Chapter 14

Question 1

Many people, especially after they reach mid-life, may find the idea that they are aging to be what? What is the reality?

Answer 1

> to be distressing,

> yet research shows that older adults experience more happiness than most other age groups

Question 2

Older adults represent what segment of the population in the US and Canada? How many are there in the US that over the age of 65?

Answer 2

> Older adults represent the fastest-growing segment of the US and Canadian populations, with the leading edge of the baby boomers turning 65 in 2011.

> Over 46 million adults in the United States are 65 years of age + with this portion increasing rapidly

Question 3

The prevalence of most types of disability (e.g., problems in mobility, agility, hearing, vision,
and pain) increases with age, with the highest rates occurring in what age?

Answer 3

> the highest rates occurring in those aged 75 and older.

Question 4

All conditions except which two increase across the lifespan?

Answer 4

> All conditions except obesity and asthma increase across the lifespan.

Question 5

By age 70, what percent of older adults will have hypertension and arthritis?

Answer 5

> 7% hypertension
55% arthritis

Question 6

What condition decreases as age increases? At what age is the rate the highest for this condition?

Answer 6

> obesity decrease as age increases, with obesity rates being the highest in adults 55 to 64 years old

Question 7

At the age of 75 and older, what percentage of the Canadian population will have CVD?

Answer 7

> 23 per cent of Canadians have cardiovascular disease

Question 8

What is dementia and what are some symptoms? What does it represent?

Answer 8

> Dementia, which refers to a variety of conditions that affect the brain (e.g., Alzheimer’s disease [AD])

> produce symptoms such as memory loss and impairments in language skills
represents a significant public health need in older populations.

Question 9

What percentage of older adults aged 74 to 85 years of age have a diagnosis of dementia? (Break it down by gender)

Answer 9

> 11.6 per cent of females and 10.4 of males

Question 10

What is the prevalence rates for males and females respectively aged over 85 years respectively for dementia? (for diagnosis of)

Answer 10

> 37.1 per cent and 28.1 per cent for females and males over 85 years respectively.

Question 11

The majority of people with dementia suffer from what specific condition under this umbrella term? How many people in the US experience this?

Answer 11

> AD (alzheimers disease)
In the United States, 5.4 million Americans are estimated to suffer from AD

Question 12

Health disparities reduce the ability to achieve what among which groups and how do they arise?

Answer 12

> reduce the ability to achieve the best health outcomes among minority groups, including people of colour + those with low education and income, + rural-dwelling individuals

> Health disparities arise due to poverty, poor access to health care, and educational differences.

Question 13

Lifespan and health are determined by both what influences? What percentage is largest between these two factors in terms of influence.

Answer 13

> by both genetic and environmental or lifestyle influences, with genetics accounting for roughly 35 per cent and health behaviours

Question 14

Can health behaviours be changed?

Answer 14

> health behaviours may be changed through culturally competent educational programs.

Question 15

Ability to decrease risk factors is important for health geropsychology, but what childhood + adulthood epidemic may affect this? What are they are increased risk for?

HD,T2D,HBP,S,O,RP,C

Answer 15

> the childhood and adult obesity epidemic threatens longevity and health for people as they grow older.

> Overweight individuals are at increased risk for heart disease, type 2 diabetes, high blood pressure, stroke, osteoarthritis, respiratory problems, and some cancers.

Question 16

Approximately 75 million people in the United States have what type of condition?

Answer 16

> have more than one chronic condition

Question 17

What health outcomes are associated with chronic illnessss?

IH,CMS,DMTS,CMA,ID,D

Answer 17

> increased hospitalizations,
complicated medication schedules,
duplicated medical tests,
conflict-ing medical advice,
increased disability,
death.

Question 18

Chronic conditions often are accompanied by what disorders? As a result, what intervention has been made?

Answer 18

> are accompanied by psychological disorders such as anxiety and depression

> this has led to the development of integrated health programs that combine mental health screening and services of medical care settings treating patients (called collaborative care)

Question 19

What is a collaborative care approach? (What does it entail)

Answer 19

> an approach in which physicians and mental health–care providers work together in an organized way to manage common mental disorders and chronic disease.

