| How to cite this article: Borker SA. Geriatrics quiz for P.G. students. Ann Trop Med Public Health 2014;7:209-16 |
| How to cite this URL: Borker SA. Geriatrics quiz for P.G. students. Ann Trop Med Public Health [serial online] 2014 [cited 2021 Feb 27];7:209-16. Available from: https://www.atmph.org/text.asp?2014/7/4/209/152738 |
Dear Sir,
The author organized a Geriatrics and Gerontology Quiz for postgraduates of Community Medicine of 7 private Medical Colleges of Dakshina Kannada District of Karnataka in August 2013 from 2.00-4.00 pm IST (Indian Standard Time). 1 All the college students were aware about the quiz 1 months in advance. The Aim of the quiz was to make the Postgraduate students of Community Medicine aware of the extent of the problem, reasons for the rise in number, how it will affect our economy and health care, issues involved, after effects, and role of family, society and Government and NGOs and International Organizations. It had four rounds which are as given below:
First Round: 10 questions: Multiple choice: 4 options. Choose the most appropriate option. (No negative marks. 1 mark per correct answer)
1. The term ageism was coined by
- Robert Butler
- Ignatz Leo Nascher
- Dr. O.P. Sharma
- Dr Sharad Gokhale
Answer: (a)
- Robert Neil Butler (January 21, 1927 – July 4, 2010) was a physician, gerontologist, psychiatrist, and Pulitzer Prize-winning author, who was the first director of the National Institute on Aging. Butler is known for his work on the social needs and the rights of the elderly and for his research on healthy aging and the dementias. He coined the term ageism.
- Ignatz Leo Nascher coined the term geriatrics. Ahead of his time, Dr. Nascher suggested this new term as “an addition to our vocabulary, to cover the same field in old age that is covered by the term pediatrics in childhood, to emphasize the necessity of considering senility and its diseases apart from maturity and to assign it a separate place in medicine.”
- Dr. O P Sharma is president of Geriatric society of India.
- Dr Sharad Gokhale was the founder president of International longivity centre Pune.- India
2. Which of the following statements regarding Definition of Old age is not true:
- Most developed countries have accepted the chronological age of 65 years as a definition of ‘elderly’ or older person
- In contrast to the chronological milestones which mark life stages in the developed world, old age in many developing countries is seen to begin at the point when active contribution is no longer possible.”
- Government of India adopted ‘National Policy on Older Persons’ in January, 1999. The policy defines ‘senior citizen’ or ‘elderly’ as a person who is 60 years of age or above.
- The United Nations generally uses 65+ years to refer to the older population
Answer: (d) The UN generally uses 60+ years to refer to the older population
3. The elderly population (>60 years) accounted for what percent of total population of India in 2011.
- 6.2%
- 7.4 %
- 8.3%
- 9.3%
Answer: (c), Source: Registrar General & Census Commissioner of India
4. Which of the following statements regarding Dementia is not true
- Dementia is a normal part of ageing and it is not possible for persons with dementia to continue to engage and contribute within society and have a good quality of life.
- Dementia is overwhelming for the caregivers and adequate support is required for them from the health, social, financial and legal systems.
- Countries must include dementia on their public health agendas. Sustained action and coordination is required at international, national, regional and local levels.
- People with dementia and their caregivers often have unique insights to their condition and life. They should be involved in formulating the policies, plans, laws and services that relate to them
Answer: a) Dementia is not a normal part of ageing. With appropriate support, many can and should be enabled to continue to engage and contribute within society and have a good quality of life.
Source: Dementia a public health priority by World Health Organization 2010
5. About 64 /1000 elderly (>60 years) persons in rural areas and 55/1000 in urban areas suffer from one or more disabilities. The Most common disability among the elderly in India is
- Locomotor disability
- Visual disability
- Hearing disability
- Speech disability
Answer: (a) 3% (30/1000) suffer from locomotor disability.
Source: Situation Analysis Of The Elderly in India: Central Statistics Office Ministry of Statistics & Programme Implementation Government of India
6. Which of the following statements regarding Depression in old age is true:
- Depression in older adults is easily diagnosed and treated.
- Health care providers may mistake symptoms of depression as just a natural reaction to illness or the life changes that may occur with ageing and may not treat depression.
