11-1 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd CHAPTER 11 AGING AND PSYCHOLOGICAL DISORDERS

11-2 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Ageing and psychological disorders Ageing The demographics and epidemiology of ageing In Australia and many industrialised countries, the proportion of people over the age of 65 is increasing Lifespan is also increasing Currently, the average life expectancy in Australia is 80.2 years The type and frequencies of illnesses affecting older illnesses have changed dramatically over time The most common causes of morbidity and mortality today are chronic illnesses such as heart disease and cancer The mortality rates for diseases such as diabetes are between 7 and 11 times higher among Indigenous Australians than non-Indigenous people 40% of older Australians (60+) require help to manage their health or cope with a disability

11-3 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Ageing and psychological disorders Ageing Historical overview of the psychology of ageing Throughout history people have searched for ways to lengthen the lifespan In modern times, understanding of ageing has advanced through new technologies and research techniques Researchers have discovered that reductions in brain size when comparing older and younger adults were due to cohort effects – differences in life circumstances between the age groups In addition, basic cognitive functioning holds steady into the 9 th decade Longitudinal studies, where the same individuals are followed over time, are particularly important for research on ageing Dr. Elsie Harwood – an Australian pioneer in psychology and ageing known for studies of longevity and cognitive processes in older adults

11-4 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Ageing and psychological disorders Ageing Normal ageing processes: cognitive, emotional and social Primary ageing are changes that are a product of normal ageing Secondary ageing includes disease states such as coronary artery disease, major depression, and Alzheimer’s disease Cognitive changes with increasing age Complex attention tasks, such as switching between cognitive tasks, are most affected by increasing age Lapses in memory are also part of the normal ageing process Language is the most robust in the face of ageing processes Several theories attempt to account for changes in cognition in later life Information processing capacity- age-related changes occur in tasks that require speed of processing but not for automatic processing Frontal Lobe Theory focuses on the fact that functions in the frontal lobe deteriorate with normal ageing Wisdom – expert knowledge and judgment – improves with age

11-5 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Ageing and psychological disorders Ageing Normal ageing processes: cognitive, emotional, and social Emotion and personality in later life Depression and most other psychiatric conditions may decrease in incidence in later life May be partly due to the fact that older adults have better coping strategies Erickson’s Stages of Psychosocial Development Theory has been influential Development is characterised by movement through various stages in different life periods Each stage entails the need to resolve opposing tendencies In contrast, in the Five Factor (“Big Five”) Model broad personality traits have been found to be remarkably stable over adult life

11-6 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Ageing and psychological disorders Ageing Normal ageing processes: cognitive, emotional, and social Social changes with age Carstensen’s Socioemotional Selectivity Theory Older adults prioritise more meaningful relationships, leading to a reduction in quantity but an increase in quality of the social network The perceived amount of social support received predicts satisfaction with one’s relationships Social networks are important in helping older adults cope with adversity both through instrumental activities and emotional activities Gender is an important variable Women give and receive more support over their life than men and experience greater benefits It is also important for relationships to be reciprocal, which may be more difficult in later life

11-7 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Ageing and psychological disorders Psychological disorders in later life: the dementias The definition of dementia A broad class of neurological disorders associated with cognitive, personality, and behavioural changes in later life Defined as “an acquired syndrome of intellectual impairment produced by brain dysfunction” (Cummings & Benson, 1992) The main symptom is intellectual impairment, usually impaired memory and disturbance in at least one other cognitive area (e.g., language) Approximately 6% of the Australian population over 65 has some form of dementia The prevalence of dementia is expected to triple by 2051 Direct health costs of dementia in Australia is $3.2 billion

11-8 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Ageing and psychological disorders Psychological disorders in later life: the dementias Alzheimer’s disease Most common form of dementia – 50-70% of all cases of dementia Underlying biological process is characterised by the presence of: neurofibrillary tangles - twisted masses of tiny filaments inside nerve cells neuritic plaques – abnormal clumps of degenerating brain cells surrounding a protein core The course of the disease is characterised by increasing cognitive dysfunction, including difficulties with remembering new information and changes in language, particularly the ability to name objects, people, and places Also includes changes in personality and emotional functioning, such as apathy and agitation and behavioural problems such as wandering and toileting difficulties Over 25% experience hallucinations or delusions at some point

11-9 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Ageing and psychological disorders Psychological disorders in later life: the dementias Alzheimer’s disease According to DSM-IV-TR, the hallmark of the disorder is memory impairment, which becomes very severe as the disorder progresses The memory impairment must be accompanied by declines in one or more of the following areas Aphasia - language disturbance Apraxia - impaired ability to carry out motor activities Agnosia - failure to recognise or identify objects and people Disturbance in executive function (planning, organising, etc.) The memory and cognitive disturbances must result in significant impairment in functioning and represent a significant decline from prior functioning

11-10 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Ageing and psychological disorders Psychological disorders in later life: the dementias Alzheimer’s disease Aetiology A certain protein called ApoE E4 constitutes a major risk factor The ApoE gene on chromosone 19 is polymorphic (has different forms) 40-60% of people with Alzheimer’s carry the ApoE E4 version The Nun Study 15 year longitudinal study of ageing and Alzheimer’s disease Examined neuropathology at autopsy and conducted retrospective analysis of autobiographies Characteristic neurobiological features (plaques and tangles) are not sufficient for Alzheimer’ s disease to develop Non-biological factors (such as cognitive ability) may also be relevant

