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Psychosocial Aspect Of Older Adults Flashcards

1
Q

Mental health risks in nursing homes

A

Abuse, neglect, involuntary seclusion, somatic disease, psychiatric comorbidities, cognitive decline, poly pharmacy, extrapyramidal symptoms, adverse side effects of psychotropics

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2
Q

Extrapyramidal symptoms

A

Movement dysfunction such as dystonia, tardive dyskinesia, bradykinesia, tremors, rigidity, akathisia (feeling restless, need to move), parkinsonism

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3
Q

Consequences of inattention to mental health

A

Physical: somatic and health challenges, cog decline, polypharm and adverse side effects of medication, accelerated molecular brain aging, decreased physical function

Social/emotional: psychiatric comorbidity, barriers to accessing health care, stigma and discrimination, financial difficulties/decreased income

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4
Q

Depression statistics

A

17% of US population, 50% of older adults, more women

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5
Q

Reactive depression

A

Neurotic or exogenous depression, linked to significant life event
-loss of spouse
-loss of (I)
-new dx

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6
Q

Psychotic depression

A

Endogenous or unipolar depression, associated with previous experiences at a younger age, frequent h/o psychiatric illness, signs of institutionalism, frequently misdx as dementia

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7
Q

Paraphrenia

A

Delusions of persecutions with auditory hallucinations, preoccupied, suspicious, aggressive behaviors

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8
Q

Geriatric depression

A

Men experience different sx (memory complaints), older men have the highest suicide rates

Geriatric depression leads to:
Increased ED/dr visits
Use more medication
More outpatient charges
Increase LOS in hospitals

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9
Q

Life satisfaction

A

Self-evaluation of one’s life as a whole, influenced by socioeconomic, health, environmental

Decreased life satisfaction = increase risk of risky behaviors (smoking, drinking, inactivity), increased risk of obesit

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10
Q

Frequent mental distress effects

A

Interferes with eating well
Maintain home
Ability to work
Sustaining relationships
Inactivity which leads to poor health

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11
Q

Risk factors for late onset depression

A

Widowhood
Physical illness
Low educational attainment (less than hs)
Impaired functional status
Heavy alcohol consumption

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12
Q

Anxiety

A

Uncontrolled feelings of panic, fear, and apprehension, obsessive thoughts, reactions that are disproportional, restlessness, trouble with memory and focus, insomnia, nightmares, refusal to engage in activities, ritualistic behaviors

Underdx in older adults

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13
Q

Generalized Anxiety Disorder

A

Most common, constant worrying about many things, fearing worst in every situation, feeling a lack of control over emotions

More prevalent in those who experienced divorce, separation, loss of spouse

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14
Q

Social anxiety disorder

A

Extreme nervousness and self consciousness in everyday scenarios involving others

Marked by:
Fear of judgement
Avoidance of social situations
Difficulty making friends

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15
Q

Phobia

A

Avoidance of specific situations or objects due to an extreme fear of something that poses a perceived threat

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16
Q

OCD

A

Experiencing unwanted recurring thoughts and obsessions

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17
Q

Schizophrenia

A

Increase risk of dementia, prevalence expected to double

Symptoms different in older adults: fewer active positive symptoms (hallucinations/delusions), more passive symptoms (lack of initiative/interest, severe cognition, decreased memory/recall and naming abilities)

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18
Q

Alzheimer vs Schizophrenia

A

Alzheimer delusions are persecutory, theft, incidental VS schizophrenia delusions are persecutory and though control

Alzheimer hallucinations are more visual VS schizophrenia hallucinations auditory more commin

Alzheimer’s presents with flattened affect, avolition, apathy, poverty of speech/thought VS schizophrenia presents with disengagement and apathy

Alzheimer family h/o =alzheimer’s d/s VS schizophrenia family h/o = major
Mental illness

Alzheimer’s trajectory is progressive declining with aging VS schizophrenia trajectory fluctuates

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19
Q

BIPOLAR D/O

A

Often mistake with anxiety/depression

late onset bipolar d/o (LOBD) = older adults experiencing manic episode

Early onset Bipolar d/o (EOBD) = older adults with ling standing clinical h/o bipolar d/o

No difference in mortality between the 2

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20
Q

Clinical features of late onset Bipolar D/o

A

Increased premorbid psychosocial fxn
More affective episodes
Less severe psychopathy
Cognitive impairment
Mood reactivity
Increased appetite/weight gain
Extrapyramidal symptoms
Increased episode duration or chronicity increases with age at onset, hypersomnia
leaden paralysis
decreased mental flexibility

Increased rates of alcohol d/o, GAD and panic disorder
Sensitivity to interpersonal rejection
Increased risk of suidied
CVA 2x more likely
Increased prevalence of mixed eoisodes

Decreased psychomotor speed, selective attention, visual memory, verbal fluency, executive functioning, psychosocial fxb

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21
Q

Dx associated with LOBD (late onset bipolar d/o)

