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  • Correct Answer: A This question can be modified into the interactive i-clickers question software. Additionally, you can ask the students to restate what they learned about the “Suicide risk and rates” for the older adults in their “own words”.
  • Correct answer: A You may also place this question into i-clickers if you have access to the software. After the students respond, you can use this opportunity to see what the students recall about “Later life depression” as well as “Dementia”.
  • Transcript

    1. <ul><li> Prepared by: </li></ul><ul><li> Ashlea R. Smith, PhD </li></ul><ul><li> Argosy University-Phoenix </li></ul><ul><li>This multimedia product and its contents are protected under copyright law. The following are prohibited by law: </li></ul><ul><li>-any public performance or display, including transmission of any image over a network; </li></ul><ul><li>-preparation of any derivative work, including the extraction, in whole or in part, of any images; </li></ul><ul><li>-any rental, lease, or lending of the program. </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    2. Aging and Cognitive Disorders Chapter 13 Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    3. Chapter Outline <ul><li>Symptoms and Disorders of Aging </li></ul><ul><li>Depression and Anxiety in Later Life </li></ul><ul><li>Substance Abuse and Psychosis in Later Life </li></ul><ul><li>Cognitive Disorders </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    4. Geropsychology as a unique field… Geropsychology is a subdiscipline of psychology that addresses issues of aging, including normal development, individual differences, and psychological problems unique to older persons. Figure 13.1 The Aging Population of the United States Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    5. What it takes to be successful at aging… <ul><li>One-third of older adults age successfully </li></ul><ul><li>Good health and active lifestyle </li></ul><ul><li>Independence in functioning </li></ul><ul><li>Lack of disability </li></ul><ul><li>Absence of cognitive impairment </li></ul><ul><li>Positive social relationships </li></ul><ul><li>Selective optimization and compensation </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    6. I OBJECT or ACCEPT! What are your thoughts? <ul><li>1. The text defines successful aging as perceived good health, an active lifestyle, continued independence, lack of disability, absence of cognitive impairment, and positive social relationships. </li></ul>Which do you feel would be the HARDEST to lose and why from the list below? Can you think of anything else from maybe what you see from older adults in your life that would exhibit successful aging? Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    7. Psychological Symptoms and Disorders among Older People <ul><li>20 to 30% of older adults have a psychological disorder </li></ul><ul><li>Higher among homebound and people who live in nursing homes with chronic illness </li></ul><ul><li>Stigma around seeking treatment (only 50% actually receive treatment) </li></ul><ul><li>Inadequate recognition and treatment </li></ul><ul><li>Ageism (attribute problems to advancing age) </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    8. Depression and anxiety in later life… <ul><li>Things to consider: </li></ul><ul><li>Types of loss (death of loved one, changes in job or financial status, deterioration in physical abilities) </li></ul><ul><li>Most common psychological problems </li></ul><ul><li>Not a natural consequence of growing old </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    9. Unipolar and Bipolar Depression <ul><li>Executive dysfunction (difficulty planning, thinking abstractly, initiating, and inhibiting actions) </li></ul><ul><li>Reversible dementia (also known as pseudodementia occurs when the full syndrome of dementia appears to be present but resolves after treatment) </li></ul><ul><li>-Vascular depression (a mood disorder that occurs in the context of cerebrovascular disease) </li></ul><ul><li>-Few older adults develop mania or bipolar after the age of 65 </li></ul>Older adults over the age of 65 commit suicide twice that of younger adults, especially Anglo men are at a higher risk for completing suicide, however women attempt suicide more frequently. Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    10. Suicide and Older Adults What factors contribute to the high risk for suicide for older adults. Figure 13.2 Suicide Rates Among Older Americans Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    11. Prevalence and Impact <ul><li>Major depression impact 1 to 4% of older adults </li></ul><ul><li>Rates of depression increase to 14% for older adults who are homebound or have cognitive impairment </li></ul><ul><li>Affect daily functioning and survival </li></ul><ul><li>-Depression affects outcome of medical disorder </li></ul><ul><li>-Recover less well, use more health care services, and greater cost </li></ul><ul><li>-Suicide risk </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    12. Sex, Race, and Ethnicity <ul><li>Affect more women </li></ul><ul><li>More common in African American and Hispanic older adults, but less likely to receive treatment </li></ul><ul><li>Asian Americans and Anglo older adults both experience increased levels of suicidal ideation </li></ul><ul><li>Suicide rates are highest among Anglo men, followed by non-Anglo men </li></ul><ul><li>African American and Hispanic adults have lower rates of suicide than Anglos </li></ul><ul><li>Rates of suicide for Asian adults increase with age </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    13. Etiology of Depression <ul><li>Most likely to have existent cognitive impairment and more evidence of brain abnormalities </li></ul><ul><li>More common with vascular, neurological, or other physical diseases </li></ul><ul><li>Depression is diagnosed after a medical condition is diagnosed </li></ul><ul><li>Stressors (associated with retirement and the loss of a loved one) </li></ul><ul><li>Life-span developmental diathesis-stress model (reviews influence of biological, stressful life events, and personal protective factors associated with depression) </li></ul><ul><li>Loss of enjoyable activities </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    14. Factors that contribute to depression for older adults Figure 13.3 Life-span Diathesis-stress Model Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    15. Treatment of Depression in Older Patients <ul><li>Begin with a physical evaluation </li></ul><ul><li>60% improve once on medication </li></ul><ul><li>Electroconvulsive therapy (ECT) </li></ul><ul><li>Lithium in one-half to two-thirds of dosage for younger patients </li></ul><ul><li>Cognitive-behavioral therapy </li></ul><ul><li>Reminiscence Therapy </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    16. Research HOT Topic: Translating Research in Geropsychology to the “Real World” <ul><li>Controlled clinical trials </li></ul><ul><li>-Participants are mostly Anglo </li></ul><ul><li>-Healthy </li></ul><ul><li>-Better educated </li></ul><ul><li>Many older adults never seek treatment for mental health services, usually treated by primary care physician </li></ul><ul><li>What are some benefits of increasing evidence-based interventions in community practice settings? </li></ul>How can we use this information to educate older adults on the benefits of seeking treatment for mental health issues? Thoughts on home- based problem- solving therapy? Often barriers to treatment exist such as being too fragile and unhealthy to get to a medical clinic. Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    17. Fact Or Fiction? Anxiety disorders is one of the most common and significant mental health problems affection older adults. Fact or fiction? Yes, approximately 3.5 to 10.2% of all older adults suffer from anxiety disorders. Generalized anxiety disorder (GAD) is found to be more common in older adult women than their male counterparts. Fact or fiction? Yes…especially African American women, however women have longer life expectancies which is not considered to be a factor in determining prevalence rates. Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    18. Anxiety and the Older Adult Population <ul><li>Worries center around health issues, stressful life transitions, care-giving responsibilities, economic and legal issues, reduced income, increased health care costs, and end of life planning </li></ul><ul><li>Wording is important (shame, guilt, fret, or concern to describe worry or anxiety) </li></ul><ul><li>Overlap with depression and other medical conditions </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    19. Prevalence and Impact <ul><li>Anxiety most common and significant mental health problem (particularly specific phobias and Generalized Anxiety Disorder) </li></ul><ul><li>3.5 to 10.2% of older adults suffer from anxiety disorders </li></ul><ul><li>More common in those living in nursing homes and homebound older adults </li></ul><ul><li>Associated with less physical activity and poorer functioning </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    20. Sex, Race, and Ethnicity <ul><li>More common among women </li></ul><ul><li>Anxiety