Chapter 15: Late Life and Psychological Disorders

Transcription

1 \ Chapter 15: Late Life and Psychological Disorders 1. Ageism refers to a. the physical deterioration that accompanies old age. b. the intellectual deterioration that frequently occurs as a person ages. c. the diversity present among older adults. d. prejudice against a person based on their age. Answer: D Type: Factual Page: The age at which one is considered 'old,' which is now 65, is based upon a. clear biological changes that begin at about that age. b. social policy. c. the age at which individuals begin to refer to themselves as old. d. a scientific standard. Answer: B Type: Factual Page: Generally older adults a. are lonely. b. are unhappy. c. complain about minor physical symptoms. d. have mild cognitive losses. Answer: D Type: Factual Page: Compared with young people, people over the age of 60 tend to a. experience more negative emotion. b. experience less negative emotion. c. experience more physiological reactivity in response to emotionally charged topics. d. report more somatic symptoms. Answer: B Type: Factual Page: Social selectivity refers to a. cultivating only one s most important social relationships. b. restricting one s social interactions only to family members. c. seeking out new social interactions. d. seeking out solitary social activities. Answer: A Type: Factual Page: 499

2 6. Which of the following medical problems is a particular problem for older adults? a. kidney disease b. lung cancer c. high blood pressure d. insomnia Answer: D Type: Factual Page: Which of the following statements is an example of a time-of-measurement effect? a. Today's older adults are less likely to seek mental health services because when they were growing up, mental illness was stigmatized. b. Because exercise has become widely promoted in the media, many older adults are now exercising and thus are healthier than predicted by earlier measures of their physical well-being. c. Because of the effects of aging on the brain, older adults do worse than younger adults on measures of "fluid" intelligence. d. In a longitudinal study, many of the elderly subjects died before the followup data was collected. Answer: B Type: Applied Page: A group of people age 40 are compared to a group age 70. This type of research is called a. longitudinal. b. time-of-measurement. c. cross-sectional. d. cohort effect. Answer: C Type: Factual Page: As the hippies of the 1960s reach old age, research may find increased drug abuse among older adults. This increase would be a(n) a. age effect. b. cohort effect. c. longitudinal effect. d. time-of-measurement effect. Answer: B Type: Factual Page: In cross-sectional research on aging, a. two age groups are compared at one point in time. b. people with different mental disorders are compared at one point in time. c. the same group of people are followed over time.

3 d. people from different cultures are compared at one point in time. Answer: A Type: Factual Page: Longitudinal studies involve a. testing several different age groups on two or more measures. b. testing age effects vs. cohort effects in a population. c. testing one cohort over time. d. testing the effects of time-of-measurement. Answer: C Type: Factual Page: Which of the following statements is an example of selective mortality? a. Today's older adults are less likely to seek mental health services because when they were growing up, mental illness was stigmatized. b. Because exercise has become widely promoted in the media, many older adults are now exercising and thus healthier than predicted by earlier measures of their physical well-being. c. Because of the effects of aging on the brain, older adults do worse than younger adults on measures of "fluid" intelligence. d. In a longitudinal study, many of the elderly subjects died before the followup data was collected. Answer: D Type: Applied Page: Impairment in which of the following areas is the most prominent symptom of dementia? a. memory b. abstract thinking c. judgment d. language Answer: A Type: Factual Page: Alzheimer's disease is evident in post-mortem brains because of the presence of a. smaller ventricles. b. atrophy of the cerebral cortex by plaque deposits. c. plaque deposits on the medulla oblongata. d. None of the above are correct. Answer: B Type: Factual Page: What is an early sign of Alzheimer's disease? a. loss of sensation or motor control on one side of the body

4 b. difficulty comprehending speech c. difficulty remembering new material d. clouded states of consciousness Answer: C Type: Applied Page: Alzheimer's disease is the result of a. age-based slowing of all bodily processes. b. low social and intellectual stimulation. c. tangled abnormal protein filaments called neurofibrillary tangles. d. side-effects of long-term medication, such as anti-parkinson's medication. Answer: C Type: Applied Page: In what brain areas are abnormalities found in Alzheimer's patients? a. cerebellum b. sensory cortical areas c. brain stem d. cerebral cortex Answer: D Type: Applied Page: Alzheimer s disease is characterized by a. plaques between neurons. b. pick bodies within neurons. c. cerebellum deterioration. d. swelling of the cortex. Answer: A Type: Factual Page: Plaques, which develop as part of Alzheimer's disease, are a. protein deposits that are outside neurons. b. cholesterol remains from poor diet. c. composed of serotonin and fatty deposits. d. equivalent to neurofibrillary tangles. Answer: A Type: Factual Page: Which of the following has been shown to play a role in the development of Alzheimer's disease? a. head injury b. immune system functioning c. an abnormality on chromosome 21 d. All of the above are correct.

