Chapter 9 Pt 2

Question 1

what is the most common psychiatric disorder in the elderly

Answer 1

major depressive disorder

Question 2

who has the highest rate of completed suicide

Answer 2

white elderly males

Question 3

what kind of symptoms are common inpatients with major neurocognitive disorder, as well as often the source of many psychosocial problems surrounding their care

Answer 3

behavioral symptoms

agitaiton and aggression can be distressing and dangerous for caregivers

Question 4

describe mood disorders in major neurocognitive diserder

Answer 4

difficult to diagnose

patients may display symptoms of depression that are merely natural manifestation of their disease

mood and affect are often poor diagnostic indicators in patients with moderate-to-severe cognitive impairment

Question 5

describe aggression in major neurocognitive disorders

Answer 5

may be provoked by the patients confusion in the setting of cognitive, memory, and language defects

may be provoked by hallucinations

Question 6

describe psychosis in major neurocongitive disorders

Answer 6

delusions reported in up to 50% of Alzheimers

hallucinations (auditory and visual mostly) in lat least 25% of patients with major neurocognitive

if hallucinations not bothersome, pharmacotherapy unnecessary

Question 7

how are the psychiatric manifestations of major neurocongitive disorders treated

Answer 7

behavior and environmental treatments for behavioral symptoms preferred

Question 8

what are non-pharmacological treatments for the psychiatric manifestations of major neurocongitive disorders

Answer 8

music, art, exercise, and pet therapy
strict daily schedules to minimize changes in routine
continual reorientation of patient
reduce stimuli (quiet living environment)
surround patient with familiar objects (family photos, a favorite quilt)

Question 9

what are pharmacological treatments for the psychiatric manifestations of major neurocongitive disorders

Answer 9

antipsychotics

• limited efficacy and increase mortality
• try olanzapine or quietiapine
• short term halloo of Risperdal work too

anxiolytics:

• SSRIs treat anxiety due to unrecognized depression well
• benzos should only be used very short-term, acute episodes

Question 10

what happens to incidence of sleep disturbance with age

Answer 10

increases

reported as: difficulty sleeping, daytime drowsiness, and daytime napping

Question 11

what are some normal age related changes in sleep

Answer 11

decreased REM latency and total REM

increase in stage 1 and 2 sleep, decrease stages 3 and 4 (deep sleep)

frequent nocturnal waking (decreased sleep efficiency)

decrease in total amount of sleep

sleep cycle advances (earlier to bed, earlier to rise)

Question 12

what are some causes of sleep disturbances outside of normal aging

Answer 12

other medical conditions
drug/alcohol use
social stressors
medications

Question 13

what is sleep like in patients with movement disorders

Answer 13

shallow

may be more restless at night because of trouble turning in bed

Question 14

RLS moments in sleep are likely due to what and called what

Answer 14

called Periodic Leg Movement s(PMLs)

likely due to dopamine imbalance

Question 15

sedative-hypnotic drugs are more likely to do what in elderly

Answer 15

side effects (memory impairment, ataxia, paradoxical excitement, rebound insomnia)

Question 16

what medication is safer in elderly for sedation than benzos

Answer 16

trazodone (watch for orthostasis)

Question 17

how should restraints be used in the elderly

Answer 17

used as last resort
reassessed at regular intervals

patient safety, health, and well-being should be most important concern

Question 18

why do elderly suffer from more side effects of medications

Answer 18

less lean body mass and impaired liver and kidney function

Question 19

when confronted with a new symptom in elderly patient on many medications what should one try and do

Answer 19

remove a medication before adding one

Question 20

what are the types of elder abuse

Answer 20

physical
psychological (treats, insults)
neglect (withholding of care)
exploitation (misuse of finances)
sexual, rarely

Question 21

elder abuse occurs in approximately what percentage of those over 65

Answer 21

10%

Question 22

perpetrator of elder abuse is usually whom

Answer 22

caregiver (spouse or adult child) who lives with victim

Question 23

nursing homes provide care and rehabilitation for whom

Answer 23

chronically ill and impaired patients as well as patients who are in need of short-term care before returning to their prior living arrangement

major of patients stay permanently, and fewer than half are discharged after only a short period of time