Geriatric Psychology

Geriatric psychology—also called geropsychology or psychogeriatrics—is the study of the psychology of aging and the clinical treatment of psychological problems in older adults. Geriatric psychology presents a paradox: Aging is associated with a progressive decline in physical abilities and frequently increased health problems and chronic medical conditions, yet it is also generally associated with improved psychological health and wellbeing. Research indicates that healthy aging is accompanied by positive neurological changes and psychological development.

In the early twenty-first century, seniors were the fastest growing population in the United States and many other countries. There will be an estimated 72 million Americans over age 65 by 2030, up from 40 million in 2010. Other than cognitive impairment, aging is generally associated with improved mental health. Nevertheless, with growing senior populations, geriatric psychology becomes increasingly important.

Geriatric Depression Scale
  1. Are you basically satisfied with your life? YES NO
  2. Have you dropped many of your activities and interests? YES NO
  3. Do you feel that your life is empty? YES NO
  4. Do you often get bored? YES NO
  5. Are you hopeful about the future? YES NO
  6. Are you bothered by thoughts you can't get out of your head? YES NO
  7. Are you in good spirits most of the time? YES NO
  8. Are you afraid that something bad is going to happen to you? YES NO
  9. Do you feel happy most of the time? YES NO
  10. Do you often feel helpless? YES NO
  11. Do you often get restless and fidgety? YES NO
  12. Do you prefer to stay at home, rather than going out and doing new things? YES NO
  13. Do you frequently worry about the future? YES NO
  14. Do you feel you have more problems with memory than most? YES NO
  15. Do you think it is wonderful to be alive now? YES NO
  16. Do you often feel downhearted and blue? YES NO
  17. Do you feel pretty worthless the way you are now? YES NO
  18. Do you worry a lot about the past? YES NO
  19. Do you find life very exciting? YES NO
  20. Is it hard for you to get started on new projects? YES NO
  21. Do you feel full of energy? YES NO
  22. Do you feel that your situation is hopeless? YES NO
  23. Do you think that most people are better off than you are? YES NO
  24. Do you frequently get upset over little things? YES NO
  25. Do you frequently feel like crying? YES NO
  26. Do you have trouble concentrating? YES NO
  27. Do you enjoy getting up in the morning? YES NO
  28. Do you prefer to avoid social gatherings? YES NO
  29. Is it easy for you to make decisions? YES NO
  30. Is your mind as clear as it used to be? YES NO

Scoring is based on one point for each bolded answer.
Normal: 0–9
Mild depression: 10–19
Severe depression: 20–30

SOURCE: Stanford/VA Aging Clinical Research Center (ACRC).

Psychological health

Psychological development continues throughout life. Although short-term memory and performance of certain specific mental tasks may deteriorate with age, other areas, such as wisdom and judgment, become sharper. Furthermore, in their early fifties, adults begin to undergo profound emotional changes— often referred to as attaining maturity—that may contribute to improved mental health. Thus, aging is typically accompanied by increased emotional equanimity. Numerous studies have found that older people moderate their emotional responses more effectively than younger people, approach problems with a more balanced attitude, and behave more appropriately. Older adults are more attentive to positive emotional stimuli and are more likely to remember positive emotions than negative emotions. Although learning and experience play an important role in the development of emotional control, there are also age-related decreases in the activity of amygdalae—structures in the brain that are responsible for intense emotions, particularly negative emotions. Thus, older adults are less prone to the following:

Other psychological changes accompany aging. Some studies have found that the ability to solve everyday problems improves significantly in later life. This ability, which has been called pragmatic creativity or crystallized intelligence, may reflect a lifelong accumulation of problem-solving strategies. The human brain also has an amazing ability to influence its own aging. From middle age on, the drive to achieve usually diminishes, and the need for community and belonging increases. Studies have repeatedly shown that strong social and community connections and physical activity are among the most important factors for successful aging. Seniors who play musical instruments have been found to be physically and psychologically healthier than their nonmusical peers. Furthermore, geriatric psychologists believe that the process of reviewing one's life is a part of normal aging that can lead to greater self-awareness and self-acceptance. These and other psychological factors can have a profound influence on the immune system and overall health.

