Week 4.3: Affective and common disorders in old age Flashcards
Explains the changes in birth and death rates over time, leading to population aging.
Demographic Transition Model
The study of the distribution and determinants of health related
states or events, including disease.
And the application of this study to the control of disease and other health problems.
Epidemiology
What is the current state of mental health in older adults?
Prevalence: Approximately 15% of adults over 60 suffer from a mental disorder.
Under-Identification: Mental health problems are often not recognized by healthcare professionals or the older adults themselves.
Stigma: Mental health stigma can prevent individuals from seeking help.
The most common affective disorder in older adults.
Depression
Does the early or late onset of depression have an effect on individuals?
Late-onset depression tends to recur more frequently and persist longer compared to depression in younger adults.
Two or more symptoms of depression for at least two weeks, not severe enough for a full depression diagnosis.
Prevalence: More common than major depression in older adults, affecting 6-10% in primary care settings and 30% in medical and long-term care settings.
Subsyndromal Depression
Both are associated with greater cognitive impairment
Increased Age and Depression Severity
These cognitive domains are often impaired in depression
Attention and Processing Speed
Refers to substances that block the action of acetylcholine, a neurotransmitter involved in transmitting signals in the nervous system.
Anticholinergic
Bipolar disorder in individuals aged 60 and over.
Similar to early onset bipolar disorder but with generally less severe manic symptoms
Old Age Bipolar Disorder (OABD)
What is the difference between morbidity and mortality?
Morbidity: Focuses on how common and severe a disease is within a population.
Mortality: Focuses on how many people die from the disease.
Is common in older adults, leading to confusion, psychosis, and agitation due to underlying organic causes like infections.
Acute Delirium
A sudden and severe change in mental state, characterized by confusion, disorientation, agitation, and hallucinations
Delirium
The condition of waking up during the night to urinate more than once.
It can be caused by various factors, including excessive fluid intake before bedtime, sleep disorders, or underlying health conditions like bladder obstruction
Nocturia
When do symptoms of primary psychiatric illnesses manifest?
Early Manifestation: Most primary psychiatric illnesses, other than cognitive disorders, manifest earlier in life.
First Episode After Age 40: Raises suspicion for an underlying medical problem
Overlooked and Minimized: Often seen as a normal part of aging.
Risk Factor: Fundamental risk factor for developing mental disorders and increasing suicidal risk
Pain
Critical for physical and emotional health of older adults
Sexual Functioning
These are adverse mental health effects caused by medical treatments or medications
Iatrogenic Psychiatric Symptoms
Both share common risk factors like smoking, hypertension, diabetes, and atherosclerosis.
These conditions can coexist because the underlying vascular issues (e.g., atherosclerosis) can affect both the heart and the brain
Cardiovascular Disease and Cerebrovascular Disease
Observes and describes a patient’s current state of mind across various domains.
Diagnosis and Formulation: Combined with biographical and historical information to make an accurate diagnosis.
Mental State Examination (MSE) in Older Adults
What are the common stressors in later life?
Loss of Capacities
Medical Comorbidities
Bereavement
Socioeconomic Changes
What is the impact of later stressors in life?
Isolation and Loneliness
Psychological Distress
Caregiving
Stereotyping, prejudice, and discrimination against people based on their age.
Can lead to marginalization, exclusion, and negative health outcomes for older adults.
Ageism
What are the categories of risk in older adults?
Personal History: Includes forensic history, lack of supportive relationships, poor concordance with treatment, discontinuation or disengagement, impulsivity, and substance use.
Environmental and Social Risks: Includes risks such as fire, cluttering, falls, self-neglect, and environmental neglect.
Mental State Risks: Assess whether symptoms like psychotic symptoms (delusions, paranoia, command auditory hallucinations) pose a risk to self or others
What are the types of risk in older adults?
Risk to Self: Includes self-harm, suicidal ideation, and behaviors that could lead to injury.
Risk to Others: Includes violent behaviors, homicidal ideation, and emotional arousal that could lead to harm.
Risk from Others: Includes potential abuse or exploitation from others
Characterized by excessive worry, hyperarousal, and fear that is counterproductive and debilitating.
Anxiety Disorder
A type of anxiety disorder characterized by persistent and excessive worry about various aspects of life.
Often occurs alongside depression in older adults.
Treatment: SSRIs, CBT, and Benziodiazepines
Generalized Anxiety Disorder
A state of increased psychological and physiological tension, often associated with anxiety.
Hyperarousal
What are the physical symptoms of hyperarousal?
Hypervigilance: Being constantly on the lookout for potential danger or threats.
Startling Easily: Reacting strongly to sudden noises or movements.
