Flashcards in Aging, Death, and Bereavement Deck (36):
The fastest growing segment of the population is people over ...?
Gerontology is the study of ...?
Geriatrics is the ...?
Care of aging people.
Geriatricians typically ...?
Manage rather than cure the chronic illness of aging such as HTN, cancer, and diabetes.
Geriatrics - A major aim of geriatrics is to keep elderly patients ...?
Mobile and active.
Prevention and management of osteoporosis includes:
1. Weight bearing exercise.
2. Incr. calcium and vitD.
3. Medications which decrease bone resorption by blocking osteoclasts, for example, alendronate sodium (fosamax) or increase bone formation by stimulating osteoblasts, for example, teriparatide (forteo) are also useful.
Aging - Somatic and neurologic changes:
1. Stregth and physical health gradually decline.
2. This decline shows great variability but commonly includes not only osteoporosis but also impaired vision, hearing, and immune responses + decr. muscle mass/strength.
3. Incr. fat deposits.
4. Decr. renal, pulmonary, and GI function.
5. Reduced bladder control.
6. Decr. responsiveness to changes in ambient temperature.
Changes in the brain occur with aging - These changes include:
1. Decr. brain weight.
2. Enlarged ventricles and sulci.
3. Decr. cerebral blood flow.
4. Amyloid (senile) plaques + neurofibrillary tangles are present in the normally aging brain.
Neurochemical changes that occur in aging include:
1. Decr. availability of neurotransmitters such as NE, dopamine, GABA, and ACh.
2. Incr. availability of monoamine oxidase.
3. Decr. responsiveness of neurotransmitter receptors.
4. These changes can be associated with psychiatric symptoms such as DEPRESSION + ANXIETY.
Aging - Cognitive changes:
1. Although learning speed may decrease, in the absence of brain disease, INTELLIGENCE remains approx. the same throughout life.
2. Some memory problems may occur in normal aging.
Aging - Psychological changes - In late adulthood there is either ...?
1. A sense of ego integrity (ie satisfaction and pride in one's past accomplishments).
2. Or a sense of despair and worthlessness (Erikson's stage of ego integrity versus despair).
3. Most elderly people achieve ego integrity.
What is the MC psychiatric disorder in the elderly?
Factors associated with depression in the elderly include:
1. Loss of spouse.
2. Other family members.
4. Decr. social status.
5. Decline of health.
Depression can be managed successfully or unsuccessfully?
Successfully using supportive psychotherapy in conjunction with pharmacotherapy or electroconvulsive therapy.
Sleep patterns in the elderly change ...?
1. Loss of sleep.
2. Poor sleep quality.
Aging - Psychological changes - Anxiety and fearfullness may be associated with ...?
Realistic fear-inducing situations (eg worries about developing a physical illness or falling and breaking a bone).
Alcohol-related disorders are often unidentified but are present in ...-...% of the geriatric population.
Psychoactive agents may produce different effects in the elderly than in younger patients. For example:
Using antihistamines, such as diphenhydramine as sleep agents should be avoided because they may cause delirium in elderly patients.
For a realistic picture of the functioning level of elderly patients, the physician should ideally ...?
Evaluate patients in familiar surroundings, such as their own homes.
The average life expectancy in the US is currently ...?
The longest-lived group is ...?
The shortest-lived group is ...?
Factors associated with longevity include:
1. Family history of longevity.
2. Continuation of physical and occupational activity.
3. Advanced education.
4. Social support systems, including marriage.
According to Dr. Elizabeth Kubler-Ross, the process of dying involves 5 stages:
--> The stages usually occur in the following order, but also may be present simultaneously or in another order.
What is another name for normal grief?
Characteristics of normal grief:
1. Grief is characterized initially by shock and denial.
2. In normal grief, the bereaved may experience an illusion that the diseased person is physically present.
3. Normal grief generally subsides after 1-2years, although some features may continue longer.
4. Even after they have subsided, symptoms may return on holidays or special occasions (the "anniversary reaction").
The mortality rate is high for close relatives (especially ...) in the 1st year of bereavement.
Normal grief vs Abnormal grief:
1. Weight loss --> Minor vs significant (>5% of body weight).
2. Sleep disturbances --> Minor vs significant.
3. Guilty feelings --> Mild vs Intense.
4. Illusions vs Hallucinations or delusions.
5. Return to work and social activities --> Attempt vs few.
6. Crying and sadness vs considers or attempts suicide.
7. Severe symptoms --> 2mos.
8. Moderate symptoms subside within 1yr vs moderate symptoms persists >1yr.
Management of normal grief:
1. Incr. calls and visits to the physician.
2. Grief peer support groups.
3. Short acting sleep agents, eg zolpidem (Ambien) for transient problems with sleep.
Management of abnormal grief:
3. Electroconvulsive therapy.
4. Incr. contact with the physician.
Physician's response to death - The major responsibility of the physician is to ...?
Give support to the dying patient and the patient's family.
Generally, physicians make the patient completely ...?
Aware of the diagnosis and prognosis.
--> HOWEVER, the physician should follow the patient's lead as to how much he or she wants to know about the condition.
When may the physician tell the family the diagnosis and other details of the illness?
WITH THE PERMISSION OF THE PATIENT.
Physicians often feel what at not preventing the death of a patient?
A sense of failure.
How may the physician deal with the sense of failure?
By becoming emotionally DETACHED from the patient in order to deal with his or her imminent death.
--> Such detachment can preclude helping the patient and family through this important transition.