disorders are more common among African American women </li></ul><ul><li>GAD occurs most frequently among older Puerto Rican medical patients </li></ul><ul><li>Higher level of suicidality </li></ul><ul><li>Poorer self-perceptions of health </li></ul><ul><li>Increased use of health services </li></ul><ul><li>Culture-bound syndromes (may be more common in older adults due to lower levels of education, less assimilation to majority culture, and foreign born adults) </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    21. Etiology of Anxiety in Later Life <ul><li>Experience of long-term or lifetime symptoms of anxiety </li></ul><ul><li>Stressful life events play a role in anxiety </li></ul><ul><li>Overlap with other medical diseases </li></ul><ul><li>Psychological response to medical illness </li></ul>With the current state of the economy do you think we will see a dramatic increase in the amount of older adults reporting anxiety symptoms? Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    22. Treatment of Anxiety in Older Patients <ul><li>Rule out physical illnesses </li></ul><ul><li>Benzodiazepines are the most frequently prescribed </li></ul><ul><li>-Can create serious side effects (memory problems and slowing of motor behaviors) </li></ul><ul><li>Antidepressants (such as serotonin reuptake inhibitors) </li></ul><ul><li>-Effective for older adults </li></ul><ul><li>-Fewer side effects </li></ul><ul><li>When given a choice older adults prefer psychosocial treatments than medication </li></ul><ul><li>CBT (best suited for older adults because time-limited, directive, and collaborative) </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    23. Substance Abuse and Older adults <ul><li>Most common problems </li></ul><ul><li>-Overuse of alcohol </li></ul><ul><li>-Misuse of prescription medications </li></ul><ul><li>-Tobacco use </li></ul><ul><li>Alcohol abuse is associated with </li></ul><ul><li>-Antisocial behavior </li></ul><ul><li>-Legal problems </li></ul><ul><li>-Unemployment </li></ul><ul><li>-Lower socioeconomic status </li></ul>The National Institute on Alcohol Abuse and Alcoholism recommends that adults age 65 and over have no more than one drink per day or 7 drinks per week. Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    24. Prevalence and Impact <ul><li>Tobacco is the most commonly abused substance (over 17.1 million adults over age 50) </li></ul><ul><li>Alcohol abuse or dependence for men (1.9 to 4.6% and women 0.1 to 0.7%) </li></ul><ul><li>Older adults take 25% of the medications consumed in the United States </li></ul><ul><li>Late onset alcohol abuse occurs more often in women </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    25. Sex, Race, Ethnicity, and Etiology <ul><li>Older adult males use alcohol twice that of the rate of women </li></ul><ul><li>Differences consist across ethnic and racial groups </li></ul><ul><li>Illicit drug use is more common in older men </li></ul><ul><li>Women are more likely to abuse prescription medication for nonmedical reasons </li></ul><ul><li>No differences in substance abuse based on ethnicity </li></ul><ul><li>Drinking is uncommon among older Chinese Americans </li></ul><ul><li>Personal history of habitual use or risky drinking </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    26. Treatment of Substance Abuse <ul><li>Brief alcohol counseling (BAC) </li></ul><ul><li>Behavioral self-control procedures </li></ul><ul><li>Medications for alcohol abuse (naltrexone and disulfiram) </li></ul><ul><li>Medications for benzodiazepines abuse (gradual discontinuation) </li></ul><ul><li>Smoking cessation (brief interventions in primary care, transdermal nicotine patch therapy) </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    27. <ul><li>Late-onset Schizophrenia (schizophrenia that first appears after age 40) </li></ul><ul><li>Very-late-onset Schizophrenia (a schizophrenic-like-disorder, but with symptoms that do not include deterioration in social and personal functioning) </li></ul><ul><li>80% of older adults with schizophrenia, the onset occurred in young adulthood </li></ul>Psychosis and Older adults Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    28. Prevalence, Gender, and Ethnicity <ul><li>Schizophrenia occurs in 0.6% of people age 45 to 64 and 0.1 to 0.5% age 65 and older </li></ul><ul><li>Psychotic symptoms are more common among patients in nursing homes </li></ul><ul><li>Poor functioning related to worse cognitive performance, less education, and severe negative symptoms </li></ul><ul><li>Late-onset schizophrenia is more common in women </li></ul><ul><li>Symptoms of psychosis and schizophrenia