Deck 16: Aging and Mental Health

Question 1

Historically, the majority of older people with mental disorders were labeled as "eccentric," and treatment consisted of

A) isolation or institutionalization.
B) improved diet and fresh air.
C) psychoanalysis.
D) medications.
E) psychosurgery.

Answer 1

isolation or institutionalization.

Question 2

Often, losses of physical functioning, retirement, or death of loved ones will increase the likelihood that an individual will develop a mental disorder because

A) the individual finds it difficult to cope with several losses.
B) the individual becomes depressed and disheartened.
C) they do not go for counseling when it is needed.
D) these are known risk factors of mental disorders in the aging population.
E) they lack support from family and friends.

Answer 2

the individual finds it difficult to cope with several losses.

Question 3

A normal aging process involves

A) reminiscing and memory loss.
B) decreased functioning of organ systems.
C) some type of pathology.
D) an increase in disorders such as Alzheimer's disease.
E) development of diseases and poor health.

Answer 3

decreased functioning of organ systems.

Question 4

Large-scale community surveys suggest that

A) mental disorders are the most common among older adults.
B) men are more likely to have diagnosable health problems across the lifespan.
C) there is a linear increase with age in lifetime prevalence rates of combined major disorders.
D) except for dementia and sleep-wake disorders, mental disorders are less common among older adults.
E) the highest 12-month prevalence of any mental disorder exists among those over 65.

Question 5

Which of the following findings is consistent with the socio-emotional selectivity theory (SST)?

A) Older adults process negative information less deeply than positive information.
B) Older adults process positive information less deeply than negative information.
C) Older adults tend to focus more on negative information than younger adults.
D) Older adults are less likely to respond positively to emotional stimuli.
E) Older adults are more future-oriented than are younger adults.

Question 6

Why is it generally believed that older people with mental illnesses do not benefit from treatment?

A) Older people are more distrustful of psychologists than are younger people.
B) Older people are viewed by many as "set in their ways" and unable to change.
C) The types of disorders usually found in older adults are more resistant to treatment.
D) Mental illnesses are seen as a normal part of aging.
E) Older people tend not to respond to treatment as well as younger people.

Question 7

Which of the following provides one reasonable explanation as to why the percentage of older individuals has increased and will likely continue to increase over time?

A) higher levels of education that prevent people from entering physically dangerous careers.
B) effective medications that slow the cellular aging process
C) more support from younger generations
D) substantial drop in new births
E) an increase in natural, anti-aging products

Question 8

Why is it particularly difficult to properly diagnose mental disorders in older adults?

A) Side effects of medications may mimic the symptoms of certain disorders.
B) Clinicians are largely unfamiliar with the disorders specific to this age group.
C) Similar symptoms are indicative of more than one disorder.
D) Older adults often are afraid to get help for their problems.
E) Older individuals are less able to explain their problems than younger patients.

Question 9

Three personality characteristics associated with positive health appear to increase across the lifespan. These are:

A) extraversion; openness; agreeableness
B) conscientiousness; emotional stability; agreeableness
C) conscientiousness; openness; agreeableness
D) extraversion; emotional stability; agreeableness
E) extraversion; openness; conscientiousness

Question 10

According to the selective optimization with compensation viewpoint, successful aging involves

A) practising old skills more so that they are not lost to aging.
B) making the most of skills and creatively by using alternative means to achieve one's goals despite limited capacities.
C) focusing on learning new skills, where applicable.
D) recognizing that you will begin to slow down as you age.
E) continuing to keep activity level high.

Question 11

Cross-sectional surveys are limited in that they cannot tell us if the results are due to

A) the paradox of aging.
B) normal aging.
C) an aging effect.
D) a cohort effect.
E) client barriers.

Question 12

The reason that theoretical frameworks of mental disorder have not typically been extended to older adults could be due to the early thinking of __________.

