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
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 group.
Age, Cohort, and Time-Of-Measurement Effect
Age effects are the consequences of being given chronological age
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 earlier date.
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 cohort
• 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
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 polygon.
• 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
• 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 prominent symptom.
• 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. Alzheimer’s Disease
• 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
• 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%. H