- Older adults themselves often seek help for depression because they feel that they could get better with appropriate treatment
- Questions that assess the symptoms of depression using the Patient Health Questionnaire are commonly used in surveys in India.
- Answer: (b),
Source: Enhancing Use of Clinical Preventive Services Among Older Adults- closing the Gap: Centers for Disease Control and Prevention: Available at www.cdc.gov/aging
7. The population projection is required for preparation of perspective plan for the future. Which of the statements below is not true as per the population projections in India
- India’s population above 60 years in 2026 will be 15 % of total population.
- By 2026, North India’s population would be younger compared to the South.
- By the year 2026 Kerala will have highest educated working people with average age hovering above 35 years
- By 2026 Uttar Pradesh will have highest uneducated and less educated working population with average age below 30 years.
Answer: (a), (Projected population >60 Years: 12.17%)
Source: Registrar General & Census Commissioner of India
8. Which of the following Institutions in India does not conduct Geriatric Medicine courses.
- IGNOU
- AIIMS Delhi
- Mysore Medical College
- Madras Medical College
Answer: (c) MMC Madras has 2 seats in MD Geriatric Medicine. AIIMS Delhi has been allotted 7 seats this year. IGNOU has PG Diploma in Geriatric Medicine. M. M. C. has not started as yet
Reference- http://www.geriatricindia.com/Geriatric_Courses.html
9. Which of the following statements regarding diet of the elderly is true.
- Elderly persons require more calories as compared to young adults.
- Healthy food habits (& regular physical activity) are required to minimize the ill effects of ageing and to improve the quality of life.
- Elderly persons need less calcium, iron, zinc, vitamin A to prevent age-related degenerative diseases.
- ICMR expert group has recommended that elderly persons require more proteins as compared to young adults.
Answer: (b) ICMR expert group has not made any special recommendations regarding protein requirements for the elderly.
Source: Dietary Guidelines for Indians by NIN Hyderabad: 2010
10. In India, organized sector provides pension for retired persons. But for others, The Ministry of Rural Development has implemented the National Old-Age Pension Scheme (NOAPS) – for persons above 65 years belonging to a household below poverty line. The amount paid per month is:
- Rs 150 per month.
- Rs 200 per month.
- Rs 250 per month.
- Rs 300 per month.
Answer: (b) Source: Situation Analysis Of The Elderly in India: Central Statistics Office, Ministry of Statistics & Program Implementation Government of India
No elimination. Marks carried over to the next round.
2 nd Round: 10 questions: Fill in the Blanks (No negative marks. 1 mark / correct answer)
11. A scientific discipline which deals with the phenomenon of ageing and all issues related to this process is called
Answer: Gerontology
Reference- IGNOU BOOKS. Geriatric medicine is treatment of disease and geriatrics and geriatric medicine are same. There is no term called gerodemography.
12. Across the world, and have jointly resulted in higher numbers and proportions of older persons.
Answer: declining fertility and increasing longevity
Source: Demographics of Population Ageing in India, Institute for Social and Economic Change, Bangalore United Nations Population Fund, New Delhi Institute of Economic Growth, Delhi. – December 2011
13. present age specific mortality rate for persons aged 60 to 64 years in India is 20 per 1000, While it is for persons aged 75 to 79 years.
Answer: (80 per 1000).
Source: Situation Analysis Of The Elderly in India: Central Statistics Office, Ministry of Statistics & Programme Implementation Government of India
14. The old-age dependency ratio in 2001 for India as a whole was
Answer: (13.1%)
(The old-age-dependency ratio is the ratio of the number of elderly people (>60 years), compared to the number of people of working age (i.e. 15-60 years old).) Source: Situation Analysis Of The Elderly in India: Central Statistics Office, Ministry of Statistics & Programme Implementation Government of India
15. The nodal Ministry in India that focuses on policies and programs for the Senior Citizens in close collaboration with State governments, Non-Governmental Organizations and civil society is
Answer: Ministry of Social Justice and Empowerment
Source: Central Statistics Office Ministry of Statistics & Programme Implementation Government of India
16. The is the highest body to advise the Government in the formulation and implementation of policy and programs for the aged.
