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90 Cards in this Set

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Top 3 GMC's in people over 45?
Arthritis
Hypertension
Hearing Impairment
Patients older than age 65 often have subjective complaints of minor memory impairments, such as forgetting persons' names and misplacing objects. Minor cognitive problems also can occur because of anxiety in the interview situation. These age-associated memory impairments are of no significance; the term ? has been used to describe them.
benign senescent forgetfulness
Condition?, the patient's understanding remains intact, but the ability to speak is impaired. The patient cannot pronounce “Methodist Episcopalian.”
Words are generally mispronounced and speech may be telegraphic
In nonfluent or Broca's aphasia
A simple test for ? is to point to some common objects—such as a pen or a pencil, a doorknob, and a light switch—and ask the patient to name them.
Wernicke's aphasia
The ? part of the WAIS-R is a more sensitive indicator of brain damage than the ? part.
performance > sensitivity than verbal part
The Geriatric Depression Scale is a useful screening instrument that excludes ? from its list of items. The presence of ? on a rating scale tends to confound the diagnosis of a depressive disorder.
somatic complaints
The National Institute of Mental Health's Epidemiologic Catchment Area (ECA) program has found that the most common mental disorders of old age are
depressive disorders,
cognitive disorders,
phobias, and
alcohol use disorders
Explain each test and category it tests:
Trailmaking Part B
Stroop C
Wisconsin Card Sorting Test
Verbal fluency (FAS and category):
Design fluency
Executive functions
Trailmaking Part B: rapid alternation between tasks
Stroop C: inhibition of an overlearned response
Wisconsin Card Sorting Test: categorization and mental flexibility
Verbal fluency (FAS and category): rapid word generation
Design fluency: rapid generation of novel designs
List tests of learning and memory
An 8- to 10-item word list learning task: learning and recall of rote verbal information
Wechsler Memory Scale-Revised (WMS-R) or Wechsler Memory Scale-III (WMS-III)
Logical Memory subtest: immediate and delayed recall of paragraph information
Visual Reproduction subtest: immediate and delayed recall of visual designs
Rey-Osterrieth Complex Figure 3-minute delayed recall: delayed recall of complex design
WAIS-R or WAIS-III Digit Symbol:
Trailmaking Part A:
Stroop A and B

Test what?
Information processing speed
Digit Span tests what?
Basic Attention
Several psychosocial risk factors also predispose older persons to mental disorders. These risk factors include
loss of social roles,
loss of autonomy,
the deaths of friends and relatives,
declining health,
increased isolation,
financial constraints, and
decreased cognitive functioning.
Only ? is a more common cause of DISABILITY among adults age 65 and older than dementia, a generally progressive and irreversible impairment of the intellect, the prevalence of which increases with age
arthritis
About ? percent of persons in the United States older than age 65 have severe dementia, and ? percent have mild dementia.
5% severe
15% mild
Of persons older than age 80, about ? percent have severe dementia
20%
Known risk factors for dementia are ???
age, family history, and female sex.
Delusions and hallucinations occur during the course of the dementias in nearly ? percent of patients.
75%
most
About ? percent of all patients who exhibit symptoms of dementia have potentially treatable conditions
10 to 15%
The ?(cortical or subcortical) dementias are associated with movement disorders, gait apraxia, psychomotor retardation, apathy, and akinetic mutism, which can be confused with catatonia
subcortical
A subcortical dementia occurs in ?????
Huntington's disease, Parkinson's disease, normal pressure hydrocephalus, vascular dementia, and Wilson's disease.
The cortical dementias occur in , which frequently manifest SX?
dementias of the Alzheimer's type, Creutzfeldt-Jakob disease (CJD), and Pick's disease

aphasia, agnosia, and apraxia
Human prion diseases result from coding mutations in the prion protein gene (PRNP) and may be inherited, acquired, or sporadic.

The inherited ones include? (and what type of inheritance)
familial CJD,
Gerstmann-Sträussler-Scheinker syndrome, and
fatal familial insomnia.

These are inherited as autosomal-dominant mutations
Acquired prior diseases?
The acquired diseases include kuru and iatrogenic CJD
? was an epidemic prion disease of the Fore people of Papua, New Guinea, caused by cannibalistic funeral rituals, which peaked in incidence in the 1950s
Kuru
? is rare and is caused, for example, by the use of contaminated dura mater and corneal grafts and treatment with human cadaveric pituitary-derived growth hormone and gonadotropin
Iatrogenic CJD
Sporadic CJD accounts for ? percent of the human prion diseases and occurs worldwide, with a uniform distribution and an incidence of about 1 in ? per annum, with a mean age at onset of ? years.

