Quiz 1

Question 1

Young-old adults

Answer 1

65 to 74

Question 2

Middle-old adults

Answer 2

75 to 84

Question 3

Old-old adults
fastest growing segment
of the population in Canada

Answer 3

85 and up

Question 4

fastest growing segment
of the population in Canada

Answer 4

Old-old adults

Question 5

Census 2021-7,000,000 people aged 65 and older (____%) of the population (Census 2021: 37,000,000 total)

Answer 5

19

Question 6

Baby boomers make up ____% of the population

Answer 6

24.9

Question 7

Retirements from an aging labour forces grows ____ times faster than children 0-14.

Answer 7

six

Question 8

The highest concentration of seniors is found in the ___________. The largest number of seniors are located in British Columbia.

Answer 8

Atlantic Provinces

Question 9

More seniors are _______ and as seniors age the proportion of ______ increase.

Answer 9

women

Question 10

About 28% of seniors are ________. Most have been living in Canada since they were a relatively young age.

Answer 10

immigrants

Question 11

In 2006, adults (65+) comprise 4.8% of the Indigenous population . In 2016, this proportion had grown to ___%. (projected to double by 2036)

Answer 11

7.3

Question 12

remembering you couldn’t find your car last time you went to a game, so you took the time to find a landmark next time. 911. COVID.

Answer 12

Episodic memory

Question 13

relate to significant events in YOUR life. Death of family/friends. Year you graduated. This part is the clearest in elderly – it is important for them to share & makes them feel good.

Answer 13

Autobiographical memory

Question 14

general knowledge. Geography, prime minster of Canada, knowing an apple is a fruit. 454 grams = 1 pound.

Answer 14

Semantic memory

Question 15

Theories of aging

Answer 15

Biological, Psychological & Sociological

Question 16

looking at length of live and viability of organs

Answer 16

Biological

Question 17

Looks at behavioral capacities, including learning, perception, and memory

Answer 17

Psychological

Question 18

Life satisfaction, adjustment to role changes

Answer 18

Sociological

Question 19

The theory suggests that aging results from a gradual deterioration of the cells and tissues of the body via _______, oxidative stress, exposure to radiation, toxins, or other deteriorative processes.

Answer 19

wear and tear (theory of aging)

Question 20

Cells have a predefined suicidal pathway – then they die
Pre programed to die at a certain age

Answer 20

Programed senescence theory

Question 21

A type of unstable molecule that is made during normal cell metabolism (chemical changes that take place in a cell). Free radicals can build up in cells and cause damage to other molecules, such as DNA, lipids, and proteins. This damage may increase the risk of cancer and other diseases.

Answer 21

Free radical theory

Question 22

The cross-linking theory of aging was proposed by Johan Bjorksten in 1942 (8). According to this theory, an accumulation of cross-linked proteins damages cells and tissues, slowing down bodily processes resulting in aging.

Answer 22

Cross-linking theory

Question 23

Leonard Hayflick introduced the hayflick limit as the number of times a cell population can divide until it attains a cell cycle arrest. It is found to correlate with end regions of DNA strand called telomeres as telomeres get shorter by each cell division.

Answer 23

Hayflick Limit Theory

Question 24

“If you don’t use it, you lose it”
Continue learning new things, playing new games, education.

Answer 24

Plasticity theory

Question 25

A dose appropriate for the older adult in a schedule that is acceptable to the client (client centered).

Answer 25

Considerations for Determining If and What Medications are Appropriate

Question 26

A review of current medications the client is taking that may be reduced or eliminated, or any medications that may possibly interact.

Answer 26

Considerations for Determining If and What Medications are Appropriate

Question 27

Individual treatment plans that include education on non-drug options and information on side effects, action to take, & who to call.

Answer 27

Considerations for Determining If and What Medications are Appropriate

Question 28

may be defined as what the body does to the drug ADME

Answer 28

Pharmacokinetics

Question 29

which may be defined as what the drug does to the body.

Answer 29

pharmacodynamics

Question 30

intestinal motility decreases, increase in gastric pH as we age, drugs are sitting in our systems longer

Answer 30

Absorption in Elderly

Question 31

less muscle mass as we age, increased fat to muscle ratio

Answer 31

Distribution in Elderly

Question 32

decrease in liver size, metabolizing enzymes are effected

Answer 32

Metabolism in Elderly

Question 33

renal capacity as we age is poorer

Answer 33

Excretion in Elderly

Question 34

Age-related sensitivity to the therapeutic and toxic effects of medicines, especially centrally acting medicines (i.e., medications that lower heart rate and blood pressure). These medications can cause slowed heart rate, dizziness headache, etc.). Sensitivity to sedating medications in older people. Pharmacokinetic interaction- one medication affects the plasma concentration of the other medication.

