B: Support the family in learning advocacy skills, while providing empathy for their burden in caregiving.

C: Encourage the family to consider inpatient treatment when finances and/or emotional resources are limited.
D: “A” and “B”.

2. Medical management is often the priority when treating elder clients. This type of care is emphasized in:

A: Palliative care.

B: Inpatient long-term care.

C: Community long-term care
D: Preventive care.

3. Cultural diversity considerations, when treating minority elders and their families, are vital to ensure that treatment is meaningful and effective. In this context, it is important that therapists:

A: Avoid a discussion of inpatient institutional care.

B: Help the family reframe long-term care so that they are able to do so effectively at-home.

C: Encourage the family and the elder to express their attitudes and conflicts about long-term caregivin
 D: Address the family’s attitudes about long-term care options when the elder is not present.

4. At-home informal care has several defining characteristics. Which of the following are true of informal care
 A: “Sandwich” generation women develop expertise in long-term care
B: “Women in the middle” comprise a small constituency of the overall delivery of healthcare services.

 C: Informal caregivers do so because their desire to care and their ability to care are aligned.
 D: Informal care usually precedes formal care because an elders’ needs often become more complex and acute as time passes.

5. Although informal long-term care is common and often a preference for elders and their families, some limits and cautions of at-home care include:

 A: Families become unable to diagnose and respond to advancing illness.

 B: Families come to depend upon medical professionals.

 C: Elders become more reluctant to seek the support of medical professionals.
 D: Caregivers avoid obtaining support because they are committed to the caretaking role.

6. The type of care in which a multidisciplinary team of caregivers addresses the comprehensive needs of a client who is dying is called:

 A: Transitional care, i.e., moving a patient to/from hospital and home

 B: Palliative care

 C: Hospice care
 D: Community long-term care

7. Therapists working with clients whose elderly relative requires long-term care will be most concerned with helping those clients to:

 A: Find a community long-term care facility that meets the family’s needs.

 B: Explore the role adjustments and role conflicts that long-term caretaking induces.

 C: Improve their “transitional care” skills and tactics.
 D: Anticipate or work through symptoms of depression.

8. After several sessions with a 68-year-old client, a therapist wants to discuss the efforts the client has taken to continue pursuing interests and personal growth after retirement. The client is still working, however. What error did the therapist make?

 A: The therapist invoked a negative ageist stereotype.

 B: Countertransference.

 C: The therapist was making ageist assumptions.
 D: Reframing older age as a time of vigor and continued personal growth.

9. The context in which retirement is discussed and decided upon is critical to a client’s ability to adjust to it. Which of the following is NOT a factor that makes retirement a difficult transition?

 A: A husband and wife decide to retire at approximately the same time.

 B: A client decides to take early retirement because her elderly parent needs care.

 C: A client chooses to continue working because he cannot afford to retire.
 D: A man reaches retirement age at his company and finances are such that his wife continues to work.

10. Menopause can be a challenging time in a woman’s life because of the physical changes and sociological meanings attached to a woman’s fertility. Which of the following are some other reasons that make this transition difficult?

 A: Women in menopause are often treated with Hormone Replacement Therapy.

 B: Mood changes may be intense.

 C: Women who have been long-time caretakers adopt a self-care orientation.
 D: Women at midlife are often in the process of retirement and launching of adult children.

11. Substance abuse may become a risk for elders because:

 A: Long-term addicts are reluctant to find alternative ways of coping.

 B: Drug interaction effects are minimized because elders tend to only use pain medications.

 C: Elders metabolize drugs slowly.
 D: They have learned to cope with the social and psychological losses that they have experienced.

12. With advancing age, elders’ risk for certain medical conditions increases. Treating therapists should be familiar with secondary symptoms resulting from these medical conditions, so they can make the necessary medical referrals. Which of the following is/are a secondary symptom(s) associated with medical conditions that tend to affect the senior population?

 A: Malnutrition and dehydration.

 B: Skin-related disorders.

 C: Anxiety Disorders.
 D: All of the above.

13. Assessing depression is complex for elderly clients because they:

 A: May experience subthreshold depression.

 B: Present with co-occurring Neurocognitive Disorder due to Alzheimer’s Disease and Major Depressive Disorder.

 C: Obtain medical treatment after relieving depressive symptoms.
 D: Experience depression as a normal part of aging.

14. To assess for depression that co-occurs with PTSD, which of the following tools may be used?

 A: Beck Depression Inventory

 B: Kubler-Ross’ stages of grief

 C: Suicide assessment
 D: Impact of Events Scale

15. Which of the following is NOT a characteristic of cognitive functioning in Neurocognitive Disorder due to Alzheimer’s Disease?

