CHAPTER 11
AGING AND PSYCHOLOGICAL
DISORDERS
11-1
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
11-2
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 9th 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
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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
11-4
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

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
11-5
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

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
11-6
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
11-7
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

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
11-8
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

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
11-9
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


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
11-10
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

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
11-11
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

Other forms of dementia

Frontotemporal dementia



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Lewy body dementia

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

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
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
11-12
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

The assessment, treatment, and prevention of dementia


Comprehensive assessment including careful clinical history,
neuropsychological assessment, and neuroimaging investigations
Medication


Psychological and behavioural interventions


Strategies include facilitating effective communication, modifying the
environment, and providing pleasant activities
Caregivers



Cholinesterase inhibitors inhibit reuptake of acetylcholine and increase its
availability
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
11-13
PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
Ageing and psychological disorders

Psychological disorders in later life: 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 cognitivebehavioural therapy and interpersonal therapy
Unfortunately a high rate of older adults go undiagnosed and untreated
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

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
11-15
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
11-16
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

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
11-17
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
11-18
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






Psychological Disorders in Later Life: Depression and Anxiety



Depression
Anxiety Disorders
Life Events Associated with Later Life




Definition of Dementia
Alzheimer’s Disease
Vascular Dementia
Other Forms of Dementia and Related Disorders
The Assessment, Treatment, and Prevention of Dementia
Retirement
Grandparenting
Bereavement
Positive Ageing
11-19
PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd