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Chapter 15 Practice Exam Questions

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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 15: Late Life and Psychological Disorders LEARNING GOALS 1. Be able to describe common misconceptions about age-related changes and understand genuine age-related changes. 2. Be able to discuss issues involved with conducting research on aging. 3. Be able to explain the symptoms of dementia and delirium and understand current approaches to etiology and treatment. 4. Be able to describe the prevalence, etiology, and treatment of psychological disorders in the elderly. 5. Be able to explain the issues involved with community living, assisted living, and nursing homes. Summary Aging: Issues and Methods Until recently, the psychological problems of older people were neglected by mental health professionals.As life expectancy continues to improve, it will become even more important to learn about the disorders suffered by some older people and the most effective means of treating them.  Several stereotypes about aging are false. Generally, people in late life report low levels of negative emotion, are not inappropriately concerned with their health, and are not lonely. They typically report active sexual lives. On the other hand, poverty, stigma, and physical disease are common challenges for people as they age.  In research studies, differences between a younger and an older group could reflect either cohort effects or effects of chronological age. Longitudinal studies are more helpful for making this distinction than are cross-sectional studies. Cognitive Disorders in Late Life  Serious cognitive disorders affect a small minority of older people. Two principal disorders have been distinguished: dementia and delirium.  In dementia, the person’s intellectual functioning declines, and memory, abstract thinking, and judgment deteriorate. If the dementia is progressive, as most cases are, the individual comes to seem like another person altogether and is, in the end, oblivious to his or her surroundings.Avariety of diseases can cause this deterioration. The most common is Alzheimer’s disease, a progressive, irreversible illness in which cortical cells waste away. Genes probably play some role in the etiology of Alzheimer’s disease.Ahistory of head injury and depression are also risk factors.  Other forms of dementia include frontal-temporal dementia, frontal-subcortical dementia, and dementia with Lewy bodies.  Dementia usually responds only minimally to medication treatment, but the person and the family affected by the disease can be counseled on how to make the remaining time manageable and even rewarding. If adequate support is given to caregivers, many patients can be looked after at home.  In delirium, there is sudden clouding of consciousness and other problems with thinking, feeling, and behaving, such as fragmented and undirected thought, incoherent speech, inability to sustain attention, hallucinations, illusions, disorientation, lethargy or hyperactivity, and mood swings. The condition is reversible, provided that the underlying cause is adequately treated. Causes include overmedication, infection of brain tissue, high fevers, malnutrition, dehydration, endocrine disorders, head trauma, cerebrovascular problems, and surgery. Psychological Disorders in Late Life  Data indicates that people over age sixty-five have the lowest overall rates of mental disorders of all age groups. When older people experience psychological disorders, the symptoms are often a recurrence of a disorder that first emerged earlier in life.  In older adults, depression tends to be accompanied by more cognitive impairment. When the onset of a first episode of depression occurs after age 65, cardiovascular disease is often a cause.  More of the suicide attempts of old people result in death than do those of younger people, and the group with the highest rate of suicide is elderly Caucasian men.  Anxiety disorders are more prevalent than depression among older adults.  Delusional (paranoid) disorder may also be seen in older patients. Sometimes, onset occurs in the context of brain disorders, sensory losses, or increasing social isolation.  Medication treatments for psychological disorders are similar in effectiveness during adulthood and late life but must be used with caution because the elderly are more sensitive to side effects and toxicity. Issues Specific to Treatment with OlderAdults  The treatments shown to help most psychological disorders in adulthood appear to be helpful for late life disorders. For example, cognitive, behavioral, and interpersonal psychotherapy are effective for depression, and cognitive behavioral treatment is effective for anxiety.  Psychological treatments may need to be tailored to the needs of older people. Clinicians should sometimes be active and directive, providing information and seeking out the agencies that give the social services needed by their clients. Living Situations: Community Living, Nursing Homes and OtherAlternatives  Most older people reside in the community.  Nursing homes sometimes do little to encourage residents to maintain whatever capacities they have. Both physical and mental deterioration may occur. Serious neglect can be found in some nursing homes, and access to mental health care is limited. Several efforts have been made to correct these deficiencies.  An increasingly popular alternative is assisted-living facilities. 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: 500 2. 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: 497 3. 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: 502 4. 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: 499 5. 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:AType: Factual Page: 499 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: 500 7. 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 follow-up data was collected. Answer: B Type:Applied Page: 501 8. Agroup 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: 501 9. 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: 500 10. 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. d. people from different cultures are compared at one point in time. Answer:AType: Factual Page: 501 11. 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: 501 12. 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 follow-up data was collected. Answer: D Type:Applied Page: 501 13. Impairment in which of the following areas is the most prominent symptom of dementia? a. memory b. abstract thinking c. judgment d. language Answer:AType: Factual Page: 502 14. 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: 504 15. What is an early sign ofAlzheimer's disease? a. loss of sensation or motor control on one side of the body b. difficulty comprehending speech c. difficulty remembering new material d. clouded states of consciousness Answer: C Type:Applied Page: 504 16. 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: 504 17. In what brain areas are abnormalities found inAlzheimer's patients? a. cerebellum b. sensory cortical areas c. brain stem d. cerebral cortex Answer: D Type:Applied Page: 504 18. Alzheimer’s disease is characterized by a. plaques between neurons. b. pick bodies within neurons. c. cerebellum deterioration. d. swelling of the cortex. Answer:AType: Factual Page: 504 19. Plaques, which develop as part ofAlzheimer'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:AType: Factual Page: 504 20. 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. Answer: C Type:Applied Page: 505 21. Which of the following may serve as a protective factor againstAlzheimer'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 in
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