As we have seen, Alzheimer’s disease is a devastat­ing condition, not only to patients, but to those who care for them as well. To the extent we can design effective interventions for caregivers so that they acquire the necessary skills to provide quality care, society would benefit by delaying placement into nursing homes, keeping the costs of care as low as possible, and improving the quality of life.

To achieve these societal benefits, though, we must have solid research evidence that intervention programs work. Pillemer, Suitor, and Wethington (2003) point out that intervention programs need to be firmly based on a close link between theory and research. What is the evidence to date? Schulz and colleagues (2002) took a close look. They found that intervention programs for caregivers were socially effective, in that participants rated them as beneficial, helpful, or valuable. But policymakers look for something more: clinical significance. To date, the evidence on this front is that intervention
programs can reduce depressive symptoms, and to a lesser degree anxiety, anger, and hostility. The most impressive clinical effects have been demonstrated for delaying institutionalization. However, quality of life for caregivers tends not to improve in clini­cally significant ways.

From a social policy perspective, what these results mean is that caregiver intervention pro­grams are better at addressing specific, focused outcomes, such as the number and severity of depressive symptoms or when a patient is admit­ted to a nursing home, than they are at improving general quality of life. Thus policymakers are more likely to support, through direct appropriation and research funding, programs in these areas. Indeed, the White House Conference on Aging in 2005 had several such recommendations for future policy ac­tions because targeted intervention efforts have the potential to have far-reaching effects for promoting the mental health of caregivers and reducing the costs of care.

Summary

10.1 Mental Health and the Adult

Life Course

How are mental health and psychopathology

defined?

• Definitions of mental health must reflect appropriate age-related criteria.

• Behaviors must be interpreted in context. Mentally healthy people have positive attitudes, accurate perceptions, environmental mastery, autonomy, personality balance, and personal growth.

What key areas are included in a multidimensional approach to assessment?

• Considering key biological, psychological, sociocultural, and life-cycle factors is essential for accurate diagnosis of mental disorders.

• Diagnostic criteria must reflect age differences in symptomatology.

Why are ethnicity and aging important variables to consider in understanding mental health?

• Little research has been done to examine ethnic differences in the definition of mental health and psychopathology in older adults.

• There is some evidence of different incidence rates across groups.

10.2 Developmental Issues in Assessment and Therapy

What are the key dimensions used for categorizing psychopathology?

• Accurate assessment depends on measuring functioning across a spectrum of areas, including medical, psychological, and social.

What factors influence the assessment of adults?

• Negative and positive biases can influence the accuracy of assessment.

• The environmental conditions under which the assessment is made can influence its accuracy.

How are mental health issues assessed?

• Six assessment techniques are used most: interview, self-report, report by others, psychophysiological assessment, direct observation, and performance-based assessment.

What are some major considerations for therapy across adulthood?

• The two main approaches are medical therapy (usually involving drugs) and psychotherapy.

• With psychotherapy, clinicians must be sensitive to changes in the primary developmental issues faced by adults of different ages.

• Clear criteria have been established for determining “well established” and “probably efficacious” psychotherapies.

10.3 The Big Three: Depression, Delirium, and Dementia

What are the most common characteristics of people with depression? How is depression diagnosed? What causes depression? What is the relation between suicide and age? How is depression treated?

• Depression is the most common mental disorder in adults, but it declines in frequency with age. Gender and ethnic differences in rates have been noted.

• Common features of depression include dysphoria, apathy, self-deprecation, expressionlessness, changes in arousal, withdrawal, and several physical symptoms. In addition, the problems must last at least 2 weeks, not be caused by another disease, and negatively affect daily living. Clear age differences exist in the reporting of symptoms. Some assessment scales are not sensitive to age differences in symptoms.

• Possible biological causes of severe depression are neurotransmitter imbalance, abnormal brain functioning, or physical illness. Loss is the main psychosocial cause of depression. Internal belief systems also are important.

