Quiz 1 Flashcards
Young-old adults
65 to 74
Middle-old adults
75 to 84
Old-old adults
fastest growing segment
of the population in Canada
85 and up
fastest growing segment
of the population in Canada
Old-old adults
Census 2021-7,000,000 people aged 65 and older (____%) of the population (Census 2021: 37,000,000 total)
19
Baby boomers make up ____% of the population
24.9
Retirements from an aging labour forces grows ____ times faster than children 0-14.
six
The highest concentration of seniors is found in the ___________. The largest number of seniors are located in British Columbia.
Atlantic Provinces
More seniors are _______ and as seniors age the proportion of ______ increase.
women
About 28% of seniors are ________. Most have been living in Canada since they were a relatively young age.
immigrants
In 2006, adults (65+) comprise 4.8% of the Indigenous population . In 2016, this proportion had grown to ___%. (projected to double by 2036)
7.3
remembering you couldn’t find your car last time you went to a game, so you took the time to find a landmark next time. 911. COVID.
Episodic memory
relate to significant events in YOUR life. Death of family/friends. Year you graduated. This part is the clearest in elderly – it is important for them to share & makes them feel good.
Autobiographical memory
general knowledge. Geography, prime minster of Canada, knowing an apple is a fruit. 454 grams = 1 pound.
Semantic memory
Theories of aging
Biological, Psychological & Sociological
looking at length of live and viability of organs
Biological
Looks at behavioral capacities, including learning, perception, and memory
Psychological
Life satisfaction, adjustment to role changes
Sociological
The theory suggests that aging results from a gradual deterioration of the cells and tissues of the body via _______, oxidative stress, exposure to radiation, toxins, or other deteriorative processes.
wear and tear (theory of aging)
Cells have a predefined suicidal pathway – then they die
Pre programed to die at a certain age
Programed senescence theory
A type of unstable molecule that is made during normal cell metabolism (chemical changes that take place in a cell). Free radicals can build up in cells and cause damage to other molecules, such as DNA, lipids, and proteins. This damage may increase the risk of cancer and other diseases.
Free radical theory
The cross-linking theory of aging was proposed by Johan Bjorksten in 1942 (8). According to this theory, an accumulation of cross-linked proteins damages cells and tissues, slowing down bodily processes resulting in aging.
Cross-linking theory
Leonard Hayflick introduced the hayflick limit as the number of times a cell population can divide until it attains a cell cycle arrest. It is found to correlate with end regions of DNA strand called telomeres as telomeres get shorter by each cell division.
Hayflick Limit Theory
“If you don’t use it, you lose it”
Continue learning new things, playing new games, education.
Plasticity theory
A dose appropriate for the older adult in a schedule that is acceptable to the client (client centered).
Considerations for Determining If and What Medications are Appropriate
A review of current medications the client is taking that may be reduced or eliminated, or any medications that may possibly interact.
Considerations for Determining If and What Medications are Appropriate
Individual treatment plans that include education on non-drug options and information on side effects, action to take, & who to call.
Considerations for Determining If and What Medications are Appropriate
may be defined as what the body does to the drug
ADME
Pharmacokinetics
which may be defined as what the drug does to the body.
pharmacodynamics
intestinal motility decreases, increase in gastric pH as we age, drugs are sitting in our systems longer
Absorption in Elderly
less muscle mass as we age, increased fat to muscle ratio
Distribution in Elderly
decrease in liver size, metabolizing enzymes are effected
Metabolism in Elderly
renal capacity as we age is poorer
Excretion in Elderly
Age-related sensitivity to the therapeutic and toxic effects of medicines, especially centrally acting medicines (i.e., medications that lower heart rate and blood pressure). These medications can cause slowed heart rate, dizziness headache, etc.).
Sensitivity to sedating medications in older people.
Pharmacokinetic interaction- one medication affects the plasma concentration of the other medication.
Pharmacodynamic Changes
Anticholinergic syndrome:
Serotonin syndrome:
*Both are more common in people who are on multiple medications, and older adults tend to be in that category.
Syndromes of concern
Avoid and reduce the use of prescription and non-prescription medications ( i.e. de-prescribe) when possible.
