PSY3032 Lecture Notes - Lecture 4: Sleep Apnea, Major Depressive Disorder, Dsm-5
11 Oct 2018
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WEEK 4 Late life and neurocognitive disorders
Ageing: issues and methods
- Life expectancy has increased e.g., average life expectancy in Australia in the 1970s was 69.4 years for
males and 76.4 years for females; now it is 79.9 for males and 84.3 for females
- Older adults are usually defined as those over the age of 65, an arbitrary point set largely by social
policies rather than any physiological process
Myths about late life
- Ethical principles state that it is important for psychologists working with the elderly to examine their
attitudes and beliefs about ageing and how this may impact on their practice
- Myth: older people are lonely – truth is that the number of social activities that older people engage in is
unrelated to their psychological wellbeing. As we age, our interests shift away from seeking new social
interactions to cultivating a few social relationships that really matter to us, such as those with family
and close friends
o Social selectivity
▪ When there is less time ahead of us, we tend to place a higher value on emotional
intimacy than on exploring the world
▪ When we cannot see a future without end, we prefer to spend our limited time with
our closest ties rather than with casual acquaintances
- Many stereotypes we hold about the elderly are false but research suggests that negative attitudes
about the elderly learned early in life persist and become negative self-perceptions as people move into
their later years
The problems experienced in late life
- Mental health is tied to the physical and social problems in a person’s life – older adults have more of
these experiences
o Older age is associated with physical decline, sensory acuity deficits, loss of loved ones, social
stress of stigmatising attitudes towards the elderly and the cumulative effects of a lifetime of
unfortunate experiences
o 80% of elderly people have at least one major medical condition
- As people age, the quality and depth of sleep decline and as many as 50% of older adult’s report
difficulties initiating or maintaining sleep
o Sleep apnoea – a disorder in which a person stops breathing for seconds to minutes during the
night, also increase with age
- Several problems complicate medical treatment for elderly people – multiple chronic conditions often
experienced by older adults coupled with the time pressure of the health care system
o Polypharmacy – prescribing of multiple drugs to a person can result when doctors do not
check to see if the person is taking other medications or seeing other health service providers
Research methods in the study of ageing
- Chronological age is not as simple a variable in psychological research as it might seem
- There are other factors associated with age may influence findings (e.g., the social, political and cultural
views or experience of that generation)
- Age effects: consequences of being a certain chronological age
- Cohort effects: consequences of growing up during a particular time period with its unique challenges
and opportunities. E.g., experiences like the great depression, a world war, or the global financial crisis
shape experiences and attitudes
- Time of measurement effects: confounds that arise because events at a particular point in time can
have a specific effect on a variable that is being studied
- Cross sectional and longitudinal research designs are used to assess developmental change
o Cross sectional: compares different age groups at the same moment in time on the variable of
interest
o Longitudinal studies: periodically retests one group of people using the same measure over a
number of years or decades
▪ Selective mortality: when people are no longer available for follow up because of
death, which results in a particular form of bias, in that results obtained with the
remaining sample are more relevant to drawing conclusions about relatively healthy
people than about unhealthy people
▪ Beyond attrition due to death, people with the most problems are likely to drop out
from a study, whereas the people who remain are usually healthier than the general
population
Psychological disorders in late life
- Research finds that persons over age 65 have the lowest prevalence of psychological disorders of all
age groups
- Most people who have an episode of psychological disorder late in life are experiencing a recurrence of
a disorder that started earlier in life rather than an initial onset e.g., 97% of older adults with generalized
anxiety disorder report that their symptoms began before the age of 65 and more than 90% of older
adults with major depressive disorder or agoraphobia report that their symptoms began earlier in life
Methodological issues in estimating the prevalence of psychopathology
- Methodologically, older adults may be more uncomfortable acknowledging and discussing mental health
or drug use problems compared to younger people
o Researchers interviewed elderly people about depressive symptoms and their family members
as well. The family members who had disclosed them as meeting the criteria – about one
quarter did not disclose depressive symptoms to the interview
- Cohort effects
o E.g., many people who reached adulthood during the drug-oriented era of the 1960s continue
to use drugs as they age
o Their generation is more likely to have problems with substance abuse in late life than previous
generations had
- People with psychological disorders are at risk for dying earlier (before 65)
o Among heavy drinkers – the peak years for death from cirrhosis are between 55 and 64 years
of age and cardiovascular disease is common
o Cardio is more common among people with a history of anxiety disorders, depressive
disorders, and bipolar disorder
o Psychological disorders are associated with increased mortality
▪ Study in Sweden of 1200 elderly people living there. Compared to those with low
score, those with high scores on a self-report measure of depression were 2.5 times
as likely to die within the next 6 years. Because people with psychological disorders
may die earlier, studies on ageing may suffer from the issue of selective mortality
Neurocognitive disorders in late life
- One US study found that the prevalence of cognitive impairment has declined among people over the
age of 70 in the last 15 years, perhaps because of improvements in diet, medical care and education
levels over time
- But cognitive disorders account for more medical costs than any other geriatric condition
1. Dementia
a. It is an umbrella term to describe a clinical syndrome characterized by progressive
deterioration of cognitive abilities to the point that functioning becomes impaired
i. Alzheimer’s disease
ii. Frontotemporal dementia
iii. Vascular dementia
iv. Dementia with Lewy bodies
b. Symptoms vary based on the type of dementia; but generally the symptoms have a gradual
onset, and are progressive and irreversible
c. Worldwide prevalence of dementia in 2010 was estimated to be 35.6 million, with numbers
expected to double to 65.7 mil in 2030
Document Summary
Life expectancy has increased e. g. , average life expectancy in australia in the 1970s was 69. 4 years for males and 76. 4 years for females; now it is 79. 9 for males and 84. 3 for females. Older adults are usually defined as those over the age of 65, an arbitrary point set largely by social policies rather than any physiological process. Ethical principles state that it is important for psychologists working with the elderly to examine their attitudes and beliefs about ageing and how this may impact on their practice. Myth: older people are lonely truth is that the number of social activities that older people engage in is unrelated to their psychological wellbeing. Many stereotypes we hold about the elderly are false but research suggests that negative attitudes about the elderly learned early in life persist and become negative self-perceptions as people move into their later years. Chronological age is not as simple a variable in psychological research as it might seem.