• Three families of drugs (SSRIs, HCAs, and MAO inhibitors), electroconvulsive therapy, and various forms of psychotherapy are all used to treat depression. Older adults benefit most from behavior and cognitive therapies.

What is delirium? How is it assessed and treated?

• Delirium is characterized by a disturbance of consciousness and a change in cognition that develop over a short period of time.

• Delirium can be caused by a number of medical conditions, medication side effects, substance intoxication or withdrawal, exposure to toxins, or any combination of factors. Older adults are especially susceptible to delirium.

• Most cases of delirium are cured, but some may be fatal.

What is dementia? What are the major symptoms of Alzheimer’s disease? How is it diagnosed? What causes it? What intervention options are there? What are some other major forms of dementia? What do family members caring for patients with dementia experience?

• Dementia is a family of disorders. Most older adults do not have dementia, but rates increase significantly with age.

• Alzheimer’s disease is a progressive, fatal disease that is diagnosed at autopsy through neurological changes that include neurofibrillary tangles and neuritic plaques.

• Major symptoms of Alzheimer’s disease include gradual and eventually pervasive memory loss, emotional changes, and eventual loss of motor functions.

• Diagnosis of Alzheimer’s disease consists of ruling out all other possible causes of the symptoms.

This involves thorough physical, neurological, and neuropsychological exams.

• Current research suggests that Alzheimer’s disease may be genetic, perhaps with an autosomal dominant inheritance pattern, although other hypotheses have been proposed.

• Although no cure for Alzheimer’s disease is available, interventions to relieve symptoms are advisable and possible, including various drug and behavioral interventions. Dealing with declining functioning is especially difficult. Respite and adult day care are two options for caregivers.

• Vascular dementia is caused by several small strokes. Changes in behavior depend on where in the brain the strokes occur.

• Characteristic symptoms of Parkinson’s disease include tremor and problems with walking. Treatment is done with drugs. Some people with Parkinson’s disease develop dementia.

• Huntington’s disease is a genetic disorder that usually begins in middle age with motor and behavioral problems.

• Alcoholic dementia (Wernicke-Korsakoff syndrome) is caused by a thiamine deficiency.

• AIDS dementia complex results from a by-product of HIV. Symptoms include a range of cognitive and motor impairments.

10.4 Other Mental Disorders and Concerns

What are the symptoms of anxiety disorders?

How are they treated?

• Anxiety disorders include panic, phobia, and obsessive-compulsive problems. Symptoms include a variety of physical changes that interfere with normal functioning. Context is important in understanding symptoms. Both drugs and psychotherapy are used to treat anxiety disorders.

What are the characteristics of people with psychotic disorders?

• Psychotic disorders involve personality disintegration and loss of touch with reality. One major form is schizophrenia; hallucinations and delusions are the primary symptoms.

• Schizophrenia is a severe thought disorder with an onset usually before age 45, but it can begin in late life. People with early-onset schizophrenia often improve over time as neurotransmitters become more balanced. Treatment usually consists of drugs; psychotherapy alone is not often effective.

What are the major issues involved with substance abuse?

• With the exception of alcohol, the substances most likely to be abused vary with age; younger adults are more likely to abuse illicit substances, whereas older adults are more likely to abuse prescription and over-the-counter medications.

• Alcohol dependency declines with age from its highest rates in young adulthood. Older adults take longer to withdraw, but similar therapies are effective in all age groups.

Review Questions

10.1 Mental Health and the Adult Life Course

• How do definitions of mental health vary with age?

• What are the implications of adopting a multidimensional model for interpreting and diagnosing mental disorders?

• Why are ethnicity and gender important considerations in understanding mental health?

10.2 Developmental Issues in Assessment and Therapy

• What is multidimensional assessment? How is it done?

• What major factors affect the accuracy of clinical assessment?

• How do the developmental forces influence assessment?

• What are the main developmental issues clinicians must consider in selecting therapy?

