Old age psychiatry ppt

OLD AGE PSYCHIATRY
By
Sumesh .k
Dept of psychiatric Nursing
Haramaya University, harar.

O B J E C T I V E S
 Discuss societal perspectives on aging.
 Describe an epidemiological profile of aging in the
world
 Discuss various theories of aging.
 Describe biological, psychological, sociocultural,
and sexual aspects of the normal aging process.

INTRODUCTION
 What is it like to grow old? It is not likely that many
people in the culture would state that it is something
they want to do. Most would agree, however, that it
is “better than the alternative.”
 The disciplines of gerontology (the study of the
aging process), geriatrics (the branch of clinical
medicine specializing in problems of the elderly),
and geropsychiatry (the branch of clinical
medicine specializing in psychopathology of the
elderly population) are expanding rapidly in
response to this predictable demand.

INTRODUCTION-CONTD
 Growing old in a society that has been obsessed
with youth may have a critical impact on the mental
health of many people. This situation has serious
implications for psychiatric nursing.
 This chapter focuses on physical and psychological
changes associated with the aging process, as well
as special concerns of the elderly population, such
as retirement, long-term care, elder abuse, and
rising suicide rates. The nursing process is
presented as the vehicle for delivery of nursing care
to elderly individuals.

HOW OLD IS OLD?
 The concept of “old” has changed drastically over the
years. Our prehistoric ancestors probably had a life
span of 40 years, with an average life span of around 18
years.
 As civilization developed, mortality rates remained high
as a result of periodic famine and frequent malnutrition.
An improvement in the standard of living was not truly
evident until about the middle of the 17th century. Since
that time, assured food supply, changes in food
production, better housing conditions, and more
progressive medical and sanitation facilities have
contributed to population growth, declining mortality
rates, and substantial increases in longevity.

HOW OLD IS OLD?
 In 1900, the average life expectancy in the United
States was 47 years, and only 4 percent of the
population was age 65 or over. By 2004, the
average life expectancy at birth was 75.2 years for
men and 80.4 years for women (National Center for
Health Statistics [NCHS], 2006).
 The U.S. Census Bureau has created a system for
classification of older Americans:
● Older: 55 through 64 years
● Elderly: 65 through 74 years
● Aged: 75 through 84 years
● Very old: 85 years and older

HOW OLD IS OLD?
 Some gerontologists have elected to used a simpler
classification system:
● Young old: 60 through 74 years
● Middle old: 75 through 84 years
● Old old: 85 years and older
 Erikson (1963) has suggested that the mentally
healthy older person possesses a sense of ego
integrity and self-acceptance that will help in
adapting to the ambiguities of the future with a
sense of security and optimism.

HOW OLD IS OLD?
 Everyone, particularly health care workers, should
see aging people as individuals, each with specific
needs and abilities, rather than as a stereotypical
group. Some individuals may seem “old” at 40,
whereas others may not seem “old” at 70. Variables
such as attitude, mental health, physical health, and
degree of independence strongly influence how an
individual perceives himself or herself.

EPIDEMIOLOGICAL STATISTICS (NCHS 2004
&AOA 2006)
The Population
 In 1980, Americans 65 years of age or older
numbered 25.5 million. By 2004, these numbers
had increased to 36.4 million, representing 12.4
percent of the population (NCHS, 2006). This trend
is expected to continue, with a projection for 2030
at about 71.5 million, or 20 percent of the
population

&AOA 2006)
Marital Status
 In 2004, of individuals age 65 and older, 72 percent
of men and 42 percent of women were married
(Administration on Aging [AoA] (2006). Forty-three
percent of all women in this age group were
widowed. There were over four times as many
widows as widowers because women live longer
than men and tend to marry men older than
themselves

&AOA 2006)
Living Arrangements
 The majority of individuals age 65 or older live
alone, with a spouse, or with relatives (AoA, 2006).
At any one time, fewer than 5 percent of people in
this age group live in institutions. This percentage
increases dramatically with age, ranging from 1.1
percent for persons 65 to 74 years, to 4.7 percent
for persons 75 to 84 years, and 18.2 percent for
persons 85 and older.

