health in later life

• Cohort effect


  -Third gerontology principle

  -Shared experiences, similar outlook
• This illustrates what is not affected by aging and what phenomena may be due to cohort effects

  Longitudinal studies
• The WHO definition of health

  A complete state of physical, mental and social wellbeing. Not merely the absence of disease or infirmity.
• Prevalence of mental disorders (older adults, general population, nursing homes)

  -Older adults: 15-25%

  -General population: 20%

  -Nursing homes: 70-90% (6-7% of population)
• A key presentation in later life for both depression and anxiety

  Memory impairment
• Memory impairment in elderly a symptom for anxiety and depression commonly misdiagnosed with what?

  Dementia
• Key risk factors for depression in elderly include:

  -Disability

  -Newly diagnosed medical illness

  -Poor health status

  -Poor self-perceived health

  -Prior depression -Bereavement
• Protective factors for depression in elderly include

  -Greater perceived social support

  -Regular physical exercise

  -Higher socioeconomic status
• Effective interventions for depression in later life includes what and how effective are they

  -Effective in 80% of cases

  -Psychotherapy

  -Pharmacological
• % of misdiagnosed dementia actually being depression

  20%
• Key risk factors for anxiety include

  -Poor self-rated general health status

  -Physical or sexual abuse in childhood

  -Current smoker.
• Protective factors of anxiety include

  -Greater perceived social support

  -Regular physical exercise

  -Higher level of education.
• Evidence-based psychotherapeutic interventions for anxiety in older adults

  -Cognitive behavioural therapy

  -Relaxation training

  -Supportive therapy
• Cognitive behavioural therapy emphases

  Linking

  
  

  1. How you are thinking and behaving

  
  

  2. How you are feeling
• Relaxation training


  -Useful to combat anxiety at any age

  -Deep breathing

  -Letting go of invasive, worrying thoughts
• Supportive therapy


  -Crisis

  -Physiological well-being

  -Psychological self-esteem

  -Self-reliance.

  -Encouraging and supportive relationship key
• Psychotherapies for older adults with depression:

  -Cognitive behavioural therapy

  -Interpersonal psychotherapy

  -Problem-solving therapy

  -Brief psychodynamic psychotherapy
• Why is avoiding polypharmacy useful in elderly

  Decreases chances of side effects
• Interpersonal psychotherapy


  -Highly structured

  -Time-limited approach

  -Resolve interpersonal problems underlying depression.
• Problem-solving therapy


  -CBT

  -Positive coping strategies

  -Replace unhelpful or maladaptive ones
• Brief psychodynamic therapy


  -Increased self-awareness

  -Understanding influence of past experiences on present behaviour.

  -Time-limited intervention

  -Oriented to current goals
• Examples where interdisciplinary teams are most effective include

  -Memory clinics

  -End of life treatment
• Bipolar disorder symptoms


  -Severe highs and lows with mood

  -Sleep

  -Thinking patterns

  -Behaviour
• Stats: Bipolar and Schizophrenia in elderly females


  -Females 2-3x more than males
• Stats: Schizophrenia early onset compared to older onset

  -75% early and mid life onset

  -25% later life onset
• Group psychotherapy approaches are most effective with whom

  Chronic mental illness in elderly
• What percentage of all dementias are attributed to Alzheimer's disease?

  50-70%
• Dementia definition


  An acquired syndrome of intellectual impairment produced by brain dysfunction.
• Dementia is characterized by changes in

  -Thinking

  -Personality

  -Behaviour
• Common age of onset dementia

  65
• What risk factors are more influential for dementia genes or lifestyle

  Lifestyle
• Prevalence of developing dementia

  6-7%
• World wide stats on dementia

  27-36 million

  2/3 in Developing world
• What is the 10/66 Dementia Research Group represents what

  10% or less of population-based research on dementia has been conducted on the two thirds or 66% of people with dementia living in low- and middle-income countries.
• Psychosocial interventions for people with dementia

  -Activity based therapy

  -Supportive therapy

  -Environmental approaches
• Supportive therapy: (Psychosocial interventions for dementia)

  Helps dementia patients with depression and anxiety symptoms
• Environmental approaches:(Psychosocial interventions for dementia)

  Living spaces like home
• Most prominent model of dementia care is

  Person centred care
• Activity based therapy: (Psychosocial interventions for dementia)

  Dementia patients stimulated
• WHO Age friendly city's, Eight dimensions of the living environment are targeted:

  -The built environment

  -Transport

  -Housing

  -Social participation

  -Respect

  -Social inclusion

  -Civic participation

  -Employment

  -Communication

  -Community support

  -Health services