Geriatric psychology

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Geriatric psychology is a subfield of psychology that specializes in the mental and physical health of individuals in the later stages of life. These specialized psychologists study a variety of psychological abilities that deplete as aging occurs such as memory, learning capabilities, and coordination. Geriatric psychologists work with elderly clients to conduct the diagnosis, study, and treatment of certain mental illnesses in a variety of workplace settings. Common areas of practice include loneliness in old age, depression, dementia, Alzheimer's disease, vascular dementia, and Parkinson's disease.

Contents

Geriatric psychology vs. geriatric psychiatry

Geriatric psychology

Geriatric psychology is based upon the study of mental functions with aging. The psychologist's purpose is to observe how the neurological and physiological process of an elderly adult's brain affects their behaviors in daily life. When a psychologist is specialized in geriatrics, they provide care for declining brain functions to improve quality of life.

Geriatric psychiatry

Geriatric psychiatry is a subspecialty of psychiatry dealing with the research, diagnosis and treatment of mental disorders in the later stages of life. [1] [2] [3] The field composes of the diagnosis, treatment, and management of areas such as depression, dementia, and Alzheimer's disease. A geriatric psychiatrist is also a licensed doctor that can prescribe medications for elderly patients. Psychiatrists require extensive education and a degree from a medical school. [4]

Role of the geriatric psychologist

A geriatric psychologist specializes in the treatment of the elderly. This treatment can include mental health problems or aid in understanding and coping with the aging process. In order to become a geriatric psychologist, one must obtain a doctoral degree in psychology and specialize in adult development and aging. Once the degree is obtained, geriatric psychologists will usually work in hospitals, mental health clinics, rehabilitation centers, nursing homes, and research centers. The elder and health care workers would best benefit from the educational purposes of this article. The elder and health care workers would best benefit from the educational purposes of this article.

Geriatric psychologists spend most of their workday addressing mental health issues in older adults and counseling those that need it. They also aid in the diagnosis of age-related problems. In order to check for mental health issues, geriatric psychologists will conduct clinical interviews, neuropsychological tests, and behavioral observations. [5]

History

Geriatric psychology began in 1978 with a spike in interest in mental health and the effects of aging. There was a slow increase in the number of aging adults in the U.S. population. There was a small group of 11 people who met together to talk about late-life mental health needs and the field of geriatrics. This meeting later created the American Association of Geriatric Psychology (AAGP). As time has gone on the small group has turned into a very large group of people dedicated to the well being of the aging population. [6]

Common areas of practice

Loneliness in elderly people

Loneliness is an emotional response to the process of social isolation. It typically entails the feelings of anxiousness due to the lack of social connectedness or communication with others. Research has shown that loneliness has negative impacts on biological, cognitive and immune functioning. It is prevalent throughout all age groups from childhood to old age. The history of elderly loneliness is particular.

Nurses and other individuals who work in association with the elderly learn the various theories of loneliness, as they may need to implement these perspectives into enhancing the lives of their patients. They are particularly problematic in old age due to the changes an individual goes through such as decreasing economic stability and resources, changes in family structures, reduced social communication and the death of a relative or spouse. [7]

The most researched outcomes of loneliness are depression and cardiovascular health. Lonely individuals have found to have increased arterial stiffness, decreased blood circulation and associated with elevated blood pressure. [8]

Social isolation and feelings of loneliness are also major risk factors for poor cognitive and physical health. A poor sense of social connectedness has a negative impact on neural processing and cognitive abilities. A meta-analysis and systematic review of 16 studies found that initially dementia-free older adults had a significantly increased risk of developing dementia when experiencing extreme levels of loneliness. The study also concluded that loneliness led to lower cognitive abilities and a rapid decline in cognition. [9]

Interventions: Animal Companions

One study revealed that loneliness in elderly veterans with PTSD might find relief from loneliness when adopting a dog. [10] Two groups were established: those who adopted a dog right away, and those who adopted a dog after a 6-month delay. The Immediate Group demonstrated significantly less loneliness (p = .034) and the Delayed Group worsened, yet was not statistically significant of this change (p = .303). The difference between the two groups was statistically significant, however (p = .026). Overall, the veterans did indeed feel that the dogs were good companions. They found that having the dog led to more social interaction, such as taking the dog on walks leading to them having to walk outside and thus, interact with others

Animal assisted therapy (AAT) might also help alleviate loneliness in veterans with PTSD. [11] AAT involves having participants interact with animals as a form of therapy, such as playing with the animal, holding them, petting them, talking to them, etc. The researchers did in fact find that the residents experienced reduced feelings of loneliness after AAT, and many of them wished to have their own pets. Even the minimum 1-time-per-week sessions yielded significant reduction in loneliness.