&AOA 2006)
Economic Status
 Approximately 3.6 million persons age 65 or older
were below the poverty level in 2004 (AoA, 2006).
Older women had a higher poverty rate than older
men, Poor people who have worked all their lives
can expect to become poorer in old age, and others
will become poor only after becoming old. However,
there are a substantial number of affluent and
middle-income older persons who enjoy a high
quality of life.

&AOA 2006)
Employment
 With the passage of the Age Discrimination in
Employment Act in 1967, forced retirement has
been virtually eliminated in the workplace. Evidence
suggests that involvement in purposeful activity is
vital to successful adaptation and perhaps even to
survival.
 Individuals age 65 or older constituted 3.4 percent
of the U.S. labor force in 2004 (AoA, 2006).

&AOA 2006)
Health Status
 The number of days in which usual activities are
restricted because of illness or injury increases with age.
The American Geriatrics Society (2005) reports that 82
percent of individuals 65 and older have at least one
chronic condition, and two-thirds have more than one
chronic condition. The most commonly occurring
conditions among the elderly population are
hypertension, arthritis, heart disease, cancer, sinusitis,
and diabetes. (AoA, 2006).
 Emotional and mental illnesses increase over the life
cycle. Depression is particularly prevalent and suicide is
increasing among elderly Americans. Organic mental
disease increases dramatically in old age.

THEORIES OF AGING
 A number of theories related to the aging process
have been described. These theories are grouped
into two broad categories: biological and psycho
social.
Biological Theories
 Biological theories attempt to explain the physical
process of aging, including molecular and cellular
changes in the major organ systems and the body’s
ability to function adequately and resist disease.
They also attempt to explain why people age
differently and what factors affect longevity and the
body’s ability to resist disease.

THEORIES OF AGING - BIOLOGICAL
Genetic Theory
 According to genetic theory, aging is an
involuntarily inherited process that operates over
time to alter cellular or tissue structures. This theory
suggests that life span and longevity changes are
predetermined

Wear-and-Tear Theory
 Proponents of this theory believe that the body
wears out on a scheduled basis. Free radicals,
which are the waste products of metabolism,
accumulate and cause damage to important
biological structures. Free radicals are molecules
with unpaired electrons that exist normally in the
body; they also are produced by ionizing radiation,
ozone, and chemical toxins. According to this
theory, these free radicals cause DNA damage,
cross-linkage of collagen, and the accumulation of
age pigments

Environmental Theory
According to this theory, factors in the environment
(e.g., industrial carcinogens, sunlight, trauma, and
infection)bring about changes in the aging process.
Although these factors are known to accelerate
aging, the impact of the environment is a secondary
rather than a primary factor in aging. Science is
only beginning to uncover the many environmental
factors that affect aging.

Immunity Theory
The immunity theory describes an age-related
decline in the immune system. As people age, their
ability to defend against foreign organisms
decreases, resulting in susceptibility to diseases
such as cancer and infection. Along with the
diminished immune function, a rise in the body’s
autoimmune response occurs, leading to the
development of autoimmune diseases such as
rheumatoid arthritis and allergies to food and
environmental agents.

Neuroendocrine Theory
 This theory proposes that aging occurs because of
a slowing of the secretion of certain hormones that
have an impact on reactions regulated by the
nervous system.
 This is most clearly demonstrated in the pituitary
gland, thyroid, adrenals, and the glands of
reproduction.

THEORIES OF AGING
Psychosocial Theories
Psychosocial theories focus on social and
psychological changes that accompany advancing
age, as opposed to the biological implications of
anatomic deterioration. Several theories have
attempted to describe how attitudes and behavior in
the early phases of life affect people’s reactions
during the late phase. This work is called the
process of “successful aging.”

