Which one of the following statements about inappropriate sexual behaviour in persons with dementia is false?
Integration of a fall prevention program (comprised of balance and functional exercises and community-engaged health education) in a primary care system has been associated with a significant reduction in the risk of self-reported falls among rural older people.
In older patients with diabetic neuropathy, postherpetic neuralgia, or fibromyalgia, treatment with gabapentin is associated with increased fall-related inpatient or outpatient visits compared to treatment with duloxetine.
Clinicians often are challenged when patients seem disconnected in their prognostic awareness. The dual framework is a theory that explains how people cope with overwhelming existential information.
When comparing behavioural and psychological symptoms of dementia with delirium, attention impairment is usually greatly impaired in delirium but not seen until late in the trajectory of dementia.
Lower volumes of physical activity (between 83 and 166 minutes of moderate activity per week) reduce the risk of morbidity and mortality in older adults.
Which one of the following statements regarding subclinical hypothyroidism in older individuals (>65 years) is false?
New dementia diagnoses are more likely to occur in older adults who sustain falls versus those who sustain other mechanisms of injury.
A simple home exercise program has no impact on appendicular lean muscle mass among healthy, physically active adults aged 70 years or older.
Which one of the following statements about the treatment of Alzheimer Disease (AD) is false?
A 72-year-old, retired immigrant engineer returns to your clinic with his wife to follow up on the efficacy of the second antidepressant prescribed for his depression. Symptoms first started about nine months ago. He started to see you seven months ago. He tried an SSRI at a therapeutic dose daily for three months and, when asked to rate his progress at that time, indicated an improvement in his symptoms of about 25%. After taking another SSRI at therapeutic dose daily for a little more than another three months, the couple reported that the second drug improved symptoms about 25%. You feel the patient meets the criteria for treatment resistant late life depression given his age. You inform them that the diagnosis is referred to as treatment-resistant late-life depression. The couple is not familiar with the diagnosis and risk factors.
When assessing frailty, different screening tools (e.g. FRAIL, Fried frailty phenotype) should be used on subsequent visits to help provide a comprehensive assessment.
Which one of the following statements about CT scanning for head injury is false?
An 85-year-old female patient was brought in by her daughter today to discuss her mother’s recent falls in her current residence. This patient lives alone in a house with 2 staircases for the 2 floors and basement. She has fallen multiple times in her house recently. She is experiencing pains in various parts of her body.
Older patients are at risk of sustaining serious intracranial injuries with ground level falls.
Which one of the following statements about lumbar spinal stenosis is false?
In patients with frailty, management of non-ST elevation myocardial infarction with coronary angiography and revascularization did not improve outcomes compared to medical management.
There is an association between periodontitis and mild cognitive impairment.
Current Montreal Cognitive Assessment (MoCA) cutoff scores are appropriate for diverse populations in an urban setting.
Patients who continue to have difficulty with understanding speech despite the use of hearing aids may be candidates for a cochlear implant.
Brexpiprazole improves agitation scores in adults with Alzheimer disease and agitated behaviors.
In nursing homes, universal decolonization with chlorhexidine and nasal iodophor leads to a significantly lower risk of transfer to a hospital due to infection than routine care.
When assessing for orthostatic hypotension in older adults, an orthostatic drop detected at 4 minutes after going from supine to standing is a greater predictor of falls than a drop detected immediately.
You see an 86-year-old patient who is admitted to the hospital with hypoactive delirium. His head CT is normal and no infectious cause is found. His creatinine level is 130 umol/L (baseline 95 umol/L), the rest of the blood results is unremarkable. He is followed for chronic lumbar pain for which he takes long-acting morphine 30 mg twice a day, the dose has been the same for many years. He also takes verapamil for hypertension. According to his family, he also has a history of recurrent falls, associated with involuntary muscle movements that cause him to fall without warning symptoms. On physical examination, he is irritable and inattentive. You also notice myoclonus without any focal neurological deficits. You suspect opioid-induced neurotoxicity (OIN).
Using dairy foods to improve calcium and protein intake in aged care residents reduces each of the following except:
A 72-year-old, retired immigrant engineer returns to your clinic with his wife to follow up on the efficacy of the second antidepressant prescribed for his depression. Symptoms first started about nine months ago. He started to see you seven months ago. He tried an SSRI at a therapeutic dose daily for three months and, when asked to rate his progress at that time, indicated an improvement in his symptoms of about 25%. After taking another SSRI at therapeutic dose daily for a little more than another three months, the couple reported that the second drug improved symptoms about 25%. You feel the patient meets the criteria for treatment resistant late life depression given his age. You inform them that the diagnosis is referred to as treatment-resistant late-life depression. The couple is not familiar with the diagnosis and risk factors.