A

TBI, epilepsy, brain tumor, encephalitis, cerebral infarctions

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22
Q

Common factors leading to suicide in older adults

A

Older adults plan suicide more carefully with more lethal methods

Loss of self-sufficiency and (I)
Cognitive impairment
Chronic illness/pain
Decreased QOL
Financial troubles 2/2 financial stressors
Grief & bereavement over the loss of loved ones

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23
Q

Warnings of suicide

A

1)Loss of interest that were previously enjoyable
2) giving away prized possessions/changes will
3) lack of concern for personal safety
4) preoccupation with death or discussion of death
5) neglecting self-care, medical regimens, personal grooming
6) avoiding social activities and isolating themselves from others

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24
Q

Strategies to decrease risk of suicide in older adults

A

Restrict access to lethal means (firearms, prescriptive meds)

Increase protective factors: social networks, positive coping skills, access to mental healthcare, meaningful engagement in activities

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25
Q

Post suicide strategies

A

Aim to reduce the risk of further suicides
Provide resources for grief

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26
Q

PTSD

A

Re-experiencing of traumatic events, avoidance of triggers, reckless behavior, negative thoughts/mood

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27
Q

Causes of PTSD

A

Sexual/physical assault
Pre-existing psychiatric/personality disorder
Minority status
Decreased education level
Socioeconomic factors
Family hx
Gender (women more likely)

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28
Q

Factors impacting PTSD in older adults

A

Life altering situation
Role loss
Function loss
Retirement
Increased health problems
Decreased sensory abilities
Decreased income
Loss of loved ones
Cognitive impairment
Decreased social suppory

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29
Q

PTSD OT intervention

A

Self-reflection through expressive thoughts (dance, drawing, role playing)
Creative coping strategies
Participation in meaningful occupations (increase role competence, promote wellness, and increased QOL)

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30
Q

General PTSD tx

A

Trauma-focuser talk therapy
Prolonged exposure
Cognitive processing therapy
Eye movement desensitization reprocessing
Medication: SSRIs, SNRIs ie sertraline and paroxetine, SNRI Venlafaxine

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31
Q

Personality disorders

A

Enduring patterns of inner experience and behavior that deviates from expectations of individual’s culture, pervasive, and inflexible

Onset adolescence or early adulthood, stable over time leading to distress and impairment

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32
Q

Personality disorders in older adult

A

More common in men
Common types in women are paranoid, avoidant, and dependent

Easily overwhelmed by age related loss/stressors
Long standing pattern of maladaptive interpersonal behavior

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33
Q

Increased risk associated with personality d/o in older adults

A

Stroke
Heart D/S
Mortality rate
Obesity
Being underweight
Smoking
Alcohol use D/O
DM
Arthritis
GI D/O

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34
Q

OT role in tx personality D/O

A

Developing adaptive skills to manage symptoms and engage in daily activities

Emotional regulation, problem-solving, communication skills

Facilitate social activities and develop meaningful relationships ie group therapy

Sensory modulation therapy, sensory integration techniques, increased attention, deep pressure, brushing

ADLs

Environmental mods

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35
Q

Cluster A Personality Disorders

A

Odd or eccentric
Paranoid personality
Schizoid personality
Schizotypal

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36
Q

Paranoid personality

A

Pattern of distrust and suspiciousness that other’s motives are malevolent

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37
Q

Schizoid personality

A

Pattern of detachment from social relationships and restricted range of emotion, appears cold and indifferent

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38
Q

Schizotypal personality

A

Pattern of acute discomfort in close relationships, cognitive/perceptual distortions, and eccentricities of behavior, odd perceptual experience and social anxiety

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39
Q

Cluster B personality Disorders

A

Typically dramatic, emotional, or erratic and evokes reactions in others
Antisocial personality
BPD
Histrionic personality
Narcissistic personality

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40
Q

Antisocial personality disorder

A

Pattern of disregard and violation of rights of others

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41
Q

Borderline Personality Disorder (BPD)

A

Pattern of instability in interpersonal relationships, self-image, and affects. Marked impulsivity, intense with relationships, fear of abandonment, self harm and suicide

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42
Q

Histrionic personality disorder

A

Pattern of excessive emotionality and attention seeking, constant need for attention, seeking emotional soothing, can’t self sooth, may be overly sexual, dramatic, provocative behavior, rapidly changing emotions, thinks relationships are grander/closer than they are

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43
Q

Narcissistic Personality D/O

A

Pattern of grandiosity, need for admiration, lacks empathy, believe they are more important

In LTC may look like the pt who thinks they should come first, fantasy about power, success, attractiveness, exaggeration of achievements, expectation of praise

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44
Q

Cluster C personality D/O

A

Traits of anxiety and fearfulness, goes under notice bc not as emotionally provoking as cluster B

Avoidant
Dependent
OCD

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45
Q

Avoidant personality D/O

A

Social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation, take criticism hard, stay to themselves, avoids activities

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46
Q

Dependent Personality D/O

A

Submissive and clinging behavior related to an excessive need to be taken care of, need to be cared for vs histrionic which is need to be soothed, asks for more help than they need, fear of having to do self care, difficulty starting on own without others, fear of disagreeing, tolerance of poor treatment

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47
Q

OCD

A

Pattern of preoccupation with orderliness, perfectionism, control, rigid, inflexible, keep broken objects, need to fix

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48
Q

What do different personality d/o have in common?