Another study found pet ownership is correlated with lower levels of loneliness. [12] Researchers found that older adults who did own a pet were over a third less likely to feel lonely.

Depression

Depression in the elderly community can have severe consequences, which is why it is an important public health problem and research area. Older adults facing this debilitating condition are less likely to endorse affective symptoms and are more likely to instead display cognitive changes, somatic symptoms, and loss of interest than are younger adults. It is comorbid with "morbidity, increased risk of suicide, decreased physical, cognitive and social functioning, and greater self-neglect", all of which are associated with an increase in mortality. [13]

Risk factors

A common pathway to depression in older adults may consist of predisposing risks as well as the life changes experienced in old age. The development of late-life depression has several risk factors that likely compose of "cognitive diathesis, age-associated neurobiological changes, genetic vulnerabilities, and stressful life events".

Insomnia is often an overlooked factor in late-life depression. Impacts of sleep deprivation are reduced glucose tolerance, elevated evening cortisol levels, and increased sympathetic nervous system activity. Sleep quality at an old age is just as important as sleep duration to avoid lack of sleep. Research shows that feelings of loneliness and depression can result in poor sleep quality and daytime dysfunctions. These daytime impairments include physical and intellectual fatigue, irritability, and low cognitive abilities. [14]

Dementia

Dementia is a variety of symptoms that apply to a decline in mental ability, not a specific disease. There are a variety of different symptoms that affect one's behavior as well as their memory and thought processes. These impairments make it hard to carry out day-to-day activities. They also give way to emotional problems as well as decreased motivation for living. Due to dementia not being a disorder of consciousness, a person's conscious is not usually affected. Geriatric psychologists work with dementia by aiding in the diagnosis of this disease. This is done through various cognitive tests and assessments. They will also look at research and potential treatment for dementia. [15]

Alzheimer's disease

Alzheimer's disease is the most common type of dementia, accounting for 60-80 percent of dementia cases. The effects of Alzheimer's are subtle at first but worsen as time passes. A common early symptom relates to difficulty recalling events of the recent past. Numerous symptoms arise as the disease progresses. These symptoms include: speech problems, disoriented states, issues with mood, lack of motivation, etc. Similar to dementia, a geriatric psychologist's role regarding Alzheimer's disease is the assessment, treatment, and research of the disease. [16] Similarly, enrichment gardens may prove beneficial as mentioned before with other forms of dementia. However, there is currently no known cure for the disease. [17]

Vascular dementia

Vascular dementia, the second most common type of dementia, is the result of a stroke. [18] Often times, it is difficult to differentiate between various types of dementia due to overlying symptoms and pathology. Ultimately, vascular dementia is the result of difficulties involved in blood supply to the brain. A geriatric psychologist aids in the assessment, diagnosing, treatment, and research of vascular dementia. [19] Non-pharmacological interventions have been researched as well. A meta-analysis on this topic found that non-pharmacological interventions had the most statistically significant outcomes when used complementarily to conventional treatments. Methods involving acupuncture tended to yield the most significant results in the studies analyzed. This could be due to acupuncture's potential ability to support synaptic plasticity, myelin integrity, and more. [20]

Parkinson's disease

Parkinson's disease is a movement disorder that has symptoms like tremors, slowed movement, stiffness, and impaired balance. It primarily affects the motor system, which supports motor functions used for movement. As the disease advances, it is common for individuals to experience dementia that is specifically associated with Parkinson's disease. Those who suffer from this disease can also experience issues with sensory systems. A geriatric psychologist's role for those with Parkinson's disease would be helping the person diagnosed deal with the stress they may encounter regarding Parkinson's disease. Since it is not a brain disorder, the geriatric psychologist would not help with diagnosing or the treatment of the disease. [21] Research has been conducted to evaluate the effectiveness of exercise in helping those with Parkinson's disease. One study found that there is potential in improving gait, balance, and strength. [22] However, research is limited and researchers are unsure about the full potential of exercise as a form of intervention. Results from the study about improving fall risk is unclear.

See also

Related Research Articles

<span class="mw-page-title-main">Dementia</span> Long-term brain disorders causing impaired memory, thinking and behavior

Dementia is a syndrome associated with many neurodegenerative diseases, characterized by a general decline in cognitive abilities that affects a person's ability to perform everyday activities. This typically involves problems with memory, thinking, behavior, and motor control. Aside from memory impairment and a disruption in thought patterns, the most common symptoms of dementia include emotional problems, difficulties with language, and decreased motivation. The symptoms may be described as occurring in a continuum over several stages. Dementia ultimately has a significant effect on the individual, their caregivers, and their social relationships in general. A diagnosis of dementia requires the observation of a change from a person's usual mental functioning and a greater cognitive decline than might be caused by the normal aging process.