Mental disorders

An estimated 20% of Americans aged 65 and older have a diagnosable psychiatric disorder, including dementia. While anxiety and depression are the most frequent mental-health disorders affecting the elderly, more than 50% of nursing-home residents have some type of cognitive impairment, and many more have personality disorders exacerbated by chronic health problems. Elderly people with serious mental disorders are at high risk for obesity, high blood pressure, diabetes, heart conditions, respiratory illnesses, and infectious diseases, and they have a significantly shorter life expectancy than their mentally healthy peers. Furthermore, many older adults have sub-clinical mental health and substance-use problems associated with the loss of functional abilities. Almost 7% of Americans aged 65–74 report experiencing frequent mental distress. In addition to serious or disabling long-term mental disorders, older adults frequently experience stress and emotional turmoil surrounding circumstances such as retirement, moving from the family home, lowered social status, reduced physical and mental capabilities, loss of family and friends, disabling illness, and the prospect of death. Substance abuse, especially alcohol and pain medications, is a growing problem among the elderly. Dementia (which often coexists with anxiety and depression) and pain from chronic diseases are also major psychological issues.

An estimated 11% of older Americans suffer from anxiety disorders, which often go unrecognized both by the elderly themselves and their doctors. Like other mental disorders, anxiety is treatable with therapy and medications. Untreated, it can lead to cognitive impairment, poor physical health and disability, and a deteriorating quality of life. Common anxieties in the elderly are:

Although depression is not a normal part of ageing, estimates of depression among older Americans range up to 20% or higher. Many older adults with depression suffered depressive episodes earlier in life. A first episode of depression late in life is usually brought on by another medical condition, disability, or dependence on others. Seniors with depression and coexisting chronic health problems, such as diabetes or heart disease, are at higher risk for heart attacks, cancer, disability, and premature death. Hip fractures are slower to heal. Even mild depression can lower immunity and increase susceptibility to infections and cancer. Dysthymia, a mood disorder characterized by mild depression and irritability, is also common in the elderly and is sometimes mistaken for depression, anxiety, or even dementia. Up to 80% of older adults recover from depression with appropriate treatment; however, lack of treatment, misdiagnosis, or inappropriate treatment can have serious physical consequences.

Depression is a major risk factor for suicide. Adults 65 and older have a 50% higher suicide rate than the general population and account for 20% of all suicides. Non-Hispanic white males aged 85 and older have six times the suicide rate of the general population. Although 20% of older suicide victims saw a doctor on the day they died—and 40% in the previous week, and 70% in the last month—physicians often miss signs of suicidal depression.

Dementia is not a normal part of aging, and some forms of dementia are treatable and reversible. Alzheimer disease (AD), the most common type of dementia, affects one in eight Americans over 65— about 5.4 million people. New diagnostic tools and interventions have enabled earlier diagnosis of AD and treatments for problematic behaviors. Psychological intervention may also help prevent AD, since it is estimated that up to half of AD cases worldwide may be attributable to modifiable risk factors, including diabetes, midlife hypertension or obesity, smoking, depression, and cognitive and physical inactivity. Psychotherapy and support groups can help people with early-stage AD develop coping strategies and reduce stress. Memory-training strategies can optimize cognitive abilities. Geriatric psychologists can assess patient capacity for making healthcare and legal decisions and teach behavioral and environmental strategies for helping caregivers. AD and other forms of dementia are often accompanied by depression, anxiety, and paranoia, which can benefit from diagnosis and treatment by geriatric psychologists.

About 80% of older adults have at least one chronic health condition, and up to 65% have two or more. Geriatric psychology can help patients manage these conditions through behavioral interventions, including treatment adherence, physical activity, nutrition, biofeedback, stress reduction, and eliminating smoking and alcohol abuse that contribute to or exacerbate chronic conditions. Other roles for geriatric psychology include:

Availability of psychological treatment

Older Americans with mental disorders are less likely than younger people to receive mental-health services and, when they do receive services, are less likely to receive them from a specialist. It is estimated that up to 60% of people over 65 with diagnosed mental or substance-use disorders do not receive services or treatment. Because their mental and physical health problems, substance use, and requirements for aging services often overlap, older people can fall through service gaps. The services that are available are not usually focused specifically on geriatric psychology. Physical health and mental health in older adults are interrelated in complex ways, and older people are more likely to complain to their primary-care provider about a physical problem than to seek mental-health care. Furthermore, their mental-health problems are often misdiagnosed, overtreated, or undertreated. Although many older adults would prefer psychotherapy to psychoactive medications, they often are not given this alternative. Other factors affecting mental healthcare access among the elderly are:

See also Anxiety disorders; Dementia ; Depression .