A

Difficulty with relationships
Restlessness
Anxiety/risk of depression
Difficulty in social situations
Trouble making decisions
Difficulty trusting others
Afraid of rejection

Difficulty maintaining relationships due to poor coping mechanisms

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49
Q

Common interactions of people with personality disorder

A

Acting out, denial, splitting, devaluation, idealization, help-rejecting, complaining

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50
Q

Personality Disorder Interventions

A

Psychotherapy, medication, behavior management

Supportive strategies include clear communication, team support, consistent approach amongst all team members, boundary/limit setting

SBAR situation background assessment recommendation

Ongoing health plan not just crisis based

Take turns treating to limit staff burnout

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51
Q

Guidelines to support Personality Disorder

A

Id problem-> gather info -> what happened before the problem-> set the realistic goals -> reward self and others for achieving goals-> continually assess/modify plan -> alter your (provider) behavior->change environment -> revisit expectations

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52
Q

Psychotropics prescribed to older adults

A

Antipsychotics, antidepressants, anxiolytics, antilepileptics, anti Parkinsonian drugs, dementia mgmt

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53
Q

Negative aspects to psychotropics

A

Leads to decreased QOL in 80%
Adverse effects including mental status
Cardiovascular exacerbation
Tardive dyskinesia
Hypotension
Above leads to increase risk of falls and fxs

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54
Q

Positive aspects of psychotropics

A

Symptom management: stabilize mood, decreased agitation, increased sleep, alleviate distressing thoughts

increase social/occupational function: manage symptoms to increase engagement in meaningful occupations =increased well being

Facilitates engagement in therapeutic interventions

Crisis intervention: provides immediate relief and stabilizes mental health

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55
Q

Social determinants of health (SDOH)

A

Conditions in the environments where individuals are born, live, learn, work, play, worship

Addressing SDOH decrease health disparities

SDOH accounts for 60% of population health out omes

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56
Q

5 domains of Social determinants of health

A

education access/quality: increase education more likely to be healthier

Economic stability: more stability leads better health, low incomes leads to less healthy foods, injury leads to less job opportunities

Social and community context: increase social support combats risk factors

Neighborhood and built environment: major impact on health ie high rates of violence, unsafe air, unsafe water, racial/ethnic groups with low incomes increases health risks

Healthcare access

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57
Q

Healthy People 2030

A

Providing high equality education
Helping people get social support
Improving access to to quality and timely healthcare

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58
Q

Elder abuse

A

1 in 10 (neglect and exploitation)
Men have higher rates of both nonfatal assaults and homicides (75% and 35% in women)

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59
Q

Steps to reporting abuse

A

Id whether abuse is occurring through observation and speak to older adult about possible presence of abuse

Assess risk: is situation emergency vs non emergency and take action

Document

Report to state and organizational policies for reporting

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60
Q

Loneliness and social isolation

A

35% of adults older than 45 experience social isolation

Leads to depressive symptoms, decline in cognition, drinking alcohol, fall risk, lack nutrition, hospital readmission, infectious disease, and increased mortality rate, stroke, htn, cardiovascular d/s, obesity, suicide ideation, progression of dementia, premature death

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61
Q

Identifying loneliness

A

Revised UCLA loneliness scale
De Jong Gierveld Loneliness Scale
Single item scale

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62
Q

Interventions for loneliness

A

Improve social skills (nonverbal/verbal communication, CBT)

Increase social support (friendly visitor, virtual connections, meal delivery, in home support)

Increase access to social interactions: telephone outreach, online chat, hearing aids , transportation services, social activities

Change unhelpful thoughts about social situations CBT

OT intervention: access available resources, facilitate social networks, address architectural barriers

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63
Q

Loss 6 types

A

Encompasses various aspects of life and significantly impacts mental health

Material: lost possession (item/income)
Relationship: change in social status
Intrapsychic: loss of self image due to bereavement, completion of task or failure
Functional loss: loss of autonomy, occupational deprivation
Role loss: retirement, acquiring new roles, responsibilities (becoming a patient)
Systemic loss: loss of function within an existing system, retiring or illness impact on function in family

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64
Q

PTSD impact on occupation

A

Struggle to perform self car, experience sleep problems, face community mobility challenges, difficulty with meal plan and financial planning

Limitations in driving lead to ability to engage in work or productive activities

Leisure: decreased interest/motivation

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65
Q

Differences between older/younger PTSD

A

Less prevalent in older than younger veterans
Older vet c2o somatic symptoms (appetite, sleep, memory)

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66
Q

Iate onset stress symtomatology

A

Development of increased thoughts and reminiscence about emotional response

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67
Q

UCLA Loneliness Scale

A

3 questions, developed for providers, short/academically rigorous, simple score, negative wording