Delirium is a specific state of acute confusion attributable to the direct physiological consequence of a medical condition, effects of a psychoactive substance, or multiple causes, which usually develops over the course of hours to days. As a syndrome, delirium presents with disturbances in attention, awareness, and higher-order cognition. People with delirium may experience other neuropsychiatric disturbances including changes in psychomotor activity, disrupted sleep-wake cycle, emotional disturbances, disturbances of consciousness, or, altered state of consciousness, as well as perceptual disturbances, although these features are not required for diagnosis.

<span class="mw-page-title-main">Dementia with Lewy bodies</span> Type of progressive dementia

Dementia with Lewy bodies (DLB) is a type of dementia characterized by changes in sleep, behavior, cognition, movement, and regulation of automatic bodily functions. Memory loss is not always an early symptom. The disease worsens over time and is usually diagnosed when cognitive impairment interferes with normal daily functioning. Together with Parkinson's disease dementia, DLB is one of the two Lewy body dementias. It is a common form of dementia, but the prevalence is not known accurately and many diagnoses are missed. The disease was first described on autopsy by Kenji Kosaka in 1976, and he named the condition several years later.

Cognitive disorders (CDs), also known as neurocognitive disorders (NCDs), are a category of mental health disorders that primarily affect cognitive abilities including learning, memory, perception, and problem-solving. Neurocognitive disorders include delirium, mild neurocognitive disorders, and major neurocognitive disorder. They are defined by deficits in cognitive ability that are acquired, typically represent decline, and may have an underlying brain pathology. The DSM-5 defines six key domains of cognitive function: executive function, learning and memory, perceptual-motor function, language, complex attention, and social cognition.

The mini–mental state examination (MMSE) or Folstein test is a 30-point questionnaire that is used extensively in clinical and research settings to measure cognitive impairment. It is commonly used in medicine and allied health to screen for dementia. It is also used to estimate the severity and progression of cognitive impairment and to follow the course of cognitive changes in an individual over time; thus making it an effective way to document an individual's response to treatment. The MMSE's purpose has been not, on its own, to provide a diagnosis for any particular nosological entity.

Memory disorders are the result of damage to neuroanatomical structures that hinders the storage, retention and recollection of memories. Memory disorders can be progressive, including Alzheimer's disease, or they can be immediate including disorders resulting from head injury.

Cognitive impairment is an inclusive term to describe any characteristic that acts as a barrier to the cognition process or different areas of cognition. Cognition, also known as cognitive function, refers to the mental processes of how a person gains knowledge, uses existing knowledge, and understands things that are happening around them using their thoughts and senses. Cognitive impairment can be in different domains or aspects of a person's cognitive function including memory, attention span, planning, reasoning, decision-making, language, executive functioning, and visuospatial functioning. The term cognitive impairment covers many different diseases and conditions and may also be symptom or manifestation of a different underlying condition. Examples include impairments in overall intelligence, specific and restricted impairments in cognitive abilities, neuropsychological impairments, or it may describe drug-induced impairment in cognition and memory. Cognitive impairments may be short-term, progressive, or permanent.

Mild cognitive impairment (MCI) is a diagnosis that reflects an intermediate stage of cognitive impairment that is often, but not always, a transitional phase from cognitive changes in normal aging to those typically found in dementia, especially dementia due to Alzheimer's disease. MCI may include both memory and non-memory neurocognitive impairments. About 50 percent of people diagnosed with MCI have Alzheimer's disease and go on to develop Alzheimer's dementia within five years. MCI can also serve as an early indicator for other types of dementia, although MCI may also remain stable or remit. Many definitions of MCI exist. A common feature of many of these is that MCI involves cognitive impairments that are measurable but that are not significant enough to interfere with instrumental activities of daily living.

The prevention of dementia involves reducing the number of risk factors for the development of dementia, and is a global health priority needing a global response. Initiatives include the establishment of the International Research Network on Dementia Prevention (IRNDP) which aims to link researchers in this field globally, and the establishment of the Global Dementia Observatory a web-based data knowledge and exchange platform, which will collate and disseminate key dementia data from members states. Although there is no cure for dementia, it is well established that modifiable risk factors influence both the likelihood of developing dementia and the age at which it is developed. Dementia can be prevented by reducing the risk factors for vascular disease such as diabetes, high blood pressure, obesity, smoking, physical inactivity and depression. A study concluded that more than a third of dementia cases are theoretically preventable. Among older adults both an unfavorable lifestyle and high genetic risk are independently associated with higher dementia risk. A favorable lifestyle is associated with a lower dementia risk, regardless of genetic risk. In 2020, a study identified 12 modifiable lifestyle factors, and the early treatment of acquired hearing loss was estimated as the most significant of these factors, potentially preventing up to 9% of dementia cases.

