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The stats on # elderly
• Increased 10-fold in last century
• Currently– 35 million > 65– 13% population
• By 2030– 70 million– 1/5 Americans > 65– 1/11 > 85
More stats
• Gender (percentage women)– > 65 58%– > 85 70%
• Ethnicity– Will be more diverse
• Currently 85% white• By 2050, 64%
Ex. EricksonStage Age Basic ConflictOral-Sensory Birth-12/18mo. Trust v. Mistrust
Muscular-anal 18 mo – 3 yrs Autonomy v. shame/doubt
Locomotor 3-6 yrs Initiative vs. guilt
Latency 6-12 yrs Industry vs. inferiority
Adolescence 12-18yrs Identity vs. role confusion
Young Adulthood 19-40 yrs Intimacy vs. isolation
Middle Adulthood 40-65 yrs Generativity vs. stagnation
Maturity 65-death Ego Integrity vs. despair
Stage 8: Maturity
• Age: Late Adulthood -- 65 years to death
• Conflict: Integrity vs. Despair
• Important Event: Reflection on and acceptance of one's life
Stage 8: Maturity
• Elements for a positive outcome:The adult feels a sense of fulfillment about life and accepts death as an unavoidable reality.
• Elements for a negative outcome:Individuals who are unable to obtain a feeling of fulfillment and completeness will despair and fear death.
Other development approaches• Psychodynamic
– Formation versus elaboration of psychic processes
• Levinson1
– Structure building and changing– Periods of transition
1 Levinson, D. (1986). A conception of adult development. American Psychologist, 41:3-13.
What do the elderly worry about?
0
5
10
15
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35
40
45
Money Health Loneliness Crime
National Council On Aging, 2000
Finances
• 65+: – net worth = $92,399
• White = $181,000• African American = $13,000
– annual household income = $22,812
Living situations
• Among 65+ – 80% own home
• 75% single unit/detached
– 45% live alone– 17% elderly householder had no
transportation
Physical Health
• Self perception
• Survey of Americans age 65 (1996-96)– vast majority considered themselves healthy.
• Whites: 74%• AA’s: 59.3 %• Hispanics 64.9%
The 3 big killers
• Heart disease
• Cancer
• Stroke
• Mortality rates– Hrt Dx/Stroke: decr 1/3 since 1980– Cancer: up slightly
Effects of Aging on the Body
• Bottom line – Most of the news is bad.
• The question– How much is inevitable?
Examples of things we can’t change
• Ocular accommodation
• Cardiac hypertrophy
• GI: malabsorption/intolerances
• Loss of immunity/allergies
• Loss of brain volume
Examples of things we can change somewhat
• Loss of skin elasticity
• Auditory acuity
• Cardiac loss of elasticity
Examples of things we can change a lot
• Muscle Mass, Muscle/Fat Ratio
• Osteoporosis
• Functional Cognition
21.6
51.3
20.6
6.5
15.7
42
25.9
16.4
0
10
20
30
40
50
60
SMI Non-SMI
Prevalence of SMI over age 18 (2.8%)
18-24
25-44
45-64
65+
Why Rates in Elderly are Low?
• Greater difficulty remembering past symptoms• Less psychologically oriented• Greater mortality• Cohort effect • Sampling errors• Instrument errors• Diagnostic challenges
Elderly Specific Criteria?
Diagnostic Criteria
Major Depression
Prevalence
AGECAT 11.4
DSM-IV 4.5
Age 65+ Edmonton CanadaNewman et al. Psychological Medicine 28; 1998
Psychosis in the Elderly
• Negative versus positive symptoms
• Look for alternative causes– Esp. if NEW ONSET or no history
• Most common:– MEDS– ACUTE problems: infections, metabolic.
» Tumors, etc. less common
Depression in the Elderly
• Why so low? (see earlier…)
• Forme Frustres
• “Pseudodementia”
• Diagnosing depression in complex cases– How to approach…
Anxiety Disorders
• Primary Versus Secondary– Common Secondary Causes
• Drugs• Medical Illness (cardiac, respiratory)• Disorders that confuse (dementia, delirium)
Problems in Dementia Prevalence Studies• Size of sample• Sample composition• Age range• Proportion of very old• Education• Method for case identification• Content of Interview• Supplementary diagnostic information• Diagnostic criteria (NINCDS-ADRDA v DSM)• Prevalence Estimate
Age Specific Prevalence
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5
10
15
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25
30
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40
45
60-64 65-69 70-74 75-79 80-84 85-89 90-95
Jorms (1987)
Stages of Dementia
• Depend on both– Cognitive ability
• Testing
– Functional Ability• Observe, ask.
One-Year Prevalence of Mental Disorders in Nursing Homes Estimates from ECA
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2
4
6
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10
12
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18
Schiz Mania Dep OCD Panic
All
65+
NH
Differences in the Psych. Interview in the elderly
• Use of multiple sources
• Respect for confidentiality, but…
• Relaxing of boundary issues
• Focus of interview– Symptoms versus stories
• Explanations and honesty
• The power of genuine interest
Other things you can do
• Don’t smoke• Low-fat, high-fiber diet• Exercised vigorously for AT LEAST 30 min
ALMOST EVERY day• Maintained a healthy weight• Consume a moderate amount of alcohol (about
one drink per day).
• All 5 = 80% reduction in heart attack/stroke risk – Which then also helps cognition Primary prevention of coronary heart disease in
women through diet and lifestyle. M. Stampfer, et al., The New England Journal of Medicine, 2000, vol. 343, pp. 16--22