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68
Q

Campaign to End Loneliness

A

3 questions, positive wording, for service providers, short sensitively worded tool

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69
Q

De Jong Gierveld Loneliness scale

A

6 questions mixed positive and negative wording
For researchers
Distinguishes between different causes of loneliness

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70
Q

Single item scale

A

Scale for loneliness
1 question
Negative wording
Used for researcher

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71
Q

Kubler-Ross Grief Cycle

A

Denial: disbelief, numbness, struggling to accept reality of loss

Anger

Depression

Bargaining: pleading, asking for loss to be reversed, blaming loss on something you cannot control

Acceptance: accommodating and adjusting to new reality, living with the loss

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72
Q

OT settings in Mental Health

A

Acute, LTC, forensic/juvenile justice centers, hospitals, residential/day programs,SNF, schools, community-based mental health centers, employment programs, military, private practice, outpatient, opioid treatment programs, preventative health, certified community behavioral center

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73
Q

Barriers to OT mental health services for geriatrics

A

Limited resources
Inadequate alternatives
Decreased # of OTs
Need for improved knowledge base in OT
Need for QA methods
Underutilization of mental health services by elderly

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74
Q

Things to consider when choosing activity to improve engagement in older adults with SMI

A

Engagement: Reduces wandering
Reduces need for restraints

Fear of failure leads to avoiding activity so grade for success for sense of productivity, focus on continuing roles (homemaking/religious role in facility)

Base on client’s motivation
Task simplification for participation and success

Risk of agitation, activity will inform what precipitates agitation and aggressive behavior/catastrophic reactions then educate staff on triggers

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75
Q

Dementia group: increasing engagement

A

Goal is to maximize use of time
Use clear directions, concrete cues, and specific first step instruction
Compensate for mistakes rather than draw attention/minimize consequences of mistake due to fear of failure leading to activity avoidance

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76
Q

Benefits of groups for dementia

A

Engagement in activity
Enhance integrity
Monitor functional level secondary to psychotropic medication titration
Preserve autonomy
Increase safety
Reduce wandering behavior
Reduce use of restraints

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77
Q

Individual placement and support model

A

Supported employment

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78
Q

OT intervention for SMI

A

Teach and support coping strategies and symptom management
ID and develop habits, rituals, and routines
ID personal values and goals
Support creation of wellness recovery action plan
Provide info on community based resources
Info on monitoring health concerns
Increase ability for long term planning

79
Q

3 tiers of services for mental health: tear 3

A

Intensive, used with identified mental, behavioral and emotional disorders

Settings: inpatient behavioral health, community mental health, alternative/public schools, home based, residential/organizational work places

80
Q

Tier 3 types of interventions/services

A

CBT, motivational interviewing, stress reduction, trauma-informed care, DBT, supported employment/education, sensory strategies, normative life roles, community integration, social skills promotion groups, ID health habits/roles/rituals/routines, functional assessments, occupational engagement to reclaim mental health and QOL, Recovery model

81
Q

Recovery Model

A

Focuses on enabling persons with Mental health challenges through client centered process to live a meaningful life, empowering individual to maintain control over theirs lives than just striving for pre-illness state

Holistic approacg
Self management strategies to increase efficacy than models just focused on physical health

Emphasizes self-discovery, personal growth, goal setting

82
Q

3 tiers of services for mental health: tier 2

A

Targeted services, at risk individuals to prevent mental health problems, individual may not have formal ID’ed mental health Disorder

Settings: hospitals, clinics, schools, residential/home, and community based environments

83
Q

Tier 2 services

A

Occupational engagement focused
Decrease early symptoms
Small therapeutic groups, environmental modifications to increase participation, modification of expectations vs expected task, coping skills, social/emotional competencies, strategies transitioning and re-entry into community

84
Q

3 tiers of mental health services: tier 1

A

All individuals with or without mental health/behavioral problems
Universal programs that promote mental health
Educational and teaching strategies
Development of coping strategies such as yoga, self-regulation, and mindfulness
Mental health literacy

85
Q

Early signs of mental illness in older adults

A

Trouble remembering things, frequent mood changes, social withdrawal, changes in personal care, changes in appetites, physical complaints, lack of interest, expressing negative thoughts, unusual behaviors

86
Q

6 steps to integrating theory to intervention: therapeutic reasoning

A

1) generate clinical ? Based on concept of the a model
2) collect info from person
3) creating a picture of thats person’s experience
4) working with person to generate intervention plan, goals, and strategies
5)implementing plan
6) evaluate outcomes

87
Q

Purpose of assessments

A

Establish a baseline
Document changes
Provide clinical observation
Mark progress
Assist in client centered planning
Generate evidences
Serve as outcome measures

88
Q

MMSE: mini mental status exam

A

Cognitive function including orientation, attention, memory, visual spatial skills, language

89
Q

Short portable mental status questionnaire

A

10 item questionnaire used to assessed cognitive function, designed for quick administration
0-2 intact
3-4 errors mild
5-7 errors moderate
8-10 errors severe