KEY TERMS

Alzheimer disease (AD)—
A progressive, neurodegenerative disease characterized by loss of function and death of nerve cells in several areas of the brain, leading to mental deterioration; the most common cause of dementia.
Anxiety disorders—
A group of disorders characterized by anxiety, including panic disorder and posttraumatic stress disorder (PTSD).
Dementia—
A group of symptoms, including Alzheimer disease, associated with progressive impairment of memory, reasoning ability, and other intellectual functions; personality changes; deterioration in personal grooming; and disorientation.
Depression—
A mental condition characterized by extreme sadness, loss of interest in life, and problems with appetite, sleep, concentration, and daily functioning.
Dysthymia—
Dysthymic disorder; a mood disorder characterized by chronic mild depression or irritability.
Geropsychology—
Geriatric psychology; psychogeriatrics; the study of aging and the clinical treatment of older adults.
Phobia—
An intense, abnormal, or illogical fear of a specific circumstance or situation, such as heights, open spaces, or social situations.

Resources

PERIODICALS

Ballew, Shoshana H., et al. “The Role of Spiritual Experiences and Activities in the Relationship Between Chronic Illness and Psychological Well-Being.” Journal of Religion and Health 51, no. 4 (December 2012): 1386–96.

Jeste, Dilip V., and Andrew J. Oswald. “Individual and Societal Wisdom: Explaining the Paradox of Human Aging and High Well-Being.” Psychiatry 77, no. 4 (December 2014): 317–30.

Tovel, Hava, and Sara Carmel. “Maintaining Successful Aging: The Role of Coping Patterns and Resources.” Journal of Happiness Studies 15, no. 2 (April 2014): 255–70.

Wang, Huali, et al. “The State of Psychogeriatrics in Different Regions of the World: Challenges and Opportunities.” International Psychogeriatrics 25, no. 10 (October 2013): 1563–69.

Wiesmann, Ulrich, and Hans-joachim Hannich. “A Salutogenic Analysis of the Well-Being Paradox in Older Age.” Journal of Happiness Studies 15, no. 2 (April 2014): 339–55.

Wuthrich, Viviana M., and Jacqueline Frei. “Barriers to Treatment for Older Adults Seeking Psychological Therapy.” International Psychogeriatrics: Late Life Anxiety (supp.) 27, no. 7 (July 2015): 1227–36.

WEBSITES

American Psychiatric Association. “Seniors.” http://www.psychiatry.org/mental-health/people/seniors (accessed August 6, 2015).

American Psychological Association. “Mental and Behavioral Health and Older Americans.” http://www.apa.org/about/gr/issues/aging/mental-health.aspx (accessed August 6, 2015).

Geriatric Mental Health Foundation. “Anxiety and Older Adults: Overcoming Worry and Fear.” http://www.aagponline.org/index.php?src=gendocs&ref=anxiety&category=Foundation (accessed August 26, 2015).

Geriatric Mental Health Foundation. “Consumer/Patient Information.” http://www.gmhfonline.org (accessed August 26, 2015).

Geriatric Mental Health Foundation. “Depression in Late Life: Not a Natural Part of Aging.” http://www.aagponline.org/index.php?src=gendocs&ref=depressioncategory=Foundation (accessed August 26, 2015).

National Alliance on Mental Illness. “Depression in Older Persons Fact Sheet.” http://www2.nami.org/Content/ContentGroups/Helpline1/Depression_In_Older_Persons.htm (accessed August 26, 2015).

ORGANIZATIONS

American Association for Geriatric Psychiatry/Geriatric Mental Health Foundation, 6728 Old McLean Village Dr., McLean, VA, 22101, (703) 556-9222, Fax: (703) 556-8729, main@aagponline.org, http://www.aagponline.org .

American Psychiatric Association, 1000 Wilson Blvd., Ste. 1825, Arlington, VA, 22209, (703) 907-7300, (888) 35PSYCH (357-7924), apa@psych.org, http://www.psychiatry.org .

American Psychological Association, 750 First St. NE, Washington, DC, 20002-4242, (202) 336-5500, (800) 374-2721, http://www.apa.org .

Mental Health America, 2000 N. Beauregard St., 6th Fl., Alexandria, VA, 22311, (703) 684-7722, (800) 9696642, Fax: (703) 684-5968, http://www.mentalhealthamerica.net .

National Alliance on Mental Illness, 3803 N. Fairfax Dr., Ste. 100, Arlington, VA, 22203, (703) 524-7600, (800) 950-6264, Fax: (703) 524-9094, https://www.nami.org .