> These programs are practical and apply principles of chronic disease manage-ment

> supports systematic diagnosis and health or mental health outcomes tracking.

> It also facilitates adjustment of treatments based on these outcomes

Question 20

What does the collaborative approach represents what kind of practice - particularly under what condition?

Answer 20

> Collaborative care represents best clinical practice, particularly given the multiple chronic conditions experienced by many older adults

Question 21

he National Hospice and Palliative Care Organization (2017) defines advance care planning as what?

Answer 21

as, “making decisions about the care you would want to receive if you become unable to speak for yourself.”

Question 22

Advance care planning includes what 4 elements?

Answer 22

(1) getting information on the types of life-sustaining treatments that are available;

(2) deciding what types of treatment you would or would not want should you be diagnosed with a life-limiting illness;

(3) sharing your personal values with your loved ones; and

(4) completing advance directives to put into writing what types of treatment you would or would not want should you be unable to speak for yourself.

Question 23

What are advance directives usually (how are they created)

Answer 23

> Advance directives usually are written documents designed to allow competent patients the opportunity to guide future health-care decisions in the event that they are unable to participate directly in medical decision making.

Question 24

In order to make the process of advance care planning, including advance directives, easier for individuals to complete, multiple methods have emerged. Provide some examples (3)

Answer 24

> Five Wishes and Making Your Wishes Known are two self-guided, web-based programs that provide individuals with documented end-of-life care goals.

> Respecting Choices® is a program designed and verified to improve advance care planning by training individuals to engage patients in these discussions.

Question 25

Which groups are less likely to use advance directives?

Answer 25

> People from minority groups are disproportionately less likely to complete advance directives

Question 26

Despite the many positive aspects of caregiving, providing care to an older family member with a chronic illness can be associated with what?

Answer 26

> psychological distress and and feelings of caregiver burden

Question 27

Family caregivers of individuals approaching the end of life are at risk for what health outcomes? When are they especially at risk for these outcomes?

S,D,+HP.

Answer 27

> are at risk for stress,
depression,
and health problems

• especially when there have not been previous discussions of the dying person’s wishes for medical care at the end of life.

Question 28

What is more relevant in the health care of minority groups than advanced directives?

Answer 28

> In ethnic minority groups, inclusion of family in medical decision making is common; for example, among Hispanics and African Americans the use of family to communi-cate the wishes of the patient is often seen as more relevant than a written directive

Question 29

What 4 family responses to illness management have been associated with negative patient outcomes?

BC,BO,BC,BD

Answer 29

> Being critical,
Being overprotective,
Being controlling,
and being distracting

Question 30

The Caregiver Stress–Health Model (Monin & Schulz, 2009) suggests what about Geropsychology?

Answer 30

> suggests ways in which an older adult’s suffering may influence family members’ emotion regulation and, thus, provision of care.

Question 31

What are the two possible family member response patterns as suggested by the caregiver-stress-health model?

Answer 31

> cognitive empathy and conditioned emotional responses.

Question 32

What is cognitive empathy?

Answer 32

> Cognitive empathy refers to the shared or complementary emotional experience of the family member in response to the older adult’s physical and emotional suffering.

Question 33

When do conditional emotional responses occur? What emotions do they create?

Answer 33

> occur when the family member has paired certain emotions with past experiences of the older person’s suffering (i.e., becoming angry when the older relative displays fatigue or pain)

> and can cause defensive emotions (e.g., denial, fatalism) and withdrawal from the older patient.

Question 34

Chronic pain affects what cent of older adults who live in the community and what per cent of seniors who live in long-term care

Answer 34

> at least 50 percent of older adults who live in the community

> as many as 80 for those in LTC

Question 35

Gauthier and Gagliese (2010) have discussed some of the issues specific to pain assessment for older adults and have pointed out what makes assessment for older adults harder to do?

Answer 35

> age-related changes may make it more difficult (I.e., changes in hearing / visual acuity)

Question 36

What attitude is considered a complicating factor for older adults and health care?

Answer 36

> the idea that pain is an inevitable part of aging that must be endured = a false belief

Question 37

Pain is not the result of aging per se, but the result of what mindset?

Answer 37

> but the result of pathology that ought to be treated irrespective of a person’s age.

