In less than 200 years, life expectancy has almost doubled in the Western world
40% of practicing psychologists regularly conduct clinical work with older adults
Myths about late life
Aging involves inexorable cognitive decline
Severe cognitive problems do not occur for most
Mild declines are common
Older adults are unhappy
Older adults are more skilled at emotion regulation; Attend more to positive; Display less psychophysiological response to negative emotion
Late life is a lonely time
Problems experienced in late life
Physical decline and disabilities
Sensory acuity deficits
Loss of loved ones
Social stress of stigmatizing attitudes towards elderly
Cumulative effects of a lifetime of stressors
Decline in quality and depth of sleep
Polypharmacy: Prescribing multiple drugs to a person; 40% of elderly persons are prescribed at least 5 medications; Increases the risk of adverse drug reactions
Cross-sectional studies
Researcher compares different age groups at the same point in time on a variable of interest; Fails to provide information about how people change over time
Longitudinal studies
Researcher retests the same group of people with the same measures at different points in time; May extend over several years or decades; Attrition can lead to biased sample; Selective mortality – no longer available for follow-up because of death; People with the most problems are likely to drop out from a study
DSM criteria are the same for older and younger adults
Disentangling medical and psychological concerns is complex!
Psychological disorders are less common in the elderly than in younger adults
Reasons for lower prevalence of psychological disorders in the elderly
More positive emotionality
More close-knit social circles
May grow out of those symptoms
Methodological issues lead to underestimation of prevalence
Most people with psychological disorders in late life are experiencing a continuation of symptoms that began earlier
Methodological issues leading to underestimation of prevalence
Response bias: Discomfort discussing symptoms may minimize prevalence estimates
Cohort effects: E.g., many people who reached adulthood during the drug-oriented era of the 1960s continue to use drugs as they age
Selective mortality: Psychological disorders are associated with premature mortality
Treatment for psychological disorders in the elderly
Similar to treatments that work in earlier life
Many medications can cause serious side effects in elderly
Psychotherapy is the first line approach for anxiety
Adapt to adjust for vision and hearing loss
Telemental health for people with limited mobility
May include a caregiver in therapy sessions
Use of memory aids (e.g., worksheets on session content)
Dementia
Deterioration of cognitive abilities causing impairment
Most common symptoms of dementia
Diminished memory, especially for recent events
Depression
Sleep disturbances
Delusions and hallucinations
Difficulty with impulse control
Most dementias develop slowly over a period of years
Mild Cognitive Impairment (MCI)
Early signs of decline before functional impairment
Problems with DSM-5 criteria requiring a low score on only one cognitive test
Some cognitive tests are more reliable and relevant than others; Using more than one test improves reliability
10% of the time, cognitive declines are tied to other problems: Infection, sleep loss, thyroid disease, vitamin deficiencies
Current MCI criteria may not be very reliable; Could lead to over-diagnosis