Introduction to Gerontology (SZC1)

Correct Answer: C Fluid intelligence

Fluid intelligence generally declines with age, particularly after individuals reach their 30s and 40s.

Fluid intelligence involves processing speed, problem-solving, and abstract thinking abilities, all of which tend to decrease over time as individuals age.

Why the Other Options are Wrong: 

a) Verbal comprehension and expression:

Verbal comprehension and expression typically remain stable with age. In fact, these abilities may improve or remain consistent because they rely on crystallized intelligence, which tends to stay stable or even improve as individuals accumulate knowledge and experience.

b) Vocabulary:

Vocabulary often improves with age due to the accumulation of knowledge and life experience. This improvement is associated with crystallized intelligence, which is not subject to the same decline as fluid intelligence.

d) Wisdom and practical expertise:

Wisdom and practical expertise generally improve with age as individuals accumulate life experiences. These aspects of cognitive function tend to become stronger, contributing to better decision-making and problem-solving in later life.

Summary:

Fluid intelligence tends to decline with age, particularly in terms of processing speed, abstract thinking, and problem-solving abilities. In contrast, crystallized intelligence, such as verbal comprehension, vocabulary, and wisdom, generally remains stable or may even improve with age.

Correct Answer: D. Stand up slowly from sitting or lying positions.

Tricyclic antidepressants (TCAs) can cause orthostatic hypotension (a drop in blood pressure when standing up quickly), which increases the risk of falls and injury.

To prevent injury, it is essential for the older adult to stand up slowly from sitting or lying positions, allowing their body to adjust to the change in position and prevent dizziness or fainting.

Why Other Options are Wrong:

Eat a diet high in roughage:

While a high-fiber diet is beneficial for older adults, especially to prevent constipation (which can be a side effect of TCAs), it doesn't specifically address the risk of injury from orthostatic hypotension.

Get an additional night light:

Although a night light can help prevent falls in general, it doesn't specifically address the side effects of TCAs, like orthostatic hypotension, which can cause dizziness when standing up quickly.

Provide lubrication for the oral mucosa:

This is useful for preventing dry mouth, a common side effect of TCAs, but it doesn't prevent injury related to dizziness or hypotension.

Summary:

Therefore, the most relevant advice to prevent injury related to TCAs is to stand up slowly from sitting or lying positions. 

Correct Answer: C Gently encouraging engagement in minor activities and providing support

Gently encouraging engagement in even minor activities and providing consistent support is key in improving the mood of depressed older adults.

This approach helps them feel less isolated and can improve their mental well-being gradually.

It is important to show that help is available without pushing them too hard, and persistence is essential. This method respects their emotional state while offering the opportunity for improvement.

Why the Other Options are Wrong:

a) Encouraging them to "snap out of it" to overcome depression:

Telling a depressed individual to "snap out of it" can be harmful and dismissive. Depression is not a willful condition, and such statements can worsen feelings of helplessness and guilt. A more compassionate approach is necessary.

b) Avoiding any communication to give them space:

While it is important to respect personal space, complete avoidance of communication can lead to further isolation and worsen depression. Encouraging engagement is important for their well-being, even if it starts with small efforts.

d) Avoiding repetition of information to prevent overwhelming them:

Due to potential lack of concentration and indecisiveness, depression can make it difficult for individuals to retain information. Repeating important information or using memory aides (e.g., sticky notes) can actually be helpful in assisting their understanding and retention, so avoiding repetition is not recommended.

Summary:

When communicating with depressed older adults, it is important to gently encourage participation in small activities and provide consistent support. It is also important to be patient and understanding, avoiding dismissive attitudes such as telling them to "snap out of it." Because depression can affect concentration and memory, it may be helpful to use repetition and memory aides to facilitate communication and retain information.

Correct Answer: A. Paget's disease.

Paget's disease of bone is a chronic disorder that typically affects adults over the age of 55 to 60. It is characterized by excessive bone resorption and deposition, leading to abnormal bone remodeling.

This results in bones that are enlarged, misshapen, and structurally weak, which can lead to pain, fractures, and deformities.

Why the Other Options are Wrong:

Osteoporosis:

Osteoporosis is characterized by decreased bone density and increased fragility but does not involve excessive bone resorption and deposition. It is due to an imbalance between bone formation and resorption, leading to bone thinning.

Wright's disease:

This is not a recognized medical condition or disease related to bone health.

Scott's disease:

This is also not a recognized medical condition or disease related to bone health.

Summary:

Paget's disease is the condition that involves excessive resorption and deposition of bone, affecting adults primarily over the age of 55. It is distinct from osteoporosis, which involves bone loss but not abnormal remodeling. Proper diagnosis and treatment of Paget's disease can help manage symptoms and prevent complications.

Correct Answer: B Flattening and shallowing of the alveoli

Aging causes the alveoli to become flatter and shallower, reducing their ability to expand and contract during breathing.

These structural changes result in a decrease in the alveolar surface area, which is critical for gas exchange.

This reduction limits the efficiency of oxygen and carbon dioxide transfer between the lungs and the bloodstream, contributing to a decline in respiratory function commonly observed in older adults.

Why the other options are wrong:

a) Increased surface area for gas exchange:

 Aging leads to a decrease in the surface area of the alveoli, not an increase. This reduction occurs due to the flattening of alveoli and loss of dividing tissue, impairing the lungs' ability to facilitate efficient gas exchange. 

c) Increased amount of tissue dividing individual alveoli:

The opposite is true. With aging, there is a decrease in the amount of tissue dividing individual alveoli, which contributes to the loss of structural integrity and surface area.

d) No changes in alveolar structure with age:

Structural changes in the alveoli are a well-documented consequence of aging. To say there are no changes is incorrect, as these changes significantly impact respiratory efficiency.

