First Aid CH9 Geriatric Psych

Question 1

what’s the trend of the geriatric population?

Answer 1

double by year 2050 d/t aging Baby Boomers

Question 2

how many people over age 60 have a psychiatric disorder?

Answer 2

20%

Question 3

normal aging

Answer 3

decreased brain wt/enlarged ventricles and sulci
decreased muscle mass and inc fat
impaired vision and hearing
minor forgetfulness (age-associated memory impairment)

Question 4

depression in the elderly is often associated with?

Answer 4

poor physical health

Question 5

elderly pt presents with memory loss or non-specific physical complaints, what should be worked up?

Answer 5

major depressive disorder

Question 6

pseudodementia and tx

Answer 6

presence of apparent cognitive deficits in pts with major depression

supportive psychotherapy, engage pt in community resources, SSRI

Question 7

what’s often the response of a depressed elderly pt? how does it differ from someone with a NCD?

Answer 7

“I don’t know”, but when pressed they show capacity to answer a question correctly

NCD will confabulate (exaggerated, fabricated) answers if they don’t know

Question 8

Which TCA is favored in the elderly?

Answer 8

Nortriptyline d/t fewest anti-cholinergic side effects (elderly are sensitive to these effects)

Question 9

which SARA increases appetite?

Answer 9

Mirtazapine

Question 10

5 stages of grief

Answer 10

DABDA
Denial
Anger
Bargaining
Depression
Acceptance

Question 11

how long might normal grief (bereavement) last?

Answer 11

6 months, should abate (become smaller, reduce, removed)

Question 12

what are the sxs of normal grief?

Answer 12

intense feelings of guilt and sadness, sleep disturbances, appetite changes, illusions

NOT: helplessness or hopelessness, worthlessness.. this is bereavement-associated major depression

Question 13

chronic medical conditions worsened by ETOH

Answer 13

liver dx, GI dx, CV dx, gout, diabetes, depression and anxiety

Question 14

what’s the MC psychiatric disorder in the elderly?

Answer 14

major depressive disorder

Question 15

what population commits the highest rate of suicides?

Answer 15

elderly white males

Question 16

ETOH/medication interactions

Answer 16

H2 blockers = inc BALs

Metronidazole, sulfonamides, LA hypoglycemic = n/v

Question 17

major neurocognitive disorders

Answer 17

dementia

Question 18

tx for hallucinations that don’t bother the pt or interfere with caring for a pt

Answer 18

nothing, pharm not indicated

Question 19

non-pharm txs in geriatric population for major neurocognitive disorders (dementia)

Answer 19

music, art, exercise, pet therapy
strict schedules/consistent routine
continual reorientation of pt
reduce stimuli (quiet living environment)
surround pt w/ familiar objects

Question 20

pharm txs in geriatric population for MND (dementia)

Answer 20

antisphychotics: limited efficacy and inc mortality
anxiolytics: SSRI, benzos (reserved for very short-term, acute episodes)

Question 21

restless leg movements/periodic leg movements (PLM) cause

Answer 21

dopamine imbalance

Question 22

sleep disturbance tx

Answer 22

first line: non-pharm, sleep hygiene

second line: Trazodone (less sedating)

Question 23

are restraints used in non-emergency situations?

Answer 23

as a last resort, yes
Dr. Kohler: we had a pt go into rhabdo on PCP because of the self-inflected muscle damage from attempting to get out of the restraints

Question 24

why do the elderly suffer from more med side effects?

Answer 24

less mass to store drug, poor liver/kidney function as it relates to metabolism and excretion

Question 25

who’s the MC perpetrator of elderly abuse?

Answer 25

caregiver (spouse, adult child)