A) Freud
B) Erikson
C) Baltes
D) Carstensen
E) Hayflick

Question 13

Strength and vulnerability integration theory posits that aging is associated with __________ ability to regulate emotions due to several factors, including __________.

A) decreased; increasing stressors and increased activation of the HPA axis
B) increased; possession of a time-limited perspective with greater emphasis on emotionally meaningful goals; increased present-moment awareness, strength-based appraisal of information
C) decreased; increasing stressors, slower processing speed, proneness to rumination
D) increased; increased time to make social connections, consider various ways of meeting needs, avoiding stressors, and coping with existing stressors
E) decreased; increasing stressors, slower processing speed, proneness to rumination and increased activation of the HPA axis

Question 14

Veronica has recently learned that her spouse is suffering from cancer. At this time, Veronica would be more __________ to mental difficulties, and may not be able to cope with more problems.

A) resigned
B) predisposed
C) reactive
D) resistant
E) vulnerable

Question 15

The finding that there is a decreasing prevalence of most mental disorders with age should be interpreted cautiously for which of the following reasons?

A) Older adults are more likely to remember having symptoms of a disorder.
B) Older adults who participate in surveys may reflect a survivor effect.
C) Older adults are less likely to express symptoms in somatic ways.
D) Older adults are more likely to participate in surveys because they have more time.
E) Older adults are more likely to report their symptoms.

Question 16

You are an accomplished painter in your 70s and find that arthritis prevents you from enjoying the lengthy painting sessions that you love. Selective Optimization with Compensation theory suggests that you

A) obtain occupational therapy in order to treat and minimize the impact of your arthritis.
B) shorten the length of your painting sessions, paint subjects that have less fine detail, and explore opportunities to work or volunteer as an instructor.
C) seek counseling in order to minimize the impact of diminished function.
D) seek counseling in order to mourn the loss of your painting activity and identify new and similar activities that you can do, such as attending art shows.
E) meet regularly with peers who are in a similar position, engage in reminiscing of your painting career, and encourage younger people to paint.

Question 17

Older adults are disproportionately underrepresented as users of mental health services for all of the following reasons, except

A) Older adults themselves are responsible for not seeking psychological help when they need it.
B) Mental health professionals may be less willing or able to treat older adults.
C) Psychologists and psychiatrists prefer to work with younger clients.
D) Family physicians are less likely to treat older patients and to refer them to mental health professionals.
E) There is an insufficient number of mental health professionals who specialize in older adult mental health.

Question 18

What is the "paradox of aging"?

A) The finding that people with Alzheimer's dementia are often in very good physical health.
B) The finding that some older adults develop serious physical disease despite stellar psychological health.
C) The finding that older adults are treated without value in society, even though they are more experienced and knowledgeable than are younger people.
D) The evidence of positive mental health among older adults who normally are considered vulnerable.
E) The finding that older adults are understudied in psychology research, even though they are the fastest growing segment of the population.

Question 19

Cross sectional research shows that older adults are mentally healthier than are younger adults. What is one way to interpret this finding?

A) It may be a baby boomer effect.
B) It may depend on whether the older adults have access to good mental health care.
C) The older adults in these studies may be a distinct group due to their high levels of education.
D) Most of this research comes from North America, so perhaps there is an effect of culture that needs to be considered.
E) This between-group difference may represent a cohort effect.

Question 20

Why is it important that mental disorders in older adults be viewed as a cause for concern?

A) Mental disorders are more common among older adults.
B) It is far more difficult to diagnose and treat older adults.
C) Older people are more likely to sink into despair.
D) Treating mental disorders in older adults is far more difficult than when they occur in younger people.
E) Mental disorders in older people are not as common as one might expect.

Question 21

Esther has been having problems falling asleep at night, and when she finally manages to fall asleep, she awakens frequently, for apparently no reason. During the day, she feels extremely tired, depressed, and anxious. If you were Esther's psychologist, what would you suspect to be her problem?

