Issues faced by older adults

Question 1

Appearance changes

Answer 1

Skin
–> skin becomes wrinkled, may show age spots, moles, varicose veins, capillaries and arteries become more visible
Hair
–> hair goes grey, thins and is lost over time. Women may gain facial hair with the menopause
Appearance changes may impact insecurity and wellbeing.

Question 2

Shrinking pupils

Answer 2

There is a reduction in the amount of light entering eye, which makes it specifically hard to adapt to darkness - takes around 40 mins for an 80 year old to adapt to darkness
–> this may be important in the home (could lead to falls)
–> this may impact driving

Question 3

Decline in lens elasticity

Answer 3

It becomes harder to see objects that are close (presbyopia)
it is harder refocussing from near to far (bifocals), which lenses can help with

Question 4

what is presbyopia?

Answer 4

difficulty in clearly seeing objects up close - caused by decline in lens elasticity

Question 5

what are bifocals?

Answer 5

difficulty in refocussing from near to far

Question 6

what are cataracts?

Answer 6

this impairs central vision because there is decreased transparency of the lens
it makes us sensitive to glare, as light can be scattered
causes hazy vision

Question 7

what is glaucoma?

Answer 7

fluid in the eye cannot drain properly so there is high pressure internal damage leading to vision loss

Question 8

what is macular degeneration?

Answer 8

a degenerative condition affecting the central part of the retina (the macula) and resulting in distortion or loss of central vision - everything looks blurry.

Question 9

what are the implications of visual changes in life?

Answer 9

1. Driving
2. Shopping
3. Activities of daily living
4. Postural problems
5. More vulnerable to falls (unable to see hazards, judge distances, and have to rely more on proprioception rather than vision)
6. Social interaction
7. Well-being

Question 10

what is cataract surgery?

Answer 10

this replaces the cataract. It very common and many older adults require it so it is strenuous for the NHS. For this reason they often operate on the most impaired eye and it is less common to operate on both.

Question 11

why are cataracts so bad for driving?

Answer 11

People with cataracts experience more problems when driving. For this reason, older adults often self regulate their driving behaviours. This is particularly important at night as bright lights could cause scattered vision. Those who undergo cataract surgery show improved driving (Wood & Carberry, 2006).

Question 12

how do cataracts impact falls and motor function?

Answer 12

Sheppard et al. (2022)
- second eye surgery had a positive impact on mobility and fall rates
- second eye surgery is not very pronounced on driving showing that it may not be super important

Question 13

driving in older adults

Answer 13

• driving requires many abilities such as cognitive, physical, sensory
• these all decline with age, making it hard to drive
• many older adults choose not to drive or they self regulate their driving behaviours and routes
• older adults who stop driving are negatively impacted in other aspects of living, such as greater depressive symptoms, less social engagement, and poorer functional status

Question 13

what is presbycusis?

Answer 13

age related hearing impairment:
- Difficulty hearing high pitched tones as well
- They are troubled by background noise – unable to filter out
- This impacts mental health as it affects communication and loss of independence
- Variable – is impacted by exposure to loud noise throughout life

Question 14

Balance problems

Answer 14

• Impaired joint position sense
• 40% of vestibular hair and nerve cells lost by age 70 which causes postural adjustments that are too small
• Increased dizziness and vertigo
• Increased likelihood of falls

Question 15

What happens to muscle strength?

Answer 15

Muscles lose their force, especially severe in nursing home residents who are prone to falls

Question 16

What happens to muscle endurance?

Answer 16

reduction in muscle mass (sarcopenia) and muscle fibers

Question 17

how can reductions in musculoskeletal changes impact older adults psychologically?

Answer 17

• Joint problems limit movement and independence
• Muscle coordination declines, so OA move more slowly
• Avoidance of some environments
• Access problems (hard to walk up stairs)
• Fear of falls

Question 18

how do our bones change in older adulthood?

Answer 18

• Bone loss starts in late 30s and accelerates in women post-menopause because of less oestrogen.
• Bones become more hollow where they lose mass, more brittle and porous
• Increased likelihood of fractures
• Osteoperosis

Question 19

what is osteoperosis?

