Which of the following is true with regard to alcohol use disorders in elderly people?
D. The prevalence of alcohol use disorders in elderly people is generally lower than in younger adults, but it is generally accepted that the rates are underestimated because of under detection and misdiagnosis. It is known that elicitation and documentation of alcohol misuse in the medical records of the elderly people is poor. In addition, elderly people are less likely to spontaneously disclose alcohol use. Even in those identified with alcohol misuse, referral to a specialist team is very low, probably due to a degree of existing therapeutic nihilism (the belief that the illness is incurable) among health workers. Alcohol problems often present atypically in elderly people – falls, confusion, and depression are common presentations. It is also often masked by poor physical health . Furthermore, weekly limits of sensible drinking for adults, i.e. 21 units for men and 14 units for women, may not apply to elderly people. This is due to age-related changes in the pharmacokinetics of alcohol. In most countries, age-appropriate limits have not been established for elderly people. A history of lifetime alcohol consumption may be more important than current levels of drinking to ascertain the degree of alcohol use in elderly people. The CAGE questionnaire has relatively good sensitivity and specificity in older people, but, compared with younger adults, it works better in elderly people when supplemented by further questions.
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The most common perpetrators of elder abuse in private UK households are:
A. Fieldwork carried out in the UK by the National Centre for Social research showed that 2.6% (1 in 40) of people aged 66 and over living in private households had experienced abuse (from family, friends, or care workers) in the past year. Neglect is the predominant form of mistreatment, followed by financial, physical, and psychological abuse. The rates of sexual abuse were low. Partners (51%) and other family members (49%) were most commonly reported as the perpetrators of mistreatment compared with care workers (13%) or friends (5%).
All of the following are associated with a higher risk of elder abuse except:
B. Various risk factors have been proposed from prospective analysis of elder abuse. Shared living situation is a major risk factor; older people living alone are at lowest risk. Having a ‘poor social network’ and subsequent social isolation significantly increases the risk of mistreatment. A diagnosis of dementia makes elderly people more vulnerable to mistreatment. The prevalence rates of elder abuse in samples of dementia caregivers is far higher than the elder abuse seen in the general community. Similarly, a higher rate of mental illness, such as depression or substance abuse, among caregivers increases the risk of elder abuse. It is also found that perpetrators of elder abuse tend to be financially dependent on the abused individual.
Which of the following drugs has the least evidence in the form of randomized controlled trials (RCTs) for the management of behavioural and psychological symptoms of dementia?
D. Evidence from RCT exists for the treatment of behavioural and psychological symptoms of dementia (BPSD) using atypical antipsychotics, such as olanzapine and risperidone, typical antipsychotics, such as haloperidol, and cholinesterase inhibitors. In addition, RCT evidence exists for use of antidepressants for depressive symptoms in dementia. RCTs suggest an approximate doubling in the risk of cerebrovascular accidents in patients receiving risperidone, olanzapine, or quetiapine. Zolpidem has a weak evidence base for use in BPSD; it may help insomnia in elderly patients with dementia.
Cholinesterase inhibitors are unlikely to be useful in the management of:
D. Cholinesterase inhibitors have been shown to be useful in the treatment of senile dementia of Alzheimer’s type, mixed Alzheimer’s and vascular dementia, Lewy body dementia, Parkinson’s disease dementia, and young onset Alzheimer’s-type dementia. Too date, there is no evidence of reasonable quality to recommend their use in FTD. Normal levels of cholinacetyltransferase have been demonstrated in patients with FTD compared with reduced levels seen in Alzheimer’s disease; this might explain the lack of efficacy of cholinesterase inhibitors in FTD.
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