90
Q

Executive function performance test

A

Person’s ability to perform real world tasks that require cognitive skills including cooking, telephone use, and med mgmt

Top down approach that shows amount of assist needed for task completion, individuals capacity for independent function, executive function impace

91
Q

Executive function performance test tasks

A

Performed in order
Handwashing (if unable to follow do not proceed)
Oatmeal prep
Telephone use
taking medication
Paying bills

92
Q

Allens Cognitive screen

A

3 craft based tasks, leather lacing stitches to assess learning and problem solving

93
Q

Routine task Inventory RTI

A

Part of Allen’s Model of Cognitive Disability, semi-standardized, 25 ADLs and IADLs
4 subscales—> physical adls, community IADLs, communication, and work readiness

Direct observation in naturalistic context/perception of performance by client/caregiver, associated with 6 levels of ACO

94
Q

allen diagnostic module

A

Battery of 34 standardized assessments of cognitive abilities needed for ADLS, leisure, or work tasks, craft based for new learning and problem solving

Verify results of ACLs

95
Q

Allen’s Cognitive level 0

A

Reflexes/coma

96
Q

Allen’s Cognitive Level 1: automatic

A

Withdraws from noxious stimuli, responding to one sensory stimulus, locating stimuli, rolling in bed, raising a body part

97
Q

Allen’s Cognitive level 2: postural actions

A

Sitting, righting reactions, standing, aimless walking, directed walking, using grab bars

98
Q

Allen’s Cognitive level 3: manual actions

A

Grasp, distinguishing objects, sustaining actions on an object, noting effects on objects, using all objects

99
Q

Allen’s cognitive level 4: goal directed

A

Sequencing familiar actions, differentiating features of objects, completing a goal, personalizing features of objects, learning by rote memorization

100
Q

Allen’s Cognitive level 5: exploratory

A

Comparing and changing variations in actions/objects, discriminating among sets of actions/objects, self-directed learning, social standards, consulting others

101
Q

Allen’s Cognitive level 6: planned

A

Typical functioning adults

102
Q

Cognitive Performance Test

A

Initially developed to assess Alzheimer’s disease and dementia

Intact 5 or 6 to profound disability level 2

103
Q

Montreal Cognitive Assessment MOCA

A

30 point questionnaire to assess cognitive decline in memory, attention, and language

104
Q

Beck’s Depression Scale

A

21 questions self report inventory
Clinical research, used with those diagnosed, self report of depressive symptoms

105
Q

Elder depression scale

A

Self-report measure to identify depression in older adults

106
Q

Hamilton Depression Rating Scale HDRS

A

Multiple item questionnaire, indication of depression and guides recovery

107
Q

Weekly Calendar Planning Activities WCPA

A

Assesses executive functioning, ability to plan or organize activity for a week
10-18 appointments/errands
Need to adhere to rules, monitor time, and manage conflicts

Assesses mild executive function deficits for those I with IADLs, not rated but direct observation in performance wrrors

108
Q

Weekly Calendar Planning Activity applicable population

A

Ages 12-94: TBI, MS, Brain tumor, parkinson’s disease, stroke, MCI, Cancer, renal/cardiac disorders, COPD, Lupus, RA, DM, autism, ADHD, CP, schizophrenia, BD, depression, substance abuse, PTSD, community dwelling adults

109
Q

3 levels of Weekly Calendar Planning activity based on age and cognitive ability

A

Level 1- organize checklist with cues, preplanning not required
Level 2- unorganized list of appointments, no curs, pre planning required
Level 3- paragraph of appointments with irrelevant info included, need to sort out relevant infor

110
Q

WCPA short form

A

Level 2 weekly Calendar Planning Activity, frequently used in inpatient setting due to tome constraints, 10-15 minutes

Semi-structured interview s/p task to see insight

Self-rating of awareness, performance, and strategies

111
Q

Hamilton Anxiety Scale

A

Quantify severity of anxiety symptoms, psychotropic drug evaluation

112
Q

Schroeder-Block Campbell Adult Psychiatric sensory integration evaluatio

A

Sensory processing assessment, physical/motor functioning including abnormal movement disorders process vs medications
Coordination, grip, diadochokinesis, gait, neck ROM, posture

Draw 2 circles

113
Q

Adolescent and adult sensory profile

A

Family of self-report tools that evaluate behavioral responses to everyday sensory experiences, quantifying 60 items
Age 11+
Taste/smell, movement, visual, touch, activity level, and auditory

15 items each quadrant: low registration, sensory seeking, sensory sensitivity, sensory avoiding

Represents patterns of sensory processing, Dunn’s Model of Sensory Processing

114
Q

Dunn’s Model of sensory processing

A

Neural regulation occurs as a balance of excitation and inhibition which creates thresholds for responses

115
Q

Goal Attainment Scale

A

Assesses performance/roles, formulating/tracking individualized goals

Scales goal; much less than goal, less than goal, expected outcome, more than goal, much more than goal