It is very rare in individuals under ? years of age?
Sporadic CJD accounts for 85 percent of the human prion diseases and occurs worldwide, with a uniform distribution and an incidence of about 1 in 1 million per annum, with a mean age at onset of 65 years.
rare <30
Categories of reversisble dementias?
Substance
Psychiatric: Mood Anxiety Delusional
Metabolic/Endocrine
Misc: fecal impaction, hospitalization, impaired hearing or vision
Depressive symptoms are present in about ? percent of all older adult community residents and nursing home patients.
15%
Age is a risk factor for the development of depression
True or False?
False
it is NOT by itself
being widowed and having a chronic medical illness are associated with vulnerability to depressive disorders
Late-onset depression is characterized by (low or high) rates of recurrence.
high
Older persons are particularly vulnerable to major depressive episodes with ? features
melancholic
features of melancholic depression in elderly?
characterized by depression, hypochondriasis,
low self-esteem,
feelings of worthlessness, and
self-accusatory trends (especially about sex and sinfulness) with
paranoid and suicidal ideation
Compare pseudodementia and dementia
In true dementia, intellectual performance usually is global,
and impairment is consistently poor;

in pseudodementia, deficits in attention and concentration are variable.

Compared with patients who have true dementia, patients with pseudodementia are less likely to have language impairment and to confabulate;

when uncertain, they are more likely to say “I don't know”;

and their memory difficulties are more limited to free recall than to recognition on cued recall tests.
Pseudodementia occurs in about ? percent of depressed older patients, and ? percent of patients with dementia are depressed
Pseudodementia occurs in about 15 percent of depressed older patients

25 to 50 percent of patients with dementia are depressed
(sex?) are more likely to have a late onset of schizophrenia than (sex?)
women more likely than men
A difference between early-onset and late-onset schizophrenia is the greater prevalence of ? schizophrenia in the late-onset type
paranoid
About ? percent of persons with schizophrenia show no active symptoms by age 65;
? percent show varying degrees of impairment. Psychopathology becomes (more or less) marked as patients age.
About 20 percent of persons with schizophrenia show no active symptoms by age 65; 80 percent show varying degrees of impairment. Psychopathology becomes LESS marked as patients age.
The residual type of schizophrenia occurs in about ? percent of persons with schizophrenia. Its signs and symptoms include ????. Delusions and hallucinations (are or are not)common. (few, some, most) persons with residual schizophrenia cannot care for themselves and long-term hospitalization is required.
30%

emotional blunting, social withdrawal, eccentric behavior, and illogical thinking


Delusions and hallucinations are uncommon. Because most persons with residual schizophrenia cannot care for themselves, long-term hospitalization is required.
Older persons with schizophrenic symptoms respond (poorly, well) to antipsychotic drugs
well
The age of onset of delusional disorder usually is between ages ?
40 and 55
In geriatric period, delusions can take many forms; the most common are ?
persecutory—patients believe that they are being spied on, followed, poisoned, or harassed in some way
Delusional disorder prognosis: poor, fair or good?
best results through what tx?
The prognosis is fair to good in most cases
best results are achieved through a combination of psychotherapy and pharmacotherapy.
A late-onset delusional disorder called ? is characterized by persecutory delusions. It develops over several years and is not associated with dementia. Some workers believe that the disorder is a variant of schizophrenia that first becomes manifest after age 60. Patients with a family history of schizophrenia show an increased rate of ?
paraphrenia
The ECA study determined that the 1-month prevalence of anxiety disorders in persons age 65 and older is? percent. By far the most common disorders are?
5.5
phobias
(4 to 8 %)
rate for geriatric panic ds?
1%
More than ? percent of persons over 65 years of age have at least one chronic disease—usually arthritis or cardiovascular problems. After age 75, ? percent have diabetes and an average of ? diagnosable chronic illnesses that require medical attention.
More than 80 percent of persons over 65 years of age have at least one chronic disease—usually arthritis or cardiovascular problems. After age 75, 20 percent have diabetes and an average of four diagnosable chronic illnesses that require medical attention.
Hypochondriasis is common in persons over 60 years of age, although the peak incidence is in those ? years of age.