399

10.3 The Big Three: Depression, Delirium, and Dementia

• How does the rate of depression vary with age, gender, and ethnicity?

• What symptoms are associated with depression? How do they vary with age?

• What biological causes of depression have been proposed? How are they related to therapy?

• How is loss associated with depression?

• What treatments for depression have been developed? How well do they work with older adults?

• What is delirium? What causes it? Why are older adults more susceptible?

• What is Alzheimer’s disease? How is it diagnosed?

• What causes Alzheimer’s disease? What interventions are available?

• What other types of dementia have been identified? What are their characteristics?

10.4 Other Mental Disorders and Concerns

• What symptoms are associated with anxiety disorders? How are anxiety disorders treated?

• What are psychoses? What are their major symptoms? What treatments are most effective for schizophrenia?

• What developmental differences have been noted regarding substance abuse? How is alcohol dependency defined?

Integrating Concepts in Development

1. Why is it so difficult to diagnose mental disorders in older adults? What concepts from Chapters 3 and 4 provide major reasons?

2. Why do you think people with Alzheimer’s disease might experience hallucinations and delusions?

3. Why is there a connection between depression and dementia?

4. What would studying people with Alzheimer’s disease tell us about normal memory changes with age?

399 CHAPTER 10

Key Terms

Alzheimer’s disease An irreversible form of dementia characterized by progressive declines in cognitive and bodily functions, eventually resulting in death; it accounts for about 70% of all cases of dementia.

behavior therapy A type of psychotherapy that focuses on and attempts to alter current behavior. Underlying causes of the problem may not be addressed.

beta-amyloid A type of protein involved in the formation of neuritic plaques both in normal aging and in Alzheimer’s disease. cognitive therapy A type of psychotherapy aimed at altering the way people think as a cure for some forms of psychopathology, especially depression. delirium A disorder characterized by a disturbance of consciousness and a change in cognition that develop over a short period of time. dementia A family of diseases characterized by cognitive decline. Alzheimer’s disease is the most common form.

dysphoria Feeling down or blue, marked by extreme sadness; the major symptom of depression.

mental status exam A short screening test that assesses mental competence, usually used as a brief indicator of dementia or other serious cognitive impairment.

spaced retrieval A behavioral, implicit-internal memory intervention used in early- and middle-stage dementia.

sundowning The phenomenon in which people with Alzheimer’s disease show an increase in symptoms later in the day.

vascular dementia A form of dementia caused by a series of small strokes.

Resources

www. cengage. com/psychology/cavanaugh

Visit the companion website, where you will find tutorial quizzes, glossary, flashcards, and more. You can also access the following websites from the companion website.

The Alzheimer’s Association website has a wide range of information on the disease, including current research information, tips for caregivers, and links to local chapters.

The National Institute on Alcohol Abuse and Alcoholism website provides many useful summaries, data, and links to other good websites.

The National Institute of Mental Health has several useful sites regarding mental health in adults, and the National Institute on Aging has good sites specific to older adults. Both have helpful links to other organizations.

Readings

Mace, N. L., & Rabins, P. V. (2006). The 36-hour day: A family guide to caring for people with Alzheimer’s disease, other dementias, and memory loss in later
life (4th ed.). Baltimore: Johns Hopkins University Press. Still the best guidebook to caregiving for people with various forms of memory impairment. Easy reading.

Thompson, T. (1996). The beast: A journey through depression. New York: Penguin. A moving firsthand account of living with depression. Easy reading. Whitehouse, P. J., & George, D. (2008). The myth of Alzheimer’s: What you aren’t being told about todays most dreaded diagnosis. New York: St. Martin’s Press. Co-authored by one of the world’s leading experts on Alzheimer’s disease, this book challenges traditional views. Easy reading.

Zarit, S. H., & Zarit, J. M. (2006). Mental disorders in older adults (2nd ed.). New York: Guilford. A comprehensive overview of mental health issues in older adults. Easy to moderate difficulty.

Clinical Assessment

Mental Health, and

Mental Disorders