Quiz #2

Question 1

mental health

Answer 1

• About 20% of older adults have a mental health issue
• Depression, dementia, anxiety, delusional disorders are most common
• Women tend to have higher rates of mental illness
• Decline often results from disease processes or inability to cope with stress related to change in physical health, death of a partner, social isolation, etc.
• Mental health disorders are often undiagnosed or misdiagnosed

Question 2

depression

Answer 2

• Depression affects 2-5% of older persons
• Higher rates for women and LTC residents
• Triggered by multiple concurrent personal crises/losses, lack of social support, living alone, drug interactions, chronic pain, disability, physical illness, dementia, fear of falling, strain of caring for a frail spouse, diagnosis of a terminal illness
• Depression amplifies functional disabilities, interferes with treatment and rehabilitation, and contributes to decline in physical and cognitive functioning

Question 3

symptoms of depression

Answer 3

• Loss of energy
• Decreased interest and pleasure in usual activities
• Pain and somatic complaints
• Decreased interest and pleasure in usual activities
• Complaints of memory problems

Overlooked by health professionals/difficult to detect due to:
- Older adults reluctant to admit to psychological difficulties/symptoms; more likely to communicate physical symptoms
- Several symptoms of depression (sleep issues, fatigue/low energy) also naturally occur in older adulthood - misattributed to normal aging
- Myth that its normal for older adults to feel some amount of depression

Question 4

suicide

Answer 4

Males 85 and older are most at risk
Rates are rising as longevity increases

Question 5

delirium

Answer 5

• worsening or change in a person’s mental state that happens suddenly, usually over one to two days, fluctuations are common
• Those with dementia can have delirium too, making cognition worse or causing the person to not be their usual self; therefore important to get a baseline from family/friends/carers

Question 6

hyperactive delirium

Answer 6

restlessness, agitation, resistive/aggressive, hallucinations/delusions

Question 7

hypoactive delirium

Answer 7

withdrawn, lethargic, drowsy, unfocused (often missed due to the patient being “well behaved”)

Question 8

mixed delirium

Answer 8

Combination of hyperactive and hypoactive; switch between the two

Question 9

symptoms of delirium

Answer 9

• Be easily distracted
• Be less aware of where they are or what time it is (disorientation)
• Suddenly not be able to do something as well as normal (functional decline) (eg. walking or eating)
• Unable to speak clearly or follow a conversation
• Sudden mood swings
• Hallucinations (seeing or hearing things, often frightening)
• Have delusions or become paranoid

Question 10

risk factors for delirium

Answer 10

Hospitalization
Pain
Infection or other medical condition
Poor nutrition
Constipation or urinary retention
Dehydration
Low levels of blood oxygen (anemia)
A change in medication
Abnormal metabolism (eg. low salt or blood sugar levels)
An unfamiliar or disorientating environment

Question 11

those at high risk for delirium

Answer 11

Those with dementia
Over 65
Frailty
Multiple medical conditions
Poor healing/vision
Polypharmacy
Previous delirium

Question 12

dementia

Answer 12

• progressive impairments in memory and other cognitive functions
• impairs memory, thinking, behaviour
• Prevalence is greater among women and increases with age
• To be considered dementia, impairment must be present in at least two functions: memory, communication/language, ability to focus or pay attention, reasoning/judgment, and visual perception and later mood and behaviour
• types of dementia: Alzheimer’s disease, vascular dementia, Lewy body, frontal-temporal dementia, mixed dementia
• Most common type is alzheimer’s disease
  
  • Degenerative disease of the brain
  • Begins with loss of short term memory and progressively destroys most cognitive functioning
  • No simple test confirms a diagnosis of alzheimer’s disease

Question 13

risk factors of dementia

Answer 13

Lower levels of early life education (up to 12 years of age)
Midlife hypertension (45-65 years of age)
Obesity
Hearing loss
Smoking in later life (over age 65)
Depression
Physical inactivity
Diabetes
Social isolation

Question 14

recommendations for how to deal with rising rates of dementia

Answer 14

1) Increasing the investment in dementia research
2) Providing support for informal caregivers
3) Emphasizing prevention and early intervention
4) Building an integrated system of care

Question 15

most common chronic illnesses

Answer 15

Hypertension
Osteoarthritis
Ischemic heart disease
Osteoporosis
COPD

Question 16

chronic illnesses more common among women

Answer 16

Osteoporosis
Rheumatoid arthritis
mood/anxiety disorders
Dementia
Asthma
Osteoarthritis

Question 17

chronic illnesses more common among men

Answer 17

Gout
Ischemic heart disease
Parkinsons
Diabetes
Cancer
Heart failure

Question 18

chronic illness and health perception

Answer 18

• Almost half of canadian seniors perceive their health as very good or excellent and over ⅔ report their mental health as being very good or excellent, despite living with chronic illnesses
• Older adults perception of personal health status is not dependent on the absence of health
• Other factors that may attribute to positive perceptions of health status include:
  
  • Economic security
  • Social connectedness
  • Satisfaction with life and psychological well being

Question 19

living with multiple diseases can

Answer 19

Affect ADLs
Reduce quality of life
Increase mortality risk
Chronic pain
Lead to use of multiple medications-risk of inappropriate drug use and adverse drug events
Isolation and loneliness
Require greater health care resources

Question 20

chronic illness: risk factors

Answer 20

Tobacco use
Harmful use of alcohol
Unhealthy eating
Physical inactivity

Question 21

chronic illness: prevention

Answer 21

through supporting healthy behaviors and choices
the creation of age-friendly, safe, and socially supportive environments
reducing health inequities faced by vulnerable seniors

Question 22

chronic illness: interventions

Answer 22

Care coordination interventions are most effective combined with:
- Case management
- Care pathways
- Self management
- Education

Question 23

impact of falls

Answer 23

• falls are the direct cause of 95% of all hip fractures, leading to death in 20% of cases
• The majority of falls resulted in broken or fractured bones, and over ⅓ of fall related hospitalizations were associated with a hip fracture
• Hospitalization was an average of 9 days longer than those hospitalized for any cause
• The number of deaths due to falls increased by 65% from 2003 to 2008
• In 2017-2018, over half of all injury related hospitalizations in Canada were for seniors 65+
  Of these hospitalizations 81% were due to falls

Question 24

risk factors for falls: biological

Answer 24

Acute illness
Balance and gait deficits
Chronic conditions and disabilities
Cognitive impairment
Low vision
Muscle weakness and reduced fitness

Question 25

risk factors for falls: behavioural

Answer 25

Assistive devices
Excessive alcohol
Fear of falling
Footwear and clothing
History of previous falls
Inadequate diet
Medications
Risk taking behaviors
Vitamin D deficiency

Question 26

risk factors for falls: social and economic

Answer 26

Social networks
socioeconomic status

Question 27

risk factors for falls: environmental

Answer 27

Community factors
Living environment factors
Weather and climate

Question 28

falls prevention

Answer 28

• multifactorial falls risk assessment, and a subsequent management program tailored to an individual’s risk factors and setting

Components of successful multifactorial approach:
- Assistive devices and other protective equipment
- Clinical disease management, including chronic disease management
- Education
- Environmental modification
- Exercise programs
- Medication review and modification
- Nutrition and supplements