> Beliefs that pain in old age is natural may make older persons less likely to seek assessment and treatment of their pain and contribute to the under-treatment of pain that is often seen in this population

Question 38

The CBT methods used with older adults are similar to those employed with younger persons, although the focus is considered what?

Answer 38

> the focus may be different.

> For example, older adults often present with inaccurate beliefs about pain and aging such as the aforementioned idea that pain is inevitable in old age and must be endured.

Question 39

With respect to CBT treatments, the psychologist will challenge what beliefs that have what kind of dialogue?

Answer 39

> beliefs with Socratic dialogue.

> In other words, the psychologist queries the client regarding the logic underlying inaccurate be-liefs about pain experienced by older adults

Question 40

Are the types of stressors faced by older adults the same as those faced by younger adults?

Answer 40

> are different from those typically seen among younger persons

> (e.g., younger persons are concerned about their ability to perform the duties of their occupation whereas retired older persons are more likely to be preoccupied with such issues as widowhood and empty nest).

Question 41

Lunde and colleagues (2009) found CBT to be moderately effective, with demonstrated benefit on what kind of pain for older adults? What has it not benefited?

Answer 41

> demonstrated benefit on self-reported pain

> but not on physical function, depression, or patterns of medication use

Question 42

Have acceptance and commitment therapy (ACT) approaches been beneficial?

Answer 42

> Initial results have demonstrated promising findings with respect to number of days off from work, medical care utilization, illness-focused coping strategies, catastrophic think-ing, and global distress levels over time

> Further research has been promising

Question 43

While pain tends to be under-treated in older adults in general (Herr, 2010), this under-treatment is an even more significant concern when focusing specifically on what population? What factor excaberates this?

Answer 43

> those that live in LTC

> There is evidence that older persons who live in LTC in both the United States and Canada suffer from unnecessary pain.

> One of the factors contributing to this under-treatment is the communication challenge associated with advanced dementia.

Question 44

Advanced AD and other dementias are associated with major impairments in what? As a result, how does this affect older adults and getting proper health care?

Answer 44

> in judgement and language abilities. As a result, older adults with dementia often do not report their pain.

Question 45

Health psychologists and other professionals have played an active role in trying to solve the problem of pain under-reporting by developing what assessment methods?

Answer 45

> by developing behavioural observation assessment methods, emphasizing non-verbal pain behaviours (e.g., vocalizations, grimaces).

> Such automatic, reflexive pain behaviours tend to be less affected by advanced dementia compared to self-report

Question 46

One of the most effective standardized assessment tools for identifying pain in this population is what assessment tool?

Answer 46

> the Pain Assessment Checklist for Seniors with Limited Ability to Communicate
(PACSLAC) and the PACSLAC-II

Question 47

What does the (PACSLAC) require?

Answer 47

> require health-care personnel to observe the patient and evaluate him or her for pain behaviours

Question 48

Untreated pain in LTC can lead to what specifc outcome? What is this outcome misattributed to and as a result what does it lead to?

Answer 48

> behavioural disturbances (e.g., aggression, loud vocalizations),
can easily be misattributed to psychiatric con-ditions
as a result, it can lead to unnecessary and risky phar-macological therapies

Question 49

Jane Fisher and her colleagues developed what intervention model? What does this model recognize?

the FAMI

Answer 49

> developed the Functional Analytic Model of Intervention

> this model recognizes that all behaviours are influenced by a person’s psychological and physiological history and his or her current social and physical context.

> through appropriate assessment sources of distress are identified and managed through a variety of integrated approaches

Question 50

What is one of the most frequent sources of painful injury among older adults? Approximately how many older people out of 3 exprience this a year and how many experience it more than once within the same year?

Answer 50

> Falls
Approximately one in three older persons experiences a fall, with roughly half of these individ-uals falling more than once per year

Question 51

What are falls a leading cause to? When do the rates double for falls?

Answer 51

> cause of injury and hospitalization, with hospitalization rates doubling in seniors above age 75

Question 52

In an American study, Stevens, Mack, Paulozzi, & Bal-lesteros (2008) found what what percent of falls resulted in what?

Answer 52

> found that 31 per cent of falls reported over one year resulted in at least one med-ical visit and at least one day of restricted activity.