 A: Abstract reasoning becomes more acute.

 B: Conversation skills become impaired.

 C: Judgment becomes poor.
 D: Depression may be a co-occurring symptom.

16. Which of the following is typically associated with Neurocognitive Disorder due to Alzheimer’s Disease?

 A: Negative symptoms such as understimulation.

 B: Insomnia.

 C: Delusional Disorder.
 D: Major Depressive Disorder.

17. The decision to place an elder in a formal care includes the elder and his/her family. This process can be conflicted if the elder:

 A: Requires care that exceeds a family’s skills but does not recognize his/her incapacity.

 B: Is in an ethnic minority group and is confident about his/her ability to find similar peers.

 C: Participates in all of the decision-making regarding timing, location and reasons for placement.
 D: Believes that formal care setting with provide for his/her medical and social needs.

18. The decision to place an elder in formal care includes the elder and his/her family. This process can be eased if the caregiver:

 A: Decides to make a decision without discussions with siblings who disagree.

 B: Explores his/her historical resentments before placement in a formal care setting.

 C: Assumes that nursing home staff and other care team members will communicate.
 D: Learns how to provide medical care.

19. Transitional care has been defined and reframed to assist families with the process of moving an elder from one care setting to another. Which of the following is NOT appropriate in therapy for families in transitional care circumstances?

 A: Using psychoeducation and collaboration as transitions in care proceed.

 B: Getting a release from a legally designated person to interface with the desired placement.

 C: Exploring the family’s concerns about formal placement.
 D: Helping them to understand that some disorders, such as Neurocognitive Disorder due to Alzheimer’s Disease, require home-care.

Julie is a single mother with three children. She has been divorced for five years. Her 16-year-old son has drug problems and is often truant from school. Her 9-year-old daughter has been diagnosed with AD/HD and also has learning disabilities. Julie’s 23-year-old daughter and her 4-year-old son recently moved back home with Julie, since the daughter is getting a divorce and has financial problems. Julie receives inconsistent financial support from her ex-husband, so she must work a part-time job on weekends, in addition to her full-time job during the week. Julie’s 75-year-old father has recently been diagnosed with Alzheimer’s disease and asks if he could move into the small garage apartment that is on her property. Although Julie’s doctor has told her to monitor her stress levels as she is beginning to show signs of heart problems, she feels as if she cannot refuse her father’s request for help, especially since her mother died last year. Julie is also going through menopause and feels exhausted and sad most of the time. Her physician prescribed an anti-depressant medication for her but she cannot afford the monthly copayments.

20. The “Julie” vignette presented the complexities associated with providing informal care. Which of the following accurately describes Julie’s issues?

 A: She is a member of the “sandwich generation” and therefore prepared to take care of children and elderly dependents.

 B: She feels unable to reject her responsibilities as a caretaker.

 C: Her family supports her efforts to care for her father.
 D: She is an ideal candidate for private therapy.

21. When working with elders and families in long-term care circumstances, therapists must make some adjustments to typical therapeutic protocol. Which of the following is NOT an appropriate adjustment?

 A: Adjusting the fee and session schedules for caregivers.

 B: Including all caregivers in informed consent and therapy contents.

 C: Discussing the appropriateness and desirability of in-home sessions.
 D: Slowing down the pace of therapy for seniors who are unfamiliar with the therapeutic process.

22. Communication with elders in therapy requires that therapists be sensitive to certain factors. To promote a strong and effective alliance, therapists should:

 A: Inquire into the meaning of elders’ stories.

 B: Encourage disclosure while educating about the process of therapy.

 C: Raise the subject of advanced directives and death.
 D: Remind the client of what s/he said in the prior session due to memory lapses.

23. Autonomy and purpose may be common themes for older people in therapy. Which of the following are conducive to restoring an elderly client’s sense of control and meaning?

 A: Discouraging blame related to family caretakers who may be doing “too much”.

 B: Encouraging a client’s spiritual attitudes and affiliation.

 C: Help the client adjust to dependent living.
 D: Suggest that the client direct the pacing, topics and scheduling of therapy.

24. The presentation suggested a variety of accommodations that must be made when working with elders and/or family caregivers in therapy. Which of the following is NOT an appropriate adjustment?

 A: Establishing flexible goals to meet the physical impairments that elders have.

 B: Taking a directive rather than passive stance.

 C: Accepting longer or shorter session lengths for each visit.
 D: Discuss the purpose and value of family caregiver sessions.

25. The assessment and treatment of depression in elders can become complicated by other disorders. As a result, a differential diagnosis is important because:

 A: When cognitive impairments are present, they must be treated first.

 B: Other caretakers may focus on physical disabilities, and therapists may notice the co-occurring depression.

