Mental Health in Older Adults
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Questions and Answers

What is a major reason why older people may not seek help for mental health problems?

  • Stigma associated with mental health problems (correct)
  • Lack of access to healthcare services
  • Denial of having a mental health problem
  • Fear of being institutionalized

    • What is a consequence of depression on the physical health of older adults?

  • Increased risk of obesity, frailty, and diabetes (correct)
  • Increased bone density
  • Improved sleep quality
  • Reduced risk of cardiovascular disease

    • What is a key factor in providing effective care to older adults with mental health disorders?

  • Providing medications only
  • Educating caregivers about mental health disorders (correct)
  • Focusing on physical health only
  • Isolating the older adult from others

    • What is a common consequence of mental health disorders in older adults?

    <p>Increased psychological and physical morbidity</p> Signup and view all the answers

    Why is it important to screen for and manage depression in older adults?

    <p>To improve their intrinsic capacity and functional ability</p> Signup and view all the answers

    What is a consequence of depression on the mortality rate of older adults?

    <p>Increased risk of mortality, independent of baseline health status</p> Signup and view all the answers

    Which of the following is a characteristic of late-onset psychosis?

    <p>It is characterized by delusions, hallucinations, or both</p> Signup and view all the answers

    What is the primary reason why older adults with anxiety may not present to mental health services?

    <p>Because they often complain of physical health complaints such as pain</p> Signup and view all the answers

    Which anxiety disorder is characterized by recurrent, unexpected panic attacks?

    <p>Panic disorder</p> Signup and view all the answers

    What is the primary goal of psychological therapies such as cognitive behavioural therapy in the treatment of anxiety disorders?

    <p>To improve day-to-day functioning</p> Signup and view all the answers

    Which of the following is a common co-morbid condition with anxiety disorders among older adults?

    <p>All of the above</p> Signup and view all the answers

    What is the first-line pharmacotherapy for older adults with anxiety disorders?

    <p>SSRIs</p> Signup and view all the answers

    Which of the following is a characteristic of non-cognitive symptoms of dementia (NCSD)?

    <p>Delusions, anxiety, depression, hallucinations, and apathy</p> Signup and view all the answers

    What is the primary risk associated with the use of benzodiazepines in older adults with anxiety disorders?

    <p>All of the above</p> Signup and view all the answers

    What is the primary reason why older adults may not seek help for mental health disorders?

    <p>Multiple factors, including stigma, lack of access, and lack of awareness</p> Signup and view all the answers

    Which of the following is a symptom of generalized anxiety disorder?

    <p>Both a and b</p> Signup and view all the answers

    Which of the following is a common side effect of selective serotonin reuptake inhibitors (SSRIs)?

    <p>Loss of libido</p> Signup and view all the answers

    What is the primary goal of behavioral activation (BA) in depression treatment?

    <p>To re-establish daily routines and regular chores</p> Signup and view all the answers

    Which assessment tool is used to differentiate between signs of normal aging and mild dementia?

    <p>Eight-item Informant Interview to Differentiate Aging and Dementia (AD8)</p> Signup and view all the answers

    What is the main objective of psychoeducation in depression treatment?

    <p>To help patients understand the causes and treatments of depression</p> Signup and view all the answers

    Which of the following screening questions indicates depressive symptoms?

    <p>Have you been bothered by feeling down, depressed, or hopeless?</p> Signup and view all the answers

    What is the primary goal of promoting functioning in depression treatment?

    <p>To encourage patients to spend time doing activities they enjoy</p> Signup and view all the answers

    Why is depression often unrecognized in older adults?

    <p>Because it is often confounded with other conditions that commonly affect this age group</p> Signup and view all the answers

    What is the primary advantage of selective serotonin reuptake inhibitors (SSRIs) over other antidepressants?

    <p>They have fewer adverse effects and drug interactions</p> Signup and view all the answers

    Why is it essential to assess for depression in vulnerable groups?

    <p>Because depression is often unrecognized in these groups</p> Signup and view all the answers

    What is the purpose of strengthening supports in depression treatment?

    <p>To encourage patients to take ownership of their depression treatment</p> Signup and view all the answers

    What should be performed on older people presenting with depressive symptoms?