THEORIES OF AGING- PSYCHOSOCIAL
Personality Theory
 Personality theories address aspects of
psychological growth without delineating specific
tasks or expectations of older adults
 In a classic study by Reichard, Livson, and
Peterson (1962), the personalities of older men
were classified into five major categories according
to their patterns of adjustment to aging
 Mature men are considered well-balanced persons
who maintain close personal relationships.

Personality Theory contd
 “Rocking chair” personalities are found in passive-
dependent individuals
 Armored men have well-integrated defense
mechanisms, which serve as adequate protection.
 Angry men are bitter about life, themselves, and
other people.
 Self-haters are similar to angry men, except that
most of their animosity is turned inward on
themselves

 The investigators identified the mature, “rocking
chair,” or armored categories as characteristic of
healthy, adjusted individuals and the angry and self
hater categories as those who are less successful
in aging.
 Srivastava and associates (2003) examined the
“big five” personality trait dimensions in a large
sample to determine how personality changes over
the life span. Age range of the subjects was from 21
to 60.

 The personality traits tested included
conscientiousness, agreeableness, neuroticism,
openness, and extraversion.
 conscientiousness (being organized and
disciplined) increased throughout the age range
studied, with the biggest increases during the 20s.
 Agreeableness (being warm, generous, and helpful)
increased most during a person’s 30s.

 Neuroticism (being anxious and emotionally labile)
declined with age for women, but did not decline for
men.
 Openness (being acceptable to new experiences)
showed small declines with age for both men and
women.
 Extraversion (being outwardly expressive and
interested in the environment) declined for women
but did not show changes in men

Developmental Task Theory
 Developmental tasks are the activities and
challenges that one must accomplish at specific
stages in life to achieve successful aging. Erikson
(1963) described the primary task of old age as
being able to see one’s life as having been lived
with integrity. In the absence of achieving that
sense of having lived well, the older adult is at risk
for becoming preoccupied with feelings of regret or
despair

Disengagement Theory
 Disengagement theory describes the process of
withdrawal by older adults from societal roles and
responsibilities.
 According to the theory, this withdrawal process is
predictable, systematic, inevitable, and necessary
for the proper functioning of a growing society

Activity Theory
In direct opposition to the disengagement theory is
the activity theory of aging, which holds that the
way to age successfully is to stay active. Multiple
studies have validated the positive relationship
between maintaining meaningful interaction with
others and physical and mental well-being.

Continuity Theory
 This theory, also known as the developmental
theory, is a follow-up to the disengagement and
activity theories. It emphasizes the individual’s
previously established coping abilities and personal
character traits as a basis for predicting how the
person will adjust to the changes of aging. Basic
lifestyle characteristics are likely to remain stable in
old age, barring physical or other types of
complications that necessitate change.

Myths About Aging – Physiological Aspects
Myth
Our physiological processes
remain at a fairly constant level
of efficiency until we approach
old age, at which time they
undergo a drastic decline.
Most adults proceed at much
the same rate through a series
of similar physical changes.
Most adults past age 65 are so
physically incapacitated that they must
depend to a great extent on other
people.
Taking large doses of antioxidants (or
ginseng, selenium, pantothenic acid or
vitamin C) will extend the length of
your life.
Best Available Evidence
Most of our bodily functions
reach their maximum capacity
prior to or during early
adulthood and begin a gradual
decline thereafter.
Age related physical changes
do not occur according to a
strict timetable. Adults age at
different rates, and such
groupings as “the elderly” are
more heterogeneous than is
commonly believed.
Helplessness and dependency
are not characteristic of old age.
Some 87% of adults over 65
are able to cope more than
adequately with the demands of
everyday living.
There are no drugs, pills,
powders, vitamins, dietary
supplements, or diets with
PROVEN anti-aging capacities.

