Chapter 16 Aging and Psychological Disorders. Issues, concepts, and methods in the study of older...
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Transcript of Chapter 16 Aging and Psychological Disorders. Issues, concepts, and methods in the study of older...
• Issues, concepts, and methods in the study of older adults, old age, and brain disorders
•Old age and psychological disorders• Treatment and care of older adults • Issues specific to therapy with older adults
Chapter Outline
Facts About Aging Population
• 65 years old and older: • Young-old: 65-74• Old-old: 75-84• Oldest-old: 85 and over
•Changing demographics in Canada• In 1998, 3.7 million (12.3%) of population were 65 and
over• In 2011, over 5 million (14.8%) of Canadians • In 2041, expectation are 10 million Canadians• In 2015, more senior citizens than children
• In 2050, 1 in 5 people in the world will be 60 and older
Dementia
•Dementia— term for gradual deterioration of intellectual abilities to the point that social and occupational functions are impaired
•Course may be progressive, static, or remitting
• Prevalence of dementia with advancing age• 13.9% in people aged 71 and older• 37.4% in people aged 90 and older
• Incidence of cognitive impairment without dementia occurs in 22.2% of people age 71 or older
Symptoms of Dementia
•Difficulty remembering things• Especially recent events
• Leaving tasks unfinished •Hygiene may be poor and appearance sloppy •Getting lost •Difficulty comprehending making plans or
decisions• Poor impulse control
• May use coarse language, tell inappropriate jokes, or shoplift
•Deterioration of abstract ideas, make faulty judgments
•Disturbances in emotions, including outbursts, depression
Classification of Dementias
•Alzheimer’s Disease•Frontal-temporal Dementias•Frontal-subcortical Dementias
Alzheimer’s Disease (AD)
•Described by German neurologist Alois Alzheimer (1906)
•Accounts for about 50% of dementia in older people• Prevalence in Canada: 1.5% of population (2010)• Estimated prevalence 2.8% of population (2038)• 1/13 Canadians over age 65 has AD or related dementia
•Death usually occurs 10 or 12 years after onset•Although women live longer, more die as a result
of AD than men • Promoting mental and physical exercise could
reduce risks by 10%
Alzheimer’s Disease (cont.)
Main neurological changes:•Atrophy of cerebral cortex
• Begins with entorhinal cortex and hippocampus, then frontal, temporal, and parietal lobes
• As neurons and synapses are lost, fissures widen and ridges become narrower and flatter
• Ventricles also become enlarged
• Plaques— small, round areas comprising remnants of lost neurons and b-amyloid are scattered throughout cortex
•Neurofibrillary tangles— tangled, abnormal protein filaments accumulate within cell bodies of neurons
• Plaques and tangles are present throughout cerebral cortex and hippocampus
Causes of Alzheimer’s Disease
•Genetics – strong evidence
• Risk first-degree relatives of afflicted individuals
• Concordance for MZ twins is greater than for DZ twins
•Environmental role• ‘Use it or lose it’• Research shows:
• Engaging in cognitive activities helps to preserve intellectual functioning
• Cognitive activity preserves crystallized intelligence more than fluid intelligence (new learning)
• Cognitive reserve hypothesis that high education levels help to delay onset of dementia
Frontal-Temporal Dementias
•Accounts for 10 to 15% of cases• Typical age of onset is late fifties•Marked by extreme behavioural and
personality changes•Not closely linked to loss of cholinergic
neurons• Pick’s disease is one cause of frontal-temporal
dementia • Degenerative disorder where spherical inclusions
(known as Pick bodies) are present in neurons
Frontal-Subcortical Dementias
Types include:•Huntington’s chorea —caused by single
dominant gene located on chromosome 4 • Major behavioural feature presence of writhing
(choreiform) movements
• Parkinson’s disease — marked by muscle tremors, muscularrigidity, and akinesia • an inability to initiate movement
•Vascular dementia — diagnosed when patient with dementia has neurological signs or when brain scans show evidence of cerebrovascular disease
Other Causes of Dementia
• Infectious diseases• Encephalitis• Meningitis• Syphilis (Treponema
pallidum)
•Head traumas•Brain tumours•Nutritional
deficiencies• Especially of B-
complex vitamins
• Kidney or liver failure
• Endocrine-gland problems• Hyperthyroidism
• Exposure to toxins• Lead or mercury• Chronic drug and
alcohol use
Treatment of Dementias
•Biological Treatments of Alzheimer’s Disease• Involves death of brain cells that secrete
acetylcholine thus try to levels• Blocking creation of amyloid from its precursor
protein • Antioxidants (vitamin E) may be useful in
slowing progression
Treatment of Dementias (cont.)
• Psychosocial Treatments for Patients• Supportive psychotherapy aiming at minimizing
the disruption caused by the person’s behavioural changes
•Many individuals with dementias are supported by family members• Ratio of individuals with dementia living with
family in the community versus in institutions 2:1
Treatment of Dementias (cont.)