Seek, use, and teach clients and their families about alternative strategies to manage the challenges and illnesses.
Create a societal and institutional culture where clients, professionals, and others do not believe that medication is the answer or… the only answer.
Encourage using pharmacist as a resource.
Safer med use for Elderly
Educate clients and their support system re: safe administration
For older persons who are in hospital/facility care, safety processes, such as medication reconciliation, should be utilized. Each facility should have its own process.
Strategies … blister packs, medication diaries, regular review of medications with providers, he introduction of strategies to de-prescribe whenever possible….
Safer med use for Elderly
several definitions in literature, but the general consensus is 5 or more medications
Polypharmacy
This cut off point of __ medications has been shown to be associated with the risk of adverse outcome such as falls, frailty, disability, and mortality in older adults (Dona Varghese; Hayas Haseer Koya, 2019).
5
_____________ for Potentially Inappropriate Medication Use in Older Adults (_____ List), are guidelines for healthcare professionals to help improve the safety of prescribing medications for older adults.
The Beers Criteria
The incidence of psychosis increases with age. It has two presentations in older persons:
Chronic or recurring psychosis
Developed psychotic symptoms first time
_________ in older persons who have had lifelong schizophrenia spectrum disorder, psychotic depression, bipolar disorder with psychosis, and
Chronic or recurring psychosis
Psychosis can be with other ________. Some of these are:
Brain tumour
Lupus
Bipolar disorder
UTIs / Delirium / Infection
Multiple Sclerosis
Substance use
Syphilis
diseases
__________________:
Early onset (before 40 yrs), late onset (40-60 yrs),
very late onset (over 60 years).
LO/VLO schizophrenia: more common in females, lower incidence of family history of psychosis/lower genetic risk (compared to EO schizophrenia (Chen, Selvendra, Stewart, & Castle, 2018).
LO and VLO schizophrenia requires lower doses of neuroleptics.
Older individuals with EO schizophrenia have prominent negative symptoms and poor social functioning.
*some controversy regarding diagnosis
Chen,L.,Selvendra,A.,Stewart,A., &Castle,D.(2018).Risk factors in early and late onset schizophrenia.Comprehensive Psychiatry,80,155–162. doi:10.1016/j.comppsych.2017.09.009
Schizophrenia Spectrum Disorder
____________:
More common in middle to old age
Delusional content…..
Person may be very guarded about their delusion, so assessment may take some time.
Delusional disorder
________:
Hallucinations are primarily visual…often accompanied by illusions (misperception of actual visual stimuli). Can be tactile or olfactory as well.
Paranoid delusions may be present. Tend to be simple (e.g., people are following them, stealing from them, etc.).
(40) Dementia - Redirecting Hallucinations with Teepa Snow of Positive Approach to Care - YouTube
Delirium
Many underlying causes, so a comprehensive assessment is necessary. First, rule out physical/medical triggers. (e.g. infections, polypharmacy, substance use, sensory impairment, trauma, thyroid disease, etc.). Bloodwork/imaging.
Involve family/caregivers.
Is onset sudden? This can provide clues.
Obtain thorough history – (e.g. previous episodes of psychosis/depression/bipolar illness, hospitalizations, cognitive function)
Assessment of Psychosis
Treatment with medication if necessary – Are symptoms distressing? Do symptoms pose a risk to patient or others?
Antipsychotic agents- typical and atypical
Treatment of Psychosis
Short-term - for psychosis with depression, mania, substance abuse-induced psychosis.
Use with caution, especially in those with dementia.
Lower doses due to physical changes with aging.
Consider fall risk, interaction with other medications, physical status and monitor carefully.
Monitor adherence/overuse….consider cognitive deficits and other factors that may interfere with proper use. Monitor effectiveness. If medication is not effective, it may suggest a physical, underlying cause for psychosis. Medications that are not effective should not be continued.
Treatment of Psychosis
Develop a strong therapeutic relationship with client.
Services at the individual, family and community level.
Assessments and interventions should be ongoing.
