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					                           New Basic Concepts II
                       Aging, Health Care, and Society
1.     Which of the following is the most prevalent chronic disease of old age?
A)     arthritis
B)     osteoporosis
C)     Parkinson's disease
D)     cancer
E)     cardiovascular disease


4.     ______ refers to the private health insurance policies that older people may
purchase to supplement their Medicare coverage.
A)     Medicaid
B)     Medicare Part A
C)     Medicare Part B
D)     Medigap
E)     Prospective payment policies

7.     The lowest rate of suicide in the U.S. occurs among which of the following
groups?
A)     younger black men
B)     older black men
C)     young white men
D)     older white men
E)     none of the above

9.     The highest rate of suicide in the U.S. occurs among which of the following
groups?
A)     younger black men
B)     older black men
C)     young white men
D)     older white men
E)     older white women

12.    According to gerontologists, aging begins at birth.
A)     True
B)     False


17.    It is thought that both genetic and environmental factors contribute to Alzheimer's
disease.
A)     True
B)     False




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                           Controversy 4
            Should We Ration Health Care for Older People?

1.      “Backdoor rationing” refers to which of the following?
A)      rationing health care on the basis of age without public acknowledgement of the
practice
B)      implementing a waiting list to replace a market system for allocating some types
of medical care
C)      implicit or indirect methods of rationing that limit access to the health care
system, such as through case management
D)      setting up special committees to decide which patients will have access to certain
services
E)      none of the above

2.      “Managed care” refers to which of the following?
A)      age-based rationing of health care to control costs
B)      hiring managers to oversee health care providers in various hospital departments
in order to control utilization of services
C)      combining insurance with health care providers and facilities in a unified
network to control costs
D)      avoiding unneeded care or treatment that prolongs dying
E)      using cost-benefit analysis to select the most cost effective treatment options

3.      Alternative approaches to rationing health care that would improve the efficiency
of the health care system include which of the following?
A)      limit medical procedures based on effectiveness
B)      implement cost-benefit analysis
C)      assess individuals' quality-adjusted life years and limit health care accordingly
D)      implement cost-effectiveness analysis
E)      all of the above

5.     Which of the following factors is responsible for rising health care costs?
A)     increasing longevity
B)     increasing intensity of services
C)     fraud, waste, and abuse
D)     all of the above
E)     a and b above

9.    Medicare beneficiaries who are near death are the primary cause of large
Medicare payments.
A)    True
B)    False

10.   Medical costs in the last year of life amount to about 30 percent of the entire
Medicare budget.


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A)     True
B)     False

                             Controversy 5
                 Should Families Provide for Their Own?
2.      In order to allow caregivers some time off, ______ may be provided, which
constitutes temporary care of dependent elders.
A)      exchange care
B)      filial care
C)      long-term care
D)      respite care
E)      none of the above

5.     The major public payer of care in nursing homes is ______.
A)     Medicare
B)     Medicaid
C)     families
D)     Social Security
E)     none of the above


7.     The vast majority of care for aged relatives is provided by women, typically
wives, daughters, or daughters-in-law.
A)     True
B)     False


9.     Public opinion poll data show that a majority of adults in the U.S. support
increased taxes to help pay for a long-term care program.
A)     True
B)     False


                          Controversy 6
        Should Older People Be Protected From Bad Choices?

3.     Which of the following is the best predictor of sexuality in old age?
A)     marital status
B)     earlier sexual behavior
C)     feelings of an older person about sexuality
D)     physical health
E)     none of the above



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6.     Data from National Crime Victimization Surveys show that people over age 65
are more likely than other age groups to be victims of serious crimes, such as robbery,
personal theft, assault, and rape.
A)     True
B)     False

9.     Older people are more likely to be victims of financial exploitation than physical
abuse.
A)     True
B)     False

10.    All states require mandatory reporting whenever there is evidence of elder abuse.
A)     True
B)     False


                           Controversy 7
          Should People Have the Choice to End Their Lives?
3.     Which of the following are predictors of suicide?
A)     intolerable psychological pain and frustration
B)     psychological needs
C)     a feeling of hopelessness or helplessness
D)     expressing the intent to kill oneself
E)     all of the above

4.     Among old persons, clinical depression is the most important cause of suicide.
A)     True
B)     False

9.     U.S. common law holds that people have a right to accept or reject medical
treatment.
A)     True
B)     False

10.     Termination of life-sustaining treatment is not homicide, suicide, or assisted
suicide according to court decisions.
A)      True
B)      False




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             Reading 16, Why We Must Set Limits, Callahan
1.      Callahan argues that the primary role of elders is to serve the young and the
future.
A)      True
B)      False