A) insomnia disorder
B) hypersomnolence
C) somnambulism
D) sleep apnea
E) major depressive disorder

Question 22

Why is drug therapy not necessarily the best choice for older adults who suffer from depressive disorders?

A) Drugs have a shorter half-time in older people and are less effective.
B) Drug therapy is more effective with younger adults.
C) Side effects are tolerated less well in older adults.
D) Older adults are less likely to remember to take their medication.
E) Older adults do better with psychotherapy.

Question 23

Sleep apnea results in ________________ and awakenings from sleep.

A) Low blood oxygen saturation
B) High blood oxygen saturation
C) Suppressed cortisol release
D) Hypercortisolemia
E) HPA axis suppression

Question 24

Which pair of factors places an older individual at greatest risk for developing depression?

A) low income and poor physical health
B) lack of support and poor emotional health
C) poor physical and emotional health
D) low income and lack of support
E) poor physical health and lack of support

Question 25

Blockage of the upper airways results in __________ apnea, while __________ apnea is due to impairment of respiratory control.

A) upper; medullary
B) obstructive; central
C) upper; central
D) obstructive; medullary
E) mixed; peripheral

Question 26

Each of the following factors has been shown to be involved in the development or maintenance of insomnia disorder EXCEPT

A) Being female.
B) Being sedentary.
C) Excessive worry about sleep.
D) aytime napping.
E) Never having been married.

Question 27

Depression in people over age 60 is more likely to be ________ than in younger adults.

A) acute
B) chronic
C) mild
D) extremely severe
E) contextually triggered

Question 28

Sleep-wake patterns often change in older adults. All of the following are considered changes EXCEPT

A) circadian rhythms change.
B) changes in the organization of sleep stages.
C) less synchronous Stage 2 EEG activity.
D) decreases in total sleep time.
E) increases in the length of REM periods.

Question 29

This treatment process involves educating the patient about normal age-related changes in sleeping and involves techniques such as stimulus control and correction of dysfunctional sleep-related attitudes.

A) brief dynamic therapy
B) cognitive-behavioural therapy
C) hypnotherapy
D) sleep therapy
E) remote relaxation transmission

Question 30

Depression is __________ common in older people and when it occurs, tends to be __________.

A) more; more severe
B) less; less severe
C) more; less severe
D) less; more chronic
E) more; less chronic

Question 31

All of the following statements are true about sleep apnea EXCEPT

A) the disorder results in hypoxemia.
B) sufferers often have difficulty remembering things.
C) sleep apnea is more common in men, especially with age.
D) sufferers often fall asleep during meetings, concerts, movies, etc.
E) episodes of cessation of breathing occur that last 10 seconds and occur approximately twice per night.

Question 32

Which of the following statements about suicide and older Canadians is TRUE?

A) Older Canadian women are around 6 times more likely to commit suicide than older Canadian men.
B) Suicide attempts are more common among young Canadians but attempts by older Canadians are more successful.
C) Older Canadian women are more likely to attempt drug overdose than any other group.
D) Older Canadian men are around 5 times more likely to commit suicide than older Canadian women.
E) Older Canadians are less likely than younger Canadians to commit suicide.

Question 33

What is the main difference between younger and older adults in the symptoms of major depressive disorder?

A) Younger adults are more likely to report sleep difficulties.
B) Older adults are more likely to report feelings of guilt and sadness.
C) Older adults are more likely to report feelings of worthlessness.
D) Older adults are more likely to report somatic symptoms.
E) Younger adults are more likely to report physical complaints.

Question 34

Depressive disorders are __________ among older adults than younger adults.

A) less common
B) more or less common, depending on the type of disorder
C) equally prevalent
D) more common
E) ten times more common

Question 35

The DSM-5 diagnostic criteria for insomnia disorder include all of the following EXCEPT

A) The disturbance is not due to the direct physiological effects of a substance or a medical condition.
B) Difficulty falling asleep, staying asleep, or early morning awakening with inability to return to sleep.
C) There is significant distress or impairment in some area of functioning.
D) The sleep disturbance is frequently accompanied by nightmares which cause nighttime awakening.
E) The sleep disturbance occurs at least 3 nights per week for at least 3 months.