Heart Palpitations: Feeling like your heart is racing, pounding, or flip-flopping.
Trembling or Shaking: Uncontrollable shaking or trembling.
Sweating: Excessive sweating, often without physical exertion.
Breathing Fast: Rapid breathing or feeling dizzy and lightheaded.
Insomnia: Difficulty falling asleep, staying asleep, or experiencing restless sleep.
What are the emotional symptoms of hyperarousal?
Heightened Sensitivity: Extreme sensitivity to sounds, smells, textures, or sights.
Angry Outbursts: Sudden and intense anger or rage.
Persistent Worry: Constantly thinking or worrying about things, even after situations have been resolved.
Flashbacks: Vivid memories or flashbacks of traumatic situations from the past.
The most common anxiety disorder in later life.
Phobias
Characterized by sudden and repeated panic attacks.
Panic Disorder
A condition characterized by unwanted and intrusive thoughts (obsessions) and repetitive behaviors (compulsions).
Obsessive-Compulsive Disorder
A mental health condition triggered by experiencing or witnessing a traumatic event.
Post-Traumatic Stress Disorder (PTSD)
Physical symptoms that can be caused or exacerbated by mental factors.
Somatic Symptoms
Symptoms that indicate an absence of normal functions, such as lack of motivation or emotional expression.
Negative Symptoms
Symptoms that indicate an excess or distortion of normal functions, such as hallucinations or delusions.
Positive Symptoms
Is a significant health concern in older adults, with varying prevalence based on demographic factors.
Smoking
Is a complex issue influenced by underreporting, comorbid conditions, and decreased tolerance.
Alcohol Misuse
Is a syndrome, usually chronic or progressive, characterized by the deterioration of cognitive functions. This includes impairments in memory, thinking, behavior, and the ability to perform everyday activities.
Dementia
Long-lasting and persistent.
Chronic
Increasing in severity over time.
Progressive
The most common type of dementia, accounting for up to two-thirds of cases.
Alzheimer’s Disease
Depression, psychosis, apathy, sleep disturbances, agitation, and aggression.
Behavioral and Psychological Symptoms of Dementia (BPSD)
Accounts for approximately 10% to 15% of all dementia cases.
A broader category of dementia caused by reduced blood flow to the brain, often due to strokes or other vascular conditions
Symptoms vary depending on the affected brain area. Common symptoms include memory loss, confusion, difficulty with attention, and impaired judgment
Vascular Dementia
A type of dementia that affects the subcortical regions of the brain, often leading to motor and cognitive impairments.
Is considered a type of vascular dementia
Subcortical Dementia
Represents several distinct dementia syndromes that primarily affect the frontal and temporal lobes of the brain.
Fronto-Temporal Dementia (FTD)
What are the common sub-types of Fronto-Temporal Dementia (FTD)?
Behavioral Variant (bvFTD)
Semantic Dementia
Progressive Non-Fluent Aphasia (PNFA)
Symptoms: Early onset, stronger familial loading, behavioral changes such as disinhibition, apathy, socially inappropriate behaviors, and executive dysfunction.
Overlap with Extrapyramidal Disorders: May include symptoms similar to Parkinsonism.
Behavioral Variant Fronto-Temporal Dementia (bvFTD)
Symptoms: Specific loss of word meaning and comprehension difficulties.
Ex. A person might refer to a “dog” as an “animal” because they can no longer recall the specific word
Semantic Dementia
Symptoms: Characterized by agrammatic and telegraphic speech
Progressive Non-Fluent Aphasia (PNFA)
A stronger genetic component is often observed
Family Loading
Lack of restraint manifested in disregard for social conventions, impulsivity, and poor risk assessment
Disinhibition
Lack of interest, enthusiasm, or concern.
Apathy
Movement disorders such as Parkinsonism, characterized by tremors, rigidity, and bradykinesia.
Extrapyramidal Disorders
Speech that lacks grammatical structure, often seen in progressive non-fluent aphasia.
Ex. Instead of “She is going to the store,” they might say, “She go store.”
Agrammatic Speech
Speech that is concise and omits unnecessary words, resembling a telegram.
Ex. “Joe hungry” instead of “Joe is hungry”
Telegraphic Speech
Is the second most common form of dementia, accounting for about 5% of all dementia cases
Lewy-Body Dementia
These are abnormal protein deposits (synuclein inclusions) found in the neocortex and brain stem, similar to those seen in Parkinson’s disease
Lewy Bodies
A group of movement abnormalities including tremor, rigidity, and bradykinesia (slowness of movement)
Parkinsonism
Dysfunction in the autonomic nervous system, affecting involuntary bodily functions.
