differetnt things in geri

Question 1

Depression course in late life

Answer 1

same prognosis

but longer more frequent episodes

Question 2

depression prevalence

Answer 2

full DO less: 2-4%
depressive sx high: 15-25%
in older medically hospitalized patients: 15%

Question 3

suicide in elderly

Answer 3

more violent
less attempts, more completions
4:1 attempt: completion (vs 20:1)
higher rate than gen pop
23/100,000 (vs 11/100,000)
risk of suicide for women decreases or plataus with age

Question 4

brain findings in suicide in general

Answer 4

low 5H1AA with suicide
low impramine binding to platelets in depression
low alpha 2 in CBin suicide

Question 5

cognitive changes in elderly

Answer 5

NOT reduced verbal fluency
but:
b. reduced complex visuospatial skills
c. reduced analytic skills (mild)
d. reduced speed of motor responses (most reliable)

Taken together, studies suggest a profile of cognitive changes with old age that includes
significantly reduced information processing speed and pure motor speed and mild decrements in
spontaneous recall, executive skills, complex attentional processes, and complex visuoperceptual
and visuoconstructive abilities

Question 6

delerium rates in elderly (CSMH)

Answer 6

50% in acute care settings
post hip: 50%
ICU: 70%
terminal: 88%

Question 7

main RF for delerium

Answer 7

dementia

then acute medical illness

Question 8

main intervention to prevent delerium

Answer 8

multidisciplinary approach

Question 9

scale for depressoin in dementia

Answer 9

cornell scale for depression in dmentia

Question 10

threpies for depression in elderly

Answer 10

CBT
IPT
Brief dynamic
Reminiscence
supportive

Question 11

reponse to medications in depression in elderly

Answer 11

same as younger, same even if they have medical illness, need same doses

Question 12

good antidepressants in elderly

Answer 12

3. Good choices: Sertraline, Citalopram, Escitalopram, Velafaxine, Buproprion, Mirtazapine
   If TCAS: nortrptyline and desipramine
   SSRIs=TCA in terms of fall risk

Question 13

augmentatoin of antidepressants in elderly

Answer 13

b. For partial response, consider augmentation with Mirtazapine, Buproprion or Lithium. SGAs and Stimulants can be considered. Or augment with psychotherapy.

Question 14

SIADH with SSRIs and venlafaxine

Answer 14

10%

check a 1 month after starting

Question 15

preferred Tx for depression in dementia

Answer 15

b. Preferred Rx: Moclobemide, Citalopram, Escitalopram, Sertraline, Venlafaxine and Buproprion. Mirtazapine ok but mild anticholinergic.

Question 16

bipolar in elderly medication?

Answer 16

Li first unless contraindication

CCSMH

Question 17

post stroke dperssion prognosis

Answer 17

high rates of spontaneous remission

Question 18

LTC stats

Answer 18

80-90% have mental illness
60% have dementia
15-25% have depression

Question 19

BPSD rates in dementai

Answer 19

10% have severe

Question 20

agitation in dementia medications

Answer 20

most evidence: SGA if severe
also PRN benzo if it is situation specific
can try SSRI, Trazodone

so: hose are 1st line
2nd line is carbamazepine (don’t use valproate)

secual disinhibitoin: SSRI, SGA
FTD disinhibition: trazodone

LBD or PDD: CEI, clozapie and seroquel if that fails

CEI and memantine “may” delay behavioural problems in Alz disease, may be tried for BPSD, but no real evidence that they work as they do for LBD say

Question 21

physiological changes in geri

Answer 21

increased basal ADH
reduced ADH release in response to hyponatremia
decreased GFR
lower urine acidity
osteoclasts normal, but decreased osteoblasts and osteocytes
decreased adaptation and accomodation to light,
loss of high and low frequency sounds

Question 22

Li level in geri

Answer 22

0. 6-0.9 in acute

0. 4-0.8 maintenance