FAP5_Lecture_Ch15 - Chapter 15 Disorders of Aging and...

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Unformatted text preview: Chapter 15 Disorders of Aging and Cognition Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 Slides & Handouts by Karen Clay Rhines, Ph.D. 1 Disorders of Aging and Cognition Dementia deterioration of one's memory and related cognitive faculties is currently the most publicized and feared psychological problem among the elderly It is, however, hardly the only one A variety of psychological disorders are tied closely to later life As with childhood disorders, some of the disorders of old age are caused primarily by pressures that are particularly likely to appear at that time of life, others by unique traumatic experiences, and still others like dementia by biological abnormalities 2 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 Old Age and Stress Old age is usually defined in our society as the years past age 65 More than 35 million "old" people in the U.S. Older women outnumber older men by 3 to 2 Like childhood, old age brings special pressure, unique upsets, and key biological changes 3 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 Old Age and Stress The stresses of elderly people need not result in psychological disorders; however, studies indicate that as many as 50% of elderly people would benefit from mental health services Fewer than 20% actually receive them Geropsychology is the field of psychology dedicated to the mental health of elderly people Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 4 Old Age and Stress The psychological problems of elderly persons may be divided into two groups: Disorders that are found in people of all ages but are connected to the process of aging Depressive, anxiety, and substancerelated disorders Disorders of cognition that result from brain abnormalities Delirium, dementia 5 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 Depression in Later Life Depression is one of the most common mental health problems of older adults The features of depression are the same for elderly people as for younger people As many as 20% of people experience this disorder at some point during old age The rate is highest in older women Several studies suggest that depression among older people raises their chances of developing significant medical problems 6 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 Depression in Later Life Elderly persons are more likely to commit suicide than younger ones, and often their suicides are related to depression Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 7 Depression in Later Life Like younger adults, older people who are depressed may be helped by cognitive therapy, interpersonal therapy, antidepressant medications, or a combination of these approaches More than half of older patients with depression improve with these treatments It is sometimes difficult for elderly people to use antidepressant drugs effectively and safely because the body's metabolism works differently in later life Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 8 Anxiety Disorders in Later Life Anxiety is also common among the elderly At any given time, around 6% of elderly men and 11% of elderly women in the U.S. experience at least one of the anxiety disorders GAD is particularly common, experienced by up to 7% of all elderly persons Anxiety in the elderly may be underreported 9 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 Anxiety Disorders in Later Life There are many things about aging that may heighten anxiety levels, including declining health Researchers have not, however, systematically tied anxiety disorders among the elderly to specific events or losses Older adults with anxiety disorders are often treated with psychotherapy of various kinds, particularly cognitive therapies Many also receive antianxiety medications Again, all such drugs must be used cautiously with older people Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 10 Substance Abuse in Later Life Although alcohol abuse and other forms of substance abuse are significant problems for many older persons, the prevalence of such patterns actually appears to decline after age 60 Accurate data about the rate of substance abuse among older adults is difficult to obtain because many elderly persons do not suspect or admit they have such a problem 11 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 Substance Abuse in Later Life Surveys find that 4% to 7% of older people, particularly men, display alcoholrelated disorders in a given year Researchers often distinguish between older problem drinkers who have experienced significant alcoholrelated problems for many years and those who do not start the pattern until their 50s and 60s 12 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 Substance Abuse in Later Life Alcohol abuse and dependence in elderly people are treated much as in younger adults Approaches include detoxification, Antabuse, Alcoholics Anonymous (AA), and cognitive behavioral therapy Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 13 Substance Abuse in Later Life A leading kind of substance abuse in the elderly is the misuse of prescription drugs Most often it is unintentional Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 14 Psychotic Disorders in Later Life Elderly people have a higher rate of psychotic symptoms than younger persons Among aged people, these symptoms are usually due to underlying medical conditions such as delirium and dementia However, some elderly persons suffer from schizophrenia or delusional disorder Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 15 Psychotic Disorders in Later Life Schizophrenia is less common in older persons than in younger ones Many people with schizophrenia find that their symptoms lessen in later life It is uncommon for new cases of schizophrenia to emerge in later life Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 16 Psychotic Disorders in Later Life Another kind of psychotic disorder found among the elderly is delusional disorder, in which individuals develop beliefs that are false but not bizarre This disorder is rare in most age groups, but its prevalence appears to increase in the elderly population Some clinicians suggest that the rise is related to the deficiencies in hearing, social isolation, greater stress, or heightened poverty experienced by many elderly