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