Treatment of Psychosis
defined as MDD occurring in adults 60 years and older. (MacQueen et al., 2016)
Late Life Depression (LLD)
Compared to patients with earlier onset of MDD, late-onset depression has a worse ______, a more chronic course, a higher relapse rate, and higher levels of medical comorbidity, cognitive impairment, and mortality.
prognosis
Depression is more likely to be _____ in older patients – especially older men.
fatal
Research is showing depression is linked to ________ and that it increases progression of chronic illness. ( so, it is important to treat!!)
poor health outcomes
Signs of depression are often overlooked – assume it is just normal part of aging ( “They are just old.”…..ageism?) Often unrecognized and under-treated.
Under-treated & undiagnosed
Older people often ASSUME that depression is a __________ and symptoms of depression are often incorrectly attributed to physical (e.g. neuro) illnesses.
normal part of aging
Requires a social and physical assessment as well as a thorough mental status assessment.
Physiologic changes in the brain
Vascular
Hormonal changes
Life events/psychological.
Etiology of Depression
PHQ-2 – a quick initial screening tool.
PHQ-9- first self-report 9 item questionnaire specific to depression for use in primary care.
Cornell Scale for Depression in Dementia
Assessment tools for Depression
Older adults are a higher risk group for ________ - especially older men. They don’t tend to tell anyone and choose lethal means – assessment can be challenging and building rapport is essential.
suicide
First-line consists of:
nonpharmacological treatments (environmental/behavioral strategies)
Pharmacological treatment and nonpharmacological interventions
Others - ECT
Treatment of Depression in Elderly
Medications- “start low go slow”.
SSRI in combination with psychotherapy- first line trt.
Adequate trial- 6 to 12 weeks with close monitoring
SSRI’s and venlafaxine – stimulating so give in AM
Venlafaxine (Effexor) – caution with persons with hypertension- monitor vitals when dose is increased.
Treatment of Depression in Elderly
Nursing Care for depression in elderly
Enhance physical function & social support
Causes or triggers:
anxiety disorders;
co-morbid conditions (depression and dementia in later life);
direct consequence of physical health conditions common among aging persons;
drug and diet association;
and response to social, environmental, personal, and health-related stressors in later life
Anxiety in elderly
Dementia or anxiety?
Depression or anxiety?
Is it a disorder or reaction?
Is it from the past?
Challenges for assessment of anxiety
Comprehensive and thorough assessment (physical, social, psychological and spiritual)
Historical factors
Physical health conditions, medication use, addictions
Current social, environmental, personal, and health related stressors
Patterns of coping
Obtain collateral whenever possible
The same assessment used with all clients including older clients who may require additional time, patience, and compassion to build & sustain a therapeutic alliance
Assessment of anxiety in later life
CBT
Relaxation training
Supportive therapy
Alternative therapies
Psychoeducation strategies
Treatment of anxiety in later life
Pharmaological interventions - may not be needed should be short term, and should be used to complement other interventions not relace them
SSRIs
Anxiolytics
For older adults who have had anxiety in the past, make sure to ask what worked/didn’t work for them (medication and other interventions)
Treatment of anxiety in later life
Dementia is a syndrome, of a chronic and progressive nature with a decline in cognitive functions accompanied by deterioration in emotional control, language skills, and social behaviour.
In most cases, the course is progressive and irreversible, and treatments are only minimally effective in slowing progression.
Symptoms of dementia include: disorientation, memory loss, impaired judgment, intellectual and social functioning, personality change, and shallow and labile effect.
Behavioural and psychological symptoms become highly prevalent.
Neurobiology of dementia
Dementia is a __________, of a chronic and progressive nature with a decline in cognitive functions accompanied by deterioration in emotional control, language skills, and social behaviour.
syndrome
Dementia, in most cases, the course is ________ and ____________, and treatments are only minimally effective in slowing progression.
progressive; irreversible
The neuropsychiatric inventory
The behavioral pathological rating scale for Alzheimer’s Disease
The Cohen-Mansfield Agitation Inventory
The Cornell Scale for Depression in Dementia
Measures of the behavioural and psychological symptoms of dementia
Dementia screening questionnaire for caregivers
The min-mental state examination
The cognitive abilities screening instrument
Short portable mental status questionnaire
Older Americans resources and services
The ten point clock test
Activities of daily living and instrumental activities of daily living
Instruments used for nursing assessment