Question 36

Which of the following statements regarding depressive disorders and older adults is true?

A) Both major depressive disorder and persistent depressive disorder are more prevalent among younger than older adults.
B) There is a higher prevalence of depressive disorders among older men.
C) There is a higher prevalence of depressive disorders among older women.
D) Depressive disorders are easier to treat in older adults.
E) Major depressive disorder is one of the most common psychiatric problems among older adults.

Question 37

Diagnosing and treating sleep disorders in older adults is complicated by all of the following factors, EXCEPT:

A) Self-reports of sleep quantity or quality may be biased.
B) It can be hard to determine whether the sleep disturbance is occurring independently of other physical and mental disorders.
C) There are age related changes in sleep that appear to be universal and may be considered normal.
D) Older adults often deny that their sleep patterns are problematic, which makes sleep disorders much harder to treat.
E) Life circumstances like retirement may lead to disturbances in sleep routines.

Question 38

Research has shown which of the following treatments to be most effective for older adults suffering from depressive disorders?

A) cognitive therapy
B) drug therapy
C) a wide array of treatments has been shown to be effective
D) behavioural therapy
E) brief dynamic psychotherapy

Question 39

Which of the following reasons for choosing non-pharmacological treatments is NOT supported by clinical observations or research?

A) Increased renal clearance in older persons can increase drug tolerance
B) Polypharmacy is an issue for many older persons
C) Older people actually prefer psychotherapy for treatment of depression
D) Drug interactions can have unknown and dangerous consequences for older persons
E) ECT often has undesirable side effects

Question 40

One of the major difficulties in determining whether an older adult is suffering from a depressive disorder is

A) many people feel that it is normal for older people to be depressed.
B) older people don't want to admit that they feel depressed.
C) many older people experience higher levels of sadness, but not true depression.
D) other medical problems have similar symptoms to depressive disorders.
E) depressive disorders are not common among older adults.

Question 41

Depression, nutritional deficiency, and other disorders can cause symptoms similar to neurocognitive disorders, such as forgetfulness and difficulty concentrating. These occurrences are also known as

A) mild cognitive impairment.
B) pseudodementia.
C) comorbidity.
D) major cognitive impairment.
E) senility.

Question 42

The treatment of choice for older adult patients suffering from psychotic disorders is

A) neuroleptics.
B) psychoanalysis.
C) psychological treatment.
D) institutionalization.
E) psychosurgery.

Question 43

What is the major difference between the symptoms of late and early onset schizophrenia?

A) Hallucinations and delusions are more often of a persecutory nature in early-onset cases.
B) Hallucinations and delusions are more bizarre in early-onset cases.
C) Lack of logical thought is found more often in late-onset schizophrenia.
D) Late-onset schizophrenia is more likely to involve disorganized speech and flattened affect.
E) Persecution delusions in older adults make differential diagnosis more challenging.

Question 44

An excessive fear of eating out in public or speaking in public is indicative of __________, whereas fear of a specific object or situation indicates that the individual is suffering __________.

A) social anxiety disorder; GAD
B) specific phobia; social anxiety disorder
C) specific phobia; GAD
D) public anxiety; private anxiety
E) social anxiety disorder; specific phobia

Question 45

Cortical dementias primarily attack __________, whereas subcortical dementias primarily attack _.

A) the occipital lobes; the frontal lobes
B) the cerebellum; the cerebral cortex
C) white matter; grey matter
D) brainstem areas; the cerebral cortex
E) grey matter; white matter

Question 46

The most common mental disorder among older adults is

A) neurocognitive disorder.
B) delirium.
C) anxiety disorder.
D) memory loss.
E) depression.

Question 47

__________ interest researchers and clinicians because it is thought to represent a transitional state between normal aging and neurocognitive disorder.