Question 53

In a Canadian six-month longitudinal study involving 571 older adults over age 69, Hadjistavropoulos and colleagues found how many falls had occured at this time and what percentages of these falls were associated with pain/medical injury

Answer 53

> found that 199 falls occurred, with 50 per cent of these falls leading to significant injury and 22 per cent leading to pain lasting more than a few days. Moreover, 18 per cent of the falls resulted in seeking medical attention.

Question 54

What 3 medical factors increase the risk of falling? Do any other factors increase the risk of falling?

Answer 54

> visual problems,
significant orthopedic diagnosis,
use of medications that affect balance

> BUT psychological factors ALSO increase the risk of falling.

Question 55

What factors can predict future falls?

Answer 55

> depression and excessive fear of fall-ing can predict future falls

> It is often assumed that fear of falling leads to excessive avoidance of activity, which in turn leads to loss of muscle tone and fitness, which then leads to falls

> what is actually the case = older people walk in a less stable way when they become anxious (there is a change in gait)

Question 56

What method treats falls in older adults? What does it specifically allow an older adult to do? What do therapists put an emphasis on with respect to CBT?

Answer 56

> CBT

> reduces the fear of falling + recurrent falls, especially when it is combined with an appropriately supervised physical exercise program

> Allows patients to get a sense of control over falling

> An emphasis is also placed on correcting misconceptions about falls/fall risk + setting realistic goals for safely increasing physical activity + changing the home environ-ment to reduce risk

Question 57

Transition to any residential care may result in what? What are the rates for this condition for those that are in residental care?

Answer 57

> may result in depression and loneliness

> 6-25% have a diagnosis of major depression
12-25% suffer from mild depressive disorders,
and 30-50% display significant depressive symptoms

Question 58

Transitions to LTC often are pre-cipitated by what?

Answer 58

> increasing physical or cognitive impairments, which are associated with decreased quality of life in multiple domains, such as privacy, individuality, relationship, and mood

Question 59

Passage of the Nursing Home Reform Act as part of the Omnibus Budget Reconciliation Act of 1987 in the United States mandated what?

Answer 59

> mandated adequate care in skilled nursing facilities include psychosocial and quality-of-life assessments and required certified LTC facilities to employ activities per-sonnel

Question 60

he Brief Behavioural Activation Treatment for Depression (BATD) focuses on what?

Answer 60

> focuses on unique environmental contingencies that maintain depressed behaviour across settings.

> he intervention seeks to increase participation in meaningful events through goal setting and ac-tivity planning.

> A modified version of BATD with inpatients in a geropsychiatric facility involving eight sessions over a four-week period improved depression in patients

Question 61

Animal-assisted therapy in LTC has health benefits. It can improve what states including what?

Answer 61

> It can improve psychological states
including self-worth, and increase morale

Question 62

What outcomes (improvments) have occurred for older adults that take care of a canary? What 3 factors did they also expeirence decreases in compared to the controls?

PF,SC,D/A,CF,SF,LS.

Answer 62

> WITH CANARY = have demonstrated improvements in:
physical functioning,
self-care,
depression/anxiety,
cognitive functioning,
social functioning,
and life satisfaction

> the canary group also demonstrated significant decreases in somatic complaints + significant decreases in anxiety and psy-chotic symptoms

Question 63

Depressed residents are less likely to engage in what kind of activities at a LTC?

Answer 63

> informal spontaneous activities and may benefit from more structured activitie

Question 64

he American Psychological Association (APA, 2005) defines end of life as what period?

Answer 64

> defines end of life as the period when health-care providers would not be surprised if death occurred within six months.

Question 65

The APA ad-hoc committee on end-of-life issues identified four time periods when psychologists can contribute to end-of-life care: what are the four time periods?

Answer 65

(1) before illness strikes;

(2) after illness is diag-nosed;

(3) during advanced illness and the dying process; and

(4) after the death of the patient with bereaved caregivers.

Question 66

Palliative care is defined by the World Health Organization (2017) as what?

Answer 66

> as an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identi-fication and impeccable assessment and treatment of pain and other physical, psychosocial, and spiritual problems

Question 67

What does hospice require? Where can it be provided?

Answer 67

> Hospice requires a prognosis of six months or less with focus on physical and emotional comfort, not curing illness.