persons Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 17 Disorders of Cognition Cognitive "mishaps" (e.g., leaving without keys, forgetting someone's name) are a common and quite normal feature of stress or of aging As people move through middle age, these memory difficulties and lapses of attention increase, and they may occur with regularity by age 60 or 70 Sometimes, however, people experience memory and other cognitive changes that are far more extensive and problematic Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 18 Disorders of Cognition While problems in memory and related cognitive processes can occur without organic causes (in the form of dissociative disorders), more often, cognitive problems have organic roots, particularly when they appear in later life The leading cognitive disorders among elderly persons are delirium and dementia 19 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 Delirium Delirium is a clouding of consciousness As a person's awareness of the environment becomes less clear, he or she has great difficulty concentrating, focusing attention, and thinking sequentially This leads to misinterpretations, illusions, and, on occasion, hallucinations Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 20 Delirium This state of massive confusion typically occurs over a short period, usually hours or days Delirium apparently affects more than 2 million people in the U.S. each year It may occur in any age group, including children, but it is most common in elderly persons Fever, metabolic disorders, infections, poor nutrition, head injuries, certain brain diseases, and stress (including the trauma of surgery) may all cause delirium 21 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 Dementia People with dementia experience significant memory losses along with losses in other cognitive functions such as abstract thinking or language People with dementia may also experience changes in personality and behavior At any given time, around 3% to 9% of the world's adult population are suffering from dementia 22 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 Dementia The experience of dementia is closely related to age Like delirium, some forms of dementia result from nutritional, metabolic, or other problems that can be corrected Most forms, however, are caused by brain diseases or injuries, such as Alzheimer's disease or stroke, which are currently difficult or impossible to correct 23 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 Alzheimer's Disease Alzheimer's disease, identified in 1907, is the most common form of dementia, accounting for as many as twothirds of all cases This gradually progressive disease sometimes appears in middle age, but most often occurs after the age of 65 Its prevalence increases markedly among people in their late 70s and early 80s 24 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 INSERT TABLE 151 DSM: DEMENTIA Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 25 Alzheimer's Disease The time between onset and death is typically 8 to 10 years, although some people may survive for as many as 20 years It usually begins with mild memory problems, lapses of attention, and difficulties in language and communication Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 26 Alzheimer's Disease As symptoms worsen, the person has trouble completing complicated tasks and remembering important appointments Eventually sufferers also have difficulty with simple tasks, distant memories are forgotten, and changes in personality often become very noticeable 27 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 Alzheimer's Disease As the symptoms of dementia intensify, people show less and less awareness of their limitations Eventually they become fully dependent on other people The late phase of the disorder can last from 2 to 5 years Alzheimer's victims usually remain in good health until the later stages of the disease 28 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 Alzheimer's Disease In most cases, Alzheimer's can be diagnosed with certainty only after death, when structural changes in the brain can be identified in autopsy Neurofibrillary tangles are twisted protein fibers found within the cells of the hippocampus Senile plaques are sphereshaped deposits of a small molecule that form in the spaces between cells in the hippocampus, cerebral cortex, and certain other brain regions Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 29 Alzheimer's Disease Research has suggested several possible causes for the development of the disease, including genetic factors and abnormalities in brain structure and brain chemistry Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 30 What Are the Genetic Causes of Alzheimer's Disease? It appears that Alzheimer's disease often has a genetic basis Studies have found that mutations in particular genes increase the likelihood of plaque and tangle formations and, in turn, of Alzheimer's disease Genetic studies have also linked certain kinds of the disease to defects on specific chromosomes All of these discoveries are promising but limited, since many people with the disease do not have a clear family history of the disorder 31 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 What Are the Structural and Biochemical Causes of Alzheimer's Disease? Researchers have identified a number of biological factors related to the brain abnormalities seen in Alzheimer's disease Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 32 What Are the Structural and Biochemical Causes of Alzheimer's Disease? One line of research suggests that some of the proteins involved in memory formation may take an abnormal form and essentially run amok in people with Alzheimer's disease Another line of research points to abnormal activity by the neurotransmitters and related chemicals involved in the production of the memory proteins 33 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 What Are the Structural and Biochemical Causes of Alzheimer's Disease? A third explanation holds that certain substances found in nature, including zinc, may produce brain toxicity A fourth explanation is the autoimmune theory: Changes in aging brain cells may trigger an autoimmune response, leading to the disease Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 34 What Are the Structural and Biochemical Causes of Alzheimer's Disease? A final explanation is a viral theory Because Alzheimer's