A) Impairment of intellect
B) Mild cognitive impairment
C) Frontotemporal cognitive impairment
D) Vascular disease
E) Secondary cognitive impairment

Question 48

In contrast to early-onset schizophrenia, late-onset schizophrenia is ______ and mostly affects __________.

A) not common; men and women equally
B) common; men
C) not common; women
D) common; women
E) not common; men

Question 49

Whereas delirium refers to __________, neurocognitive disorder refers to __________.

A) short-term disturbance of consciousness; permanent losses in memory, judgment and/or reasoning ability
B) short-term disturbance of consciousness; short-term loss of memory, judgment and/or reasoning ability
C) short-term and temporary loss of memory; permanent disturbance of consciousness
D) long-term and permanent disturbance of consciousness; permanent losses in memory, judgment and reasoning ability
E) short term and temporary or permanent loss of reasoning ability; short-term and temporary or permanent losses in memory

Question 50

Significant symptoms of __________ are among the most common psychiatric symptoms experienced by older adults.

A) self-harm
B) mania
C) anxiety
D) substance abuse
E) dissociation

Question 51

The three most common anxiety disorders among older adults are

A) panic disorder, GAD, and social anxiety disorder.
B) social phobia, obsessive-compulsive disorder, and PTSD.
C) specific phobia, panic disorder, and obsessive-compulsive disorder.
D) panic disorder, GAD, and PTSD.
E) social anxiety disorder, specific phobia, and GAD.

Question 52

Treatment of sleep apnea often involves all of the following EXCEPT

A) learning to avoid sleeping on one's back.
B) losing weight.
C) avoiding alcohol and hypnotic medication.
D) wearing a mask attached to an air compressor while sleeping.
E) cognitive-behavioural therapy.

Question 53

Which of the following statements is TRUE regarding the treatment of anxiety disorders in older adults?

A) Psychological methods are usually less effective with older adults.
B) Doctors prefer to recommend medication despite the side effects.
C) Gentle herbal remedies like St. John's Wort and Gingko biloba are recommended for older adults in the treatment of anxiety disorders.
D) Cognitive-behavioural therapy is generally not effective compared to no treatment.
E) Pharmacological treatments are effective and have few side effects.

Question 54

Delirium in older patients is often misdiagnosed as

A) neurocognitive disorder.
B) delusional disorder.
C) generalized anxiety disorder.
D) late-onset schizophrenia.
E) dissociative identity disorder.

Question 55

Fred believes that his children are attempting to have him put in an "old-age" home, and he is quite upset. Every time his son and daughter come to visit, Fred tells them that he refuses to go to a home and he knows they are trying to trick him into agreeing. Fred's children are concerned, however, because they have not mentioned a residential home in years. Fred appears to be suffering from

A) brief psychotic disorder.
B) schizophrenia.
C) late-onset schizophrenia.
D) delusional disorder.
E) early-onset schizophrenia.

Question 56

Recent research cited in the text found that chronic anxiety in older adults leads to increased risk of

A) heart disease and accidental death.
B) cancer and accidental death.
C) obsessive-compulsive disorder.
D) heart disease and vascular disease.
E) Alzheimer's disease.

Question 57

What is the main difference between pseudo-dementia and bonafide dementia?

A) Pseudo-dementia has an earlier onset, while dementia develops later.
B) Pseudo-dementia involves loss of cognitive functioning, whereas neurocognitive impairment refers to the loss of one's normal personality.
C) Pseudo-dementia involves a decrease in the individual's capacity to care for him or herself, while neurocognitive impairment usually does not.
D) The loss of cognitive functioning in a neurocognitive disorder is reversible.
E) The loss of cognitive functioning in pseudo-dementia is generally not degenerative.

Question 58

Which of the following is not part of the prevention or treatment of delirium?

