PSYC1030 Lecture Notes - Lecture 12: Psychodynamic Psychotherapy, Ageism, Heritability
PSYC1030 Lecture Twelve: Health in Later Life
Normal Ageing
• The study of ageing is called gerontology
• There is a paradox about ageing--most people want to live a long time, but also
particularly doesn't want to get old
• In the scientific and medical community, the agreed upon age at which a person is
considered old is age 65
• There, in many situations, a greater focus on the physical health of an older person
than the mental and emotional health. The World Health Organisation's definition of
health states that health goes beyond physical health to encompass "a complete state
of physical, mental and social well-being, and not merely the absence of disease or
infirmity" (WHO, 1948)
• Older adults often tend to be more happy than younger people
• Older adults in the general population have about a 15 to 25% chance of having a
serious mental illness compared to a 20% chance in the general population, because
older adults are more heterogeneous as a group (it also depends whether or not the
study included people in nursing homes, since they make up only around 6-7% of the
population-- but 70-90% of people in nursing homes have either a psychiatric
condition and/or dementia)
• The chance of having a diagnosable psychiatric condition decreases with increasing
age. Population based prevalence of mood disorders, anxiety disorders, and substance
abuse disorders has a lower percentage of people effected over the age of 65 than
dementia, the chance of getting dementia increases with age. This is why the overall
lifetime chance of having a psychiatric illness is fairly constant, at 20%
• All health and mental health professions lack an adequate supply of new trainees to
specialise in seeing older people
• Helmes and Gee (2003) showed the ageism against older people with psychiatric
issues and psychologist's unwillingness to treat older patients
• Older adults are less likely to rget a thorough work-up and be offered the widest
range of treatment options compared to young adults, in both mental and physical
illness
• Key principles from gerontology are important for understanding older people and the
ageing process. The principles enable people to interpret data correctly, and
understand why older adults are different to people at other ages. The first principle is
the idea of the difference between primary and secondary ageing.
-Primary ageing reflects changes in the organism that are a result of the passage of
chronological time, and typically happens to everyone. Over time, many parts of a
person's physical, psychological and social make-up will change
e.g. Visual acuity declines, thus leading to many people needing reading glasses to
read fine print after a certain age. This happens as one's ability to focus short
distances declines with age. Most adults experience declines in bone and muscle mass
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with age. Heredity, poor diet, lack of weight-bearing exercise can lead to someone
developing osteoporosis--a disease where the bones thin to a dangerous extent,
putting a greater risk of bone breakages from falls. Metabolic changes in midlife result
in all women experiencing menopause. Typically, men will experience greater hearing
loss by the time they're in their 80's. A decreased resistance to infections is a part of
normal, primary aging, due to the decreased production of white blood cells and
general decreased efficiency of the immune system (which actually decreased quite
early in life, in one's mid 20's). Lung capacity also declines, less red blood cells are
produces, short term memory becomes unreliable, and people even grow hair in their
ears
All these changes are due to changes in the organism with time passing. There isn't
much to prevent these changes other than to adapt
-Secondary ageing are changes due to a specific disease process, or a result of trauma
or lifestyle choices due to ageing. Only the people affected are the ones suffering from
the disease, trauma, or pursue certain lifestyle choices, rather than every person who
grows old.
e.g. Not everyone is going to get dementia, depression, type two diabetes, high blood
pressure--although they are staples of old age.
They are symptoms or conditions that are due to illness, and/or lifestyle choices such
as regular exercise or high caloric intake over time. People can act to lower the risk of
many illnesses. It's best to stay healthy, stay active, not be overweight, don't smoke
(smoking doubles the risk of Alzheimer's disease). People, even some health
professionals, assume that things including depression are due to primary ageing
Heterogeneity
• By the time a person is 80 they've made unique choices and had a variety of things
happen to them, their personas, their brains, their personality, their social networks,
everything is unique to a single person
• Which is why, in the realm of statistics or personality, older adult populations have a
greater standard deviation--there is no such thing as a typical 70-year-old. With
increasing age, people get more and more different from each other. There is
increased heterogeneity with increasing age, which is the second key gerontology
principle.
• Time and experience add up to heterogeneity
Cohort Effects
• Certain behaviours that are adopted by certain people living in a certain time
e.g. Those living during the Great Depression becoming very frugal and cautious about
food waste
• The Cohort effect is the third key gerontology principle. It is when people are born into
certain periods of times and go through a certain set of experiences, and they all share
a relatively similar outlook
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• This key principle is important when, for example, two people from different cohorts
are asked the same questions. Their answers will typically differ due to the cohort
effect. It has to do with what the generations have experienced, not their age
• Things cannot be attributed to ageing if people are just chosen from different age
groups and then asked to perform the same tasks. The best way study the changes in
people over time is to a longitudinal study. It asks the same questions over time,
measures the changes in physiology or behaviour over many years of time. This helps
show what is and is not affected by ageing, and what phenomena may be due to
cohort effects
Depression and anxiety
• It is more typical for younger people to be more anxious and depressed than older
people, despite what is generally thought, which can be seen in longitudinal research
• Depression and anxiety are presented differently in older people than when they occur
earlier in life, particularly anxiety, and risk factors include:
-self-rated general health status
-sexual or physical abuse during childhood
-being a current smoker
• Protection factors include:
-greater perceived social support
-regular exercise
-higher level of education
e.g. Memory impairment is a key presentation in later life for both anxiety and
depression, which leads to older adults to be mistakenly diagnosed with dementia
when they're actually suffering from depression or anxiety. Some studies have found
that as high as 20% of cases of dementia are likely to have been misdiagnosed, during
the autopsy
• Key risk factors for depression include:
-disability
-newly diagnosed medical illness
-poor health status
-poor self-perceived health
-prior depression
-bereavement
• Protective factors include:
-greater perceived social support
-regular physical exercise
-high socioeconomic status
• There are currently good interventions for depression in later life, i.e. Psychotherapy,
pharmacological treatments, or a combination of the two, which are effective in about
80% of cases. But there are no current treatments which slow or reverse dementia
• Both socioeconomic status and education reflect economic resources, and research
shows greater protection against both depression and anxiety at all ages
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Document Summary
Normal ageing: the study of ageing is called gerontology, there is a paradox about ageing--most people want to live a long time, but also particularly doesn"t want to get old. Population based prevalence of mood disorders, anxiety disorders, and substance abuse disorders has a lower percentage of people effected over the age of 65 than dementia, the chance of getting dementia increases with age. The principles enable people to interpret data correctly, and understand why older adults are different to people at other ages. The first principle is the idea of the difference between primary and secondary ageing. Primary ageing reflects changes in the organism that are a result of the passage of chronological time, and typically happens to everyone. Over time, many parts of a person"s physical, psychological and social make-up will change e. g. visual acuity declines, thus leading to many people needing reading glasses to read fine print after a certain age.