common across all racial and ethnic groups </li></ul><ul><li>African Americans most likely to be diagnosed </li></ul><ul><li>Use of spirituality, witchcraft, and herbal medications </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    29. <ul><li>Genetics (10 to 15% have a relative with the disorder) </li></ul><ul><li>Brain abnormalities (enlarged ventricles, increased density of dopamine receptors, and reduced size of the superior temporal gyrus) </li></ul><ul><li>Other causes (hormonal changes, psychosocial stressors, and deficits with hearing and vision) </li></ul><ul><li>Medical conditions (stroke, tumor, Alzheimer's disease) </li></ul>Etiology of Schizophrenia and Psychosis Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    30. Treatment of Psychosis <ul><li>Typical and atypical antipsychotic medications </li></ul><ul><li>Skills training </li></ul><ul><li>Family support </li></ul><ul><li>Cognitive-behavioral therapy </li></ul><ul><li>Psychoeducation </li></ul><ul><li>Coping skills training </li></ul><ul><li>Behavioral management </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    31. Cognitive Disorder: Delirium <ul><li>Alteration in consciousness that typically occurs in the context of a medical illness or after ingesting a substance </li></ul><ul><li>Altered states of consciousness (hypoactive type decreased wakefulness and stupor and hyperactive type hyperarousal) </li></ul><ul><li>Onset is sudden (hours or days) and symptoms can persist for months for older adults </li></ul>Men are at a greater risk for delirium than women. Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    32. Prevalence and Impact of Delirium <ul><li>Common in general hospitals (11 to 16%) </li></ul><ul><li>Common in patients with AIDS (30 to 40%) </li></ul><ul><li>Increased risk of institutional placement </li></ul><ul><li>20% of patients with Alzheimer’s disease </li></ul><ul><li>Causes longer hospital stays, complications after surgery, and poor post-hospitalization functioning </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    33. Stop and Think! <ul><li>Does dementia have it’s greatest impact on the patient or the caregivers? Why or why not? Are the caregivers of the patient with dementia at risk for psychological issues as well? </li></ul>Key Points: The text outlined that dementia affects caregivers and family members, specifically the wives, daughters, and daughter-in-laws have the greatest burden of care. Family members are responsible for assistance with nutrition, activities of daily living, behavioral plans, and memory aids. Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    34. Etiology of Delirium <ul><li>Caused by serious systemic medical illness (AIDS, congestive heart failure, infection, or toxic effects of medication) </li></ul><ul><li>Metabolic disorders (hypothyroidism or hypoglycemia) </li></ul><ul><li>Neurological disorders (head trauma, stroke, seizure, or meningitis) </li></ul><ul><li>Other health issues (malnutrition, severe dehydration, substance use) </li></ul>How does the diathesis-stress model explain delirium? Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    35. Treatment of Delirium <ul><li>Often missed or inadequately treated </li></ul><ul><li>First step is screening for known risks </li></ul><ul><li>Support for family and patient </li></ul><ul><li>Medication (antipsychotic and benzodiazepines) </li></ul><ul><li>Education and supportive care </li></ul><ul><li>Beneficial environmental manipulations </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    36. Cognitive Disorder: Dementia <ul><li>Takes away ability to function independently (multiple cognitive difficulties) and causes significant emotional problems (for the patient and family) </li></ul><ul><li>Not accompanied by changes in consciousness or alertness </li></ul><ul><li>Requires extensive interviews, history taking to make a diagnosis, and testing </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    37. Types of Dementia <ul><li>Dementia due to other general medical conditions </li></ul><ul><li>Alzheimer’s disease </li></ul><ul><li>Cerebral senile plaques </li></ul><ul><li>Neurofibrillary tangles </li></ul><ul><li>Dementia of the Alzheimer’s type </li></ul><ul><li>Vascular dementia </li></ul><ul><li>Substance-induced dementia </li></ul><ul><li>Multi-infarct dementia </li></ul><ul><li>Subcortical dementia </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    38. Living with Dementia Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    39. Living with Dementia Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    40. Real People, Real Disorders… Ronald Regan <ul><li>40 th President of the United States (1981-1989) </li></ul><ul><li>Diagnosed in 1994, died in 2004 </li></ul><ul><li>He knew something was wrong ( at a regular medical check-up) </li></ul><ul><li>Friends noticed signs in the early 1990s </li></ul><ul><li>Strain on his family </li></ul>What may be some early warning signs to be aware of if you think a family member has Alzheimer’s Disease? How does being diagnosed with Alzheimer’s Disease change one’s life? Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    41. Prevalence and Impact: Dementia Figure 13.4 The Prevalence of Dementia Increases with Age Progressive dementia occurs in 5 to 10% of adults age 65 and older. Although many patients remain undiagnosed. Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    42. Sex, Race, Ethnicity, and Etiology <ul><li>More frequent in women than men </li></ul><ul><li>Higher rates are found in African Americans and Hispanic groups </li></ul><ul><li>Presence of the Genetic allele (APOE) for Anglos and Japanese patients </li></ul><ul><li>Asian populations have increased rates of Alzheimer’s and vascular dementia </li></ul><ul><li>Genetic factors </li></ul><ul><li>Increasing age itself </li></ul><ul><li>Mutation of (e4, APOE gene) </li></ul><ul><li>Mild cognitive impairment </li></ul><ul><li>Diathesis-stress model </li></ul><ul><li>Amnestic MCI (mild cognitive impairment in which cognitive complaints focus on memory difficulties) </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    43. Ways to Protect or Increase Risks for Dementia What would be some examples of mental activities to engage as protective factors? Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    44. Is MCI a precursor of dementia or a separate syndrome? <ul><li>Let’s examine the evidence </li></ul><ul><li>1. 10 to 15% of MCI progress to AD </li></ul><ul><li>2. People with MCI and APOE4 allele gene are at an increased risk of dementia </li></ul><ul><li>3. Neuroimaging shows shared features </li></ul><ul><li>Fact: Some people with MCI never progress to significant cognitive impairment with conversion rates varying widely, and last MCI can result from numerous causes. </li></ul><ul><li>Evidence: Amnestic MCI is probably a risk factor for dementia but there are likely many forms of MCI like dementia. </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    45. Treatment of Dementia and Related Difficulties <ul><li>Cannot be reversed or cured </li></ul><ul><li>Targets delaying disease progression </li></ul><ul><li>Providing support and assistance to caregivers </li></ul><ul><li>Changing the environment </li></ul><ul><li>Medication (cholinesterase inhibitors CEIs and Aricept, memantine or Namenda) </li></ul><ul><li>High doses of vitamin E </li></ul><ul><li>Antidepressants </li></ul><ul><li>Antipsychotics </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    46. Quick Recap <ul><li>1. Suicide rates for individuals over 65 are twice that of younger adults. </li></ul><ul><li>(a) True </li></ul><ul><li>(b) False </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    47. Quick Recap <ul><li>2. The Apolipoprotein (APOE) e4 allele is responsible for later in life depression and dementia. </li></ul><ul><li>(a) True </li></ul><ul><li>(b) False </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    48. Critical Issues to Remember <ul><li>Geropsychology is the subdiscipline of psychology that focuses on problems unique to older adults. </li></ul><ul><li>Approximately 20 to 30% of older adults have a psychological disorder that often goes missed or misdiagnosed. </li></ul><ul><li>When evaluating older adults symptoms it is important to remember that psychological symptoms and cognitive impairment can overlap with medical conditions. </li></ul><ul><li>Dementia and delirium are two major cognitive disorders however delirium deals with changes in consciousness and dementia deals with difficulties in memory. </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .
    49. Critical Issues to Remember <ul><li>The best approach to understanding the development of cognitive disorders is by using the diathesis-stress model emphasizing psychological, biological, and environmental stressors. </li></ul><ul><li>The treatment options that are most commonly used to treat younger adults with depression, anxiety, substance abuse, and psychosis are also used to treat older adults with modifications in dosage levels. While the medication for dementia slows the progression of the disease and improves quality of life. </li></ul>Copyright © 2010 by Pearson Education, Inc. All rights reserved .

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