Chapter 16 - Aging and Mental Health Flashcards by Philia Yip

What age is considered older adult?

Over 65

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Why is Canada’s population aging at a fast rate?

Aging of baby boomers

Canadians living longer

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As proportion increases, so will older adults with _______________.

Mental health disorders

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Why would there be increased vulnerability through the aging process?

Physical illness

Psychological losses

Loss of independence

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Why is aging often a time of psychological resilience for many?

Decreased prevalence of most mental disorders

Increased life satisfaction

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Positive well-being despite increased vulnerability is called…

Paradox of aging

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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

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What is survivor effect?

Only healthiest survive to old age

Mental disorders = high mortality rates

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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

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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

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What does the selective optimization with compensation theory of aging state?

Old age brings losses of ability and skills

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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

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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

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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

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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

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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

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What are factors of sleep-wake disorders?

Dissatisfaction with sleep quality

Sleep problems

Medical problems and more medications

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What are the diagnostic issues of sleep-wake disorders?

Unrealistic expectations of sleep

Insomnia

Age-related changes

Sleep patterns/characteristics vary widely

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What are 4 normal changes in sleep patterns with age?

Decreased sleep time

EEG activity

Sleep stages

Circadian rhythm

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All the normal changes in sleep patterns contribute to sleep of the elderly as _________ or more fragile.

Lighter

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What are the 4 nocturnal symptoms of insomnia disorder?

Difficulty falling asleep

Frequent awakenings

Shortened sleep

Non-restorative sleep

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What are the 4 daytime symptoms of insomnia disorder?

Fatigue

Sleepiness

Depression

Anxiety

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What are the 3 factors of etiology for insomnia disorder?

Predisposing

Precipitating

Perpetuating

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What are the predisposing factors of insomnia disorder?

Female

Lower education/income

Poor health behaviours

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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