    <p>A thorough physical examination</p> Signup and view all the answers

    What is the prevalence of schizophrenia among older adults?

    <p>0.1%-0.5%</p> Signup and view all the answers

    What is characterized by a decline in personal functioning, transitory and attenuated psychotic symptoms, and social withdrawal?

    <p>Prodromal phase</p> Signup and view all the answers

    What is often secondary in older adults?

    <p>Psychosis</p> Signup and view all the answers

    What may persist for years after treatment?

    <p>Negative symptoms</p> Signup and view all the answers

    What is a common reason persons with dementia need to move from home to residential care?

    <p>Non-cognitive symptoms of dementia</p> Signup and view all the answers

    What is characterized by delusions or hallucinations in older adults?

    <p>Late-onset psychosis</p> Signup and view all the answers

    What is associated with an increased suicide risk?

    <p>Psychotic depression</p> Signup and view all the answers

    What should be considered as differential diagnoses for psychotic symptoms in older adults?

    <p>All of the above, including neurodegenerative disorders and seizure disorders</p> Signup and view all the answers

    What can be undiagnosed and overlooked in primary care settings?

    <p>Depression</p> Signup and view all the answers

    What is the first-line therapy for late-life depression?

    <p>SSRIs</p> Signup and view all the answers

    What is a risk factor for depression in older adults?

    <p>Neurotic and ruminative personality types</p> Signup and view all the answers

    What is a characteristic of very-late onset schizophrenia (VLOS)?

    <p>More hallucinations and accusatory characteristics</p> Signup and view all the answers

    What type of therapy is used to manage depressive symptoms?

    <p>Cognitive behavioral therapy (CBT)</p> Signup and view all the answers

    What is a clinical feature of psychotic depression in older adults?

    <p>Severe psychic anxiety</p> Signup and view all the answers

    What is a benefit of exercise programs for older adults with depressive symptoms?

    <p>Increased social interaction</p> Signup and view all the answers

    What is a common co-occurring condition with depression in older adults?

    <p>All of the above</p> Signup and view all the answers

    What is a medication that can cause or aggravate depression?

    <p>Benzodiazepines</p> Signup and view all the answers

    What is the term for a person who has two or more symptoms of depression simultaneously for at least 2 weeks, but does not meet the criteria for diagnosis of depression?

    <p>Low mood</p> Signup and view all the answers

    What is the goal of mindfulness in managing depressive symptoms?

    <p>To focus on the present moment</p> Signup and view all the answers

    What is the primary goal of history taking and examination in psychosis?

    <p>To rule out underlying medical causes</p> Signup and view all the answers

    What symptom may indicate malignancy with cerebral metastasis?

    <p>Sudden weight loss or change in bowel habit</p> Signup and view all the answers

    What is an important aspect of communicating with a person with suspected psychosis?

    <p>Remaining neutral and supportive</p> Signup and view all the answers

    What is a key component of family intervention for people with psychosis?

    <p>Meetings with the person with psychosis and family members</p> Signup and view all the answers

    What is the aim of cognitive behavioral therapy (CBT) for psychosis?

    <p>To reduce distress and regain a sense of control</p> Signup and view all the answers

    What is assertive community treatment (ACT) primarily focused on?

    <p>Helping people with mental illness become independent and integrate into the community</p> Signup and view all the answers

    What is a critical aspect of non-pharmacological interventions for late-onset psychosis?

    <p>Input from caregivers and family members</p> Signup and view all the answers

    What is a common characteristic of schizophrenia spectrum disorders?

    <p>Impaired insight into illness</p> Signup and view all the answers

    What medical condition may be indicated by constipation?

    <p>Delirium</p> Signup and view all the answers

    What is a priority when an older person presents with psychotic symptoms?

    <p>Ruling out underlying medical causes</p> Signup and view all the answers

    What is the primary reason why people with dementia exhibit inappropriate behaviors when experiencing excessive stress?

    <p>As a result of their reduced capacity to cope with stress</p> Signup and view all the answers

    What is a common characteristic of hallucinations in people with dementia?

