Chapter 15: Disorders of Aging and Cognition
Old Age and Stress
- Old age is usually defined in our society as the years past age 65.
o 43 million people in the United States (13.6%)
- Overall population of the elderly is on the rise.
- About half of adults over 65 have two or three chronic illness, and 15% have
four or more.
- Geropsychology: the field of psychology concerned with the mental health of
o Only 4% of clinicians work primarily with elderly people
- The psychological problems of elderly people may be divided into two
o Depression, anxiety, and substance abuse disorder
o Delirium, mild neurocognitive disorders, and major neurocognitive
Depression in Later Life
- The features of depression are the same for elderly people as for young
people, including feelings of profound sadness and emptiness, low self-
esteem, guilt, and pessimism; and loss of appetite and sleep disturbances.
- Overall 20% of people become depressed at some point during old age.
o The rate is highest in older women.
- Elderly are more likely to commit suicide than young people
o Rate of suicide in elderly is more than 16 per 100,000
- Older people who are depressed may be helped by cognitive-behavioral
therapy, interpersonal therapy, antidepressant medications, or a
combination of these approaches.
Anxiety Disorders in Later Life
- As many as 11% of elderly individuals in the United States experience at least
one of the anxiety disorders.
- Rate of anxiety increases throughout old age.
- Older adults with anxiety disorders have been treated with psychotherapy of
various kinds particularly cognitive-behavioral therapy.
Substance Misuse in Later Life
- Survey finds that 3-7% of older people, particularly men, have alcohol use
disorder in a given year.
- Older patients who are instiutioanlized, however, do display high rates of
- The latter group typically being abusing alcohol as a reaction to the negative
events and pressure of growing older.
- Most often misuse of prescription drugs is unintentional.
- Research suggests that antipsychotic drugs are currently being given to
almost 30% of total nursing homes population in U.S., despite the fact that
many of residents do not display psychotic functioning.
Psychotic Disorders in Later Life - Some elderly people, through, suffer from schizophrenia or delusional
- Many people with schizophrenia find that their symptoms lessen in later life.
- Another kind of psychotic disorder found among the elderly is delusional
disorder, in which people develop beliefs that are false but not bizarre.
o 2 of every 1,000 people- but its prevalence appear to increase in the
- Older people with delusional disorder may develop deeply help suspciions of
often family members, doctors, or friends- are conspiring against, cheating,
spying on, or maligning them
Disorder of Cognition
- As people move through middle ages, these memory difficulties and lapses of
attention increase, and they may occur regularly by age of 60 or 70.
- delirium: a rapidly developing, acute disturbance in attention and orientation
that make it very difficult to concentrate and think in a clear and organized
o Dx checklist:
▪ 1. Over the course of hours or a few days, individual
experiences fast-moving and fluctuating disturbances in
attention and orientation to the environment.
▪ 2. Individual also displays a significant cognitive disturbance.
- 1% of people over 55 years of age and 14 % of those over 85 years of age.
- At least another 10% develop delirium during stay at hospital
- 60% of nursing homes residents older than 75 years of age have some
- Fever, certain diseases and infections, poor nutrition, head injuries, strokes,
and stress may all cause delirium.
Alzheimer’s Disease and Other Neurocognitive Disorders
- neurocognitive disorder: a disorder marked by a significant decline in at least
one area of cognitive functioning.
- Major neurocognitive disorder: a neurocognitive disorder in which the
decline in cognitive functioning is substantial and interferes with a person’s
ability to be independent.
o Dx checklist:
▪ 1. Individual displays substantial decline in at least one fo the
following area of cognitive function: memory and learning,
attention, perceptual-motor skills, planning and decision-
making, language ability, social awareness