116
Q

Activities Health Assessment

A

Performance/roles, assesses ability and confidence to perform various ADLs
Time usage
Patterns
Roles
Skills
Habits
Configuration of activities

Color coded chart of how time is spent during the week, questionnaire and interview

117
Q

Canadian Occupational Performance Measure

A

Detects client’s self-perceived change in occupational performance overturn setting intervention goals

118
Q

Occupational Case Analysis Interview and Rating Scale (OCAIRS)

A

Structured to gather, analyze, and report data on individual’s occupational participation, describes hx and performance

119
Q

Occupational Performance History Interview (OPHI)

A

MOHO, semi-structured interview to explore client’s life hx in areas of work, play, and self-care

120
Q

Role Checklist

A

MOHO based, asseses client’s perception of roles and value in role in their role, self report survey, not normed based

10 roles:
Student
Worker
Volunteer
Caregiver
Home maintainer
Friend
Family member
Religious participant
Hobbyist
Participants in organizations

Select roles and rate satisfaction on 4 point likert scale

121
Q

Occupational elder abuse checklist

A

Tool used to identify elder abuse

122
Q

Occupational experience profile

A

Semi-structured interview to help clients identify their occupational
History, patterns, values, interests, personal causation (MOHO)

123
Q

Activity Card Sort

A

Assesses individuals participation in 20 Instrumental activities, 35 low physical demand leisure, abd 17 high physical demand leisure, and 17 social activities

Level of engagement and if activity has been discontinued, 60+ years

124
Q

Social community integration scale

A

Degree which individuals with chronic conditions are integrated into their community

125
Q

Performance Assessment of selfcare skills PASS

A

Assesses functional tasks needed to live independently in the community, 26 core tasks in 4 domains

Criterion referenced, performanced base

126
Q

4 domains of the performance Assessment scale

A

Functional mobility, BADL, IADLs with physical emphasis, and IADL with cognitive emphasis

127
Q

Emotional Regulation Questionnaire

A

Psychological assessment, assesses individual’s tendencies to regulate emotion in cognitive reappraisal and expressive suppresion

128
Q

Satisfaction with Life Scale

A

Measure of life satisfaction, subjective well-being, psychological assessment

129
Q

Independent living scale

A

Assesses client’s ability to perform tasks related to independent living, weighted score , 65+ age, dementia, MR, TBI, psychiatric disorders

130
Q

5 scales of Independent Living scales

A

1) memory orientation
2) managing money
3) managing home/transportation
4) health and safety
5) social adjustment

131
Q

Mental Health Continuum Short form

A

Self-report measure that assesses emotional, psych, and social well being

132
Q

Test of grocery shopping skills

A

Performance base measure on client’s ability to shop
For groceries efficiently and accurately

Population: mental illness, developmental disability, tbi

133
Q

Nonstandardized therapeutic writing

A

Informal psych assessment, encouraged expression to increase understanding of feelings, experiences, and thoughts to facilitate healing and personal growth

134
Q

Leisure education programs

A

Increase social participation, decrease stress, improve psychological well being, and provide meaning in daily, decreases decline in cognition, And physical dysfunction

135
Q

Exercise, weight loss, and relaxation as interventions for mental health

A

Tai Chi improves depressive sx

Exercise shows positive results for schizophrenia, anxiety, and dementia

Yoga positive for schizophrenia and anxiety, mixed research for depression

Relaxation increases psychosocial well being

136
Q

Behavioral interventions for mental health

A

More effective in improving depression and sleep quality

137
Q

CBT groups

A

Focus on thought challenging, problem-solving, behavioral social skills training (seeking social supports)

138
Q

Functional Adaptation skills training (FAST)

A

Social skills training in Communication, transportation, medication management, social skills, organization, planning, and financial management

139
Q

Helping Older People Experience Success (HOPES)

A

Psychosocial skills and preventative healthcare management

140
Q

Adl and IADL groups

A

Independent living skills including nutrition, cooking, gardening, money management, transportation, social/leisure

Cooking increase psychosocial well being, socialization, self-esteem, QOL

141
Q

Community reintegration groups

A

Woodwork

142
Q

Leisure group

A

Arts, crafts, woodworking

143
Q

Reminiscence group

A

Group collage, life story book, life review through writing/oral story telling

Decreases depressive symptoms and risks of Alzheimer’s disease

144
Q

Sensory awareness and stimulation group

A

Feeling oriented discussion, role playing, poetry, music snoezelen

145
Q

Snoezelen

A

Controlled multisensory environment
Placing individual in soothing stimulating environments

Reduces agitation and anxiety
Promotes engagement and communication

146
Q

Coping skills group

A

Reality oriented discussion groups, transactional analysis, assertiveness training, role playing

147
Q

Validation therapy

A

Validity and dignity to feelings expressed by disoriented clients who no longer benefit from reality orientation, resolves past conflicts, uses empathy