> It can be provided in the patient’s home, in freestanding hospice centres, hospitals, nursing homes, and other LTC facilities

Question 68

Is all palliative care hospice care? What about vice versa?

Answer 68

> Patients receiving palliative care can be receiving curative therapy; therefore, all hospice care is palliative care, but not all pal-liative care is hospice care.

Question 69

In order to meet goals of improved quality of life, what approach is adopted?

Answer 69

> the team approach is employed and often includes psychologists as well as social workers, chaplains, complementary and alternative practitioners (massage therapists, music therapists, art therapists, etc) in addition to physicians and nurses.

Question 70

One of the most familiar models of grief is the work of Elisabeth Kübler-Ross, which describes five stages of grief: what are they?

DABDA

Answer 70

> denial, anger, bargaining, depression, and acceptance

Question 71

In contrast to the five stages of grief suggested by Kubler-ross, how is grief now conceptualized?

Answer 71

> grief has been conceptualized as a life process that varies in intensity (Wessel & Garon, 2005) rather than a single experience or series of stages as described by Kübler-Ross.

Question 72

he Fraser Health Hospice Psychosocial Care Guidelines (2006) describe that grief work is not so much acceptance but what instead? As a result, what do they reccomend a grieving person to do? What do they note is an important part of grief work?

Answer 72

> it is about exploring and adjusting to life without the person who has died.

> They recommend that healing is about taking on:
the changes the loss has created,
developing a new sense of self,
investing in new roles and relationships.

> They also describe normalizing and validating the grief process as an important part of grief work.

Question 73

Of note, what per cent of individuals are resilient and experience emotional recovery following the loss of a loved one? What does this not mean though?

Answer 73

> 75%

> but that does not mean they do not experience sadness and emotional pain

Question 74

What are risk factors for persistent complex bereavement disorders?

Answer 74

> sudden and unexpected death;

> loss of a child;

> death after a lengthy illness;

> death that the mourner perceives as having been preventable;

> a relationship with the deceased that was markedly angry, ambivalent, or dependent;

> multiple losses (past or present) or additional stressors;

> mental health concerns;

> and a mourner’s perception of lack of support

Question 75

Although older adults experience declines in episodic memory with advancing age (Radvansky, 2011), considerable evidence demonstrates that what methods are popular in reducing depression in older age populations? What else improves?

Answer 75

> demonstrates that life review and reminiscence interventions are effective in reducing symptoms of depression in this population

>

• improving social interaction, quality of life, and aspects of well-being and assisting in the in-tegration, maintenance, or development of the self

Question 76

Haber (2006) clearly differentiates reminiscence (the universal, passive recall of memories) from life review: what is the difference?

Answer 76

> Life review describes a structured, potentially multi-session interview focused around one or more life themes such as family, work, major turning points, the impact of historical events, the arts, aging, dying and death, and socialization issues such as meaning, values, and purpose in life.

Question 77

We discuss reminiscence therapy in relation to three different populations: which 3?

Answer 77

> older adults in community, LTC residents, and persons in palliative care settings.

> Notably, across settings, incorporation of volunteer-delivered interventions incorporating schoolchildren, a folklor-ist/oral historian, or same-aged peer may be effective means of improving accessibility of reminiscence interventions to older adults with chronic illness

Question 78

Reminiscence has received support as an evidence-based treatment for depression among community-dwelling older adults. What is the evidence proving so?

Answer 78

> Using coding criteria suggested by the APA, Scogin and colleagues found the life review to be one of six treatments that are beneficial in reducing geriatric depression, and it is the only intervention developed specifically for older adults.

Question 79

In 28 studies, published between 1990 and 2003, using life review with nursing home patients with mild to moderate dementia, benefits were found in what areas?

SE,SI,QOL,MOPB

Answer 79

> benefits were found in self-esteem and self-integration, quality of life, and modification of problematic behaviour

Question 80

In 28 studies, published between 1990 and 2003, using life review with nursing home patients with mild to moderate dementia, which group benefited the most?

Answer 80

> Specifically, the individuals with mild to moderate dementia appeared to benefit most in the five interventions that targeted self-integration

Question 81

What were the features for the interventions used for enhanced sense of identity in the 28 studies published between 1990 and 2003 were what three elements?