11-11 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Ageing and psychological disorders Psychological disorders in later life: the dementias Vascular dementia Second or third most common form of dementia, 10-30% of cases 3 most common causes of dementia are multiple cortical infarcts (strokes), a strategic single infarct, small vessel disease in the brain Similar to Alzheimer's, vascular dementia is characterised by multiple cognitive deficits (DSM-IV-TR) Memory impairment is central Declines in one or more of the following: aphasia, apraxia, agnosia, or disturbance in executive functioning In contrast to Alzheimer’s, focal neurological signs such as problems with gait, weakness of muscles in arms or legs, or evidence from neuroimaging scans of past strokes Also differs from Alzheimer’s because more sudden onset, association with vascular disease risk factors, and generally better preserved memory Psychiatric and behavioural changes may include depression, emotional lability, and hallucinations

11-12 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Ageing and psychological disorders Psychological disorders in later life: the dementias Other forms of dementia Frontotemporal dementia Prominent changes in personality and behaviour Memory changes may not appear until later stages Decline in interpersonal conduct such as rude behaviours, inappropriate sexual comments, general disinhibition One or more: aphasia, apraxia, agnosia, or disturbance in executive functioning Lewy body dementia Affects over 10% of those diagnosed with dementia Core features include waxing and waning cognition, recurrent complex visual hallucinations, and spontaneous features of Parkinson’s disease Characterised by the presence of Lewy bodies – abnormal cells Mild cognitive impairment Described as a potential precursor to Alzheimer’s disease Subjective memory complaints and objectively measured impairments in memory in the absence of other cognitive disturbance or impaired activities of daily living Do not meet criteria for any dementia or other psychiatric condition

11-13 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Ageing and psychological disorders Psychological disorders in later life: the dementias The assessment, treatment, and prevention of dementia Comprehensive assessment including careful clinical history, neuropsychological assessment, and neuroimaging investigations Medication Cholinesterase inhibitors inhibit reuptake of acetylcholine and increase its availability Psychological and behavioural interventions Strategies include facilitating effective communication, modifying the environment, and providing pleasant activities Caregivers Carers for persons with dementia have high rates of anxiety/depression Coping strategies, such as relaxation, can lead to positive outcomes Preventative approaches Lifestyle factors, such as increased physical and mental activity and social engagement, may decrease the risk for developing dementia

11-14 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Ageing and psychological disorders Psychological disorders in later life: depression and anxiety Depression Approximately 1% of Australians over 65 met criteria for depression, lower than the rate for younger adults Symptom presentation among older adults more likely to include loss of short-term memory and difficulty concentrating Older adults with depression must receive a thorough medical evaluation Late–life depression has its onset as a first occurrence of major depression after the age of 60 Compared with early-onset depression, those with late-onset depression experience significant cognitive dysfunction, increased comorbidity of medical illnesses, and higher rates of either lethargy or agitation Suicide is a serious concern for late-life depression A variety of treatment approaches are effective, including cognitive- behavioural therapy and interpersonal therapy Unfortunately a high rate of older adults go undiagnosed and untreated

11-15 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Ageing and psychological disorders Psychological disorders in later life: depression and anxiety Anxiety More common than depression in later life - 4.5% of Australians over 65 More commonly affects females and those with a comorbid medical illness Older adults with anxiety more often complain of cognitive (memory and attention) and vegetative (poorer sleep and appetite) symptoms than younger adults A variety of treatment approaches are effective for anxiety disorders in later life Anxiolytic medications are not recommended Tend to be addictive, disrupt sleep, and result in unsteady balance Good outcomes with cognitive-behavioural therapy Older adults do not seek treatment as often as their younger counterparts Also evidence of biases in the treatment of older adults

11-16 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Ageing and psychological disorders Life events associated with later life: retirement, grandparenting, and bereavement Retirement Critically life transition – generally positive Several variables predict who will experience retirement as a positive experience: Good health Having enough money to retire with Having the support of friends and family Baltes’ theory of Selection, Optimisation, and Compensation – proposes that individuals who age successfully use three strategies, selection, optimisation, and compensation, to achieve their desired goals Emphasises older adults making active choices about how they will compensate for limitations in the pursuit of their goals

11-17 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Ageing and psychological disorders Life events associated with later life: retirement, grandparenting, and bereavement Grandparenting Grandparenting as a full or nearly full-time occupation is related to a variety of positive and negative outcomes Some findings of increased depression, diabetes, hypertension, insomnia among custodial grandparents Also positive benefits of extremely close bond with grandchildren Bereavement Common event but does not necessarily result in clinically significant psychological stress Older adults fare better than their younger counterparts, although the loss of a long-term spouse may be devastating Normal grief reactions include some of the symptoms that occur in depression Other symptoms, such as pervasive guilt or hopelessness, suggest that the bereavement has precipitated a depressive episode

11-18 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Ageing and psychological disorders Positive ageing Three important characteristics and behaviours: low risk of disease and disease-related disability a high level of mental and physical functioning an active engagement with life Centenarian studies are used to study healthy ageing Three groups: Escapers - 20% people who have avoided serious illness completely until 100 or completely Delayers - 40% people who have delayed serious illness until after age 80 Survivors - 40% people who develop serious illness before 80 but survive it Healthy cognitive functioning better predictor of independence in later life than physical health Certain factors decrease longevity (cigarette smoking, obesity), while others promote longevity (regular exercise, healthy diet) Other more subtle factors may play a role, such as a positive view of oneself and one’s place in the world and volunteerism

11-19 PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd Summary Ageing The Demographics and Epidemiology of Ageing Historical Overview of the Psychology of Ageing Normal Ageing Processes: Cognitive, Emotional, and Social Functioning Psychological Disorders in Later Life: The Dementias Definition of Dementia Alzheimer’s Disease Vascular Dementia Other Forms of Dementia and Related Disorders The Assessment, Treatment, and Prevention of Dementia Psychological Disorders in Later Life: Depression and Anxiety Depression Anxiety Disorders Life Events Associated with Later Life Retirement Grandparenting Bereavement Positive Ageing