148
Q

Sensory integration group

A

Weighted blankets decrease anxiety and stress

149
Q

Anxiety management group

A

Relaxation techniques

150
Q

Self-expression group

A

Art, collages, role playing, self awareness exercises

151
Q

Intergenerational programs

A

Engage different generations in planned activity to increase meaning and purpose

152
Q

Foundations of therapeutic use of self

A

Establish rapport
Respect client’s wishes
Maintain personal honesty
Strong communication skls
Person centered strong listening skills
Instill sense of security
Nonjudgmental feedback
Acknowledge mistakes

153
Q

Inter-profession intervention models

A

Prevention/early intervention: short term mental health tx, mild to moderate issues, prevent exacerbation and increase QOL

Collaborative Care Model: team based evidence based dx, tx, and follow up with mental health concerns “primary setting

154
Q

Collaborative Care Model

A

Used with Substance abuse, improves access, clinical outcomes, pt satisfaction, cost-effective

Components:
Team (PCP, care manager, psych consult, therapy)
Population Based Care: proactively manages pt’s with condition in a practice
Measurement based tx: tx determined by quantitative assessment of clinical status, standardized tools
EBP
Accountable care: practitioners accountable for quality of care and pt’s outcome

155
Q

Trauma informed care mod

A

Assists practitioners in understanding interconnected factors contributing to an individual’s trauma

Examples racism, prejudice, bias

Prolonged exposure to trauma leads to chronic health conditions, DM, chronic pain, heart disease, cognitive decline

Goal: create safe space/avoid retraumatizatiin

156
Q

6 Key principles of trauma informed care

A

1) safety: client to feel secure and comfortable in therapeutic relationships and settings
2) trust worthiness and transparency: rapport, building trust is critical, communicate clearly to improve comprehension of tx process
3) peer support
4) collaboration/mutuality: shift from traditional power dynamic, shared decision making, partnership
5) empowerment voice/choice: check in, ask for permission, seek client’s opinion
6)cultural, historical, and gender issues: be aware of discrimination, marginalization can impact suicidality

157
Q

3 phases of traumatic stress program

A

Phase 1: safety planning, coping skills, wellness recovery plan
Phase 2: addresses losses, boundaries, self-esteem, guilt, and forgiveness
Phase 3: engagement in meaningful occupations and post traumatic growth and resilience

158
Q

Acceptance and commitment therapy in trauma informed care

A

Psychological flexibility, being present and open to experience, taking action guided by values

Decreases PTSD sx

159
Q

BioPsychosocial Model

A

Biological, psychological, and sociological

Fight: combative, struggling for personal power, may appear non-compliant

Flight: tx resistant, may appear uncooperative, disengaging

Trauma response: adaptation may come out in therapy

160
Q

Lawton’s Environmental press theory

A

Behavior is communication
Adaptive functioning depends on interaction between stimuli and pt’s capacity

161
Q

Trauma brain

A

Dysregulated behavior due to more emotional brain than thinking brain less engaged

162
Q

Ways to help someone regulate their brain after trauma

A

Warmth, validation, flexibility, structure, hope, humor, being part of connected community

163
Q

Trauma informed vs trauma specific tx

A

Takes into account knowledge about trauma in all care vs evidence based, best practice tx model that facilitates recovery from trauma

Not specifically designed to treat sx related to trauma vs directly addresses impact of trauma on an individual’s life and facilitate recovery, treat consequence of trauma

Trauma informed care: philosophy of care that recognizes possibility of trauma in client’s hx

164
Q

Recovery Model

A

Centered around concept of resilience, empowering individuals to maintain control over their lives more than merely striving to return to pre-illness state

Holistic approach to mental illness
Self mgmt strategies have higher efficacy of those focused on physical health

Emphasis self-discovery, personal growth, goal setting

165
Q

Recovery Model Oriented Approach: WRAP-Wellness Recovery Action Planning

A

Individualized prevention and wellness tool

Manage mental health with personalized strategies

166
Q

Recovery Model Oriented Approach: DREEM-Developing Recovery Enhancing Environments Measure

A

Assesses how well a service’s environment supports recovert

167
Q

Recovery Model Oriented Approaches: Recovery Star

A

Tracks and supports recovery by measuring progress across various life areas affected by mental gealth

168
Q

Recovery Model Oriented Approached: Checklist of Good Practice

A

Set of guidelines for health services personnel to ensure practice supports to recovery

169
Q

Healthy IDEAS- Identify Depression Empowering Activities for Seniors

A

service delivery model
Self management program to identify, manage, and reduce depressive symptoms

Empowers by advocating for mental health wellness, links to providers

170
Q

PEARLs- Program to Encourage Active Rewarding Lives for Seniors

A

Alleviate depressive sx and enhance QOL for senior community/older adults

Promotes active engagement and rewarding experiences
Educates on what depression is
Empowers with new skills
Train coaches within community based organizations

Problem solving, activity planning, and connections reduces social isolation, loneliness, lowers hospitalizations, and nursing home stays

171
Q

BRITE- Brief Intervention and Treatment for Elders

A

Screening and intervention solutions geared towards with substance abuse issues

Motivational interviewing
Uses health promotion work book
Summary of goals to improve QOL
Health Habits
Education

