geropsychology
subdicipline of psychology that addresses issues of aging, including normal development, individual differences, and psychological problems unique to older persons
ethics and responsibility
-many psych training programs do not provide sufficient education/expierence in geropsych
-must be competent
-2003 APA published guidelines ensure knowledge of:
-aging process
-cog and psychological problems for older ppl
-assessment tools
-treatment
-imp
successful aging
-1/3 of older adults are judged to age successfully
-good health & active lifestyle
-independence in functioning
-lack of disability
-abscense of cog impairment
-positive social relationships
-selective optimization and compensation
Selective optimization and compensation
-Theory of pos. aging
-people age more successfully when they modify their goals and choices to make best use of their personal characteristics
Psychological symptoms and disorders among older people
-20% of older adults have a psychological disorder
-higher among home bound and people who live in nursing homes with chronic illness
-stigma around seeking treatment
-only about 50% receive treatment
-inadequate recognition and treatment
-ageism (attribu
depression and anxiety in later life
things to consider:
-types of loss
-uncertainty about future
-not always natural consequence of growing old.
Major depressive disorder
-depression often manifesting as cognitive difficulties: attention, information processing, executive dysfunction (difficulty planning, thinking abstractly, initiating and inhibiting actions.
-Vascular depression (a mood disorder that occurs in the contex
prevalence and impact
-major depression and dysthymia impacts 4% of older adults
-rates of depression increase to 14% for older adults who are homebound or have cog. impairment
-affectts daily functioning and survival:
depression affects outcome of medical disorder,
recover le
sex, race, ethnicity
-affect more women
-more common in hispanic older adults, but less likely to receive tx
-asian americans and white older adults both experience levels of suicidal ideation
-suicide rates are highest among white men, followed by non white men.
-african ame
executive functioning
difficulty planning, thinking abstractly, nitrating and inhibiting actions.
-symptoms that are apart of depression in older adults.
vascular depression
now known as "depressive disorder due to another medical condition"
-diagnoses in the context of cerebrovascular disease (arteries supplying blood to brain)
symptoms: difficulty with language, slowed movements, less agitation and guilts
etiology of depression
-most likely to have existent cognitive impairment and more evidence of brain abnormalities
-more common with vascular, neurological or other physical diseases
-depression is diagnosed afer a medical condition is ruled out, or depression is specified with
factors that contribute to depression for older adults
DIathesis stress model pg 471
-stressful life event
plus
-biological predispositions (genetics, medical disease)
-increased age
-personal protective factors reduce negative impact of biological and environmental risk factors (maturity/prev. life experienc
treatment of depression in older patients
-begin with a physical evacuation
-same psych tx
-60% improvement after medication (lower doses)
-reminiscence threapy
reminiscence therapy
focuses on significant past events and how they managed the distress.
Anxiety with older adults
Worrying centered around:
-wording is important (shame, guilt, fret, or concern to describe worry or anxiety.)
-greater overlap with depression and other medical conditions
-most common: specific phobia and GAD
Prevalence and impact of anxiety
-anxiety is most common and significant mental health problem
-11.6% of older adults suffer from anxiety disorders
-more common in those living in nursing homes and homebound older adults.
sex, race, ethnicity factors with anxiety
-more common among older women
-anxiety disorders are more common among african american women
-GAD occurs most freq. among older peurto rican medical patients and older Af. American women
-higher level of suicidality
-culture bound syndromes : may be mor
Etiology of anxiety later in life
-experience of long term or lifetime symptoms or anxiety
-stressful life events play a role in anxiety
-overlap with other med. diseases
-psychological response to medical illness
TX of anxiety in older patients
-rule our physical illnesses
-benzodiazepines are the most freq. prescribed (43%) Can create serious side effects like memory problems and slowing of motor behaviors.
-antidepressants (SSRIs) effective for older adults, fewer side effects.
-older adults p
Substance-related disorders and older adults
Most common problems:
-overuse of alcohol
-misuse of prescription meds
-tobacco
Alcohol abuse is associated with:
-antisocial behavior
-legal problems
-unemployment
-lower SES
* the National institute on alcohol abuse and alcoholism recommends that ppl 65
prevalence and impact for substance related disorders
-tobacco is the most commonly abused substance: over 17.1 million adults over age 50
-alcohol abuse or dependence for men
-older adults take 25% of the meds consumed in the US
-late onset alcohol abuse occurs more often in women
sex, race, ethnicity & etiology
-older adult males use alcohol twice that of the rate of women
-illicit drug use is more common in older men
-differences consist across ethnic and racial groups. Caucasians highest with substance abuse.