The disorder usually is (short in duration or chronic), and the prognosis (guarded, fair, good)
40 to 50
The disorder usually is chronic, and the prognosis guarded
Of nursing home patients, ? percent have alcohol dependence
20%
Over all, alcohol and other substance use disorders account for ? percent of all emotional problems in older persons,
10%
The maintenance of chronically ill cancer patients with narcotics prescribed by a physician produces dependence.
The need to provide pain relief (does or does not) take precedence over the possibility of narcotic dependence
the need to provide pain relief takes precedence over the possibility of narcotic dependence and is entirely justified
Older persons may misuse over-the-counter substances, including nicotine and caffeine. Over-the-counter analgesics are used by ? percent of older persons and ? percent use laxatives. Unexplained gastrointestinal, psychological, and metabolic problems should alert clinicians to over-the-counter substance abuse
35%

30%
? is the single most important factor associated with the increased prevalence of sleep disorders
Advanced age
Sleep-related phenomena reported more frequently by older than by younger adults are ????
sleeping problems,
daytime sleepiness,
daytime napping, and the
use of hypnotic drugs.
(Younger or older) persons experience higher rates of breathing-related sleep disorder and medication-induced movement disorders
Clinically, older persons experience higher rates of breathing-related sleep disorder and medication-induced movement disorders than younger adults.
Most common primary sleep disorder among elderly?
Among the primary sleep disorders, dyssomnias are the most frequent, especially primary insomnia, nocturnal myoclonus, restless legs syndrome, and sleep apnea
Most common elderly parasomnia?
rapid eye movement (REM) sleep behavior disorder occurs almost exclusively among elderly men
The conditions that commonly interfere with sleep in older adults include ????
pain, nocturia, dyspnea, and heartburn

The lack of a daily structure and of social or vocational responsibilities contributes to poor sleep
As a result of the decreased length of their daily sleep–wake cycle, older persons without daily routines, especially patients in nursing homes, may experience ?
an advanced sleep phase, in which they go to sleep early and awaken during the night
Changes in sleep structure among persons over 65 years of age involve both REM sleep and non-rapid eye movement (NREM) sleep.
The REM and NREM changes include:
The REM changes include the redistribution of REM sleep throughout the night, more REM episodes, shorter REM episodes, and less total REM sleep.

The NREM changes include the decreased amplitude of delta waves, a lower percentage of stages 3 and 4 sleep, and a higher percentage of stages 1 and 2 sleep. In addition, older persons experience increased awakening after sleep onset.
Much of the observed deterioration in the quality of sleep in older persons is caused by ?

For example, with advanced age, persons have a (lower or higher) amplitude of circadian rhythms, a (6 or 8 or 10 or 12) -hour sleep-propensity rhythm, and (shorter or longer) circadian cycles.
the altered timing and consolidation of sleep

