of unprompted or spontaneous recall of memories or events
84
A relatively new intervention not included in these reviews was conducted by Cohen-Mansfield and colleagues (not reminiscence or life-review). What was it based on? What identity roles were associated with older adults? As a result of these roles, what functioning improved in the sample?
> was based on their prior work in developing the Self-Identity in Dementia Questionnaire
> Older persons with dementia most frequently report the follow-ing salient identity roles, in order of prevalence:
(1) family heritage;
(2) success of a relative;
(3) academic achievement;
(4) occupations;
(5) traits; and
(6) survival.
> Notably, better cognitive functioning was shown to be consistently related to a greater saliency of identity role in their sample
85
Cohen-Mansfield and colleagues found that those with moderate dementia provided what kind of input about their former roles? When does the saliency of caregiver input increase?
> provided more salient input regarding their prior roles; the saliency of caregiver input increased as the severity of dementia within an individual increased.
86
A product called CIRCA was developed by who? Why was it developed?
> Scottish computer designers and psychologists to support reminiscence among individuals with dementia working with family and professional caregivers in adult daycare settings.
87
How does the CIRCA work? How does it stand up compared to traditionally administered therapy?
> It is a touch-screen interface to support reminiscence.
> The interface was designed to be attractive and as simple as possible, with command prompts at the bottom of the screen to lessen fatigue.
> The system contains audio and audio-visual elements organized into three themes: (1) recreation; (2) entertainment; and (3) city life.
> In comparison with traditionally administered reminiscence therapy, CIRCA sessions are more conversational with more varied topics and materials
88
Haight and colleagues (2000) examined the potential therapeutic effects of a face-to-face structured life review with a therapeutic listener over three years- what was found?
> Results indicated that the life-review inter-vention was beneficial.
> Scores on the baseline and post-test measures stayed the same in the interven-tion group but went down in the friendly visit control group, indicating the life-review intervention helped residents maintain stability in affect and identity over three years.
89
Two intervention models using reminiscence and life review with individuals with advanced chronic illness and either health-care professionals or family caregivers have been applied in pal-liative care settings: what are the two?
> (1) Chochinov’s Dignity Therapy
> (2) the Legacy Project
90
What is Chochinov’s Dignity Therapy?
> is a combination treatment approach that bor-rows elements from supportive therapy with its emphasis on empathy and connectedness; exis-tential psychotherapy with engagement of issues such as meaning, hope, and mortality; and life review.
91
One component of Chochinov’s (2012) dignity-conserving repertoire is what kind of exercise?
> is “generativity or legacy,” an exercise that attempts to provide comfort through the telling of the life story and sense that one’s life will transcend death. In the Dignity intervention
92
Has the legacy project been successful in decreasing caregiver stress? What two factors has it also affected?
> the Legacy Project has been found to decrease caregiving stress and increase positive affect and family communication as the patient was approaching the end of life.
93
A new, promising area of psychological treatment for those facing life-limiting illness is called what?
> acceptance and commitment therapy (ACT).
> ACT is a new wave of ther-apy within CBT
> the ACT treatment model is designed to help people change how they cognitively ap-proach problems using techniques related to mindfulness,
acceptance, and values-based living
94
On October 27, 1997, Oregon enacted what act?
> On October 27, 1997, Oregon enacted the Death with Dignity Act, which allows ter-minally ill Oregonians to end their lives through the voluntary self-administration of lethal medications expressly prescribed by a physician for that purpose
95
As of February 2017, what states in the US have dying with dignity statues? What state (Seperate from those with statues) has made physician-assisted dying legal by SCC ruling?
| C,C,DOC,O,V,W. M
> California, Colorado, District of Columbia, Oregon, Vermont, and Washington have Death with Dignity statutes.
> In Montana, physician-assisted dying is legal by State Supreme Court ruling (Death with Dignity National Center, 2018).
96
Does Canada have any legislation for medically assisted death? If so, what is the eligibility criteria?
> In 2016, new Canadian federal legislation created a regulatory framework for medically as-sisted death
> Medically assisted death is now legal in Canada, if strict eligibility criteria are met (e.g., over the age of 18 years, must be eligible for medical services funded by the Government of Canada, incurable illness/disease/disability, nat-ural death is “reasonably foreseeable”, suffering is intolerable to the person and cannot be relieved under acceptable conditions).
97
What is a consequence of cognitive decline among those with dementia?
| PDM
> Poor decision making
98
What is divided attention? Does age affect this function?
> Divided attention is the ability to pay attention to multiple streams of information simultaneously, or to ignore competing in-formation or stimulation while concentrating on a task.
> Divided attention is slightly com-promised by age, and more so by cognitive impairments
99
According to the Society for Cognitive Rehabilitation (2013), cognitive rehabilitation therapy is defined as?
> “the process of relearning cognitive skills that have been lost or altered as a result of damage to brain cells/ chemistry.”
100
Examples of cognitive rehabilitation strategies that can improve encoding (use of context and existing knowledge to understand and store information) are what?
> providing instruc-tion about activities at a slower pace,
> controlling the environment to cut down on distractions
> providing instruction in multiple modalities
> providing activities that have high levels of initial success
> using adaptive or supportive environments and assistive devices
101
Sperling and colleagues (2011) found that older persons who exhibit cognitive decline, but do not yet meet accepted criteria for mild cognitive impairment (MCI) or Alzheimer’s disease (AD), may be most likely to benefit from what kind of intervention?
> benefit from early intervention and offer a unique opportunity to reduce the public health burden posed by AD.
102
Plassman, Williams, Burke, Holsinger and Benjamin (2009) reviewed factors associated with risk and possible prevention of cognitive decline and found insufficient evidence for most factors but promise for what factors?
> acknowledged some promise for exercise, cognitive training, and certain nutritional patterns (i.e., a Mediterranean diet and fruits and vegetables).
103
Yamaguchi, Maki, and Yamagami (2010) recommend a new approach to maintaining cognitive function called what?
> called brain-activation rehabilitation.
104
Yamaguchi, Maki, and Yamagami (2010) recommend that activities designed to maintain cognitive function should include what five principles?
| EACA,ATPTWC,ETEMAP,EISRTTLLIAA,PESTAPC
(1) enjoyable and comfortable activities;
(2) activities that promote two-way communication;
(3) efforts to enhance motivation among patients;
(4) engagement in social roles that tap lifelong interests and abilities; and
(5) pleasant environmental settings that are patient-centred.
105
The available evidence is limited and there are no significant benefits of cognitive training in individuals with what conditions that are in the early stage? What is this attributed to?
> AD or vascular dementia
> this is attributed to a lack of randomized control trials in cognitive rehabilitation studies
106
In 2012, a clinical study examining cognitive rehabilitation also demonstrated no effect on what kind of functioning?
> no effect on the everyday functioning of participants with early-onset dementia