Answer 19

• Bones become weak and fragile and more likely to break (fracture).
• Causes pain
• Older adults with this are ,ore likely to fall, and more likely to be badly affected by the fall due to brittleness of bones
• 3 mil in UK have osteoporosis

Question 20

how is osteoporosis prevented?

Answer 20

–> Largely diet, weight, exercise, genes
Osteoporosis stepwise implementation model tries to reduce the problem of osteoporosis at a prevention level through to efficiency of care post-osteoporosis, tackles each level of the problem

Question 21

why are falls such a problem?

Answer 21

30% of adults 65+ have a fall every year
- Linked to osteoporosis, many bone fractures are preceded by falls
- Can be caused by many things such as vision, hearing, vestibular system, inadequate muscle strength, polypharmacy effects on balance, slower reaction times, environmental hazards
- Falls impose a significant social and economic burden for individuals, families, the health service and economy
- See currently guidelines for preventing falls: Age UK and NHS

Question 22

How to prevent falls by modifying the environment?

Answer 22

• Assistive devices can be used to prevent falls
• Improved lighting to reduce shadow
• Eliminate tripping hazards
• Home safety evaluation

Question 23

How to prevent falls by exercise training?

Answer 23

Sherrington et al. (2017) found that exercise reduced fall rates in community-dwelling older adults by 21%
- High challenge balance training was best for reduction in fall risk over high intensity or walking training exercise
- It was better to do 3+ hours a week of exercise rather than 2+

Sherrington et al. (2019) review
- Exercise reduces the number of falls over time by around one-quarter (23% reduction).
- There is not enough evidence to determine the effects of exercise programs that are either resistance, dance or walking programs.
- No evidence to determine the effects of programs that were mainly flexibility or endurance based exercise
- Does this link to current guidelines?

Question 24

how is the autonomic nervous system impacted in terms of body temperature?

Answer 24

• Elderly are less sensitive to temp changes
• More susceptible to hypothermia and hyperthermia
• Sweat less so less able to reduce hot temp

Question 25

how is the autonomic nervous system impacted in sleep?

Answer 25

• Sleep complaints common in OA
• Circadian rhythm changes – it is not as simple as day awake, night asleep
• This may impact cognition

Question 26

what kind of cognitive memory stays intact in older age?

Answer 26

Crystallized intelligence/vocab
- Scores increase up until the mid 50s where they then remain stable and slightly decline
- Knowledge accumulates with age
Salthouse (2004)

Question 27

what kind of memory declines in older age?

Answer 27

performance on fluid intelligence declines (speed, reasoning and memory)
- This happens before age 50
- This research shows that the cognitive declines are broad and span over a lot of things. It also shows that the declines happen cumulatively over the lifespan. Why do we not see a more negative consequence in every day life?

Question 28

What is general slowing?

Answer 28

A major factor contributing to age-related differences in memory and other aspects of cognition is a reduction in the speed which many cognitive operations can be executed: general neural processing is implicated

Question 29

how are older adults’ reaction times impacted?

Answer 29

Through the slowing of central processes in the nervous system (i.e. the GSH) older adults are proportionately slower compared to younger adults at harder RT tasks

Question 30

What happens to attention in older age?

Answer 30

• Sustained attention, shifting focus, dividing attention (multitasking) all become harder
• Attention tasks are often done with computer tasks- older adults are less familiar with computers and do not use as much
  The attentional resources theory says that ageing reduces available cognitive resources
  The inhibitory deficit hypothesis says that aging reduces ability to tune out irrelevant information – singling out information that is most important is hard
• Older adults might even do worse in tasks because of the idea that they are worse at memory tasks – self-fulfilling prophecy – problems with cognitive testing

Question 31

whats one way that this decline in cognitive abilities impacts daily activities?

Answer 31

driving

Question 32

how is driving impacted by the decline in cognitive abilities?

