Chapter 16 - Aging and Mental Health Flashcards
What age is considered older adult?
Over 65
Why is Canada’s population aging at a fast rate?
Aging of baby boomers
Canadians living longer
As proportion increases, so will older adults with _______________.
Mental health disorders
Why would there be increased vulnerability through the aging process?
Physical illness
Psychological losses
Loss of independence
Why is aging often a time of psychological resilience for many?
Decreased prevalence of most mental disorders
Increased life satisfaction
Positive well-being despite increased vulnerability is called…
Paradox of aging
What are limitations of prevalence data?
Older adults less likely to remember, report, experience symptoms
Older adults excluded/refuse to participate
Survivor effect
Cohort/period effects
What is survivor effect?
Only healthiest survive to old age
Mental disorders = high mortality rates
What counters the myth that treatment of mental health problems in late life is unnecessary/ineffective?
Psychotherapy and pharmacology just as effective
Adults using services good outcomes
What are 3 issues with diagnosis and treatment of age-related MDs?
Symptoms attributed to age
Comorbidity with chronic physical illness
Older adults and multiple medications
What does the selective optimization with compensation theory of aging state?
Old age brings losses of ability and skills
In the selective optimization with compensation theory of aging, what is considered successful aging?
Selecting appropriate goals/priorities
Optimizing resources towards goals
Compensating losses using alternative means
What does the socio-emotional selectivity theory of aging state?
When time perceived as unlimited, goals future oriented and focused on seeking information/expanding knowledge
When time perceived as limited, goals short term and emotionally meaningful
According to the ___________ theory of aging, when time changes from being perceived as unlimited to limited, there is a shift from _________ to ___________ focus.
Socio-emotional selectivity; knowledge; meaning
What does the strength and vulnerability integration theory state?
Aging associated with increased ability to regulate emotions and avoid negative experiences
However, older adult vulnerabilities can reverse age-related advantages in emotion regulation and well-being
According to the strength and vulnerability integration theory of aging, what are the vulnerabilities that older adults may face?
Regulating emotional arousal
Recovering from stressful events
What are factors of sleep-wake disorders?
Dissatisfaction with sleep quality
Sleep problems
Medical problems and more medications
What are the diagnostic issues of sleep-wake disorders?
Unrealistic expectations of sleep
Insomnia
Age-related changes
Sleep patterns/characteristics vary widely
What are 4 normal changes in sleep patterns with age?
Decreased sleep time
EEG activity
Sleep stages
Circadian rhythm
All the normal changes in sleep patterns contribute to sleep of the elderly as _________ or more fragile.
Lighter
What are the 4 nocturnal symptoms of insomnia disorder?
Difficulty falling asleep
Frequent awakenings
Shortened sleep
Non-restorative sleep
What are the 4 daytime symptoms of insomnia disorder?
Fatigue
Sleepiness
Depression
Anxiety
What are the 3 factors of etiology for insomnia disorder?
Predisposing
Precipitating
Perpetuating
What are the predisposing factors of insomnia disorder?
Female
Lower education/income
Poor health behaviours
What are the precipitating factors of insomnia disorder?
Loss
Pain
Mental health problems
What are the perpetuating factors of insomnia disorder?
Excessive worry about sleep
Daytime napping
What are the treatments for insomnia disorder?
Psychological (CBT-I)
Sedatives/hypnotics
Self medicate with alcohol
Self medicating with alcohol can help people ________, but reduces _________.
Fall asleep; quality of sleep
What is sleep apnea?
Episodes of cessation of breathing lasting 10+ seconds during sleep
_____% of older adults have sleep apnea, and is more common in _____ with increasing age.
20-50; men
What are the 3 factors for diagnosing sleep apnea?
Overnight polysomnography
Severity related to obesity
Underdiagnosed/undertreated in older adults
What are the 5 treatments for sleep apnea?
Lose weight
Avoid sleeping on back
Avoid depressants
CPAP to open airways
Surgery
Regarding suicide, ________ adults attempt more but _______ adults die more.
Younger; older
What are 3 reasons older adults die more by suicide?
Greater intent
More lethal methods
More socially isolated
What are risk factors of older adults for suicide?
Prior attempt
Mental illness/ PDs
Addiction, impairment, pain
Poor social support
Negative events
What is the etiology for depressive disorders in older adults?
Combo of weak support and physical health
Genetics
Medical illness
MDD often looks different in older adults as they are more likely for _________ (2) and less likely for __________ (3).