Answer: National Council for Older Persons (NCOP), with members comprising Central and State governments representatives, representatives of NGOs, citizen’s groups, retired person’s associations, and experts in the field of law, social welfare and medicine.
Source: Central Statistics Office, Ministry of Statistics & Programme Implementation Government of India
17. As per the Dementia India Report 2010 It is estimated that the number of people with dementia in India is Answer: 3.7 million
Source: Dementia a public health priority by World Health Organization 2010
18. In the year , The National Sample Survey Organisation (NSSO) for the first time, conducted a survey on the elderly (>60 years), along with the survey on social consumption to assess the nature and dimensions of the socio-economic problems of the aged.
Answer: (July 1986 – June 1987, in its 42nd round)
Source: Central Statistics Office, Ministry of Statistics & Programme Implementation Government of India
19. The Maintenance and Welfare of Parents and Senior Citizens Act, was enacted in India in the year
Answer: 2007.
Source: Situation Analysis Of The Elderly in India: Central Statistics Office, Ministry of Statistics & Programme Implementation Government of India
20. In India, the index of ageing in 2011 was ———–
Answer: (28.4 persons >60 years / 100 children < 15 years). Index of ageing is the number of persons >60 per 100 children < 15 years.
Source: Institute for Social and Economic Change, Bangalore, United Nations Population Fund, New Delhi Institute of Economic Growth, Delhi. – December 2011
No elimination. Total Marks of two rounds carried over to the next round
Third Round: Buzzer Round: (Elimination round begins)
Assertion and Reasoning type: 10 questions
(2 mark for correct answer & -1 mark for incorrect answer.)
Given below are paired statements.
Statement A = (Assertion), Statement R = (Reason).
Select appropriate answer using the code given below.
- Both A (Assertion) and R (Reason) are true and R (Reason) is the correct explanation of A (Assertion).
- Both A (Assertion) and R (Reason) are true, but R is not the correct explanation of A.
- A (Assertion) is true, but R (Reason) is false.
- A (Assertion) is false, but R (Reason) is true.
21. ASSERTION: National Program for Control of Blindness revised its target for the 10 th Plan period – to reduce prevalence of blindness to 0.8% by 2007
REASON: As per Survey in 2001-02, prevalence of blindness in India was estimated to be 1.1%.
Answer: (a) National Programme for Control of Blindness was launched in the year 1976 as a 100% Centrally Sponsored scheme with the goal to reduce the prevalence of blindness from 1.4% to 0.3%. As per Survey in 2001-02, prevalence of blindness was estimated to be 1.1%. Target for the 10 th Plan is to reduce prevalence of blindness to 0.8% by 2007. Prevalence of Blindness is 1% (2006-07 Survey).
Reference: Park K. Park’s Textbook of Preventive and Social Medicine. Banarasidas Bhonat Publishers, Jabalpur: 22 th ed. 2013
22. ASSERTION: The advisory committee on Immunization practice (ACIP) in the U.S. recommends annual influenza vaccination for all persons >six months.
REASON: About 85 percent of deaths and 63 percent of hospitalizations attributed to influenza occur in persons >65 years.
Answer- b
Influenza is a common and serious health problem in all age groups and influenza vaccine is safe and cost- effect preventive measure available.
Influenza vaccines are developed each year and are designed to protect against the three influenza viruses that are predicted to be the most common during the upcoming season.
Source: Enhancing Use of Clinical Preventive Services Among Older Adults- closing the Gap: Centers for Disease Control and Prevention: Available at www.cdc.gov/aging
23. ASSERTION: The Advisory Committee on Immunization Practices (ACIP) in the U.S, recommends pneumococcal vaccine for all persons >65 years.
REASON: Percentage of adults >65 years who reported never having pneumococcal vaccination is used as one of the Indicators to assess the utilization of Clinical Preventive Services
Answer: (b) Vaccination against pneumococcus in adults aged 65 years and older is associated with improved survival, decreased chance of respiratory failure or other complications, and decreased length of stay among hospitalized patients with community-acquired pneumonia.
Recent analyses indicate that pneumococcal vaccine is cost-effective
Source: Enhancing Use of Clinical Preventive Services Among Older Adults- closing the Gap: Centers for Disease Control and Prevention: Available at www.cdc.gov/aging
24. ASSERTION: Lower Urinary tract symptoms in elderly males are usually associated with benign prostatic hypertrophy (BPH)
REASON: BPH is due to reduced estrogen content in the body as he grows old.