Answer 32

• OA more likely to be involved in car accidents involving turns, merging and yielding, so they avoid complex roads
• Driving is impacted by cognitive, sensory and physical abilities
• Driving and aging is impacted by interlinked processes – visual changes, self-concept, social attitudes, availability of other transportation, physical changes
• The current DVLA guidelines assess whether you’re fit to drive based on many elements
• Once you reach the age of 70, your licence expires and you have to renew your licence every 3 years afterwards, so this is essentially self-reporting and regulating your ability

Question 33

how is working memory impacted by the decline in cognitive abilities?

Answer 33

• It can be detrimentally affected by ageing, in verbal and non-verbal information
• Larger declines for spatial WM rather than verbal
• There are cognitive and neural accounts to underlie why WM is limited in older age

Question 34

what kind of memory declines?

Answer 34

episodic memory, false memory, tip-of-the-tongue, prospective memory

Question 35

what kind of memory doesnt decline?

Answer 35

semantic memory, procedural memory, flashbulb memory, autobiographical memory (reminiscence bump)

Question 36

can memory training improve memory?

Answer 36

Brehmer showed that memory training can have positive impacts on WM as well as transfer effects on other things
Gross et al. (2012) showed that there is not one particular memory training strategy that is more effective than others
- Training may transfer to other tests and aspects of cognition
- Training may last for 3 months for some tasks
- The best memory training strategy would be adaptive in difficulty, and would take a multiple strategy approach
- Self-report evidence shows it may impact someones confidence/self-efficacy in their abilities
- Older adults may suffer from negative stereotypes when performing memory tasks and may show a self-fulfilling prophecy

Question 37

what did gross et al. (2012) conclude about improving cognitive function?

Answer 37

• The best improvements occurred when multiple strategies are adopted – such as pharmacotherapy, exercise, nutrition may be more effective than a training program only focusing on one aspect – ageing is biopsychosocial and so the treatment should be too. A healthy lifestyle (exercise and diet) can preserve cognition so should be considered

Question 38

How can social connectivity improve memory function?

Answer 38

Can internet connectivity and training in it for social purposes support the wellbeing of OA receiving care?
- Participants either control (care as normal) or were trained on computer use as well as social applications such as Skype and Facebook
- Cognitive examination and mental health test taken at baseline and post intervention
- The intervention group had a positive effect on cognition, through the indirect positive effects from increased social connection
- The internet social connectivity improved self-confidence and also maintained personal identity strength
 Targeting a social aspect and self-confidence can improve general cognition

Question 39

how can social policy improve cognitive function?

Answer 39

Reinhard et al. (2019)
- They measured total cognitive function, memory, executive function, and processing speed before and after the bus pass was introduced in 2006
- Implementing the free bus pass increased use of public transport, but also benefits to cognitive function in older age!
- Public transport use might promote cognitive health through encouraging intellectually, socially, and physically active lifestyles.
- Transport policies could serve as public health tools to promote cognitive health in aging populations.
 how the social/political climate can impact the adult in the measures they take to improve cognitive function.
 targeting cognition via social mechanisms

Question 40

what is dementia?

Answer 40

• Dementia is a disorder which causes many problems of ongoing decline in brain function: memory loss, thinking speed, language, understanding, mood, disorientation/confusion, difficulty carrying out daily activities
• There are many types of dementia: Alzheimer’s disease (most common), vascular dementia, mixed dementia, dementia with lewy bodies, frontotemporal dementia

Question 41

what is a mild cogntiive impairment?

Answer 41

Mild cognitive impairment (MCI)
- Transitional stage between normal ageing and dementia – may even be a risk stage for dementia
- See slide for criteria of MCI
- Some people with MCI seem to remain stable or return to normal over time, but more than half progress to dementia within 5 years.

Question 42

what is alzheimers disease?

Answer 42

• Progressive cognitive decline usually beginning with impairment in the ability to form recent memories, but inevitably affecting all intellectual functions and leading to complete dependence for basic functions of daily life, and premature death.
• Prevalence rates rise exponentially with age and increase significantly after 65 years
• 7-10 years survival time for those diagnosed earlier than 80, 3 years in 90s
• Early/mild stages, middle/moderate stage, late/severe stage

Question 43

what leads to alzheimers disease?