•Caregiver burden – four kinds identified:• Emotional• Physical• Financial • Employment
•Caregivers more likely to experience chronic health problems
•Resources available to caregivers• On-line forum• Support groups• Respite from caregiving (health care workers take over
from family for periods)
Delirium
•Delirium— “a clouded state of consciousness” • Trouble concentrating and focusing attention• Cannot maintain coherent thought• Early stages— person frequently restless especially at
night• Perceptual disturbances • Memory impairment• Paranoid delusions in 40 to 70%
• severe delirium• Speech is rambling and incoherent• Person is bewildered and confused
•Difference between delirium and other conditions• People with delirium have lucid intervals, show
fluctuations in mental state over the course of the day
Causes and Treatment of Delirium
Causes• Drug intoxications • Drug-withdrawal
reactions• Metabolic and
nutritional imbalances • Uncontrolled
diabetes and thyroid dysfunction
• Infections or fevers• Neurological disorders• Stress
Treatment• If syndrome identified
correctly and underlying cause promptly treated• 1-4 weeks for
condition to clear
• If underlying cause not treated• Permanent brain
damage• Death
• Intervention addresses risk factors • Sleep deprivation,• Immobility• Dehydration• Visual and hearing
impairment• Cognitive
impairment
Old Age and Psychological Disorders
•Rates of mental disorders are lowest in age 65 and older, most are free from serious psychopathology
• Instead, cognitive impairments are more common • 5.5% of older men and 4.7% of older women
•About 10 – 20% of older adults have psychological problems serious enough to need professional help
Depression
•Depression is less prevalent in older adults than younger people
• In Canada (2005): • 2.6% with major depression • 4.9% with minor depression (2-4 symptoms)
• Late onset depression (first episode in old age)
•Causes of depression:• Less involvement in daily activity• Depression maintained by self-critical thoughts• Is related to medical illness • Bereavement
Treatment of Depression
•Depression is under-treated in the elderly•Cognitive, behavioural, interpersonal and
brief psychodynamic approaches have been used
•Quality of client-therapist alliance is a key predictor of therapeutic response
•Reminiscence therapy can be effective• ‘life review therapy’• reflect on past experiences• re-examine events• Example: perfectionists who are pre-occupied
with past mistakes work on less self-critical interpretations of their experiences
Anxiety Disorders
•Anxiety more prevalent than depression • Less prevalent in older people than younger
adults; about 7% of people 65 and older •Risk factors: e.g., being female, having several
chronic medical conditions, not being married, low levels of education
•Can complicate other conditions •Most prevalent: GAD and agoraphobia
Substance-Related Disorders
•Alcohol use and dependence • In Canada: 8.9% had definite alcohol abuse; 3.7% had
questionable alcohol abuse • In US: 10.8% of elderly men; 2.9% in elderly women • In England: 28.6% in elderly men; 10.3% in women • Heavy drinking is linked to depression, anxiety, health
problems
•Medication misuse • Much greater problem than drug and alcohol abuse • Elderly are 13% of population but they consume 33% of all
prescribed meds • Problem: Obtain prescriptions from several doctors
Sleep Disorders
• Insomnia: • Common problem: 1 in 5 older adults (65-79) • More frequent, less severe than in younger
populations with more complications• Less night-time sleep, more daytime naps, more
night-time interruptions, less time in REM sleep• More sleep disturbance in older men than in
older women
•Causes of sleep disorders: • Medication, anxiety, depression, lack of activity,
poor sleep habits, sleep apnea
• Treatment of sleep disorders• Pharmacotherapy, possible over-use in nursing
homes
Suicide
• Prevalence: 3x higher than in younger adults
• Peak ages for suicide: 80-84 in white US men
•Older adults are less likely to communicate their intention than younger adults
•Ratio between attempted and completed suicide are much higher in older adults (4:1) compared with 8:1 in overall population
•Causes of suicide: loneliness, poor cognitive functioning, general and interpersonal hopelessness
• Link between health problems, depression and suicide
•Alcohol use associated with more violent methods
Treatment & Care of Older Adults
•Nursing Homes•Alternative Living
Settings•Community-Based
Home Care
•Considerations in Therapy:• Social context• Loneliness• Physical frailty• Death and dying
Copyright
• Copyright © 2014 John Wiley & Sons Canada, Ltd. All rights reserved. Reproduction or translation of this work beyond that permitted by Access Copyright (The Canadian Copyright Licensing Agency) is unlawful. Requests for further information should be addressed to the Permissions Department, John Wiley & Sons Canada, Ltd. The purchaser may make back-up copies for his or her own use only and not for distribution or resale. The author and the publisher assume no responsibility for errors, omissions, or damages caused by the use of these programs or from the use of the information contained herein.