18.8 PUTTING IT...together

Clinicians Discover the Elderly

Early in the twentieth century, mental health professionals focused little on the elderly. But like the problems of children, those of aging people have now caught the attention of researchers and clinicians. Current work is changing how we understand and treat the psychological problems of the elderly. No longer do clinicians simply accept depression or anxiety in elderly people as inevitable. No longer do they overlook the dangers of prescription drug misuse by the elderly. And no longer do they underestimate the dangers of delirium or the prevalence of neurocognitive disorders. Similarly, geropsychologists have become more aware of the importance of addressing the health care and financial needs of the elderly as keys to their psychological well-being. As the elderly population lives longer and grows ever larger, the needs of people in this age group are becoming more visible. Thus the study and treatment of their psychological problems will probably continue at a rapid pace. Clinicians and public officials are not likely to underestimate their needs and importance again (Hinrichsen, 2010).

CLINICAL CHOICES

Now that you’ve read about disorders of aging and cognition, try the interactive case study for this chapter. See if you are able to identify Fred’s symptoms and suggest a diagnosis based on his symptoms. What kind of treatment would be most effective for Fred? Go to LaunchPad to access Clinical Choices.

Particularly urgent is neurocognitive impairment and its devastating impact on the elderly and their families. As you have read throughout the chapter, Alzheimer’s disease and other kinds of neurocognitive disorders can be tragic and debilitating problems that shatter the lives of both patients and caregivers. Indeed, they may rob patients of the essence of their identities. The complexity of the brain makes neurocognitive disorders difficult to understand, diagnose, and treat. However, researchers are now making important discoveries on a regular basis. To date, this research has largely focused on the biological aspects of the disorders, but the disorders have such a powerful impact on patients and their families that psychological and sociocultural investigations are also starting to grow by leaps and bounds.

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In addition, society’s interest in and focus on Alzheimer’s disease and other types of neurocognitive disorders have reminded everyone about the importance of memory and related cognitive faculties. Memory is so central to our lives and to our self-concept that research in this area is of potential value to every person’s well-being, making it important that such work continue to grow in the years to come.

The happiness of old age Like these Tibetan women, many elderly people find old age to be the most enjoyable stage of their lives, despite the physical and social changes that occur as they age.

SUMMING UP

  • DISORDERS OF LATER LIFE The problems of elderly people are often linked to the losses and other stresses and changes that accompany advancing age. As many as 50 percent of the elderly would benefit from mental health services, yet fewer than 20 percent receive them. Depression is a common mental health problem among those in this age group. Older people may also suffer from anxiety disorders. Between 4 and 6 percent exhibit alcohol use disorder in any given year, and many others misuse prescription drugs. In addition, some elderly people display psychotic disorders such as schizophrenia or delusional disorder. pp. 607–615

  • DISORDERS OF COGNITION Older people are more likely than people of other age groups to experience delirium, a fast-developing disturbance marked by great difficulty focusing attention, staying oriented, concentrating, and following an orderly sequence of thought.

    Neurocognitive disorders, characterized by a significant decline in cognitive function, become increasingly common in older age groups. There are many types of neurocognitive disorders, the most common being Alzheimer’s disease. Alzheimer’s disease has been linked to an unusually high number of senile plaques and neurofibrillary tangles in the brain. According to a leading explanation of late-onset Alzheimer’s disease—the most common kind of Alzheimer’s disease—people who inherit ApoE-4, a particular form of the apolipoprotein E (ApoE) gene, are particularly vulnerable to the development of Alzheimer’s disease. Apparently, the ApoE-4 gene form promotes the excessive formation of beta-amyloid proteins, helping to spur the formation of plaques and, in turn, the breakdown of the tau protein, the formation of numerous tangles, the death of many neurons, and ultimately, the onset of Alzheimer’s disease.

    A number of other causes have also been proposed for this disease, including high levels of zinc, lead, or other toxins; immune system problems; and a virus of some kind.

    Researchers are making significant strides at better assessing Alzheimer’s disease and other types of neurocognitive disorders and even at identifying those who will eventually develop these disorders. Drug, cognitive, and behavioral therapies have been used to treat Alzheimer’s disease, with limited success. Addressing the needs of caregivers is now also recognized as a key part of treatment. In addition, sociocultural approaches such as day-care facilities are on the rise. Major treatment breakthroughs are expected in the coming years. pp. 615–630

  • KEY ISSUES In studying and treating the problems of old age, clinicians have become concerned about three issues: the problems of elderly members of racial and ethnic minority groups, inadequacies of long-term care, and the need for health maintenance by young adults. pp. 630–632

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