THE NORMAL AGING PROCESS
Biological Aspects of Aging
Individuals are unique in their physical and
psychological aging processes, as influenced by
their predisposition or resistance to illness; the
effects of their external environment and behaviors;
their exposure to trauma, infections, and past
diseases; and the health and illness practices they
have adopted during their life span.

Biological Aspects of Aging
As the individual ages, there is a quantitative loss of
cells and changes in many of the enzymatic
activities within cells, resulting in a diminished
responsiveness to biological demands made on the
body.
Age-related changes occur at different rates for
different individuals, although in actuality, when
growth stops aging begins

Psychological Aspects of Aging-
Memory Functioning
 Age-related memory deficiencies have been extensively
reported in the literature. Although short-term memory
seems to deteriorate with age, perhaps because of
poorer sorting strategies, long-term memory does not
show similar changes.
 The time required for memory scanning is longer for
both recent and remote recall among older people. This
can sometimes be attributed to social or health factors
(e.g., stress, fatigue, illness), but it can also occur
because of certain normal physical changes associated
with aging (e.g., decreased blood flow to the brain).

Intellectual Functioning
 There appears to be a high degree of regularity in
intellectual functioning across the adult age span.
Crystallized abilities, or knowledge acquired in the
course of the socialization process, tend to remain
stable over the adult life span. Fluid abilities, or
abilities involved in solving novel problems, tend to
decline gradually from young to old adulthood. In
other words, intellectual abilities of older people do
not decline but do become obsolete. The age of
their formal educational experiences is reflected in
their intelligence scoring

Learning Ability
 The ability to learn is not diminished by age.
Studies, however, have shown that some aspects
of learning do change with age. The ordinary
slowing of reaction time with age for nearly all tasks
or the over arousal of the central nervous system
may account for lower performance levels on tests
requiring rapid responses.
 Ability to learn continues throughout life, although
strongly influenced by interests, activity, motivation,
health, and experience. Adjustments do need to be
made in teaching methodology and time allowed for
learning.

FACTORS AFFECTING THE AGING PROCESS
 Aging refers usually refers to the adverse effects of
passing of time but can also refers to the positive
processes of maturation or acquiring a desirable
quality ( Busse 1996)
 The process of decline associated with growing old
are separated into
Primary aging
Secondary aging

CONTD
Primary aging
It is intrinsic and determined by
inherent or hereditary influences
Secondary aging
It refers to extrinsic changes ( defects &
disablities) caused by hostile factors in
the environment including trauma and
acquired disease.

CONTD
Primary aging
Intrinsic factors include biologic and
physiologic components such as sex, race,
intelligence , familial longevity patterns and
genetic diseases
,

CONTD
Secondary aging
Extrinsic components or factors of aging can
be controlled to some degree by the person ,
it includes employment, economic level,
education health practices and related
diseases , societal attitude , income,
economic level and educational level

DEVELOPMENT TASKS OF AGING
Duvall (1977) lists developmental tasks of the elderly
that influence their emotional needs
 Establishing satisfactory living conditions
 Adjusting to retirement income
 Establishing comfortable routines
 Maintaining love sex and marital relationships
 Keeping active and involved staying in touch with
other family member's
 Sustaining and maintaining physical and mental
health
 Finding meaning in life

DEVELOPMENT TASKS OF AGING -CONTD
Establishing satisfactory living conditions
• Is the person single , widowed , divorced or
married?
• Does the elderly person have an incapacitating
illness or handicap?
• Does the person requires assistance?
• Are the store, pharmacy, clinics, church located near
by?
• Is the person able to stay in his own house or her
home or does the person need to be relocated?

Adjusting to retirement income
Do all the people are fortunate enough to have a
savings account and receive social security,
retirement benefits or some other form of
supplemental income??
Adjusting ones standard of living can be quite
stressful for the elderly when the cost of living
continues to rise

Establishing comfortable routines
Retirement, which provides a person with
newfound leisure time, allows one to establish
a comfortable routine such as going on last-
minute trip, developing new hobbies.