Answer 34

Pharmacodynamic Changes

Question 35

Anticholinergic syndrome: Serotonin syndrome: *Both are more common in people who are on multiple medications, and older adults tend to be in that category.

Answer 35

Syndromes of concern

Question 36

Avoid and reduce the use of prescription and non-prescription medications ( i.e. de-prescribe) when possible. Seek, use, and teach clients and their families about alternative strategies to manage the challenges and illnesses. Create a societal and institutional culture where clients, professionals, and others do not believe that medication is the answer or… the only answer. Encourage using pharmacist as a resource.

Answer 36

Safer med use for Elderly

Question 37

Educate clients and their support system re: safe administration For older persons who are in hospital/facility care, safety processes, such as medication reconciliation, should be utilized. Each facility should have its own process. Strategies … blister packs, medication diaries, regular review of medications with providers, he introduction of strategies to de-prescribe whenever possible….

Answer 37

Safer med use for Elderly

Question 38

several definitions in literature, but the general consensus is 5 or more medications

Answer 38

Polypharmacy

Question 39

This cut off point of __ medications has been shown to be associated with the risk of adverse outcome such as falls, frailty, disability, and mortality in older adults (Dona Varghese; Hayas Haseer Koya, 2019).

Answer 39

5

Question 40

_____________ for Potentially Inappropriate Medication Use in Older Adults (_____ List), are guidelines for healthcare professionals to help improve the safety of prescribing medications for older adults.

Answer 40

The Beers Criteria

Question 41

The incidence of psychosis increases with age. It has two presentations in older persons:

Answer 41

Chronic or recurring psychosis Developed psychotic symptoms first time

Question 42

_________ in older persons who have had lifelong schizophrenia spectrum disorder, psychotic depression, bipolar disorder with psychosis, and

Answer 42

Chronic or recurring psychosis

Question 43

Psychosis can be with other ________. Some of these are: Brain tumour Lupus Bipolar disorder UTIs / Delirium / Infection Multiple Sclerosis Substance use Syphilis

Answer 43

diseases

Question 44

__________________: Early onset (before 40 yrs), late onset (40-60 yrs), very late onset (over 60 years). LO/VLO schizophrenia: more common in females, lower incidence of family history of psychosis/lower genetic risk (compared to EO schizophrenia (Chen, Selvendra, Stewart, & Castle, 2018). LO and VLO schizophrenia requires lower doses of neuroleptics. Older individuals with EO schizophrenia have prominent negative symptoms and poor social functioning. *some controversy regarding diagnosis Chen, L., Selvendra, A., Stewart, A., & Castle, D. (2018). Risk factors in early and late onset schizophrenia. Comprehensive Psychiatry, 80, 155–162. doi:10.1016/j.comppsych.2017.09.009

Answer 44

Schizophrenia Spectrum Disorder

Question 45

____________: More common in middle to old age Delusional content….. Person may be very guarded about their delusion, so assessment may take some time.

Answer 45

Delusional disorder

Question 46

________: Hallucinations are primarily visual…often accompanied by illusions (misperception of actual visual stimuli). Can be tactile or olfactory as well. Paranoid delusions may be present. Tend to be simple (e.g., people are following them, stealing from them, etc.). (40) Dementia - Redirecting Hallucinations with Teepa Snow of Positive Approach to Care - YouTube

Answer 46

Delirium

Question 47

Many underlying causes, so a comprehensive assessment is necessary. First, rule out physical/medical triggers. (e.g. infections, polypharmacy, substance use, sensory impairment, trauma, thyroid disease, etc.). Bloodwork/imaging. Involve family/caregivers. Is onset sudden? This can provide clues. Obtain thorough history – (e.g. previous episodes of psychosis/depression/bipolar illness, hospitalizations, cognitive function)

Answer 47

Assessment of Psychosis

Question 48

Treatment with medication if necessary – Are symptoms distressing? Do symptoms pose a risk to patient or others? Antipsychotic agents- typical and atypical

Answer 48

Treatment of Psychosis

Question 49

Short-term - for psychosis with depression, mania, substance abuse-induced psychosis. Use with caution, especially in those with dementia. Lower doses due to physical changes with aging. Consider fall risk, interaction with other medications, physical status and monitor carefully. Monitor adherence/overuse….consider cognitive deficits and other factors that may interfere with proper use. Monitor effectiveness. If medication is not effective, it may suggest a physical, underlying cause for psychosis. Medications that are not effective should not be continued.

Answer 49

Treatment of Psychosis

Question 50

Develop a strong therapeutic relationship with client. Services at the individual, family and community level. Assessments and interventions should be ongoing.