Issues with regulating blood pressure, heart rate, and other autonomic functions
Autonomic Instability
Abnormal protein deposits found in the brain.
Synuclein Inclusions
A condition where individuals act out their dreams during REM sleep.
Ex.
Physical Movements
Vocalizations
Dream Recall
REM Sleep Behavior Disorder
Dementia affects 30% to 50% of individuals with Parkinson’s disease.
Similar to Lewy body dementia, Parkinson’s disease dementia also presents Lewy bodies, but these are more diffusely distributed in the cortical regions
Dementia in Parkinson’s Disease
Is a cholinesterase inhibitor that helps improve cognitive function by preventing the breakdown of acetylcholine, a neurotransmitter important for memory and learning.
Recommended for treating dementia in Parkinson’s disease, particularly in the initial stages
Rivastigmine
his refers to how the body absorbs, distributes, metabolizes, and excretes a drug. In older adults, these processes can be significantly altered due to age-related changes in body composition and organ function.
Pharmacokinetics
This refers to how the drug affects the body, including the mechanisms of action and the relationship between drug concentration and effect. Age-related changes can also alter drug sensitivity and response.
Pharmacodynamics
The use of multiple medications increases the risk of drug interactions and drug-induced problems. This can lead to a higher chance of adverse effects
Polypharmacy
What is the impact of Age-Related Changes on Pharmacokinetics in Older Adults?
1) Slower Absorption of medication
2) Increased Volume of Distribution
3) Metabolic Capacity
4) Impaired Renal Function
This refers to the range between the effective dose and the toxic dose of a drug. Drugs with a narrow therapeutic index require careful management because small changes in dose can lead to toxicity or loss of therapeutic effect.
Therapeutic Index
Related to the liver.
Hepatic
Related to the kidneys.
Renal
Is the process by which the body chemically alters a drug, usually in the liver, to make it easier to eliminate.
Think of it as the body’s way of breaking down a drug into smaller pieces so it can be removed from the body.
Drug Metabolism
Is the process by which a drug spreads throughout the body’s tissues and fluids after being absorbed.
Imagine the drug traveling through the bloodstream to reach different parts of the body where it needs to work.
Drug Distribution
What is the importance of physical assessment prior to prescribing medication?
These assessments help identify underlying medical conditions that can influence diagnosis and treatment options.
Ex.
Vital Signs
Weight
Blood Pressure
Pain Severity
What are the basic Principles for Prescribing Psychotropic Medication to Older Adults?
1) Start slow, go slow (minimal dose)
2) Keep pharmacological regimes simple (fewer medications)
3) Expect latency response (drugs take time to take effect)
4) Monitor for side effects
5) Conduct thorough assessments
What are the basic Principles to avoid when Prescribing Psychotropic Medication to Older Adults?
1) Treating side effects with more medication
2) Dose augmentation
3) Antipsychotics in dementia
4) Medications with anticholinergic side effects
5) Very sedative medications
6) Drugs with long half-life
Gradually adjust the dose of a medication.
Titrate
The time it takes for the concentration of a drug in the blood to reduce by half.
Half-life
Is the process of determining whether an individual has the ability to make specific decisions about their care, treatment, and finances.
It is used to protect and empower individuals who may lack the mental capacity to make their own decisions.
Mental Capacity Assessment
They are at increased risk of impaired decisional capacity due to age-related cognitive decline and other health conditions.
Older Adults
Origin: Developed in the UK to provide a legal framework for decision-making for individuals over 16 years old who may lack mental capacity.
Goals: To safeguard decision-making and ensure that decisions are made in the best interests of individuals who lack capacity
The Mental Capacity Act (MCA)
When is capacity assessment needed?
It is required when there is an impairment of the mind or brain, and evidence shows that this impairment prevents the person from making a specific decision when needed
What are the four main criteria to assess decisional capacity?
1) Understanding: The person must understand the information relevant to the decision.
2) Retention: The person must retain the information long enough to make the decision.
3) Use or Weigh Up Information: They need to consider the pros and cons of the decision.
4) Communication: This can be through speech, writing, or other means.
What are the factors affecting decisional capacity?
1) Dementia and Other Mental Conditions
2) Emotional Factors
3) Specific Decision-Making Capacity (i.e., can make decisions on self-care but not finances)
4) Dynamic Nature of Capacity
Factors such as paranoia or severe hopelessness can affect a person’s ability to make decisions.
The presence of these conditions does not automatically mean the person lacks capacity.
Emotional Factors
False beliefs that one is being persecuted or targeted.
Paranoid Delusions
A profound sense of despair and lack of hope for the future.
Severe Hopelessness
Specialized medical care focused on providing relief from the symptoms and stress of a serious illness
Palliative Care