Answer 81

> the features of the interventions associated with an enhanced sense of identity were:

(1) a thorough and encompassing treatment of the individual’s life story;
(2) the translation of the life story into care interactions with nursing home staff (e.g., mutual reminis-cence); and
(3) active encouragement of the residents’ meaningful activity.

Question 82

Kitwood (1997) has argued that the emphasis on what two factors in dementia care is in the process of being adopted as a best practice within LTC? What other approach has received emphasis from this researcher?

PH+S, HE has recieved an empasis

Answer 82

> has argued that the emphasis on personhood and subjectivity is a best practice within LTC,

> also, a humanistic emphasis on seeing the person with dementia as a person capable of having experiences within physical, social, and cultural con-texts.

Question 83

Moos and Björn (2006) note several methodological problems within life-review studies, including what?

Answer 83

> inadequate information on the staging of dementia,
limitations of personalized content as a result of group sessions,
and poor documentation of unprompted or spontaneous recall of memories or events

Question 84

A relatively new intervention not included in these reviews was conducted by Cohen-Mansfield and colleagues (not reminiscence or life-review). What was it based on? What identity roles were associated with older adults? As a result of these roles, what functioning improved in the sample?

Answer 84

> was based on their prior work in developing the Self-Identity in Dementia Questionnaire

> Older persons with dementia most frequently report the follow-ing salient identity roles, in order of prevalence:
(1) family heritage;
(2) success of a relative;
(3) academic achievement;
(4) occupations;
(5) traits; and
(6) survival.

> Notably, better cognitive functioning was shown to be consistently related to a greater saliency of identity role in their sample

Question 85

Cohen-Mansfield and colleagues found that those with moderate dementia provided what kind of input about their former roles? When does the saliency of caregiver input increase?

Answer 85

> provided more salient input regarding their prior roles; the saliency of caregiver input increased as the severity of dementia within an individual increased.

Question 86

A product called CIRCA was developed by who? Why was it developed?

Answer 86

> Scottish computer designers and psychologists to support reminiscence among individuals with dementia working with family and professional caregivers in adult daycare settings.

Question 87

How does the CIRCA work? How does it stand up compared to traditionally administered therapy?

Answer 87

> It is a touch-screen interface to support reminiscence.

> The interface was designed to be attractive and as simple as possible, with command prompts at the bottom of the screen to lessen fatigue.

> The system contains audio and audio-visual elements organized into three themes: (1) recreation; (2) entertainment; and (3) city life.

> In comparison with traditionally administered reminiscence therapy, CIRCA sessions are more conversational with more varied topics and materials

Question 88

Haight and colleagues (2000) examined the potential therapeutic effects of a face-to-face structured life review with a therapeutic listener over three years- what was found?

Answer 88

> Results indicated that the life-review inter-vention was beneficial.

> Scores on the baseline and post-test measures stayed the same in the interven-tion group but went down in the friendly visit control group, indicating the life-review intervention helped residents maintain stability in affect and identity over three years.

Question 89

Two intervention models using reminiscence and life review with individuals with advanced chronic illness and either health-care professionals or family caregivers have been applied in pal-liative care settings: what are the two?

Answer 89

> (1) Chochinov’s Dignity Therapy

> (2) the Legacy Project

Question 90

What is Chochinov’s Dignity Therapy?

Answer 90

> is a combination treatment approach that bor-rows elements from supportive therapy with its emphasis on empathy and connectedness; exis-tential psychotherapy with engagement of issues such as meaning, hope, and mortality; and life review.

Question 91

One component of Chochinov’s (2012) dignity-conserving repertoire is what kind of exercise?

Answer 91

> is “generativity or legacy,” an exercise that attempts to provide comfort through the telling of the life story and sense that one’s life will transcend death. In the Dignity intervention

Question 92

Has the legacy project been successful in decreasing caregiver stress? What two factors has it also affected?

Answer 92

> the Legacy Project has been found to decrease caregiving stress and increase positive affect and family communication as the patient was approaching the end of life.

Question 93

A new, promising area of psychological treatment for those facing life-limiting illness is called what?

Answer 93

> acceptance and commitment therapy (ACT).