In the pharmacologic management of inappropriate sexual behaviour in long-term care residents with dementia, each of the following drugs, alone or in combination, could be considered as first-line agents except:
When combined with functional and balance training in older adults, resistance training can reduce the number of falls.
For people who are consuming a balanced diet and not receiving pharmacotherapy for osteoporosis, supplementation with calcium, vitamin D and protein is likely to have little to no effect on fractures.
Patients over the age of 80 experiencing an NSTEMI benefit from an invasive strategy involving early coronary angiography with immediate evaluation for revascularization and optimal medical therapy over optimal medical therapy alone.
Cataract extraction has a significant association with lower risk of developing dementia among adults 65 years of age or older.
You see an 86-year-old patient who is admitted to the hospital with hypoactive delirium. His head CT is normal and no infectious cause is found. His creatinine level is 130 umol/L (baseline 95 umol/L), the rest of the blood results is unremarkable. He is followed for chronic lumbar pain for which he takes long-acting morphine 30 mg twice a day, the dose has been the same for many years. He also takes verapamil for hypertension. According to his family, he also has a history of recurrent falls, associated with involuntary muscle movements that cause him to fall without warning symptoms. On physical examination, he is irritable and inattentive. You also notice myoclonus without any focal neurological deficits.
Among older adults undergoing coronary revascularization the type of procedure was not significantly associated with differences in the change of rate of memory decline.
New evidence suggests that in adults aged 70 years or older, a daily low dose of aspirin (100mg) is associated with an increased risk of incident solid cancers presenting at an advanced stage:
Which one of the following statements about falls prevention is false?
In very elderly Japanese patients with nonvalvular atrial fibrillation who are not appropriate candidates for a standard oral anticoagulation regimen, a once-daily 15-mg dose of edoxaban is superior to placebo in preventing stroke or systemic embolism.
Subclinical hypothyroidism is associated with the development of cognitive decline in older adults.
In patients older than 70 at risk of falling, a multifactorial intervention, administered by nurses, results in a significantly lower rate of first serious fall injury than enhanced usual care (patients receiving an information pamphlet and encouragement to discuss fall prevention with their primary care provider).
Cigarette smoking is a risk factor for age-related macular degeneration.
Older men with a recent diagnosis of mild cognitive impairment are at increased risk of attempting suicide.
The risk of intracranial hemorrhage after a head injury for patients 65 years and older on a direct oral anticoagulant is significantly higher compared with patients not on anticoagulation.
In patients aged 60 years and older with unstable distal radius fractures, there are no clinically meaningful patient-reported outcome differences 24 months after injury between patients choosing surgical treatment and those opting for closed reduction and casting.
Among individuals ≥ 75 years with no history of atherosclerotic cardiovascular disease at baseline, new statin use is associated with lower risk of mortality.
Using dairy foods to improve calcium and protein intake in aged care residents reduces each of the following except:
Which one of the following statements about community-acquired bacterial meningitis in patients of 80 years and older is false?
Daily low dose aspirin increases the risk of incident anemia in community-dwelling adults 70 years and older.
The Mediterranean-DASH Intervention for Neurodegenerative Delay (the MIND diet) slows cognitive decline in cognitively unimpaired elderly adults with a family history of dementia.
Which one of the following statements about the relationship between hormonal replacement therapy and dementia is false?
Which one of the following statements regarding the impacts of cholesterol and the use of statins in primary prevention in people over age 80 is false?
In a primary prevention setting among healthy older (> 70 years old) patients with no cardiovascular disease, long-term daily low-dose aspirin treatment reduces ischemic stroke.
Intensive inpatient treatment of asymptomatic hypertension in older adults admitted for non-cardiac conditions is associated with better outcomes.
Compared to usual care, an intensive exercise and functional activity therapy intervention in adults with early dementia improves activities of daily living.
Moderate consumption of coffee is associated with a reduced risk of cognitive disorders.
Which one of the following statements about adjusting medications for the management of treatment-resistant depression in adults over 60 years of age is false?
In frail older patients with non-ST-elevation myocardial infarction (NSTEMI) and stable clinical conditions at admission, a routine invasive strategy “consisting of coronary angiography within 72 hours of admission” with coronary revascularization if deemed appropriate increases the number of “days alive out of hospital” 1 year after discharge.