    <p>They can involve any of the senses</p> Signup and view all the answers

    What is the primary purpose of conducting a thorough assessment for people with NCSD?

    <p>To understand why the symptoms are occurring</p> Signup and view all the answers

    What is a key consideration when managing behaviors in people with dementia?

    <p>Understanding the implications of caregiver responses</p> Signup and view all the answers

    What is a common challenge in diagnosing depression in people with advanced dementia?

    <p>Difficulty in distinguishing from other psychiatric conditions</p> Signup and view all the answers

    What is a potential trigger for NCSD in people with dementia?

    <p>All of the above</p> Signup and view all the answers

    What is a key aspect of differential diagnoses for NCSD?

    <p>All of the above</p> Signup and view all the answers

    What is a common consequence of anxiety in people with dementia?

    <p>Lower quality of life</p> Signup and view all the answers

    What is a key consideration when assessing pain in people with NCSD?

    <p>Considering both verbal and non-verbal cues</p> Signup and view all the answers

    What is a common characteristic of delusions in people with dementia?

    <p>They can vary from person to person</p> Signup and view all the answers

    What is the primary purpose of a multi-disciplinary team in a community setting?

    <p>To provide community-based care and support to patients with mental health disorders</p> Signup and view all the answers

    What is the main difference between Olanzapine and Quetiapine?

    <p>Olanzapine is used to treat schizophrenia, while Quetiapine is used to treat bipolar disorder</p> Signup and view all the answers

    What is the primary reason for prescribing antipsychotic medications cautiously in late-onset psychosis?

    <p>To reduce the risk of adverse drug interactions and morbidity</p> Signup and view all the answers

    What is the primary goal of day hospital treatment?

    <p>To provide community-based treatment to patients who would otherwise require inpatient admission</p> Signup and view all the answers

    What is the term used to describe a group of symptoms that commonly occur in people with dementia?

    <p>Non-cognitive symptoms of dementia</p> Signup and view all the answers

    What is the primary reason for regularly monitoring and assessing patients taking antipsychotic medications?

    <p>To monitor for potential side effects and adjust the dosage accordingly</p> Signup and view all the answers

    What is the main difference between acute inpatient care and long-stay care?

    <p>Acute inpatient care is for patients who require a short period of treatment, while long-stay care is for patients who require a longer period of treatment</p> Signup and view all the answers

    What is the primary reason for using a low dosage of antipsychotic medications in late-onset psychosis?

    <p>To reduce the risk of adverse drug interactions and morbidity</p> Signup and view all the answers

    What is the term used to describe the process of assessing and treating patients in a day hospital setting?

    <p>Psychiatric review and assessment</p> Signup and view all the answers

    What is the primary reason for providing support to caregivers of people with dementia?

    <p>To enable caregivers to provide effective support to people with dementia</p> Signup and view all the answers

    Study Notes

    Mental Health in Older Adults

    • Mental health problems are often under-identified in older adults, partly due to stigma associated with these problems.
    • Mental health disorders are independent causes of decreased function and disability, and are associated with increased psychological and physical morbidity, and decreased satisfaction with life.

    Depression in Older Adults

    • Depression is common in older adults, especially in those who are chronically ill, isolated, or have experienced loss.
    • Depression affects intrinsic capacity and functional ability, and it is essential to screen for and manage depression in care plans.
    • Depression is linked to cardiac, cerebrovascular, and peripheral arterial diseases, and increases the risk of obesity, frailty, diabetes, cognitive impairment, and mortality.

    Non-Cognitive Symptoms of Dementia (NCSD)

    • NCSD include symptoms such as delusions, anxiety, depression, hallucinations, and apathy.
    • These symptoms can lead to behaviors perceived as challenging, such as wandering, resisting care, shouting, hoarding, and lack of sexual inhibition.

    Late-Onset Psychosis

    • Late-onset psychosis is characterized by delusions, hallucinations, or both, and includes schizophrenia and depression with psychotic symptoms.
    • It is essential to rule out underlying medical conditions, such as dementia, delirium, adverse effects of medication, or drug withdrawal, when an older person presents with depressive or psychotic symptoms.