Answer 43

diabetes, midlife hypertension, midlife obesity, physical inactivity, depression, smoking, low educational attainment
- In the UK, around 1/3 cases of AD may be attributable to these modifiable risk factors, meaning 30% of these cases could be prevented

Question 44

how can physical activity prevent alzheimers disease and cognitive impairment?

Answer 44

Stephen et al. (2017) systematic review
- 18/24 studies reported benefits of physical activity on the risk of AD
- Leisure time was best for reduced risk of AD, whilst occupational and commuting physical activity was less clear – intrinsic motivation in exercise most beneficial (doing it for leisure/pleasure rather than convenience)
- Cognitive impairment, AD, and dementia are known to have a multifactorial etiology, and focusing on physical activity alone may not be enough for effective prevention – a healthy lifestyle is not just physical activity but many aspects

Question 45

why do we need social policy on ageing?

Answer 45

Walker (2018) – we need a social policy on ageing
- Caring responsibilities are changing: the dependency ratio is shifting
- Ageing workforce
- Rising need for long-term care among the very elderly
- The UK has not planned well for this…

Question 46

problems in defining healthy aging?

Answer 46

this involves avoiding disease, being engaged with life, and maintaining high cognitive and physical functioning.
- It is subjective – one’s idea of happiness and healthiness is different from someone elses
- It is reached when a person achieves his or her desired goals with dignity and as independently as possible.
- Interventions to promote successful ageing should therefore be targeted to the individual person – person centered approach

Question 47

what is the problem with co-morbidity?

Answer 47

• Most of the major diseases in the UK are accompanied by additionally diseases- comorbidities
• In older age, people who have diseases who also have 6 or more diseases really increases
• The older you get with a disease  the more likely you are to have other diseases

Question 48

what factors in life course can predict limited functional abilities?

Answer 48

Arthiritis and cerebrovascular disease, smoking, heavy drinking, physical inactivity/sedentary behaviour, depression, social isolation, poor perceived health, SES – being wealthy may help you live longer but not always healthier

Question 49

what are the benefits of physical activity on disorders?

Answer 49

Regular PA reduces risk of: (Gov.uk publication)
- All cause mortality by 30%
- Cardiovascular disease by up to 35%
- Type 2 diabetes by up to 40%
- Colon cancer by 30%
- Breast cancer by 20%
- Depression by up to 30%
- Hip fractures by up to 68%
- Dementia by up to 30%

Question 50

what is aerobic exercise

Answer 50

moderate stress on the heart by working at 60-90% max heart rate

Question 51

what are the physiological benefits of aerobic exercise?

Answer 51

• Improved cardiovascular function
• Maximise oxygen consumption
• Lower blood pressure
• Increased strength, endurance, flexibility, coordination

Question 52

what are the psychological benefits?

Answer 52

• Lower levels of stress
• Better mood
• Increased cognitive function

Question 53

why would someone struggling with functional dependence benefit from aerobic exercise?

Answer 53

• Mortality: less risk of cardiovascular disease, type 2 diabetes, cancer
• Functional independence: increased muscle strength and aerobic fitness
• Cognitive benefits
  Someone at risk of disability/functional dependence would benefit from exercise

Question 54

why do some older adults not do enough exercise?

Answer 54

• Around 1 in 3 (34%) of men and 1 in 2 (42%) of women are not active enough for good health – gender difference here
• People tend to get less active with age
• Linked to poor health/pain/injury, environment, physician advice, and knowledge
• Older adults have more factors that put them off exercising regularly

Question 55

how do we manage pain non-pharmacologically?

Answer 55

• Deep and superficial stimulation of the skin
• Electrical stimulation to spine or pain site
• Acupuncture and acupressure
• Distraction techniques
• Relaxation
• Hypnosis

Question 56

one key problem is that older adults arent always included in medical trials?