Answer- c BPH is one of the common conditions of the ageing male which is usually associated with bothersome lower urinary tract symptoms. These symptoms affect the quality of life by interfering with sleep and daily activities. Autopsy studies have shown that 50% of men over 45 will have histological evidence of BPH, increasing to nearly 90% of men aged 85 years. BPH is due to Dihydrotestosterone (DHEA) release which induces cellular hyperplasia of both glandular and stromal components of the gland with resultant BPH. GnRH from the hypothalamus stimulates the anterior lobe of the pituitary gland to release leutinising hormone, which in turn stimulated the testicular leydig cells to release testosterone. Testosterone circulates to the prostatic epithelial cells, where under the influence of 5 alpha reductase, it is converted to (DHEA).
25. ASSERTION: The US Preventive Services Task force (USPSTF) recommends lipid disorder screening for men >35 years and for women >45 years if they are at increased risk for coronary heart disease.
REASON: Lipid disorders increase the risk for atherosclerosis. Detecting and properly managing lipid disorders early in the atherogenic process prevents the development of atherosclerotic plaques and minimises existing plaques.
Answer: (a) Source: Enhancing Use of Clinical Preventive Services Among Older Adults- closing the Gap: Centers for Disease Control and Prevention: Available at www.cdc.gov/aging
26. ASSERTION: women >65 years and men >70 years should undergo BMD (Bone Mineral Density) test. regardless of clinically apparent risk factors.
REASON: Approximately 30 to 50 percent of women and 15 to 30 percent of men will experience an osteoporotic fracture in their lifetime, the risk increasing with age.
Answer- a) Osteoporosis screening with hip DEXA scans and follow-up management in older adults has been shown in a large population-based cohort study to reduce incident hip fractures by 36% over six years compared with usual medical care.
While screening alone would not have an effect on fractures, it may lead physicians to implement management strategies that may decrease fractures.
Source: Enhancing Use of Clinical Preventive Services Among Older Adults- closing the Gap: Centers for Disease Control and Prevention: Available at www.cdc.gov/aging
27. ASSERTION: Percentage of Women Aged 65 to 74 who reported Not Receiving Mammogram within Past Two Years, is used as one of the Indicators for utilization of Clinical Preventive Services for women
REASON: Almost half of all new cases and nearly two-thirds of deaths from breast cancer occur in women >65 years.
Answer- a)
Source: Enhancing Use of Clinical Preventive Services Among Older Adults- closing the Gap: Centers for Disease Control and Prevention: Available at www.cdc.gov/aging
28. ASSERTION: Tracking of blood pressure refers to recording the blood pressure round the clock in children.
REASON: Population strategy included in primary prevention of blood pressure involves non-pharmaco-therapeutic intervention.
Answer- d Tracking of blood pressure is where we keep a record of BP of a Person right from childhood and thus we can predict if he will be at risk of hypertension or not once he grows old.
Reference Park K. Park’s Textbook of Preventive and Social Medicine. Chapter Obesity and Preventive Medicine in Pediatrics, BanarasidasBhonat Publishers, Jabalpur: 22 th ed. 2013
29. ASSERTION: Validity of a screening test has two components specificity and positive predictive value
REASON: predictive value of a screening test is affected by sensitivity, specificity, and disease prevalence.
Answer- d Validity depends on sensitivity ans specificity.
The positive predictive vlaue of the test is calculated by using the formula
Sensitivity* prevalence/ Sensitivity* prevalence(1-specificity)
30. ASSERTION: Primary prevention of Dementia should focus on providing Health Education and reducing risk factors for vascular disease, diabetes, hypertension, obesity, smoking, and physical inactivity.
REASON: It is estimated that in 2010 there were 35.6 million people living with dementia, world wide with 7.7 million new cases each year
Answer: b)
Source: Dementia a public health priority by World Health Organization 2010
Three teams to remain in competition at the end of this round -rest eliminated
4 th Round: Rapid fire round: (part 1) (Common for all teams)
All 5 questions will be simultaneously given to all teams.
