Geriatrics Flashcards Preview

Psychiatry pro +1700 > Geriatrics > Flashcards

Flashcards in Geriatrics Deck (63):
1

What is the "oldest old" segment of the population?

85+

2

What happens to cerebral blood flow with aging?

Decreases

3

What happens to the transport across the BBB with aging?

Increases

4

What is the major concern with increased fat with aging in terms of drug prescriptions?

More lipophilic drugs stay around longer--lower doses needed

5

IQ is stable until what age?

80

6

True or false: the verbal abilities of the elderly generally decline with age

False

7

True or false: simple recall declines with older age

True

8

True or false: Recognition is generally intact in the elderly

True

9

Does personality change much with age?

Thinking is no

10

What is the role of social activity in the elderly?

Socially active seniors are generally healthier, both physically and emotionally

11

What is the major issue with retirement in some older folk?

Loss of identity and self esteem

12

True or false: most people who retire voluntarily will not re-enter the workforce

False--will reenter the workforce in 2 years

13

What happens to sexuality with geriatrics?

-Frequency of orgasms declines
-social/culture factors prevent them to realize their full sexual potential

14

The level of sexual activity in the elderly depends largely on what?

The presence of and health of the spouse

15

Who are the usual caregivers with the elderly?

Wives, daughters, and daughters-in-law

16

Do caregivers to the elderly usually have jobs outside the home?

Yes--more than 50%

17

What are the levels of care for the elderly?

-Home care services
-Assisted living
-Nursing homes
-Memory care units

18

True or false: there is a good correlation between physical health, and mental health in older patients

True

19

What is the major challenge with family dynamics in the elderly?

Maintaining appropriate boundaries, and ensuring that information is released appropriately

20

How hard is it to get durable power of attorney for healthcare?

Tough-ish (legal document must be signed)

21

What is the difference between a guardianship vs a conservatorship?

Conservatorship = Court ordered person to look over a specific aspect of a pt's life (financial)

Guardianship = Personal and property interests of a person is given to another

22

True or false: a civil commitment can be filed by anyone

True--but need two

23

True or false: mental decline falls under the jurisdiction of civil commitment

True

24

Which is judge determined: competency vs capacity

Competency

25

Does self-abuse (e.g. no eating/drink etc) fall under the category of dependent adult abuse?

Yes

26

True or false: if it's not your patient, then you do not have a legal requirement to report abuse

True

27

What is the major issue with interviewing the a patient with their caretaker?

May not see abuse, or interfere with examination

28

True or false: if you are determining capacity, you should not tell the patient that you are assessing them for it

False--should inform them

29

What are the two major things that should be done with elderly patients on a regular basis?

-Updated medication list
-Cognitive screening

30

Personality changes in the elderly should be suspicious for what?

Neurocognitive disorder or dementia

31

New onset psychosis in the elderly should be suspicious for what?

Dementia or neurocognitive disorder

32

When is dividing doses appropriate in the elderly?

If they are in a nursing home, or have help with their medications

33

What is the general rule of thumb for prescribing medication in the elderly?

Start low, go slow, sometimes say no

34

True or false: prevalence of depressive disorders in the geriatric population is actually lower than younger people if they are in good health

True

35

True or false: suicide rates are higher in elderly

True

36

What is the common theme with depressive disorders in the elderly

Loss

37

True or false: elderly patients may have quasi-psychotic experiences where they sense the presence of the deceased

True

38

What type of drugs should be avoided with bereavement in the elderly?

Sedative hypnotics

39

When do the psych symptoms of bereavement subside, usually?

Within a year

40

What is the most common presentation of late life major depression?

Somatic complaints

41

True or false; relapse rates of MDD in the elderly are generally low

False-- high

42

What happens to cognition with MDD later in life?

Blunted--pseudodementia

43

Venlafaxine side effect = ?

HTN

44

What is the major side effect of citalopram?

QT prolongation

45

What is the major side effect of paroxetine?

anticholinergic effects

46

What is the major side effect of duloxetine?

Bleeding risk

47

What is the major side effect of mirtazapine?

Promotes sleep, increases appetite

48

What is the major side effect of doxepin?

QT prolongation, sleep

49

What is the major issues with Li in the elderly?

New neurological symptoms

50

Should you discontinue treatment of Li in the elderly if they are responding well w/o side effects?

No

51

How common are late life schizophrenia?

Very Rare

52

What happens to late life schizophrenia, in terms of residual s/sx?

30% will enter a residual phase where negative symptoms are more prominent and positive symptoms fade

53

What is the usual onset of late life delusional disorders?

40-55

54

What should always be suspected with late life delusional disorder?

Neurocognitive disorders

55

What is the most common type of anxiety disorder late in life? How do the s/sx of this compare to the same disorder earlier in life?

Phobias--less severe

56

What specific treatment for late anxiety disorders might you not be able to use if the patient is cognitively impaired?

Psychotherapy--will not remember

57

What are the major side effects of benzos in the elderly?

-Impair gait
-Paradoxical excitation

58

How does the pharmacological treatment for anxiety disorders in the elderly compare to the younger population?

Same meds, but more avoidance of benzos

59

What are the issues with later life substance abuse? (2)

-related injuries can be devastating
-new onset neurocognitive disorders

60

What are the common approaches to late life sleep disorder?

Sleep hygiene:
-Avoid EtOH and caffeine
-Avoid hypnotics
-CPAP PRN

61

What is the major side effect of clozapine?

Agranulocytosis

62

What is the antidepressant of choice for anorexic patients, or those with insomnia? Why?

Mirtazapine--promotes sleep and increases appetite

63

How common are late life somatic symptoms disorders (e.g. hypochondriasis etc)?

Common