disease resembles CreutzfeldtJakob disease (a form of dementia caused by a virus), some researchers propose that a similar virus may cause Alzheimer's disease To date, no such virus has been isolated from the brains of Alzheimer's victims Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 35 Other Forms of Dementia A number of other disorders may also lead to dementia, including: Vascular dementia (multiinfarct dementia) May follow a cerebrovascular accident, or stroke, during which blood flow to specific areas of the brain was cut off, with resultant damage This dementia is progressive but its symptoms begin abruptly, rather than gradually Cognitive functioning may continue to be normal in the areas of the brain not affected by the stroke This is the second most common type of dementia among the elderly Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 36 Other Forms of Dementia A number of other disorders may also lead to dementia, including: Pick's disease a rare disorder that affects the frontal and temporal lobes and is clinically similar to Alzheimer's disease CreutzfeldtJakob disease caused by a slow acting virus, this disease has symptoms that include sporadic movements 37 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 Other Forms of Dementia A number of other disorders may also lead to dementia, including: Huntington's disease an inherited progressive disease in which memory problems worsen over time, along with personality changes and mood difficulties Parkinson's disease a slowly progressive neurological disorder marked by tremors, rigidity, and unsteadiness 38 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 Other Forms of Dementia A number of other disorders may also lead to dementia, including: Viral and bacterial infectious disorders such as HIV and AIDS, meningitis, and advanced syphilis Brain seizure disorder Drug abuse Toxins such as mercury, lead, or carbon monoxide 39 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 Can Dementia Be Predicted? Several research teams are currently trying to create tools that can identify persons likely to develop dementia One research team is using PET scans; a second is using blood samples The most effective interventions for dementia are those that help prevent problems or, at the very least, are applied early, so it is essential to have tools that identify the disorders as early as possible 40 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 What Treatments Are Currently Available for Dementia? Treatments for Alzheimer's disease and most other forms of dementia have been at best modestly helpful One common approach to treatment is the use of drugs that affect the neurotransmitters known to play an important role in memory Four such drugs prevent the breakdown of acetylcholine, the NT in low supply among people with Alzheimer's disease Although the benefits of the drugs are limited and the risk of harmful side effects is sometimes high, the drugs have been approved by the FDA 41 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 What Treatments Are Currently Available for Dementia? In addition to drugs taken after the start of symptoms, a number of studies also seem to suggest that certain substances (e.g., estrogen, ibuprofen) may prevent or delay onset of Alzheimer's disease Cognitive treatments have been tried with some temporary success Behavioral interventions have been tried with modest success 42 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 What Treatments Are Currently Available for Dementia? Caregiving can take a heavy toll on the close relatives of people with dementia One of the most frequent reasons for the institutionalization of Alzheimer's victims is that overwhelmed caregivers can no longer cope with the difficulties of keeping them at home Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 43 What Treatments Are Currently Available for Dementia? In recent years, sociocultural approaches have begun to play an important role in treatment A number of daycare and assistedliving facilities have been opened to provide care for those with dementia Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 44 Issues Affecting the Mental Health of the Elderly As the study and treatment of elderly people have progressed, three issues have raised concern among clinicians: The problems faced by elderly members of racial and ethnic minority groups The inadequacies of longterm care The need for a healthmaintenance approach to medical care in an aging world 45 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 Issues Affecting the Mental Health of the Elderly Discrimination because of race and ethnicity has long been a problem in the U.S., particularly for those who are old To be both old and a member of a minority group is considered to be in "double jeopardy" by many observers Older women in minority groups are considered to be in "triple jeopardy" Because of language barriers and cultural issues, it is common for elderly members of ethnic minority groups to rely solely on family members or friends for remedies and health care 46 Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 Issues Affecting the Mental Health of the Elderly Many older people require longterm care "Longterm care" may refer variously to the services offered in a partially supervised apartment, in a senior housing complex, or in a nursing home The quality of care at such residences varies widely Worry over these issues can greatly harm the mental health of older adults, perhaps leading to depression and anxiety, as well as family conflict 47 Many worry about the costs of longterm care Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 Issues Affecting the Mental Health of the Elderly Medical scientists suggest that the current generation of young adults should take a healthmaintenance, or wellness, approach to their own aging process There is a growing belief that older adults will adapt more readily to changes and negative events if their physical and psychological health is good Comer, Fundamentals of Abnormal Psychology, 5e Chapter 15 48 ...
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This note was uploaded on 05/03/2010 for the course PSYC 120 taught by Professor Staff during the Spring '10 term at Golden West College.

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FAP5_Lecture_Ch15 - Chapter 15 Disorders of Aging and...

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