 C: Neurocognitive Disorder due to Alzheimer’s Disease makes depression less important to treat.
 D: The impact of depression on other physical ailments is unobservable.

26. An assessment of an elder client includes cognitive, emotional and functional factors. Which of the following is used to evaluate whether an elder is depressed?

 A: Maslow’s hierarchy of needs.

 B: Mental status or mini mental status exam.

 C: Medical evaluation to rule out organic impairments or medication side-effects.
 D: Psychological testing.

27. Interviews with family and other caretakers are important for assessment because:

 A: Families can summarize or clarify senior’s life stories.

 B: Elders from a prior generation prefer privacy about their own lives.

 C: Families will report if there is any elder abuse occurring.
 D: Families may observe symptoms of which the senior is unaware.

28. If a therapist is working from a psychodynamic model, what is the best approach to use with respect to defenses?

 A: Explain which defense is guarding against anxiety or fear of death.

 B: Differentiate between the regression caused by defensiveness and organic brain impairment.

 C: Manage any countertransferential reactions.
 D: Observe and manage any countertransference reactions in the client.

29. Many therapeutic approaches were discussed in the presentation. Which of the following was suggested as a way to restore an elder’s sense of meaning and identity?

 A: Hope

 B: Life review therapy

 C: Psychoanalysis
 D: Humanistic therapy

30. Many therapeutic approaches were discussed in the presentation. Which of the following was suggested for elders who are goal-oriented and whose cognitive functioning is intact?

 A: Group therapy

 B: Reminiscence

 C: Bereavement
 D: Cognitive-behavioral therapy

31. Which of the treatment processes below are being utilized when a therapist encourages a client to determine his/her therapeutic goals as an intervention?

 A: Providing hope and meaning.

 B: Supporting a client’s autonomy.

 C: Direct questioning and communication adjustments.
 D: Cognitive and functional assessments.

32. A therapist who is working with an elder and his/her family in both individual and family sessions observes that the female caregiver is suffering from burnout and depression. This caregiver has described conflicts between her family’s and her husband’s beliefs about long-term care. The therapist is observing:

 A: The “sandwich generation.”

 B: Cultural diversity

 C: Informal long-term care.
 D: All of the above.

33. Sources of caregiver burden when providing at-home care are:

 A: Bereavement.

 B: Processing the guilt related to inpatient placement.

 C: Facing a limited skill set for practical and medical care.
 D: The unpredictable demands of an elder in long-term care.

34. Caregivers often find the decision to place an elder in institutional care the most difficult process in long-term care. Which of the following can therapists do to ease the transition?

 A: Challenge family norms if inpatient care is required.

 B: Advise the client about the “relief’” that will come from sharing the care.

 C: Encourage the client to learn coping and medical skills in order to delay placement as long as desired.
 D: Explore the client’s values related to abandonment and loyalty.

35. Caregivers often show signs of depression as long-term care proceeds. The following may signal depression if the client reports that:

 A: Siblings disagree with his/her choices about care.

 B: S/he believes that the parent’s condition is worsening.

 C: The elder parent blames him/her for abandoning him/her.
 D: His/her attempts to improve communication among caregivers is becoming increasingly hopeless.

36. Treatment for caregivers may include individual sessions along with family sessions to provide for both privacy and collaboration with the entire family. What else must caregiver treatment include?

 A: Direct questions about the caregiver’s feelings and behaviors related to self-care.

 B: Psychoeducation about transitions and resultant transitional care.

 C: Elder abuse assessment.
 D: Therapy for the caregiver before long-term care begins.

37. When an elderly client begins therapy with his/her caregivers, what are some legal and ethical considerations that are important?

 A: Informed consent must include limits of confidentiality

 B: The elder must sign releases to share information with caregivers.

 C: Caregivers’ consent to treat the elder.
 D: The elder’s conservator be included in all treatment decisions.

38. Elderly women who are abused have many experiences in common with women in a partner abuse situation. Which of the following differentiates elderly abuse victims from non-elder women who are abused?

 A: Leaving the relationship is believed to be impossible.

 B: Younger women may find shelters to provide for some of their unique needs.

 C: Elderly women are not able to escape.
 D: Elderly women are isolated and thus unable to find shelters.

39. Which of the following situational and emotional factors make elder abuse less likely?

 A: Caregivers experience role strain and burnout.

 B: Elders experience their caregivers as disempowering.

 C: Elders are living alone with a minimum of care needed.
 D: Elders are in the care of a conservator.

40. Which of the following referrals would be used when a therapist believes an elder’s isolation must be reduced and that peers could provide a source of support?

 A: Community long-term care.

 B: Informal long-term care.

 C: Family therapy.
 D: Group therapy.