Chapter 16: Aging and Psychological Disorders
• Subjective age bias: A tendency to feel younger than one’s
chronological age in a way that may reflect an age bias.
• The physical realities of aging are complicated by ageism, which
can be defined as discrimination against any person young or
old, based on chronological age.
Issues, Concepts, and Methods in the Study of Older Adults
Diversity in Older Adults
• The word “diversity” is well suited to the older population. Not
only are older people different from one another, but they are
more different from one another than are individuals in any other
Age, Cohort, and Time-Of-Measurement Effect
- Age effects are the consequences of being given chronological
- Cohort effects are the consequences of having been born in a
given year and having grown up during a particular time period.
A cohort effect exists if these people have some factor that
distinguishes them from people who turned 65 or older at an
- Tim-of-measurement effects are confounds that arise because
events at an exact point in time can have a specific effect on
variable being studied over time. For example, time of
measurement could affect the results of studies assessing post-
traumatic stress disorder is Holocaust survivors if one of the
assessments occurs shortly after 9/11.
• In cross-sectional studies, the investigator compares different
age groups at the same moment in time on the variable of
interest. They allow us to make statements only about age
effects in a particular study or experiment, not about age
changes over time.
• In longitudinal studies, the researcher selects one cohort – say,
the graduating class of 2002 – and periodically retests it using
the some measure over a number of years.
• Conclusions drawn from longitudinal studies are restricted to the
• An additional problem with longitudinal studies is that
participants often drop out as the studies proceed, creating a bias commonly called selective mortality. The least-able people
are the most likely to drop out, leaving a non-representative
group of people who are usually healthier than the general
Diagnosing and Assessing Psychopathology in Later Life
• Researchers often assess cognitive functioning with the Mini-
Mental State Examination. The MMSE is brief measure of an
individual’s cognitive state, assessing “orientation, memory, and
attention . . . ability to name, follow verbal and written
commands, write a sentence spontaneously and copy a complex
• A relatively simple measure used to detect dementia and
Alzheimer’s disease is the clock drawing subset of the Clock Test.
• Respondents are presented with a previously drawn circle ( 7 cm
in diameter) and are asked to imagine that the circle is the face
of a clock and to put the numbers on the clock and then draw the
hand placement for the time 11:10. Up to 25 different types of
errors can occur, including omissions, perseverations (i.e.,
repetition), rotations, misplacements, distortions, substitutions,
and additions. This simple test has been found to be reliable and
valid, though results vary depending on the scoring system used.
• One well-known measure crafted for the elderly is the Geriatric
Depression Scale (GDS), a true-false self-report measure. The
GDS has acceptable psychometric characteristics and is
regarded as the standard measure to assessing depression in the
elderly. The Geriatric Suicide Ideation Scale (GSIS) is a 31-item
measure that is the first measure of suicide ideation created
specifically for the elderly.
Range of Problems
• “Double jeopardy”; that is, they suffer the stigmas associated
with being older and being mentally ill.
Old Age and Brain Disorders
• Dementia – what laypeople call senility – is a general descriptive
term for gradual deterioration of intellectual abilities to the point
that social and occupational functions are impaired. Difficulty
remembering things, especially recent events, is the most
• They may also have trouble recognizing familiar surroundings or naming common objects. These should be distinguished from
paraphrenia, the term used to describe schizophrenia that has its
onset during old age.
Causes of Dementia
• Dementias are typically classified into three types. Alzheimer’s
disease is the most common. Then, there are the frontal-
temporal and frontal-subcortical dementias, which are defined by
the areas of the brain the are most affected.
• The main physiological change in the brain, evident at autopsy,
is an atrophy (wasting away) of the cerebral cortex, first the
entorhinal cortex and the hippocampus and later the frontal,
temporal, and parietal lobes. As neurons and synapses are lost,
the fissures widen and the ridges become narrower and flatter.
The ventricles also become enlarged. Plaques – small, round
areas making up the remnants of the lost neurons and b-
amyloid, a waxy protein deposit – are scattered throughout the
cortex. Tangled, abnormal protein filaments – neurofibrillary
tangles – accumulate within the cell bodies of neurons. These
plaque and tangles are present throughout the vertebral cortex
and the hippocampus.
• In terms of structural imaging, volume loss within the
hippocampus (and episodic memory impairment) best
discriminated people in the early stages of Alzheimer’s disease
from control participants.
• The most reliable predictor of progression from mild cognitive
impairment to Alzheimer’s disease was not changes in the
posterior cingulate cortex and precuneus. Rather, it was atrophy
in the (trans-) entorhinal area in the hippocampus and
hypometabolism/ hypoperfusion in the inferior parietal lobules.
• About 25% of patients with Alzheimer’s disease also have brain
deterioration similar to the deterioration in Parkinson’s disease.
Neurons are lost in the nigrostriatal pathway.
• A substantial proportion of late-onset cases Alzheimer’s disease
exhibit a particular form of gene (called the apolipoprotein E 4
allele) on chromosomes 19, which functions more like the
genetic diatheses we have considered so often before. Having
one E 4 allele increases the risk for Alzheimer’s disease to almost
50% and having two alleles brings the risk to above 90%. Having