Answer 56

• they are more vulnerable to negative side effects which reflects badly on the company
• not able to make as many long-term conclusions
• they may need a higher dosage
• polypharmacy issues – they are taking lots of other medications, they may react differently together
   If we didn’t test older adults we wouldn’t know the generalizability and shouldn’t roll the drug out untested

Question 57

older and younger people differ in how drugs work for them…

Answer 57

¡ Absorption occurs mostly in small intestine – in older adults drugs take longer to get from stomach to small intestine, so by the time they get there, there is less to absorb (and drug less effective)
¡ Distribution through the bloodstream – affected by cardiovascular system. In addition, as we age more portions of the drug remain free and not bound to plasma proteins – meaning they can reach toxic levels
¡ Metabolism removes drugs from the system – this is slower in older adults: again higher risk of toxicity
¡ Excretion also removes drugs – again reduced kidney function with age can lead to slower excretion
 if there are more negative effects in older life then effectiveness of the drug will be reduced

Question 58

medication adherence in older adults

Answer 58

• They may have to take lots of different looking pills at different times and at different amounts which can get confusing
• Complex medication regime hard to stick to, especially with cognitive issues
• The more drugs people take, the more complex it is, and the less likely adherence is
• A combination of patient characteristics (personality, expectations) and contextual moderators (treatment controllability, illness severity) predicts adherence.

Question 59

how does social support impact wellbeing?

Answer 59

Chen & Feeley (2014)
- support from spouse/partner and friends alleviated loneliness
- strain from all the spouse, children, family and friends intensified loneliness – strain from our social relationships can have significant impacts on our wellbeing and loneliness
- higher support and lower strain from various sources directly and indirectly improved well-being, with indirect effects mediated through reduced loneliness.
- We need supportive relationships that are high in quality

Question 60

how does social support impact cognitive function?

Answer 60

Kelly et al. (2017) , 39 studies in a systematic review
- Social activity had a relationship with global cognition and overall executive functioning, working memory, visuospatial abilities and processing speed but not episodic memory, verbal fluency, reasoning or attention
 this is social engagement (leisurely activities that are social)
- Social networks and global cognition but not episodic memory, attention or processing speed;
- Social support and global cognition and episodic memory but not attention or processing speed;

Question 61

How does social support impact physical activity?

Answer 61

Systematic review by Smith et al. (2017)
- Positive association between social support for physical activity (SSPA) and PA levels in older adults, especially when it comes from family members.
- No clear associations were identified between general SS, SSPA from friends, or loneliness and PA levels. – fairly task specific, trends rather than obvious effects.
- SS most closely associated with increased leisure time PA (more than other types of exercise)

Question 62

why can retirement have negative impacts?

Answer 62

• Crisp or blurred withdrawal process
• Effects on the individual
• Effects on society, such as pensions

Question 63

what does successful retirement look like?

Answer 63

• Financial planning
• Staying cognitive and physically busy/active
• Maintaining social relationships
• Volunteering – maintains community ties and important for personal development

Question 64

why are leisure pursuits important in retirement?

Answer 64

• Contribute to sense of identity
• Provide focus and meaning in life
• Help maintain health and cognitive functioning
• Social connections to others
• Physical activity
   Physical activity focused leisure pursuits are especially beneficial: low leisure time PA associated with increased risk of mortality

Question 65

what are the societal impacts of retirement?

Answer 65

• Increased strain on pension plans in society
• Debates about increasing retiring age so people work for longer
• Volunteering

Question 66

what are the advantages of the NHS?

Answer 66

Public spending
- The Commonwealth fund data brief 2020, 2019 shows that we do not have as much public spending as other high income countries
- Despite our lower public spending, our overall performance has remained competitive
- Whilst there is less money invested in the NHS, it is still better performing than other countries
- An incredibly valued service for british people

Question 67

what are the disadvantages of the NHS?

Answer 67

• We have some of the lowest rates of survival for breast and cervical cancer as compared to other western countries (commonwealth fund)
• Also a fairly high rate of excess deaths (not the highest though)
• The UK’s NHS is a massive employer; good in that it provides many jobs but also requires a lot of organisation of resources and people
  Being such a huge organisation requires efficient communication, delivery and organisation of resources and people

Question 68

what are the health and social implications of the increased older adult population?