Summary:

As the lungs age, the alveoli flatten and become shallower, resulting in a reduction in surface area for gas exchange. This leads to decreased respiratory efficiency and is a key factor in age-related respiratory decline. Understanding these changes helps in managing respiratory health in older adults.

Correct answer: D All of the above

Several factors contribute to the severity of impaired glucose homeostasis in aging individuals, including:

Adiposity: Aging is associated with increased adiposity, particularly in the abdominal region, which contributes to insulin resistance and glucose intolerance.

Decreased insulin secretion: Aging may also lead to a decline in insulin secretion, contributing to impaired glucose metabolism.

Decreased carbohydrate intake: Many elderly individuals have a reduced intake of carbohydrates, which can exacerbate age-related impairments in glucose metabolism.

These factors, along with others such as physical activity levels and polypharmacy, contribute to the development and worsening of glucose intolerance and insulin resistance in the elderly.

Summary:

The correct answer is d) All of the above, as multiple factors, including adiposity, decreased insulin secretion, and reduced carbohydrate intake, contribute to the impaired glucose homeostasis observed in aging individuals.

Correct Answer: A. "Did you have the pain before the rash appeared?"

The description of a painful, vesicular rash with burning in a localized area (the left abdomen) is characteristic of shingles (herpes zoster), caused by the reactivation of the varicella-zoster virus.

A key diagnostic feature of shingles is that pain often precedes the rash by a few days, known as the prodromal phase.

Asking if the pain occurred before the rash helps confirm the suspicion of shingles and guides appropriate treatment.

Why Other Options are Wrong:

"Do you have any food or drug allergies?"

This question is important when prescribing medication or identifying allergic reactions, but it does not address the primary concern of diagnosing the rash and pain.

"Have you been around anyone with a rash?"

Shingles is not directly contagious, but individuals with shingles can transmit the varicella-zoster virus to someone who has never had chickenpox, causing chickenpox—not shingles. This question is less relevant to the patient’s condition.

"Have your grandchildren visited recently?"

While exposure to children with chickenpox could theoretically lead to reactivation of the virus in someone already infected, shingles is generally caused by stress or a weakened immune system in older adults. This question does not directly help with diagnosing the patient’s symptoms.

Summary:

The first question the nurse should ask is "Did you have the pain before the rash appeared?" because this pattern strongly suggests shingles, a common and painful condition in older adults. Understanding the sequence of symptoms is critical for accurate diagnosis and timely treatment.

Correct answer: B Decreased estrogen levels

In men, decreased bone mineral density is primarily linked to a decline in estrogen levels, rather than testosterone.

Estrogen helps regulate bone resorption, and its deficiency can lead to accelerated bone loss, even in men who do not experience the same midlife acceleration in bone remodeling as women.

Why the other options are wrong:

a) Decreased testosterone levels:

Although testosterone plays a role in bone formation, the decline in estrogen is the primary factor contributing to bone mineral density loss in men.

c) Increased estrogen levels:

Increased estrogen would likely inhibit bone resorption, not contribute to bone loss.

d) Increased bone formation:

Increased bone formation would not result in decreased bone mineral density; rather, it would help preserve or increase bone density.

Summary:

The primary cause of decreased bone mineral density in men as they age is decreased estrogen levels. Estrogen plays a key role in regulating bone resorption, and its deficiency contributes to bone loss in men. Therefore, the correct answer is b) Decreased estrogen levels.

Correct Answer: B. Do a complete history, physical, and assessment.

When an older adult expresses concerns about their mental state or the intentions of their family, it is crucial for the gerontological nurse to take a comprehensive approach to assess the situation. The nurse's initial role is to:

1. Conduct a thorough assessment:

 The nurse should begin by performing a complete history, physical examination, and cognitive assessment to understand the patient's current health status. This will help determine if there are underlying health conditions, such as cognitive impairments (e.g., dementia, depression, or delirium), which may be contributing to the family’s concerns. The assessment also provides insight into the patient’s functional status, physical health, and emotional well-being. 

2. Ensure proper care:

After gathering comprehensive data, the nurse can recommend the most appropriate course of action, whether that involves further medical evaluation, therapeutic interventions, or exploring additional support at home before making any decisions about long-term care or placement.

Why the Other Options Are Correct:

Begin the process of finding a qualified nursing home:

While placement in a nursing home might become a consideration depending on the patient's needs, this should not be the initial response. The first step should always be a complete evaluation to identify the root cause of the family’s concerns, rather than jumping directly to placement.

Speak with the family about their concerns:

Speaking with the family may be an important part of the process, but it should come after conducting a thorough assessment of the patient’s physical and cognitive health. The family may have valid concerns, but these must be addressed with evidence gathered from the patient’s health assessment.

Make light of the subject until the nurse can evaluate the situation:

This response would be inappropriate as it could invalidate the patient’s concerns and create distrust. The nurse should take the situation seriously and act promptly by conducting a full assessment, rather than downplaying the issue.

Summary:

The initial role of the gerontological nurse is to thoroughly assess the patient through a comprehensive history, physical, and cognitive evaluation. This will help identify any underlying issues and guide the nurse in addressing the patient’s concerns and determining the best course of action for both the patient and their family.