Chapter 9 pt 1 Flashcards
suicide rate of elderly (aged 85 or older) white men is what compared to national average
5x
what are common diagnoses in elderly patients
mood disorders
anxiety disorders
neurocognitive disorders
many mental disorders in this population remain underreported
what factors are associated with normal aging
decreased brain weight/enlarged ventricles and sulci
decreased muscle mass
increase in fat
impaired vision and hearing
minor forgetfulness (sometimes called age-associated memory impairment or benign senescent forgetfulness)
depression in the elderly is associated with what
poor physical health
new admits to nursing homes suffering from depression have
increased 1 year mortality rate
stroke patients who develop depression have
> 3x increase rate of death during the 10 years following stroke
post-MI patients who develop depression have
4x increased rate of death
what is pseudodementia
presence of apparent cognitive deficits in patients with major depression
symptoms of major depression in the elderly often include problems with memory and cognitive functioning
when mistaken for a neurocognitive disorder this term is used
how is pseudo dementia treated
supportive psychotherapy community resources (senior centers, senior services) Low dose SSRI
what TCA is favored in elderly and why
nortriptyline
fewest anticholinergic side effects
how can one differentiate dementia and pseudodementia
onset:
dementia: insidious; pseudo: more acute
sundowning:
common in dementia; not common in pseudo
Answers:
dementia will confabulate (guess); pseudo will say “i dont know”
awareness:
dementia- unaware of problems; pseudo-aware
anti-depressant therapy
cognitive deficits will improve with antidepressant medication in pseudo
what is safe and effective in the elderly and can be used in place of antidepressants
ECT
whiter ether 5 stages of Grief
Denial Anger Bargaining Depression Acceptance
-people may skip stages and go through them in different order
what is normal grief
intense feelings, including guilt and sadness, sleep disturbances, appetite changes, and illusions
generally abate by 6 MONTHS of the loss
patients ability to fiction appropriately in their life is preserved
what is bereavement-assoicated depression
major depression that began with a concrete death or loss in the patients life
how can one distinguish depression and grief
look for hopelessness, helplessness, severe guilt and worthlessness, neurovegetative symptoms (insomnia, appetite/weight changes, low energy), suicidal ideation
treatment for depression that occurs in association with bereavement is recommended when
2 straight weeks of depressive symptoms
what percentage of people 65+ drinks alcohol
40%
16% are heavy drinkers with adverse health effects due to the alcohol
what are the age related effects of alcohol
decreased alcohol dehydrogenase- can lead to higher blood alcohol levels with fewer drinks
less water in the body with age resulting in higher percentage of alcohol in blood compared to younger person relatively
increase CNS sensitivity to alcohol
what chronic medical conditions are worsened by alcohol
liver diseases (cirrhosis, hepatitis) GI diseases (bleeding, reflux, ulcer) CVD (HTN, heart failure) Metabolic/endocrine (gout, diabetes) mental (depression, anxiety)
what interaction does alcohol have with H2 blockers
higher blood alcohol levels
what interaction does alcohol have with benzos, TCAs, narcotic, barbs, antihistamines
increase sedation
what interaction does alcohol have with aspirin, NSAID
prolonged bleeding time, irritation of gastric lining
what interaction does alcohol have with metronidazole, sulfonamides, long-acting hypoglycemics
nausea vomiting
what interaction does alcohol have with Resperine, nitroglycerin, hydralazine
increase risk of hypotension
what interaction does alcohol have with acetaminophen, isoniazid, phenylbutazone
increased hepatotoxicity
what interaction does alcohol have with antihypertensives, anti diabetic, ulcer drugs, gout medications
worsen underlying disease