172
Q

Occupational Justice

A

Recognizing/fulfilling occupational need, all people engage in meaningful activity

173
Q

Risks during Transitional Care

A

Older adults are vulnerable secondary to misdiagnosis, underdiagnosis, and over diagnosis due to sx being attributed incorrectly to aging

174
Q

Instinctual Trauma Response Model

A

Educate individual on how brain and body are wired and why they react to traumatic situations, trains responses

175
Q

Benefits of social networks/aupport

A

Acts as buffer against stressors
encourages help seeking behavior
Validating and developing self concept
Increase self esteem, mood, and worldview
Provides structure to learn/adapt new skills

176
Q

Community Based Services: Care Program Approach

A

Prevents vulnerable clients from falling out of care, integrates social care management, prioritizes severe mental illness

177
Q

Community Based Services: Early Intervention in psychosis services

A

Initiative focuses on addressing psychosis at early stages

178
Q

Community Based services: primary care liaison teams

A

Provides resources to PCP referring clients yo specialty services

179
Q

Medical marijuana

A

Treats symptoms of chronic pain, sleep, malnutrition, depression, side effects of Ca tx

Not FDA approved as medicine

180
Q

Medical marijuana risks

A

Respiratory conditions, decreased memory, adverse cardiovascular function, alters judgement and motor skills, psychosis

181
Q

Role of OTP in medical marijuana use

A

Educate pt and/or caregivers on use, risk vs. benefits on individual basis
Monitor adverse effects
Educate on how affects compromise safety
Non-pharmacological pain intervention

182
Q

Non-pharmalogical pain intervention

A

Relaxation techniques and physical exercise and how to integrate into habits/routines for sustainable carryover

Ergonomics, nerve mobilization, functional mobility, home evals, positioning, equipment, ECT, pacing, cognitive strategies

Symptom tracking, med mgmt, modalities, sensory strategies, self regulation techniques, eating strategies to avoid dietary pain triggers

Sleep hygiene, fatigue mgmt with CBT

Assertiveness training, compensatory strategies, body mechanics, community reintegration

183
Q

Risks of unhoused older adults

A

30% of income on rent increases risk of homelessness
Experiences extreme occupational deprivation
Lack of access to resources for BADLs
Routines dictated by context ie transportation, wait lines at meal program, showers during shelter hours
Priority is maintaining safety and personal items

184
Q

OTP intervention and homelessness

A

Practice skills that fit routine/navigate community
Provide Resources
Adapt environment
Strength based Language
Develop/refer to providers
Assess boredom and engagement in meaningful activities survey and multidimensional state of boredom scale
Tx in small group/individual using checklist, role playing, searching resources, setting reminders, creating daily schedule, grooming routines, Identifying coping strategies, med mgmt, exploring leisure interests

Apply strategies together then add more complex performance skills for community transition

185
Q

Cognitive Orientation to Occupational Performance Theory (coop)

A

Performance/occupation based approach for children and adults who experience difficulties performing skills they want or need to perform

Cognitive strategies to improve task performances

Goal plan check do, skill acquisition, cognitive strategy use, generalization, and transfer of learning

Leads to increased self efficacy

186
Q

Occupational Adaptation

A

OT frame of reference, integrate occupation and adaptation domains

Occupation=self-perceived meaningful activities

Adaptation=one’s response to meet occupational challenge

When response is insufficient to master activity, focus on environment and roles to promote relative mastery

Theory of occupational adaptation: process of internal adaptation= self efficacy

187
Q

Hoarding Disorder

A

Persistent condition characterized by compulsive hoarding and sx that result in decreased health, daily function, psychiatric comorbidites and cognitive functioning

188
Q

Associated Risks with Hoarding

A

Fall risks
Fire hazards
Poor hygiene/nutrition
Escalation in medical issues
Food contamination
Social isolation
Medication management
Exacerbation pre-existing chronic health conditions

189
Q

Hoarding associated health conditions

A

61% HTN
11% stroke
22% sleep apnea
11% seizure disorder
80% limited mobility
10% cannot use toilet, 70% difficulty using stove, decreased rest and leisur

190
Q

Mood disorders associated with Hoarding

A

51.4% MDD
23% GAD
23% phobia
18% OCD
13.8% specific phobia
7.1% PTSD

191
Q

OT interventions for Hoarding

A

CBT: stop hoarding by changing thoughts and behavior, poor evidence

Help hoarders engage in activities that bring intrinsic value and promote well-being
Support roles in the community

192
Q

Hoarding and decluttering

A

Decluttering or throwing out possessions leads to emotional distress based on loss of environment, not loss of connection to item or home

Leads to overstimulation, hostility, and does not address underlying problem

193
Q

Occupational imbalance

A

Hoarding leads to occupational imbalance due to lack of ability to participate in other roles

Tx by promoting engagement in activities to redevelop lossed skills

Pacing, grading, and adapting task to promote success for self achievement

Boardz (16 decks)

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