    Anxiety in Older Adults

    • Anxiety disorders are highly prevalent in older adults, affecting almost one in five.
    • Anxiety is disabling and is associated with poor overall quality of life, and may present with physical health complaints such as pain.
    • Four types of anxiety disorders that affect older adults are Generalized Anxiety Disorder (GAD), phobias, Obsessive-Compulsive Disorder (OCD), and panic disorder.

    Barriers to Seeking Help

    • There are many reasons why older adults might be unable or unwilling to access mental health services and supports, including stigma, lack of awareness, and lack of access.
    • Healthcare professionals working with older adults should aim to overcome these barriers and provide support to patients and caregivers.

    Treatment of Mental Health Disorders

    • Psychosocial interventions, such as cognitive-behavioral therapy, acceptance and commitment therapy, and brief psychological interventions, can be effective in managing depressive symptoms.
    • Exercise, particularly social exercise, and mindfulness can also be beneficial in managing depressive symptoms.
    • Pharmacological treatment, including selective serotonin reuptake inhibitors (SSRIs), can be effective in treating depression, but it is essential to consider the potential side effects and interactions with other medications.

    Diagnosing Depression

    • Depression can be diagnosed using assessment tools such as the Geriatric Depression Scale (GDS) and the Patient Health Questionnaire for Depression (PHQ-9).
    • It is essential to assess for both depression and dementia using the appropriate tools, particularly in individuals with mild cognitive impairment.
    • Karl's symptoms, including low mood, loss of interest or pleasure, decreased appetite and weight loss, insomnia, psychomotor retardation, low energy, and diminished ability to think or concentrate, indicate depression.### Psychosis Treatment Approaches
    • Cognitive behavioral therapy (CBT) for psychosis aims to reduce distress and regain a sense of control, effective in improving positive and negative symptoms and treatment compliance.
    • Family intervention includes meetings with the person with psychosis, family, and caregivers to discuss treatment, progress, and future management, and provides ongoing support and education.
    • Assertive community treatment (ACT) is a type of community-based mental health care, providing team-based support for people with serious mental illnesses to become independent and integrate back into the community.

    Antipsychotic Medications

    • Antipsychotic medicines are recommended for treating psychosis, but should be prescribed cautiously, using a low dosage and over a short period, due to increased risk of adverse drug interactions.
    • Commonly used antipsychotic medications include:
      • Haloperidol: treats schizophrenia, rebalances dopamine to improve thinking, mood, and behavior.
      • Olanzapine: treats schizophrenia and bipolar disorder (manic depression) in adults.
      • Quetiapine: used to treat bipolar disorder (depressive and manic episodes) and schizophrenia, alone or with other medicines.

    Care Settings

    • Community: multi-disciplinary team (MDT) care for patients at home or in a nursing home setting.
    • Day hospital: provides community-based treatment, including psychiatric review and assessment, for individuals who might otherwise require inpatient admission.
    • Acute inpatient: for patients with more severe illness, who may present a risk to themselves or others, and may require inpatient care.
    • Long stay care: for patients who require admission under the Mental Health Act, often termed involuntary admission.

    Non-Cognitive Symptoms of Dementia (NCSDs)

    • NCSDs are associated with worsening cognition and progression to more severe stages of dementia, and increase the risk of secondary complications.
    • Examples of NCSDs:
      • Hyperactive behaviors (agitation, disinhibition, irritability, etc.)
      • Affective symptoms (depression, anxiety, apathy)
      • Psychotic symptoms (hallucinations, delusions)
    • Triggers of NCSDs may include unmet universal human needs (e.g., meaningful activity, belonging, acceptance, and social interaction) and environmental triggers.

    Managing NCSDs

    • Thorough assessment involving medical and social history, physical examination, and understanding of unmet needs and environmental triggers.
    • Differential diagnoses should consider medical and environmental triggers, drug-related side effects, and pain that people with NCSDs are unable to express.
    • Managing NCSDs requires understanding the implications of caregiver responses and addressing unmet needs.

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    Description

    This quiz covers the importance of identifying mental health problems in older adults, the impact of stigma, and the need for caregiver support. It also explores the consequences of mental health disorders on quality of life.

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