A) Low dose melatonin to reduce the incidence of delirium in people admitted to acute medical units.
B) Low dose haloperidol to reduce the incidence and severity of post-operative delirium.
C) Low dose, short-term psychotropic medications to treat delirium when agitation is present.
D) Progressive muscle relaxation to help calm patients with delirium who are showing high levels of agitation.
E) Investigation and targeting of the original trigger for the delirium.

Question 59

Which of the following problems is common when attempting to diagnose anxiety disorders in older adults?

A) Anxiety disorders in older people are often comorbid with substance abuse.
B) Older adults often over-report anxiety symptoms.
C) Anxiety disorders in older people are often comorbid with personality disorders.
D) Most of the scales used to measure symptoms of anxiety have been normed and validated only with younger adults.
E) The DSM-5 does not recognize anxiety in older populations.

Question 60

It is estimated that at least __________ percent of neurocognitive disorders are due exclusively to __________.

A) 20; Alzheimer's disease
B) 50; vascular insults
C) 25; vascular insults
D) 50; Alzheimer's disease
E) 75; Alzheimer's disease

Question 61

Possible protective factors against Alzheimer's disease include all of the following EXCEPT

A) high-fat protein diets.
B) vegetarian diet.
C) regular and moderate consumption of red wine.
D) dietary antioxidants.
E) lipid-lowering drugs.

Question 62

The "cohort effect" interpretation of the data showing declining prevalence of mental disorders suggests that people become more resilient over time.

Question 63

Frontotemporal NCD is a term used to describe a heterogeneous group of disorders that includes

A) Alzheimer's disease.
B) Lewy body disease.
C) Pick's disease.
D) primary cognitive impairment.
E) vascular disease.

Question 64

Fortunately, older clients are likely to be better served by the next generation of therapists.

Question 65

Major depressive disorder is four times as common among younger adults than among older adults.

Question 66

Increased pathology is part of the normal aging process and must be accepted as inevitable.

Question 67

There currently are not theories that can explain why older adults seem to be mentally healthier than younger adults.

Question 68

Common symptoms that occur during the first stage of Alzheimer's include

A) aggression.
B) sleep difficulties.
C) speech and language difficulties.
D) repetitive actions.
E) problems with concentration.

Question 69

The brains of those suffering from Alzheimer's disease are characterized by

A) less electrical stimulation.
B) plaques and tangles.
C) decreased dopamine activity levels.
D) smaller frontal lobes.
E) lesions.

Question 70

Two myths concerning mental disorders and aging are that mental illness is common among older people and that treatment is not beneficial.

Question 71

Older adults are more likely to respond to positive over negative information.

Question 72

Freud stressed the importance of psychotherapy with older adults.

Question 73

The second most common cause of neurocognitive disorder is

A) Alzheimer's disease.
B) cerebrovascular damage.
C) Parkinson's.
D) senility.
E) alcoholism.

Question 74

Lewy body disease differs from Alzheimer's and vascular NCD in that _____ is/are present.

A) a dissociative disorder
B) recurrent well-formed hallucinations
C) delusions of persecution
D) aggressive behaviour
E) personality disorders

Question 75

During the middle stage of Alzheimer's disease, sufferers may show

A) difficulty recognizing or naming people or things.
B) problems with concentration.
C) total incontinence.
D) stooped posture.
E) delusions.

Question 76

The "survivor effect" interpretation of the declining rates of mental disorder in older adults dictates that individuals with mental disorders have higher mortality rates.

Question 77

"Polypharmacy" means that older people require several medications to treat their mental disorders.

Question 78

Treatment of Alzheimer's disease with drugs results in

A) slowing, but not stopping the disease.
B) reducing the wandering behaviour but not the forgetfulness.
C) a reversal of the symptoms.
D) halting the progression of the disease.
E) reducing mild cognitive impairment but not the physical complications.

Question 79

The notion that we become focused on short-term and emotionally-meaningful matters when we perceive time as limited is most consistent with social-emotional selectivity theory.

Question 80

The increased health and longevity of Canadians solely accounts for the increase in the proportion of older people in our population.