Maintaining love sex and marital
relationships
Most people want and are able to lead an
active , satisfying sex life, when problems
occur should not be viewed as inevitable, but
as the result of the disease , disability , drug
reactions or emotional upset and as requiring
medical care.

Keeping active & involved
Butler and Lewis (1982) , These
characteristics include that desire to leave a
legacy, the desire to share a knowledge and
experience with younger generations, the
ability to demonstrate emotional investment in
the environment , a sense of immediacy or
here and now owing to the decreased number
of years left, the ability to experience an entire
life cycle, increased creativity and curiosity
and a satisfaction with life.

Staying in touch with other family
members
Persons who meet the developmental tasks of
maintaining love, sex & marital relationships ,
as well as keeping active and involved ,
probably would be able to cope with
separation from family members more readily
than those who chose to disengage
themselves from society

Sustaining and maintaining physical and mental
health
It is not easy to experience a slowing of ones
mental and physical reaction and be unable to
do anything about it or to look on as younger
people perform ones job and assume ones role
various emotional and behavioral reaction occur
as one under goes to the physiological changes
of the aging process
Loss is a predominant theme in characterizing
the emotional experience of the older people

Finding meaning in life
Listen to the aged. they will teach you. they
are distinguished faculty who teach not from
books but from long experience in life
The concept of ego transcendence versus
ego pre occupation discuss the elderly
persons out look on life
Ego transcendence describes a positive
approach to find meaning in life
Ego pre occupation resign themselves to the
aging process, become inactive, feel they
have no future and want to die

ADAPTATION TO THE TASKS OF AGING
Loss and Grief
 Individuals experience losses from the very beginning of
life. By the time individuals reach their 60s and 70s, they
have experienced numerous losses, and mourning has
become a lifelong process.
Attachment to Others
 Many studies have confirmed the importance of
interpersonal relationships at all stages in the life cycle.
 Murray and Zentner (2001) state: [Social networks]
contribute to well-being of the senior by promoting
socialization and companionship, elevating morale and
life satisfaction, buffering the effects of stressful events,
providing a confidant, and facilitating coping skills and
mastery.

Maintenance of Self-Identity
 Self-concept and self-image appear to remain
stable over time. Factors that have been shown to
favor good psychosocial adjustment in later life are
sustained family relationships, maturity of ego
defenses, absence of alcoholism, and absence of
depressive disorder (Vaillant, 2003).
 Studies show that the elderly have a strong need
for and remarkable capability of retaining a
persistent self-concept in the face of the many
changes that contribute to instability in later life.

Dealing with Death
Death anxiety among the aging is apparently more
of a myth than a reality. Studies have not supported
the negative view of death as an overriding
psychological factor in the aging process. Various
investigators who have worked with dying persons
report that it is not death itself, but abandonment,
pain, and confusion that are feared. What many
desire most is someone to talk with, to show them
their life’s meaning is not shattered merely because
they are about to die (Kübler-Ross, 1969; Murray &
Zentner, 2001)..

Psychiatric Disorders in Later Life
Aging individuals experience many losses,
potentially leading to bereavement overload. They
are vulnerable to depression and to feelings of low
self-worth. The elderly population represents a
disproportionately high percentage of individuals
who commit suicide. Dementing disorders are the
most frequent causes of psychopathology in the
elderly. Sleep disorders are very common

END NOTE
 Care of the aging individual presents one of the
greatest challenges for nursing. The growing
population of individuals aged 65 and older
suggests that the challenge will progress well into
the 21st century.
 Individuals experience many changes as they age.
Physical changes occur in virtually every body
system. Psychologically, there may be age-related
memory deficiencies, particularly for recent events.
Intellectual functioning does not decline with age,
but length of time required for learning increases.

Old age psychiatry ppt

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