Answer 50

Treatment of Psychosis

Question 51

defined as MDD occurring in adults 60 years and older. (MacQueen et al., 2016)

Answer 51

Late Life Depression (LLD)

Question 52

Compared to patients with earlier onset of MDD, late-onset depression has a worse ______, a more chronic course, a higher relapse rate, and higher levels of medical comorbidity, cognitive impairment, and mortality.

Answer 52

prognosis

Question 53

Depression is more likely to be _____ in older patients – especially older men.

Answer 53

fatal

Question 54

Research is showing depression is linked to ________ and that it increases progression of chronic illness. ( so, it is important to treat!!)

Answer 54

poor health outcomes

Question 55

Signs of depression are often overlooked – assume it is just normal part of aging ( “They are just old.”…..ageism?) Often unrecognized and under-treated.

Answer 55

Under-treated & undiagnosed

Question 56

Older people often ASSUME that depression is a __________ and symptoms of depression are often incorrectly attributed to physical (e.g. neuro) illnesses.

Answer 56

normal part of aging

Question 57

Requires a social and physical assessment as well as a thorough mental status assessment. Physiologic changes in the brain Vascular Hormonal changes Life events/psychological.

Answer 57

Etiology of Depression

Question 58

PHQ-2 – a quick initial screening tool. PHQ-9- first self-report 9 item questionnaire specific to depression for use in primary care. Cornell Scale for Depression in Dementia

Answer 58

Assessment tools for Depression

Question 59

Older adults are a higher risk group for ________ - especially older men. They don’t tend to tell anyone and choose lethal means – assessment can be challenging and building rapport is essential.

Answer 59

suicide

Question 60

First-line consists of: nonpharmacological treatments (environmental/behavioral strategies) Pharmacological treatment and nonpharmacological interventions Others - ECT

Answer 60

Treatment of Depression in Elderly

Question 61

Medications- “start low go slow”. SSRI in combination with psychotherapy- first line trt. Adequate trial- 6 to 12 weeks with close monitoring SSRI’s and venlafaxine – stimulating so give in AM Venlafaxine (Effexor) – caution with persons with hypertension- monitor vitals when dose is increased.

Answer 61

Treatment of Depression in Elderly

Question 62

Nursing Care for depression in elderly

Answer 62

Enhance physical function & social support

Question 63

Causes or triggers: anxiety disorders; co-morbid conditions (depression and dementia in later life); direct consequence of physical health conditions common among aging persons; drug and diet association; and response to social, environmental, personal, and health-related stressors in later life

Answer 63

Anxiety in elderly

Question 64

Dementia or anxiety? Depression or anxiety? Is it a disorder or reaction? Is it from the past?

Answer 64

Challenges for assessment of anxiety

Question 65

Comprehensive and thorough assessment (physical, social, psychological and spiritual) Historical factors Physical health conditions, medication use, addictions Current social, environmental, personal, and health related stressors Patterns of coping Obtain collateral whenever possible The same assessment used with all clients including older clients who may require additional time, patience, and compassion to build & sustain a therapeutic alliance

Answer 65

Assessment of anxiety in later life

Question 66

CBT Relaxation training Supportive therapy Alternative therapies Psychoeducation strategies

Answer 66

Treatment of anxiety in later life

Question 67

Pharmaological interventions - may not be needed should be short term, and should be used to complement other interventions not relace them SSRIs Anxiolytics For older adults who have had anxiety in the past, make sure to ask what worked/didn’t work for them (medication and other interventions)

Answer 67

Treatment of anxiety in later life

Question 68

Dementia is a syndrome, of a chronic and progressive nature with a decline in cognitive functions accompanied by deterioration in emotional control, language skills, and social behaviour. In most cases, the course is progressive and irreversible, and treatments are only minimally effective in slowing progression. Symptoms of dementia include: disorientation, memory loss, impaired judgment, intellectual and social functioning, personality change, and shallow and labile effect. Behavioural and psychological symptoms become highly prevalent.

Answer 68

Neurobiology of dementia

Question 69

Dementia is a __________, of a chronic and progressive nature with a decline in cognitive functions accompanied by deterioration in emotional control, language skills, and social behaviour.

Answer 69

syndrome

Question 70

Dementia, in most cases, the course is ________ and ____________, and treatments are only minimally effective in slowing progression.

Answer 70

progressive; irreversible

Question 71

The neuropsychiatric inventory The behavioral pathological rating scale for Alzheimer’s Disease The Cohen-Mansfield Agitation Inventory The Cornell Scale for Depression in Dementia

Answer 71

Measures of the behavioural and psychological symptoms of dementia

Question 72

Dementia screening questionnaire for caregivers The min-mental state examination The cognitive abilities screening instrument Short portable mental status questionnaire Older Americans resources and services The ten point clock test Activities of daily living and instrumental activities of daily living

Answer 72

Instruments used for nursing assessment