For example, with advanced age, persons have a lower amplitude of circadian rhythms, a 12-hour sleep-propensity rhythm, and shorter circadian cycles.
Elderly persons have a (the same, higher, or lower) risk for suicide as compared to other age groups?
Elderly persons have a higher risk for suicide than any other populatio
The suicide rate for white men over the age of 65 is ? times higher than that of the general population.
5
One third of elderly persons report ? as the principal reason for considering suicide
loneliness
Approximately 10 percent of elderly individuals with suicidal ideation report??? as reasons for suicidal thoughts.
financial problems,
poor medical health, or
depression
About ? percent of those who commit suicide are men
60% (most)
? percent of those who attempt suicide are women
75%
Suicide victims, as a rule, use ? or ?, whereas 70 percent of suicide attempters take a ? or slash themselves.
Suicide victims, as a rule, use guns or hang themselves, whereas 70 percent of suicide attempters take a drug overdose, and 20 percent cut or slash themselves.
. Psychological autopsy studies suggest that most elderly persons who commit suicide have had a psychiatric disorder, most commonly ?.
depression
More elderly suicide victims are ? and (fewer, more) are single, separated, or divorced than is true of younger adults
More elderly suicide victims are widowed and fewer are single, separated, or divorced than is true of younger adults
Violent methods of suicide are (less or more) common in the elderly, and alcohol use and psychiatric histories appear to be (less or more) frequent
Violent methods of suicide are more common in the elderly, and alcohol use and psychiatric histories appear to be less frequent
The most common precipitants of suicide in (younger or older) individuals are physical illness and loss, whereas problems with employment, finances, and family relationships are more frequent precipitants in (younger or older) adults
The most common precipitants of suicide in older individuals are physical illness and loss, whereas problems with employment, finances, and family relationships are more frequent precipitants in younger adults.
(few, some, most) elderly persons who commit suicide communicate their suicidal thoughts to family or friends before the act of suicide.
MOST
(few, some, many, most) cases of vertigo have a strong psychological component
Most cases of vertigo have a strong psychological component, and clinicians should ascertain any secondary gain from the symptom
About ? percent of persons over age 65 have significant hearing loss (presbycusis). After age 75, that figure rises to ? percent
About 30 percent of persons over age 65 have significant hearing loss (presbycusis). After age 75, that figure rises to 50 percent
(few, some, many, most) elderly persons with hearing loss can be treated with hearing aids
MOST
An estimated ? percent of persons above 65 years of age are abused. Elder abuse is defined by the American Medical Association as
10% abused
“an act or omission which results in harm or threatened harm to the health or welfare of an elderly person.”
Demographic data suggest that ? percent of women and ? percent of men over the age of 65 will be widowed at least once.
Demographic data suggest that 51 percent of women and 14 percent of men over the age of 65 will be widowed at least once.
Adults over 65 years of age use the greatest number of medications of any age group; ? percent of all prescriptions are written for them
25%
Psychotropic drugs are among the most commonly prescribed, along with cardiovascular and diuretic medications; ? percent of all hypnotics dispensed in the United States each year are to those older than 75 years of age, and ? percent of older persons use over-the-counter medications, compared with only ? percent of young adults.
Psychotropic drugs are among the most commonly prescribed, along with cardiovascular and diuretic medications; 40 percent of all hypnotics dispensed in the United States each year are to those older than 75 years of age, and 70 percent of older persons use over-the-counter medications, compared with only 10 percent of young adults.
The major goals of the pharmacological treatment of older persons are
to improve the quality of life,
maintain persons in the community, and
delay or avoid their placement in nursing homes.
As a person ages, the ratio of lean to fat body mass also changes. With normal aging, lean body mass (increases or decreases) and body fat (increases or decreases).
As a person ages, the ratio of lean to fat body mass also changes. With normal aging, lean body mass decreases and body fat increases.
Changes in the ratio of lean to fat body mass that accompany aging affect the distribution of drugs. Many lipid-soluble psychotropic drugs are distributed more widely in fat than in lean tissue, so a drug's action can be unexpectedly ?(shortened or prolonged) in older persons.
prolonged
In older persons, the (increased or decreased) risk of orthostatic hypotension from psychotropic drugs is related to (increased or decreased) functioning of blood pressure-regulating mechanisms.
In older persons, the increased risk of orthostatic hypotension from psychotropic drugs is related to reduced functioning of blood pressure-regulating mechanisms.
According to Sigmund Freud, persons older than 50 years (are or are not) suited for psychoanalysis
According to Sigmund Freud, persons older than 50 years are not suited for psychoanalysis because their mental processes lack elasticity.
Insight-oriented psychotherapy may help remove a specific symptom, even in older persons. It is of most benefit when patients have possibilities for libidinal and narcissistic gratification, but it is contraindicated if
it would bring only the insight that life has been a failure and that the patient has no opportunity to make up for it
Common age-related issues in therapy involve
the need to adapt to recurrent and diverse losses (e.g., the deaths of friends and loved ones),

the need to assume new roles (e.g., the adjustment to retirement and the disengagement from previously defined roles),

and the need to accept mortality.
In addition to improving interpersonal relationships, psychotherapy increases
self-esteem and self-confidence, decreases feelings of helplessness and anger, and improves the quality of life
In one study conducted in an old-age home, 43 percent of the patients receiving psychotherapy showed less
urinary incontinence,
improved gait,
greater mental alertness,
improved memory, and
better hearing than before psychotherapy.
? is characterized by the progressive return of memories of past experiences, especially those that were meaningful and conflictual.

To varying degrees, elderly patients in therapy ? about the past, search for meaning in their lives, and strive for some resolution of past interpersonal and intrapsychic conflicts
Reminiscence is characterized by the progressive return of memories of past experiences, especially those that were meaningful and conflictual. To varying degrees, elderly patients in therapy reminisce about the past, search for meaning in their lives, and strive for some resolution of past interpersonal and intrapsychic conflicts
?systematically enhances this reminiscing process and makes it more conscious and deliberate. The therapist may guide the process by encouraging the patient to write or tape a biography with review of special events and turning points. Techniques include reunions with family and good friends and looking through memorabilia, such as scrapbooks or picture albums. This technique has been reported to
Life review therapy

This technique has been reported to resolve old problems,
increase tolerance of conflict,
relieve guilt and fears, and
enhance self-esteem,
creativity,
generosity, and
acceptance of the present