Answer as many questions as possible in 3 minutes.
(2 marks for correct answer. -1 mark for incorrect answer)
1. Elderly persons need less calories as compared to young adults.
Arrange the following food articles in descending order as per their caloric value (per 100g.)
- Cow Milk,
- Banana,
- Whole Wheat,
- Soya bean.
Answer: d,c,b,a.
(Soya bean= 432, Whole wheat=346, Banana=104, Cow milk=67)
Source: Dietary Guidelines for Indians by NIN Hyderabad: 2010
2. Cancer is one of the leading causes of death in the elderly. choose the cancers in descending order of the Healthy Life Years Lost globally (2008)
- Lung cancer,
- Stomach cancer,
- Liver cancer,
- Mouth & oropharynx cancers.
Answer: a,b,c,d.
Approximately 83 million DALYs were lost to cancers in the year 2008
Lung cancer=15.5%, Stomach cancer=9.6%, liver cancer=8.6% Mouth & oropharynx cancers = 4.96%
Source: Global economic cost of cancer: American cancer Society: 2008
3. Arrange the following National Policies & Programs for the Welfare of the Elderly in the ascending order of the year they were announced / Implemented
- National Policy on Older Persons (NPOP)
- Maintenance and Welfare of Parents and Senior Citizens Act.
- Reconstituted National Council for Older Persons
- Central Sector Scheme of Integrated Program for Older Persons (IPOP)
Answer: D, A, C, B.
A) =1999, B) =2007, C) =2005, D) = 1992
Source: Situation Analysis Of The Elderly in India: Central Statistics Office Ministry of Statistics & Programme Implementation Government of India
4. As per the Census 2001, Arrange the following states in ascending order of the proportion of elderly population (>60 years)
- Kerala,
- Karnataka,
- Tamil nadu,
- Madhya Pradesh.
Answer: d, b, c, a.
Kerala = 10.5%, Tamilnadu = 8.8%, Karnataka = 7.7% Madhya Pradesh = 7.1%
Source: Situation Analysis Of The Elderly in India: Central Statistics Office Ministry of Statistics & Programme Implementation Government of India
5. Arrange the following World Health Day themes in ascending order of the year they pertain to.
- Antimicrobial resistance: “no action today, no cure tomorrow”
- 1000 Cities, 1000 Lives.
- Save lives. “Make hospitals safe in emergencies.”
- Ageing and Health, “Good health adds life to years”,
Answer: c), b), a), d).
Reference: http://www.who.int
Two teams to remain at the end of this round.
5th Round: Rapid fire round (Individual Team)
Answer if true or false. 1 marks per correct answer. 1 negative mark for an incorrect answer. 2 minutes per team. 10 question per team.
Team 1
- Receptor sensitivity is a pharmacodynamic factor affecting drug availability in elderly – true
- Bradycardia is a commonly present nonspecific anomaly in the elderly. True
- In survival analysis persons who are lost to follow up due to any reason should be omitted from the analysis. False
- Hyponatremia in elderly should be treated very slowly… true
- Pneumonia can also present as constipation in the elderly.. true
- The most important social outcome of demographic transition is Single elderly.. true
- Low grade depression for >2 years in elderly is called anhydonia. false
- In elderly with tuberculosis there is clubbing…false
- In elderly patients we should never ask leading questions False
- Facility of Reverse Mortgage can be availed lifelong by the elderly person. False Word count- 120 words
Team 2
- According to the CDC Pneumococcal vaccine is mandatory in elderly.. True
- BMI is a most reliable anthropometric parameter predicting the risk of cardiac disease, and stroke in elderly.- false
- Depression in elderly can never present as dementia….false
- Vulnerability of older workers to heat stroke is same as young workers. False
- DASH diet therapy is prescribed for patients with Diabetes.. false.
- < Ogive is a diagram used for data presentation on survival of elderly cancer patients after chemotherapy – true
- Serotonin is not linked with prevention of ageing. true
- HRT is to be started in all postmenopausal women >65 years of age. False
- To assess the cause effect relationship case control study is the best design- false
- Indian Journal of Geriatric Care is an Indexed Journal – false word count- 125 words
Team 1 Answers
- Dynamics is what the drug does to the body and kinetics is what the body does to the drug.