Answer 68

1. Dementia
   - Whilst the individual risk of dementia is lower, the older population is growing which means that there will be an overall increased projection because the risk increases with age
2. Increased multimorbidity and complex care needs
   - Patients with multi-morbidity see the GP 2.5 times more
   - They require increased demand from the healthcare system
   - More likely to require prescriptions as well

Question 69

why is it a problem that the NHS services are increasingly digitalized?

Answer 69

older adults rely on NHS the most
- yet, this group are the least likely to have high speed internet and access and the least likely to use the internet for home, social, or healthcare use, of all age groups

Question 70

what are the different kinds of social care living situations?

Answer 70

• Residential living facilities: 24 hour supportive care services and supervision to individuals who don’t need skilled nursing or health related care
• Residential homes: medical institutions, with rooms, meals, skilled care, medical services, and protective supervision
• Nursing homes – most intensive nursing care
• Care homes – health related services for those who don’t need hospital or skilled nursing

Question 71

why is social care important in an individuals financial situation?

Answer 71

• It is not free at the point of access, it is means tested
• Plans have been postponed to 2025 to put a cap on costs, and to raise the means test so more people can get free care

Question 72

how is mental health different in older adults compared to younger age groups?

Answer 72

• looking at a range of mental disorders declining over time, the drop off for depression and anxiety is slightly less reduced
• Self-harm has been rising over the last decades for all people, and older adults have showed a slight increase in this
• The reasons for self-harming are slightly different for older and younger people: younger people self harm to relieve feelings whilst it may be more important as a tool for OA to draw attention to their situation like a cry for help
• Older adults do not often reach out to personal connections after a self harm episode – they have less social support

Question 73

prevalence of depression in older adults?

Answer 73

• Some groups of older adults are higher risk for depression
• There are higher rates in nursing home residents (32% score above the cut off)
• There are higher rates of anti-depressant use in another study of care home residents, at around 29%
• But most people taking these anti-depressants are not diagnosed with depression or reporting symptoms
• High increases in anti-depressant use in all groups of OA over time (from 1990 to 2008)
   Raises the question of whether depression is getting swept under the rug

Question 74

how does loneliness impact cognitive function?

Answer 74

Donovan et al. (2017)
- Aged 65 participants
- Assessed loneliness and cognitive function
- Loneliness at baseline predicted heightened cognitive decline accelerated cognitive decline over 12 years independent of other factors. These were socio-demographic factors, social network, health conditions and depression.
 loneliness is incredibly important and can predict negative cognitive consequences if experienced throughout life

Question 75

How does loneliness impact physical health?

Answer 75

Shankhar et al. (2017)
- English Longitudinal Study of Ageing (ELSA) which studies adults over the age of 50 over 2004/2005 to 2009/2010
- This measured loneliness and functional status at baseline and at the follow up
- There was an association between loneliness at baseline and a decrease in gait speed and an increase in difficulties with activities of daily living
 this showed that loneliness was associated with decreased gait speed and a difficulty in doing activities of daily living at a later stage

Question 76

How does experiencing anxiety impact dementia?

Answer 76

• Systematic review of 4 studies
• Clinical anxiety in midlife is associated with later dementia diagnoses, 10+ years later
• For people who experience cognitive symptoms, this can be particularly anxiety provoking

Question 77

How does reducing anxiety impact dementia?

Answer 77

• This study looked at the medical records of mental health services patients, specifically talking therapy patients
• Improvements in anxiety post-treatment was associated with lower dementia risk at the follow up
   Shows the importance of anxiety on dementia

Question 78

how does depression impact dementia?

Answer 78

• Systematic review by Joyce et al. (2019)
• People with depression had a higher risk of subsequent dementia than the general population
• people with depression who take antidepressants are more at risk for dementia than those who are depressed but not using antidepressants
  –> depression increases the risk of subsequent dementia
  –> antidepressants may increase the risk of dementia
  –> medicating depression is not protective from dementia

Question 79

how does physical capability link to depression?