5 Answer: C Type: Applied Page: Which of the following may serve as a protective factor against Alzheimer's disease? a. low fat diet b. strong baseline mental abilities and continued engagement in cognitive activities c. an active lifestyle involving daily exercise and social interaction d. high spatial relations skills Answer: B Type: Applied Page: Frontal-temporal dementias (FTD) are characterized by a. early onset Alzheimer's disease. b. primarily Acetylcholine disturbance. c. problems with executive function such as planning and problem solving. d. Huntington's chorea. Answer: C Type: Applied Page: For many years, mental health professionals believed that Lewy bodies were a sure sign of a. frontal-temporal dementia. b. Huntington s chorea. c. Parkinson s. d. vascular dementia. Answer: C Type: Factual Page: The symptoms of dementia with Lewy bodies are similar to those of a. Parkinson s. b. Alzheimer s. c. Huntington s chorea. d. Both a and b. Answer: D Type: Factual Page: Which of the following diseases can produce dementia? a. meningitis b. syphilis c. HIV d. All of the above are correct. Answer: D Type: Factual Page: 506

6 26. Biological treatments for Alzheimer's a. have been very encouraging in that acetylcholine levels can be increased by medication. b. have been limited primarily to efforts to prevent further degeneration. c. focus largely on improving memory and judgment functioning. d. are the most effective in improving functioning. Answer: B Type: Applied Page: Standard treatment for Alzheimer s disease includes a. behavior therapy to maintain cognitive skills. b. helping the victim recognize deterioration and make plans. c. drugs to reduce toxic neurotransmitter levels. d. drugs to increase acetylcholine levels. Answer: D Type: Factual Page: A problem in treating elderly patients with dementia with antipsychotic medications is that a. studies have indicated that they are more likely to die from antipsychotic medications than placebos. b. elderly patients tend to experience more severe side effects. c. symptoms of tardive dyskinesia may develop. d. they often refuse to take psychiatric medications. Answer: A Type: Factual Page: Psychological treatments for individuals with late stage Alzheimer s a. focus on helping the individual admit to and understand their cognitive deficiencies and limitations. b. are usually psychodynamic c. provide little long-term benefit. d. can significantly improve their memory. Answer: C Type: Factual Page: Compared with caregiving for other disorders, caregiving for people with requires much more time. a. delirium b. schizophrenia c. bipolar disorder d. dementia Answer: D Type: Factual Page: 508: Focus on Discovery 15.2

7 31. Which of the following predicts resiliency among caregivers? a. When the patient has more severe behavioral problems. b. When the caregiver has high levels of social support. c. When the caregiver works in mental health services. d. When the caregiver is committed to changing the behavior of the patient. Answer: B Type: Factual Page: 508: Focus on Discovery Delirium, but not dementia, is characterized by a. slow onset. b. cognitive confusion. c. rapid mood changes. d. poor judgment. Answer: C Type: Factual Page: After being released from a brief hospitalization for minor surgery, 70- year-old Mrs. Bee seemed distractible and disoriented. She did not even recognize her husband when he came to pick her up from the hospital. After they returned home, they discussed their plans for the weekend and Mrs. Bee seemed fine, but as night came on, she could not sleep and began accusing Mr. Bee of throwing away her belongings while she was away. Which of the following disorders best fits Mrs. Bee's symptoms? a. delusional (paranoid) disorder b. early dementia, probably Alzheimer's disease c. delirium d. depression Answer: C Type: Applied Page: Delirium can occur only a. after age 70. b. following a stroke. c. after a significant life stressor such as loss of a spouse. d. None of these are correct. Delirium can occur at any time. Answer: D Type: Applied Page: Surgery is a common precipitant for the onset of a. Alzheimer's disease. b. delirium. c. Parkinson's disease. d. hydrocephalus. Answer: B Type: Applied Page: 510

8 36. If you are talking to a person with delirium, it may feel like you are talking a. to someone who has suffered amnesia. b. to a child. c. to someone who is depressed. d. to someone who is drunk. Answer: D Type: Factual Page: Delirium that is not treated a. resolves itself. b. reoccurs. c. can be fatal. d. progresses into dementia. Answer: C Type: Factual Page: Individuals with dementia are at high risk for a. delirium. b. meningitis. c. schizophrenia. d. dehydration. Answer: A Type: Factual Page: Compared with all other ages, people over the age of sixty-five have a. the highest prevalence of mental disorders. b. the lowest prevalence of mental disorders. c. the highest rates of schizophrenia. d. high rates of substance abuse. Answer: B Type: Factual Page: Which of the following is not a reason for why rates of psychopathology are so low late in life? a. Older adults may underreport symptoms. b. cohort effects c. People with mental illness are at risk for early death. d. Dementia masks most other psychopathology. Answer: D Type: Factual Page: Reported rates of psychopathology in older adults are low because a. older people are mentally healthier.