4.      Public entitlement programs for the health care of the elderly should be used to
relieve suffering but not to extend life through the use of life-extending technology.
A)      True
B)      False


       Reading 17, Pricing Life: Why It’s Time for Health Care
                          Rationing, Ubel

1.    Ubel argues that health care rationing amounts to an egregious crime against
humanity.
A)    True
B)    False

4.      According to Ubel, we should be concerned with effectiveness analysis rather
than rationing so that everyone has access to the same services.
A)      True
B)      False

    Reading 18, The Pied Piper Returns for the Old Folks, Hentoff
1.      Hentoff argues that Daniel Callahan's proposal to ration health care on the basis of
age is class-biased.
A)      True
B)      False

3.      For Hentoff, Callahan's proposal becomes a “decent proposal” when Callahan
suggests that age-based rationing won't go into effect until the elderly have access to
long-term home care or nursing home care.
A)      True
B)      False

4.     According to Hentoff, several influential individuals and numerous bioethicists
support Callahan's proposal in spite of individuals' “equal protection of the laws” under
the Fourteenth Amendment.
A)     True


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B)      False

      Reading 19, Letting Individuals Decide, Wetle and Besdine
1.      Wettle and Besdine criticize Callahan's proposal to ration health care on the basis
of age.
A)      True
B)      False

4.     Wettle and Besdine argue that in order to treat people fairly with regard to aging
and health care, policies must focus on groups rather than on individuals.
A)     True
B)     False

    Reading 20, Aim Not Just for Longer Life, but Expanded “Health
                      Span”, Perry and Butler
1.      According to Perry and Butler, scientific research should be focused on which of
the following activities?
A)      reduction of frailty
B)      improvement of health status
C)      increase independence
D)      all of the above
E)      a and b above

2.     While they argue that the elderly are largely to blame for rising health care costs,
Perry and Butler are critical of Callahan's proposal to ration health care on the basis of
age.
A)     True
B)     False

Reading 21, Medicaid and Long-Term Care, Strauss and Lederman

2.      Strauss and Lederman caution that people should plan ahead in order to legally
qualify for Medicaid coverage of long-term care costs.
A)      True
B)      False

3.    While divesting of one's assets to qualify for Medicaid is legal, Strauss and
Lederman argue that it is an unethical practice.
A)    True
B)    False

4.      Medicare is the fastest growing component of many state budgets.


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A)      True
B)      False

    Reading 22, Shame of the Rich: Making Themselves Poor, Quinn

1.     Quinn argues that divestment planning for the purpose of qualifying for Medicaid
coverage of long-term care costs is an ethical practice.
A)     True
B)     False

3.    According to Quinn, when middle- and upper-middle-class people qualify for
Medicaid rather than use their own money to pay for care, the quality of care deteriorates.
A)    True
B)    False

4.      People should purchase long-term care insurance or use their savings to pay for
care in a nursing home, according to Quinn.
A)      True
B)      False

          Reading 23, The Fallacy of Impoverishment, Moses

1.      The hypothetical average worker used in most discussions of Social Security
policy receives a benefit that is substantially higher than that of actual retirees.
A)      True
B)      False

4.      The hypothetical average worker used in most discussions of Social Security
policy is awarded a monthly benefit of $894, while the average monthly benefit received
by actual retirees is $1, 127.
A)      True
B)      False


Reading 24, The Case Against Paying Family Caregivers: Ethical
                 and Practical Issues, Blaser

1.      According to Blaser, those who support paying family caregivers do so for which
of the following reasons?
A)      Paying family caregivers supports and strengthens family values.
B)      Clients have a choice between hiring a family member to provide care or hiring a
stranger.


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C)      Workers would not have to be recruited, hired, trained, supervises, or paid
benefits or health insurance.
D)      all of the above
E)      a and b above


2.      Blaser argues that direct payments to families for caregiving should be avoided;
and instead, services that complement and support family members should be provided.
A)      True
B)      False


4.     The potential for fraud and abuse would increase if family members were paid to
provide care, according to Blaser.
A)     True
B)     False

    Reading 25, For Love and Money: Paying Family Caregivers,
                 Kunkel, Applebaum, and Nelson
2.     Critics of paying family members to provide care do so for which of the following
reasons?
A)     Family responsibility for caregiving would diminish.
B)     The quality of the caregiving experience for care recipient and caregiver would
decrease.
C)     Public expenditures would increase.
D)     all of the above
E)     a and b above

3.      The National Cash and Counseling Demonstration and Evaluation project found
large increases in the satisfaction levels of consumers and caregivers who participated in
consumer-directed programs.
A)      True
B)      False

4.      Consumer-directed demonstration programs show better health and safety
outcomes, fewer caregivers arriving late or not at all, and better care than in traditional
service systems.
A)      True
B)      False

