11-1 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright 2009 McGraw-Hill Australia Pty Ltd...

11-1PPTs t/a Abnormal Psychology 1e by Rieger - Copyright 2009 McGraw-Hill Australia Pty Ltd

CHAPTER 11

AGING AND PSYCHOLOGICAL DISORDERS


Ageing and psychological disorders Ageing

The demographics and epidemiology of ageing In Australia and many industrialised countries, the proportion of

people over the age of 65 is increasing Lifespan is also increasing

Currently, the average life expectancy in Australia is 80.2 years

The type and frequencies of illnesses affecting older illnesses have changed dramatically over time

The most common causes of morbidity and mortality today are chronic illnesses such as heart disease and cancer

The mortality rates for diseases such as diabetes are between 7 and 11 times higher among Indigenous Australians than non-Indigenous people

40% of older Australians (60+) require help to manage their health or cope with a disability



Historical overview of the psychology of ageing Throughout history people have searched for ways to lengthen the

lifespan

In modern times, understanding of ageing has advanced through new technologies and research techniques

Researchers have discovered that reductions in brain size when comparing older and younger adults were due to cohort effects – differences in life circumstances between the age groups

In addition, basic cognitive functioning holds steady into the 9 th decade Longitudinal studies, where the same individuals are followed over time, are

particularly important for research on ageing

Dr. Elsie Harwood – an Australian pioneer in psychology and ageing known for studies of longevity and cognitive processes in older adults



Normal ageing processes: cognitive, emotional and social Primary ageing are changes that are a product of normal ageing Secondary ageing includes disease states such as coronary artery

disease, major depression, and Alzheimer’s disease

Cognitive changes with increasing age

Complex attention tasks, such as switching between cognitive tasks, are most affected by increasing age

Lapses in memory are also part of the normal ageing process Language is the most robust in the face of ageing processes

Several theories attempt to account for changes in cognition in later life Information processing capacity- age-related changes occur in tasks that

require speed of processing but not for automatic processing Frontal Lobe Theory focuses on the fact that functions in the frontal lobe

deteriorate with normal ageing Wisdom – expert knowledge and judgment – improves with age



Normal ageing processes: cognitive, emotional, and social Emotion and personality in later life

Depression and most other psychiatric conditions may decrease in incidence in later life

May be partly due to the fact that older adults have better coping strategies

Erickson’s Stages of Psychosocial Development Theory has been influential

Development is characterised by movement through various stages in different life periods

Each stage entails the need to resolve opposing tendencies

In contrast, in the Five Factor (“Big Five”) Model broad personality traits have been found to be remarkably stable over adult life



Normal ageing processes: cognitive, emotional, and social Social changes with age

Carstensen’s Socioemotional Selectivity Theory Older adults prioritise more meaningful relationships, leading to a reduction in quantity

but an increase in quality of the social network

The perceived amount of social support received predicts satisfaction with one’s relationships

Social networks are important in helping older adults cope with adversity both through instrumental activities and emotional activities

Gender is an important variable Women give and receive more support over their life than men and experience greater

benefits

It is also important for relationships to be reciprocal, which may be more difficult in later life


Ageing and psychological disorders Psychological disorders in later life: the dementias

The definition of dementia A broad class of neurological disorders associated with cognitive,

personality, and behavioural changes in later life

Defined as “an acquired syndrome of intellectual impairment produced by brain dysfunction” (Cummings & Benson, 1992)

The main symptom is intellectual impairment, usually impaired memory and disturbance in at least one other cognitive area (e.g., language)

Approximately 6% of the Australian population over 65 has some form of dementia

The prevalence of dementia is expected to triple by 2051 Direct health costs of dementia in Australia is $3.2 billion



Alzheimer’s disease Most common form of dementia – 50-70% of all cases of dementia Underlying biological process is characterised by the presence of:

neurofibrillary tangles - twisted masses of tiny filaments inside nerve cells neuritic plaques – abnormal clumps of degenerating brain cells surrounding

a protein core

The course of the disease is characterised by increasing cognitive dysfunction, including difficulties with remembering new information and changes in language, particularly the ability to name objects, people, and places

Also includes changes in personality and emotional functioning, such as apathy and agitation and behavioural problems such as wandering and toileting difficulties

Over 25% experience hallucinations or delusions at some point



Alzheimer’s disease According to DSM-IV-TR, the hallmark of the disorder is memory

impairment, which becomes very severe as the disorder progresses

The memory impairment must be accompanied by declines in one or more of the following areas

Aphasia - language disturbance Apraxia - impaired ability to carry out motor activities Agnosia - failure to recognise or identify objects and people Disturbance in executive function (planning, organising, etc.)

The memory and cognitive disturbances must result in significant impairment in functioning and represent a significant decline from prior functioning



Alzheimer’s disease Aetiology

A certain protein called ApoE E4 constitutes a major risk factor The ApoE gene on chromosone 19 is polymorphic (has different forms) 40-60% of people with Alzheimer’s carry the ApoE E4 version

The Nun Study 15 year longitudinal study of ageing and Alzheimer’s disease Examined neuropathology at autopsy and conducted retrospective analysis of

autobiographies Characteristic neurobiological features (plaques and tangles) are not sufficient

for Alzheimer’ s disease to develop Non-biological factors (such as cognitive ability) may also be relevant



Vascular dementia Second or third most common form of dementia, 10-30% of cases 3 most common causes of dementia are multiple cortical infarcts

(strokes), a strategic single infarct, small vessel disease in the brain Similar to Alzheimer's, vascular dementia is characterised by multiple

cognitive deficits (DSM-IV-TR) Memory impairment is central Declines in one or more of the following: aphasia, apraxia, agnosia, or

disturbance in executive functioning

In contrast to Alzheimer’s, focal neurological signs such as problems with gait, weakness of muscles in arms or legs, or evidence from neuroimaging scans of past strokes

