Psychosocial Issues in the Elderly

Question 1

Risk factors for late life depression(5)

Answer 1

• social isolation
• uncontrolled pain
• insomnia
• functional or cognitive impairment
• stigma against talking about mental health issues

Question 2

Depression is not a normal part of…

Answer 2

….the aging process!!!

Question 3

Clinical presentation of depression in the elderly (2)

Answer 3

• same diagnostic criteria in any age

- might manifest as memory problems, confusion, irritability

Question 4

The PHQ-2

Answer 4

2 questionnairre (over past 2 weeks have you felt little pleasure or interests, over past 2 weeks have you felt down depressed or hopelesS) screening for depression, positive indicates need for referral to full eval

Question 5

Depression in the elderly treatment options (4)

Answer 5

• psychotherapy
• antidepressant (SSRI first line)
• SNRI’s 2nd line
• atypical, tricyclic antidepressants 3rd line

Question 6

Almost ___ of elderly see PCP within last month of life before committing suicide

Answer 6

50%

Question 7

Suicide in older adults risk factors (4)

Answer 7

• depression***
• prior attempts
• hopelessness
• inflexible personality

Question 8

Questions in a patient that has depression

Answer 8

• have they attempted before?
• do they have a plan?
• how likely it is they will act on thoughts?
• anything that would prevent?

Question 9

Substance abuse in the elderly

Answer 9

• up to 5% meet criteria for alcohol abuse
• high risk for developing sedative hypnotic substance use disorder from meds prescribed for anxiety and insomnia, strongly associated with increased risk of falls and injury

Question 10

Substance abuse DSM-5 definition

Answer 10

Problematic pattern of substance use leading to clinically significant impairment or distress manifested as 2 of the following: taking substance in larger amounts or longer than intended, persistent desire or unsuccessful effort to control use, great deal of time spent obtaining or using substance, craving substance, or recurrent use resulting in failure to fulfill major role obligations at work, school or home

Question 11

Barriers to treatment of older adults with substance abuse disorders (4)

Answer 11

• ageism
• lack of awareness
• clinician behavior (sterotyping, physical symptoms mimic, other problems compete for time and attention of provider)
• comorbidities

Question 12

How much can an older person drink alochol

Answer 12

-some should not at all depending on health history or medication, recommendation is no more than 1 standard drink per day, no more than 2 on any day or occasion, and women 65 and older should consume lower amounts than listed

Question 13

Substance abuse recovery in elderly

Answer 13

Better overall outcomes from recovery than young adults, leads to better quality of life, less stress, disability and illness