     Reading 26, The Right to Freedom From Restraints, Brown




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1.     When a person can no longer manage to prevent harm to himself or others, legal
intervention (i.e., “protective proceedings”) may be sought and may include which of the
following processes?
A)     guardianship
B)     conservatorship
C)     civil commitment
D)     all of the above
E)     a and b above

2.      Parens patriae refers to which of the following powers?
A)      The state has the authority to prohibit individuals from injuring others or harming
their property.
B)      The state has the authority to protect those who cannot protect themselves.
C)      That state has the authority to provide procedural safeguards to avoid wrongful
imprisonment.
D)      all of the above
E)      a and b above


4.     There who are generally no limits to the individual's right to exercise self-
determination.
A)     True
B)     False


    Reading 27, Ethical Dilemmas in Elder Abuse, Wetle and Fulmer

1.      Which of the following protective functions may result when health professionals
assist caregivers in recognizing the limits of their own health, identifying supportive
services, and sharing caregiving responsibilities among available family members?
A)      It may prevent elder abuse or neglect that might have been triggered by caregiver
burden.
B)      It may protect the caregiver from mistreatment or abuse.
C)      It may assist professionals in balancing autonomy and beneficence.
D)      all of the above
E)      a and b above

2.     A competent patient may refuse interventions even if a health professional
confirms that the patient is being mistreated.
A)     True
B)     False

4.      When health professionals treat families, they always know who the primary
patient is and how to balance their professional obligations among various members of
the family.


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A)      True
B)      False


      Reading 28, A Legal Perspective on Elder Abuse, Heisler and
                                Quinn
2.      The “least restrictive alternative” refers to which of the following?
A)      the promotion of self-governance; that is, being one's own person, without
constraint by others or by psychological or physical limitations
B)      what an older adult actually does to take care of daily living needs; includes
consideration of past decision-making
C)      Practitioners are ethically bound to craft individualized solutions that are
least intrusive upon their client's freedom.
D)      all of the above
E)      none of the above

3.      Practitioners should not protect a client's autonomy to the extent that they fail to
take action to protect an elder.
A)      True
B)      False

4.      Evaluating the competency of clients necessitates working with the characteristics
of the individual older adult.
A)      True
B)      False


     Reading 29, Elder Self-Neglect: A Blurred Concept, Fabian and
                           Rathbone-McCuan
1.      Which of the following terms has been used to describe elderly patients who
appear filthy and unkempt, whose homes are dirty and untidy, but who show no shame
for their situation?
A)      Self-neglect Syndrome
B)      Senile Breakdown Syndrome
C)      Dilemma of Neglect Syndrome
D)      Diogenes Syndrome
E)      none of the above

2.     The fact that there are stereotypic or “typical” cases of self-neglect assists
professionals in arriving at simplistic solutions to a variety of situations.
A)     True
B)     False



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4.     There is a clear-cut psychopathology that explains the tendency in some
individuals to neglect themselves.
A)     True
B)     False


      Reading 30, Why Do People Seek Physician-Assisted Death?,
                        Pearlman and Starks
1.        Physician-assisted suicide is illegal in the U.S. except in which of the following
states?
A)        Hawaii
B)        Massachusetts
C)        Oregon
D)        all of the above
E)        a and b above

3.     Pearlman and Starks argue that health care providers can best serve patients by
focusing on the single factor motivating them to seek physician-assisted death.
A)     True
B)     False

     Reading 31, A Time to Die: The Place for Physician Assistance,
                              McKhann
1.     McKhann prefers to use which of the following terms to describe the person who
wishes to die and asks for help?
A)     assisted suicide
B)     active euthanasia
C)     physician-assisted dying
D)     passive euthanasia
E)     none of the above

4.        Which state was the first to pass a law permitting physician-assisted dying?
A)        Massachusetts
B)        Vermont
C)        Hawaii
D)        Oregon
E)        none of the above

 Reading 33, Neither for Love nor Mercy: Why Doctors Must Not
                           Kill, Kass



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1.      According to Kass, which of the following reasons are used to support physician-
assisted death?
A)      the right to control one's body and life; freedom and autonomy
B)      when the patient's life is deemed no longer worth living, usually because of great
pain, a terminal condition, an irreversible coma, advanced senility, or extreme
degradation
C)      Once a patient is diagnosed with a terminal illness, the physician is no longer
obligated to heal.
D)      all of the above
E)      a and b above

3.      Kass argues that defining categories of “euthanizable” people is a fairly easy and
straightforward task.
A)      True
B)      False

4.     Kass argues that from the health care provider's perspective, the duty to make
whole and to heal can never be compatible with intentionally killing the patient.
A)     True
B)     False




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