Also differs from Alzheimer’s because more sudden onset, association with vascular disease risk factors, and generally better preserved memory

Psychiatric and behavioural changes may include depression, emotional lability, and hallucinations



Other forms of dementia Frontotemporal dementia

Prominent changes in personality and behaviour Memory changes may not appear until later stages Decline in interpersonal conduct such as rude behaviours, inappropriate

sexual comments, general disinhibition One or more: aphasia, apraxia, agnosia, or disturbance in executive

functioning Lewy body dementia

Affects over 10% of those diagnosed with dementia Core features include waxing and waning cognition, recurrent complex

visual hallucinations, and spontaneous features of Parkinson’s disease Characterised by the presence of Lewy bodies – abnormal cells

Mild cognitive impairment Described as a potential precursor to Alzheimer’s disease Subjective memory complaints and objectively measured impairments in

memory in the absence of other cognitive disturbance or impaired activities of daily living

Do not meet criteria for any dementia or other psychiatric condition



The assessment, treatment, and prevention of dementia Comprehensive assessment including careful clinical history,

neuropsychological assessment, and neuroimaging investigations Medication

Cholinesterase inhibitors inhibit reuptake of acetylcholine and increase its availability

Psychological and behavioural interventions Strategies include facilitating effective communication, modifying the

environment, and providing pleasant activities Caregivers

Carers for persons with dementia have high rates of anxiety/depression Coping strategies, such as relaxation, can lead to positive outcomes

Preventative approaches Lifestyle factors, such as increased physical and mental activity and social

engagement, may decrease the risk for developing dementia


Ageing and psychological disorders Psychological disorders in later life: depression and anxiety

Depression Approximately 1% of Australians over 65 met criteria for depression,

lower than the rate for younger adults Symptom presentation among older adults more likely to include

loss of short-term memory and difficulty concentrating Older adults with depression must receive a thorough medical

evaluation

Late–life depression has its onset as a first occurrence of major depression after the age of 60

Compared with early-onset depression, those with late-onset depression experience significant cognitive dysfunction, increased comorbidity of medical illnesses, and higher rates of either lethargy or agitation

Suicide is a serious concern for late-life depression A variety of treatment approaches are effective, including cognitive-

behavioural therapy and interpersonal therapy Unfortunately a high rate of older adults go undiagnosed and untreated


Ageing and psychological disorders Psychological disorders in later life: depression and anxiety

Anxiety More common than depression in later life - 4.5% of Australians

over 65 More commonly affects females and those with a comorbid medical

illness Older adults with anxiety more often complain of cognitive (memory

and attention) and vegetative (poorer sleep and appetite) symptoms than younger adults

A variety of treatment approaches are effective for anxiety disorders in later life

Anxiolytic medications are not recommended Tend to be addictive, disrupt sleep, and result in unsteady balance

Good outcomes with cognitive-behavioural therapy Older adults do not seek treatment as often as their younger

counterparts Also evidence of biases in the treatment of older adults


Ageing and psychological disorders Life events associated with later life: retirement,

grandparenting, and bereavement Retirement

Critically life transition – generally positive

Several variables predict who will experience retirement as a positive experience:

Good health Having enough money to retire with Having the support of friends and family

Baltes’ theory of Selection, Optimisation, and Compensation – proposes that individuals who age successfully use three strategies, selection, optimisation, and compensation, to achieve their desired goals

Emphasises older adults making active choices about how they will compensate for limitations in the pursuit of their goals


Ageing and psychological disorders Life events associated with later life: retirement,

grandparenting, and bereavement Grandparenting

Grandparenting as a full or nearly full-time occupation is related to a variety of positive and negative outcomes

Some findings of increased depression, diabetes, hypertension, insomnia among custodial grandparents

Also positive benefits of extremely close bond with grandchildren

Bereavement Common event but does not necessarily result in clinically

significant psychological stress Older adults fare better than their younger counterparts, although

the loss of a long-term spouse may be devastating Normal grief reactions include some of the symptoms that occur in

depression Other symptoms, such as pervasive guilt or hopelessness, suggest

that the bereavement has precipitated a depressive episode


Ageing and psychological disorders Positive ageing

Three important characteristics and behaviours: low risk of disease and disease-related disability a high level of mental and physical functioning an active engagement with life

Centenarian studies are used to study healthy ageing Three groups:

Escapers - 20% people who have avoided serious illness completely until 100 or completely

Delayers - 40% people who have delayed serious illness until after age 80 Survivors - 40% people who develop serious illness before 80 but survive

it Healthy cognitive functioning better predictor of independence in

later life than physical health Certain factors decrease longevity (cigarette smoking, obesity), while

others promote longevity (regular exercise, healthy diet) Other more subtle factors may play a role, such as a positive view of

oneself and one’s place in the world and volunteerism


Summary Ageing

The Demographics and Epidemiology of Ageing Historical Overview of the Psychology of Ageing Normal Ageing Processes: Cognitive, Emotional, and Social Functioning

Psychological Disorders in Later Life: The Dementias Definition of Dementia Alzheimer’s Disease Vascular Dementia Other Forms of Dementia and Related Disorders The Assessment, Treatment, and Prevention of Dementia

Psychological Disorders in Later Life: Depression and Anxiety Depression Anxiety Disorders

Life Events Associated with Later Life Retirement Grandparenting Bereavement

Positive Ageing

11-1 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright 2009 McGraw-Hill Australia Pty Ltd...

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