-women are at a higher risk for negative consequenc
Tx of substance-related disorders
-brief alcohol counseling (BAC) aimed at prevention of risky drinking
-behavioral self-control procedures
-medications for alcohol abuse: naltrexone and disulfiram, and antidepressants.
-medications for benzoiazepines abuse (gradual discontinuation.)
-smo
psychosis
-Late onset schizophrenia:
schizo that first appears after age 40.
-Very-late onset schizophrenia:
schizophrenic-like-disorer but with symptoms that do not include deterioration in social/personal functioning
-Among 80% of older ppl with schizo, the onset
prevalence, gender, and ethnicity
-schizo occurs less common as you get over 65
-psychotic symptoms are more common with nursing homes
-poor functioning related to worse cog. performance, less education, and severe NEG symptoms.
-Late-onset schizo is more common in women
-symptoms of psyc
etiology of schizo and psychosis
Brain abnormalities- enlarged ventricles, increased density of dopamine reception, reduced size of the temporal gyrus.
Other causes- hormonal changes, psychosocial stressors, deficits with hearing/vision
Medical conditions could be cause- stroke, brain tu
Tx of psychosis
-typical and atypical antipsychotic meds.
-skills training
-family support
-CBT
-psychoeducation
-coping skills training
-behavioral management
schizo in older ppl vs adults
late onset ppl have more freq auditory hallucinations, fewer neg symptoms, less impaired cog skills, and better functioning earlier in life.
Neurocognitive disorder: delirium
-alteration in consciousness that typically occurs in the context of a medical illness or after ingesting a substance
-hypo and hyper active types.
- disturbance in attention, awareness, and cognition
- onset is sudden (hours or days) and symptoms can per
prevalence and impact of delirium
-common in general hospitals. 14-56%
-common in patients seen in emergency room 30%
-increased risk of institutional placement
-causes longer hospital stays, complications after surgery and poor hospitalization functioning
etiology of delirium
-caused by serious systematic medical illness: aids, CHF, infection, or toxic edicts of medication.
-Metabolic disorders: hypothyroidism or hypoglycemia
-neurological disorders: head trauma, stroke, seizure, or meningitis
-other health issues: malnutritio
Tx of delirium
-often missed or inadequately treated
-first step is screening for known risks
-support for family and patient
-education and supportive care prevention
-beneficial environmental manipulations.
Neuro cognitive disorder
-syndromes characterized by cognitive decline in various domains: attention, executive functioning, learning, memory.
-takes away ability to function independently: multiple cog difficulties, and causes significant emotional problems for patient and famil
Neurocognitive disorder
-not accompanied by changes in consciousness or alertness
-requires extensive interviews, history taking to make a diagnosis, and testing
3 Types of mild or major neurocog disorder
1. major or mild due to alzheimers disease
2. major/mild vascular neurocognitive disorder
3. substance/medication induced major or mild neurocog disorder.
Neurocognitive disorder due to alzheimers
-gradual onset plus continuous cognitive decline
-major vs. mild depends on level of impairment (ability to engage in daily functioning independently.)
-75% of patients with a neurocog disorder is because of alzheimers.
Vascular cerebrovascular disease
cause of cognitive dysfunction due to result of stroke, heart disease, artery disease
substance/medication neurocog disorder
-can lead to dementia
-abstinence may stop the decline or reverse the damage
Prevalence and impact NCD
more prevalent with age
Etiology
alzheimers= neurofibrillary tangles (NFTs) and cerebral senile plaques (SPs) impair neuronal connections between dif parts of brain.
-increase with age but those with alzheimers have excessive amounts.
-Vascular= brain cell death.
sex, race, ethnicity neuro cog disorders
-more freq in women than men
-higher rates are found in African americans and hispanic groups
-diathesis stress-model.
Risk factors:
-genetic factors, certain genetic mutations (e4, a poe gene) increase risk for NCD
- increasing age itself.
Risk factors for NCD
-increasing age (risk is higher after 70)
-family history of neurocog disorder
-presence of e4 variant of APOE gene.
Protective factors for NCD
-diatary factors (increased omega3, decreased fat/cholesterol, vitamins c d and e)
-moderate alcohol use (esp red wine)
-mental activities (games, crossword puzzles)
-use of non steroidal anti-inflammatory drugs (NSAIDs)
-advanced education
-bilingialism
Tx of NCD and related difficulties
-cannot be reversed or cured
-targets delaying disease progression
-providing support and assistance to caregivers
-changing the environment
-Medication= do not reverse damage but allow NTs to function more effectively. (cholinesterase inhibitors CEIs and