Answer 79

• adults without depression aged 50+ had their hand grip measured at baseline
• this uses the whole arm so somewhat reflects functional capability physically
• they followed this up 7 years later
• at the 7 year point, those who had a better handgrip had a lower risk of depression

Question 80

diagnosing depression

Answer 80

For 2 weeks or more, you need to have:
- Continuous low mood
- Loss of interest in activities
- Significant changes in weight or appetite
- Insomnia or hypersomnia
- Psychomotor agitation or retardation (observed by others)
- Persistent fatigue/loss of energy
- Feelings of worthlessness or excessive guilt
- Diminished concentration or indecisiveness
- Recurrent thoughts of death or suicidal thoughts

Question 81

diagnosing delirium

Answer 81

Cavanaugh & Blanchard-Fields (2018)
- Characterised by confusion and reduced awareness of one’s environment
- Can include difficulties in attention, speech, memory and orientation
- Can affect personality, sleep-wake cycle and perception
- Rapid onset (a day)
- Can be caused by stroke, cardiovascular disease, dehydration, UTIs, medication side effects or medication withdrawal
- OAs particularly susceptible due to taking more medications
- Treatment is to address the cause

• Can be thought of as acute brain failure and is a medical emergency
• Can permanently affect the brain

Question 82

3 types of delirium

Answer 82

Three types:
- Hyperactive delirium. Restlessness, agitation, delusions, and/or aggressive behaviour.
- Hypoactive delirium (most common type). Lethargic, sleepier, fewer spontaneous movements, slowed movements, disinterested behaviour.
- Mixed delirium. Phases of hyperactive and hypoactive delirium

Question 83

types of dementia

Answer 83

• Alzheimer’s Disease (most common)
• Vascular dementia
• Parkinson’s disease
• Huntingdon’s disease
• Alcoholic dementia
• AIDS dementia complex
• Lewy Body

Question 84

alzheimers disease

Answer 84

Cavanaugh & Blanchard-Fields (2018)
- Causes rapid brain cell death, particularly in the hippocampus. Results in brain shrinkage
- Major symptoms include cognitive decline, memory loss, difficulty in dealing with everyday problems, difficulty completing familiar tasks, confusion with time and place, trouble understanding visual images (reading), poor judgment and personality changes
- Symptoms are vague to begin with
- Emotional problems are common
- Eventually unable to perform self-care
- The speed of deterioration varies significantly between people
- Personality changes can be particularly different for people around the patient, such as their family members
- The individual may not recognize their symptoms

Question 85

why is it hard to differentiate between the 3?

Answer 85

• OA tend to under report psychological problems so making accurate diagnoses can be hard
• Older adults suffer more with physical problems and these may manifest as symptoms as depression, such as low energy levels – inactivity and sleeping more
• The early symptoms of depression and dementia are similar, such as forgetfulness and being distracted
• Delirium and dementia also overlap in their symptoms

Question 86

what is bereavement

Answer 86

the fact and experience of having lost a loved one to death

Question 87

what is grief?

Answer 87

emotional, physiological, cognitive, and behavioral responses to a loss caused by bereavement

Question 88

what is mourning?

Answer 88

emotional, physiological, cognitive, and behavioral responses to a loss caused by bereavement

Question 89

what is prolonged grief disorder?

Answer 89

• Following the death of a partner, parent, child, or other person close to the bereaved, there is persistent and pervasive grief response characterised by longing for the deceased or persistent preoccupation with the deceased accompanied by intense emotional pain (e.g. sadness, guilt, anger, denial, blame, difficulty accepting the death, feeling one has lost a part of one’s self, an inability to experience positive mood, emotional numbness, difficulty in engaging with social or other activities).
• More than 6 months minimum
• Exceeds the expected social, cultural or religious norms for the individual’s culture and context.
• The disturbance causes significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

Question 90

main difference between grief disorder and depression

Answer 90

Symptoms are specifically focused on the loss of the loved one, whereas depressive thoughts and emotional reactions typically encompass multiple areas of life

Question 91

Study showing different antecedents leading to depression or prolonged grief

Answer 91

• Sample of widowed women, mean age 69.44
• Interviewed 6 months after bereavement
  1. Relationsip quality with spouse predicted  yearning for spouse
  2. Social support predicted  depression and negative emotions
   higher relationship quality leads to more yearning for spouse, and lower social support leads to more depression