Weight loss; somatic symptoms
Sadness; worthlessness; guilt
What is the diagnostic issue of depressive disorders in older adults?
Difficult to diagnose with other medical problems
Older adults @ greater risk for developing depression as a result of…
Medical conditions
What are the 4 treatments for depressive disorders?
Lifestyle changes
Drug therapy
ECT
Psychotherapy
Which disorders are among the most common psychiatric problems experienced by older adults?
Social anxiety
Specific phobia
Generalized anxiety
Anxiety disorders increase the risk for other age-related conditions such as ________.
Alzheimer’s
What are the diagnostic issues of anxiety disorders?
Overshadowed by depression
Associated with ranging physical/psychological issues
Measures not normed for older adults
What are the treatments for anxiety disorders?
CBT, acceptance/commitment therapy, relaxation therapy
Mindfulness training
Benzodiazepines
SSRIs
What is the downside of prescribing benzodiazepines for anxiety?
Addictive
Risk for falls
Cognitive impairment
Why would SSRIs be prescribed for anxiety?
Effective with less side effects
The symptoms of schizophrenia for those diagnosed when younger often __________ overtime, with the _______ of positive symptoms and ______ in negative symptoms.
Disappear
Decrease; increase
What can trigger late-onset of schizophrenia and other psychotic disorders?
Medical changes/substances
What is delirium?
Neurocognitive disorder with sudden onset, fluctuating course, and disturbances in functioning
What are 3 risk factors for delirium?
Surgery
Medical illness
Acute care settings
What is the etiology for delirium?
Metabolic (deficits)
Infectious (tuberculosis, HIV)
Structural (dementia, head injury)
What is a diagnostic issue of delirium?
Often undetected or misdiagnosed
What are the treatments/outcomes of delirium?
Preventative efforts
Medications (psychotropic)
Remediate cause
Chronic (minority)
_____________ are the most common mental disorders in older adults, with prevalence rates twice as high among _____.
Neurocognitive disorders (8%); women
NCDs are mostly ________, not reversible. _____________ is reversible and symptoms can mimic those of NCDs.
Progressive; pseudo-dementia
What is pseudo-dementia?
Depression impairs individual to the point of dementia-like symptoms
The 2 types of NCDs are…
Cortical dementia
Subcortical dementia
What is the difference between the 2 types of NCDs?
Cortical: attack cerebral cortex or grey matter
Subcortical: attack white matter and primitive parts of brain
What are the symptoms of cortical dementia?
Short term memory loss
Visuospatial and language problems
Poor reasoning/judgement
What are symptoms of subcortical dementia?
Cognitive slowing
Problems retrieving from memory
Difficulty with executive functioning
What are 2 factors of mild cognitive impairment (MCI)?
Transitional state between normal aging and NCDs
More likely to develop NCDs than cognitively healthy adults
What are 4 criterion for MCI?
Clinical concern
Cognitive impairment
Preserved functional independence
No dementia
Alzheimer’s disease (AD) is a progressive, fatal neurological disease caused by __________ and _________ in the CNS. The average time between diagnosis and death is _________.
Amyloid plaques; neurofibrillary tangles
6 years
What are the stages of AD?
Early
Middle
Late
What happens in the early stages of AD?
Episodic memory
Difficulty concentrating, thinking, finding words
Depressive disorder common
What happens in the middle stages of AD?
Increased symptoms severity and amnesia/aphasia
Difficulty with motor movement, remembering/recognizing
What happens in the late stages of AD?
Cognitive impairments
Immobility
Delusions, hallucinations
What is the etiology for AD?
Genetic
Vascular related factors
Depression
Head trauma
Lifestyle
There is currently no known cure for AD, but some treatments include…
Cholinesterase inhibitors (slow progression)
CBT
What causes vascular NCD?
Arteries supplying brain partly blocked
Brain lesions
What are diagnostic issues of vascular NCDs?
Sudden onset
History of stroke
Faster progression and shorter survival than AD
What characterizes lewy body dementia?
Fluctuating cognition
Recurrent hallucinations
Features of parkinsonism
What causes lewy body dementia?
Protein buildup in CNS
What characterizes frontotemporal NCD?
Pick’s disease
Changes in personality and judgement
Often mistake for psychiatric disorder
What is pick’s disease?
Brain/nerve cells gradually stop working, losing abilities
What happens during caregiver stress?
Increased depression/anxiety
Higher risk of physical health problems/premature mortality
Compromised cognitive abilities
