Name some of the common myths about ageing.
- we will become doddering and befuddled
- We will become unhappy, cope poorly with our troubles, and become focused on our poor health
- We will become lonely and our sex lives will become unsatisfying
What are some of the findings from research into ageing that might suggest a more positive future?
Severe cognitive problems do not occur for most people, though a mild decline in cognitive functioning is common
- Elderly are more skilled at regulating their emotion than young people thus the elderly experience less negative emotion than young people
- Many older people under report somatic symptoms,
- Older people have considerable sexual interest & capacity
- older people practice social selectivity: the tendency to prefer time with closest ties rather than acquaintances
What are the main challenges for people as they move towards old age?
- Physical decline & disabilities
- Sensory & neurological deficits
- Loss of loved ones
- The cumulative effects of a lifetime of many unfortunate experiences
- Social Stresses such as stigmatising attitudes towards the elderly
Several problems are evident in the medical & drug treatment available during latest life.
What are some of the issues older people face?
- Chronic health problems generally continue leading to added pressure on the health system
- Polypharmacy: the prescribing of multiple drugs - approximately 1/3 of elderly people have 5 or more prescription medications, increasing side effect risks
- It is essential to have regular medication reviews, discontinue non-essential drugs and prescribe only minimum required dose
What are 3 key factors that must be taken into account when designing research for elderly clients?
- Age effects - the consequences of being a certain chronological age
- Cohort effects - the consequences of growing up during a particular time period with it’s unique challenges and opportunities
- Time of Measurement effects - are the confounds that arise because events at a particular point in time can have a special effect on a variable that is being studied. e.g. testing after Hurricane Katrina in New Orleans might show evalated anxiety
What are the 2 major research designs used to assess developmental change and the key characteristics, advantages & disadvantages in these research designs?
- Cross-sectional designs compare different age groups at the same moment in time. Disadvantages: *these studies do not examine the same people over time; consequently, they do not provide clear information about how people change as they age
- Longitudinal designs periodically retests one group of people using the same measure over time; allowing us to trace individual patterns of consistency or change over time. However, results can be biased by attrition where participants drop out due to death (Selective mortality), illness, lack of interest & people with the most problems are likely to drop out of studies
DSM5 states that a psychological disorder should not be diagnosed if the symptoms can be accounted for by a medical condition or medication side effect.
Why is it especially important to be careful before diagnosing an older person with a psychological disorder from the DSM5?
*medical conditions are more common in the elderly,
some conditions produce symptoms that mimic schizophrenia, depression, or anxiety (Thyroid problems, Addison’s, Cushing’s, Parkinson’s, Alzheimer’s Disease, Hypoglycaemia, Anaemia, Vitamin deficiencies)
What are the findings of prevalence estimates of psychological disorders in late life?
*Most people over the age of 65 are free from serious psychopathology, those who do have an episode of a psychological disorder late in life are experiencing a recurrence of a disorder that started earlier in life rather than an initial onset.
What are the theories to explain why the rates of psychopathology is so low in late life?
- 3 methodological issues (response bias, cohort effects, & selective mortality) might be leading us to underestimate the prevalence of psychological disorders
- There may also be some processes related to ageing that promote better mental health
What is Dementia?
- Dementia is a broad term to capture cognitive decline
- most commonly a decline in memory for recent events
- as cognitive decline becomes more widespread & profound, social & occupational functioning becomes more & more disturbed
How common is Dementia?
Dementia affects 1-2% of people in the 60’s
and 20% of people over the age of 85 years
How many types of dementia are there?
There are many types including:
- Alzheimer’s Disease
- Frontotemporal Dementia (FTD)
- Vascular Dementia
- Dementia with Lewy bodies
- & Dementia from other medical conditions
How is Alzheimer’s characterised?
- Alzheimer’s is characterised by plaques & tangles in the brain
- Having 1 Apolipoprotien ε4 or ApoE-4 allele increases the risk of developing Alzheimer’s to 20%
- The expression of genetic vulnerability, though, is influenced by lifestyle & psychological factors, such as depression, exercise, & cognitive engagement
What are the key properties of Frontotemporal Dementia (FTD)?
- FTD is caused by neuronal deterioration in frontal and temporal lobes
- FTD typically begins in the mid-late 50’s
- death usually occurs within 5-10 years of diagnosis
- Unlike with Alzheimer’s Memory is not severely impaired in FTD
- Emotional processes are more profoundly effected in FTD than with Alzheimer’s disease
- People with FTD have more strained interpersonal relationships as a result of changes in emotional processing: social relationships & marriages can be damaged
What is Vascular Dementia the main consequence of?
- Cerebrovascular disease
- Most commonly the individual has a series of strokes, in which a clot is formed, impairing circulation, & causing cell death.
What are the main treatments for Dementia?
- Medications are used to treat the psychological symptoms: depression, apathy and agitation.
- Anti-psychotic medication can provide modest relief for aggressive agitation, but increases the risk of death.
- Medications can help slow it but they cannot restore cognitive decline
- Cholinesterase inhibitors interfere with the breakdown of acetylcholine and slow down memory decline. e.g.s donepezil (aricept) and rivastigmine (exelon)
- Memantine (Namenda) is a drug that affects glutamate receptors (thought to affect memory) has shown small benefits.
Describe a typical presentation of delirium
*people with delirium rather suddenly cannot maintain a coherent stream of thought as they cannot focus
* agitated at night & sleepy during the day as their sleep/wake cycle is disturbed
*impossible to engage in conversation due to wandering attention, & fragmented thinking
*unclear what day it is, where and even who they are
*Memory impairment is common
People can have lucid intervals within the course of a delirium state
*Perceptual disturbance is common: they may think they are at home when they are in hospital
*Visual hallucinations are common as are delusions
*prompt treatment of the underlying cause(s) is the best method