> ACT is a new wave of ther-apy within CBT

> the ACT treatment model is designed to help people change how they cognitively ap-proach problems using techniques related to mindfulness,
acceptance, and values-based living

Question 94

On October 27, 1997, Oregon enacted what act?

Answer 94

> On October 27, 1997, Oregon enacted the Death with Dignity Act, which allows ter-minally ill Oregonians to end their lives through the voluntary self-administration of lethal medications expressly prescribed by a physician for that purpose

Question 95

As of February 2017, what states in the US have dying with dignity statues? What state (Seperate from those with statues) has made physician-assisted dying legal by SCC ruling?

C,C,DOC,O,V,W. M

Answer 95

> California, Colorado, District of Columbia, Oregon, Vermont, and Washington have Death with Dignity statutes.

> In Montana, physician-assisted dying is legal by State Supreme Court ruling (Death with Dignity National Center, 2018).

Question 96

Does Canada have any legislation for medically assisted death? If so, what is the eligibility criteria?

Answer 96

> In 2016, new Canadian federal legislation created a regulatory framework for medically as-sisted death

> Medically assisted death is now legal in Canada, if strict eligibility criteria are met (e.g., over the age of 18 years, must be eligible for medical services funded by the Government of Canada, incurable illness/disease/disability, nat-ural death is “reasonably foreseeable”, suffering is intolerable to the person and cannot be relieved under acceptable conditions).

Question 97

What is a consequence of cognitive decline among those with dementia?

PDM

Answer 97

> Poor decision making

Question 98

What is divided attention? Does age affect this function?

Answer 98

> Divided attention is the ability to pay attention to multiple streams of information simultaneously, or to ignore competing in-formation or stimulation while concentrating on a task.

> Divided attention is slightly com-promised by age, and more so by cognitive impairments

Question 99

According to the Society for Cognitive Rehabilitation (2013), cognitive rehabilitation therapy is defined as?

Answer 99

> “the process of relearning cognitive skills that have been lost or altered as a result of damage to brain cells/ chemistry.”

Question 100

Examples of cognitive rehabilitation strategies that can improve encoding (use of context and existing knowledge to understand and store information) are what?

Answer 100

> providing instruc-tion about activities at a slower pace,

> controlling the environment to cut down on distractions

> providing instruction in multiple modalities

> providing activities that have high levels of initial success

> using adaptive or supportive environments and assistive devices

Question 101

Sperling and colleagues (2011) found that older persons who exhibit cognitive decline, but do not yet meet accepted criteria for mild cognitive impairment (MCI) or Alzheimer’s disease (AD), may be most likely to benefit from what kind of intervention?

Answer 101

> benefit from early intervention and offer a unique opportunity to reduce the public health burden posed by AD.

Question 102

Plassman, Williams, Burke, Holsinger and Benjamin (2009) reviewed factors associated with risk and possible prevention of cognitive decline and found insufficient evidence for most factors but promise for what factors?

Answer 102

> acknowledged some promise for exercise, cognitive training, and certain nutritional patterns (i.e., a Mediterranean diet and fruits and vegetables).

Question 103

Yamaguchi, Maki, and Yamagami (2010) recommend a new approach to maintaining cognitive function called what?

Answer 103

> called brain-activation rehabilitation.

Question 104

Yamaguchi, Maki, and Yamagami (2010) recommend that activities designed to maintain cognitive function should include what five principles?

EACA,ATPTWC,ETEMAP,EISRTTLLIAA,PESTAPC

Answer 104

(1) enjoyable and comfortable activities;

(2) activities that promote two-way communication;

(3) efforts to enhance motivation among patients;

(4) engagement in social roles that tap lifelong interests and abilities; and

(5) pleasant environmental settings that are patient-centred.

Question 105

The available evidence is limited and there are no significant benefits of cognitive training in individuals with what conditions that are in the early stage? What is this attributed to?

Answer 105

> AD or vascular dementia

> this is attributed to a lack of randomized control trials in cognitive rehabilitation studies

Question 106

In 2012, a clinical study examining cognitive rehabilitation also demonstrated no effect on what kind of functioning?

Answer 106

> no effect on the everyday functioning of participants with early-onset dementia