9 b. older people are reluctant to admit problems. c. disturbed people tend to die younger. d. All of the above are correct. Answer: D Type: Factual Page: Which of the following mood disorders are most common among older adults? a. major depression b. cyclothymic disorder c. mania d. bipolar I disorder Answer: A Type: Factual Page: When psychological disorders such as depression occur in older adults, there is a tendency to misattribute the problems to a. dementia. b. longstanding personality traits. c. interpersonal difficulties. d. genetic factors. Answer: A Type: Applied Page: Depression in older adults can be distinguished from depression in younger adults by higher levels of a. cognitive symptoms. b. suicidal ideation. c. hostility. d. agitation. Answer: A Type: Factual Page: Dementia and depression can be distinguished by a. higher rates of errors of omission for depression. b. higher levels of hostility in dementia. c. increased confusion in depression. d. All of the above are correct. Answer: C Type: Factual Page: Depression in older adults is often linked to a. medical illnesses. b. dopamine changes. c. retirement.

10 d. social isolation. Answer: A Type: Factual Page: Late onset first depressive episodes appear to be tied to a. vascular disease. b. dementia. c. AIDS. d. mental retardation. Answer: A Type: Factual Page: Which of the following is not an established intervention for depression in older adults? a. psychotherapy b. antidepressant medication c. St. John's Wort d. electroconvulsive therapy Answer: C Type: Factual Page: Which of the following is currently used in the treatment of depression in the elderly? a. antihypertensive medication b. psychosurgery c. placebos d. electroconvulsive shock therapy (ECT) Answer: D Type: Factual Page: For individuals who develop depression after a myocardial infarction, a. CBT did not reduce depressive symptoms. b. CBT failed to influence cardiovascular health. c. CBT decreased the risk of future heart attacks. d. CBT reduced depressive symptoms and decreased the risk of future heart attacks. Answer: B Type: Factual Page: Which of the following depressed individuals is most likely to commit suicide? a. 82-year old white male b. 34-year old white male c. 90- year old African American female d. 83-year old white female

11 Answer: A Type: Factual Page: Which of the following is not a common cause of paranoid suspiciousness in the elderly? a. overinvolvement with frightening themes from television programs b. filling in the blanks caused by hearing and memory loss c. social isolation limiting opportunities to check suspicions d. justified suspiciousness as older people are often taken advantage of by others Answer: A Type: Factual Page: The most common cause of paranoia in older adults is a. schizophrenia and schizoaffective disorder. b. delirium and dementia. c. brief psychotic disorder. d. depression. Answer: B Type: Factual Page: Treatment of paranoia in older adults involves a. supportive approaches accompanied by cognitive therapy. b. demonstrating to the patient the inaccuracy of their delusions, often with the help of significant others. c. stopping medications to determine whether prescription drugs are causing the symptoms. d. All of the above are appropriate first steps. Answer: A Type: Factual Page: Because of cognitive characteristics of older adults, psychotherapists working with them should a. focus on concrete daily issues. b. evaluate suitability for therapy. c. pace explanations carefully. d. involve families in therapy. Answer: C Type: Factual Page: Treatment for older adults is best provided by a. medical doctors. b. social workers. c. nurse practitioners. d. interdisciplinary teams.

12 Answer: D Type: Applied Page: 523: Focus on Discovery In a classic study, older adults who had intensive professional treatment were more likely to die because they were a. sick initially. b. misdiagnosed. c. overmedicated. d. institutionalized. Answer: D Type: Factual Page: Moving an elderly family member to a nursing home a. can strengthen family ties. b. increases stress in the family due to loss of control. c. usually leads to a severing of the relationship between the parent and child. d. is the first choice for most families in the U.S. who can afford it. Answer: A Type: Applied Page: Elderly individuals placed in good quality nursing homes may still deteriorate more quickly than individuals who stay in their homes. This may occur because a. family members provide better care than even good nursing homes. b. good nursing care means more drugs with increased risks of overdose. c. people wait too long to enter nursing homes due to the high financial costs. d. good care discourages them from keeping up independent living skills. Answer: D Type: Applied Page: In an attempt to improve the quality of care in nursing homes, a. several state governments have tried to move patients into assisted living facilities. b. the federal government has imposed specific quality control indices. (???) c. nursing homes now require that all staff have at least an associates degree. d. nursing homes are limiting the number of people admitted. Answer: B Type: Factual Page: Which is characteristic of continuing care retirement communities? a. Ability to move from independent living to nursing care as needed. b. Integrated programs to support those continuing to live in the community. c. High levels of professional staff support to maintain functioning.

13 d. More affordable housing. Answer: A type: Factual Page: 526 Essay Questions: 1. Describe cohort effects and time-of-measurement effects. How do these issues figure in research with older adults? 2. Distinguish between dementia and delirium. 3. What factors have contributed to the stereotypes associated with dementia and delirium among older adults? 4. How would a practitioner distinguish between delusional disorder, delirium, and dementia in an older adult? 5. Discuss the different treatment care options for families with older adult members requiring treatment beyond that possible in the home. 6. Discuss the contributions of members of an interdisciplinary team for the treatment of older adults.