- Commonly present nonspecific anomalies in the elderly are all of the following Basal crepts, Absent ankle reflex, Mild increase in RR, Premature ventricular beats, Bradycardia , Impaired GTT , and Bilateral hyper resonant note
- They should be included in the analysis. We have to calculate survival time from the time the study started to the time the event has taken place and accordingly see the outcome. Survival analysis is concerned with studying the time untill event occured. Event may be death, time may be number of days survived after operation. In time to event data 2 major problems happen, time is most unlikely to be normally distributed and there are losses to follow up due to other causes of death ofr migration to a new area etc. All of these have to be taken into consideration during analysis.
- In the elderly hyponatremia is common. The hyponatremia should be treated slowly since it is caused due to a chronic phenomenon. In times of hyponatremia the brain cells have lost their Na as well as water content. If the treatment of Na correction is done fast then the patient can suffer from CPM(Central Pontine Myelinosis) which is due to excess water entering the brain cells. The cells swell in the pons.
- The elderly will concentrate and come out with symptoms which bother him/her most and not concentrate on symptoms which he can suffer comfortably. Constipation is one such symptom. Due to masking of clinical features in the elderly it can mask pneumonia symptoms too.
- Single elderly are increasing our society more so in ladies. They are widowed and since ladies live longer than men they live widows for a longer time. This is the main social problem.
- Dysthymia is correct answer
- In TB there is no clubbing. Clubbing is due to various different causes and does not only depend on the blood oxygen supply to peripheries.
- In elderly person there are missing symptoms, symptoms pertaining to one system but disease in other system, poly-pharmacy, drug interactions, and problems in drug bioavailability. All this makes diagnosis, treatment, prognosis, and drug bioavailability more and more difficult. Hence leading questions is mandatory.
10. Reverse Mortgage is where a senior citizen who is the owner of a house but has no ostensible means of meeting day today expenditure neither by himself or any family member, can enter into an agreement with the bank and get every months money. It is given up-till 80 years of age only.
Team 2 Answers
- Pneumococcal vaccine prevents against pneumonia which is common >65 years of age. Hence CDC (Centre for disease control) has made it mandatory in elderly.
- Waist hip ratio is better than BMI. As a person grows old the height reduces due to osteoporotic changes in the bone. Weight is markedly altered due to acute under nutrition or over nutrition in old age. Under nutrition may occur due to poor dentition, defective deglutition, bereavement, depression, dementia, certain drugs, and anorexia. BMR also reduces in old age .waist hip ratio is not altered due to age. Other parameters like total body fat etc are tedious to measure and have lot of biases. Hence waist hip ratio is the single most, simple, reliable, clinical anthropometric parameter predicting the risk of obesity, cardiac disease, and stroke in elderly.
- Depression with forgetfulness can be masking dementia in clinical features.
- Ageing is associated with significant atrophy of dermis, epidermis, flattening of the dermoepidermal layers. Diminished water binding capacity and reduced secretion of accrine sweat glands leads to dry skin, pruritis, and attendant breaches of epithelial continuity. In elderly person thermal regulation is reduced. As a person grows old the skin thickens and thus sweating is reduced. So there are chances of heat stroke faster than adults.
- DASH- Dietary Alterations to Stop Hypertension. Sodium less, high potassium diet. Fruits and vegetables increased.
- It is called as the less than cumulative frequency polygon or less than Ogive.
- Serotonin is a neurotransmitter which is released by the nerve endings. Its reuptake in the endings or reduced presence in the synaptic clefts can give rise to depression. It is released in sleep. It binds to the post synaptic receptors and helps in transmission of nerve impulses.
- According to the Women Health Initiative study done in 2007 HRT initiated in early postmenopausal period in healthy women is safe. But recently there is chance of getting cardiovascular and Alzheimer’s disease with it. So it is still controversial whether to start or not the HRT in postmenopausal women. Usually HRT is to be started for vasomotor symptoms which are uncommon >65 years of age.
- Cohort study is a better study design
- It is still not indexed .it is just started by GSI (Geriatric society of India). Till date only 3 issues are printed last in Dec 2012.
Source of Support: None, Conflict of Interest: None
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DOI: 10.4103/1755-6783.152738
