Old Age Psychiatry

Question 1

Differentials for anxiety:

Answer 1

Generalised anxiety disorder
adjustment disorder
mixed anxiety and depression
dementia/cognitive impairment
organic causes

Question 2

Carers - Age UK
….m carers aged 65 and over, 417,000 of whom are aged 80 and over
Kings fund - more than one … of carers who are living with the care recipient provide care for 100 or more hours a week
Young et al 2005 - propensity to become a carer may be … in some ethnic groups - bangladeshi, pakistani and indian

Answer 2

2m carers aged 65 and over, 417,000 of whom are aged 80 and over
Kings fund - more than one fifth of carers who are living with the care recipient provide care for 100 or more hours a week
Young et al 2005 - propensity to become a carer may be higher in some ethnic groups - bangladeshi, pakistani and indian

Question 3

Symptoms self reported by carers - maher and green 2002

Answer 3

feeling both tired and stressed, being short-tempered, feeling depressed, disturbed/loss of sleep

Question 4

Issues associated with long-term caring - Hirst 2005, Keeley and Clarke 2002

Answer 4

Anxiety and depression
reduced social functioning
increased susceptibility to physical illness
reduced physical well-being

Question 5

What are the two types of delirium?

Answer 5

Hyperactive delirium:
Agitation, delusions, hallucinations, wandering, aggression
Hypoactive delirium:
Lethargy/drowsiness, slowness with everyday tasks, excessive sleeping, inattention
hypoactive delirium is often missed

Question 6

Old age psychiatrist - what symptoms in HPC?

Answer 6

Course/onset of symptoms: gradual or sudden, fluctuating or stable, triggers/variability, who noticed onset?

Question 7

Important considerations when prescribing in old-age psychiatry

Answer 7

• Drug metabolism/absorption/excretion
• Polypharmacy more likely
• start low, go slow
• consider side effects more carefully especially in patients with co-morbidities
• elderly are particularly sensitive to anticholinergic side effects, including constipation, urinary retention, delirium, cognitive impairment, dry mouth and glaucoma
• elderly are especially sensitive to extra-pymaridal side effects
• caution in prescribing in patients with parkinson’s disease

Question 8

How can we differentiate delirium/dementia/psychotic illness and depression when they have overlapping symptoms?

Answer 8

Question 9

Loneliness and isolation in older people

Answer 9

3.8 million older people live alone

5-16% older population is lonely

10% over 65 lonely most or all of the time