Adult development encompasses the changes that occur in biological and psychological domains of human life from the end of adolescence until the end of one's life. Changes occur at the cellular level and are partially explained by biological theories of adult development and aging. Biological changes influence psychological and interpersonal/social developmental changes, which are often described by stage theories of human development. Stage theories typically focus on "age-appropriate" developmental tasks to be achieved at each stage. Erik Erikson and Carl Jung proposed stage theories of human development that encompass the entire life span, and emphasized the potential for positive change very late in life.

Geriatric psychiatry, also known as geropsychiatry, psychogeriatrics or psychiatry of old age, is a branch of medicine and a subspecialty of psychiatry dealing with the study, prevention, and treatment of neurodegenerative, cognitive impairment, and mental disorders in people of old age. Geriatric psychiatry as a subspecialty has significant overlap with the specialties of geriatric medicine, behavioural neurology, neuropsychiatry, neurology, and general psychiatry. Geriatric psychiatry has become an official subspecialty of psychiatry with a defined curriculum of study and core competencies.

<span class="mw-page-title-main">Reminiscence therapy</span> Intervention technique with brain-injured patients

Reminiscence therapy is used to counsel and support older people, and is an intervention technique with brain-injured patients and those who appear to have "Alzheimer's and other forms of cognitive disease."

Pseudodementia is a condition that leads to cognitive and functional impairment imitating dementia that is secondary to psychiatric disorders, especially depression. Pseudodementia can develop in a wide range of neuropsychiatric disease such as depression, schizophrenia and other psychosis, mania, dissociative disorders, and conversion disorders. The presentations of pseudodementia may mimic organic dementia, but are essentially reversible on treatment and doesn't lead to actual brain degeneration. However, it has been found that some of the cognitive symptoms associated with pseudodementia can persist as residual symptoms and even transform into true neurodegenerative dementia in some cases.

<span class="mw-page-title-main">Alzheimer's disease</span> Progressive neurodegenerative disease

Alzheimer's disease (AD) is a neurodegenerative disease that usually starts slowly and progressively worsens. It is the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in remembering recent events. As the disease advances, symptoms can include problems with language, disorientation, mood swings, loss of motivation, self-neglect, and behavioral issues. As a person's condition declines, they often withdraw from family and society. Gradually, bodily functions are lost, ultimately leading to death. Although the speed of progression can vary, the average life expectancy following diagnosis is three to twelve years.

Sundowning, or sundown syndrome, is a neurological phenomenon wherein people with delirium or some form of dementia experience increased confusion and restlessness beginning in the late afternoon and early evening. It is most commonly associated with Alzheimer's disease but is also found in those with other forms of dementia. The term sundowning was coined by nurse Lois K. Evans in 1987 due to the association between the person's increased confusion and the setting of the sun.

Late-life depression refers to depression occurring in older adults and has diverse presentations, including as a recurrence of early-onset depression, a new diagnosis of late-onset depression, and a mood disorder resulting from a separate medical condition, substance use, or medication regimen. Research regarding late-life depression often focuses on late-onset depression, which is defined as a major depressive episode occurring for the first time in an older person.

Perminder Sachdev is an Indian neuropsychiatrist based in Australia. He is a professor of neuropsychiatry at the University of New South Wales (UNSW), co-director of the UNSW Centre for Healthy Brain Aging, and clinical director of the Neuropsychiatric Institute at the Prince of Wales Hospital, Sydney. He is considered a trailblazer in the field of neuropsychiatry. Sachdev's research interests include ageing, vascular cognitive disorders such as vascular dementia, and psychiatric disorders.

The American Association for Geriatric Psychiatry is a learned society of professionals aiming to improve the quality of life for the elderly population, promote a healthy aging process, and a greater awareness of geriatric mental health issues.

<span class="mw-page-title-main">Early onset dementia</span> Cognitive disorder

Early onset dementia or young onset dementia refers to dementia with symptom onset prior to age 65. This condition is a significant public health concern, as the number of individuals with early onset dementia is increasing worldwide.

<span class="mw-page-title-main">Clive Ballard</span> British researcher

Clive Ballard is a British, world-leading expert in dementia. He is currently Professor of Age-Related Diseases at the University of Exeter and Interim Deputy Pro-Vice-Chancellor and Dean of the University of Exeter Medical School.

References

  1. ↑ Barraclough, J.; Gill, D. (1996). Hughes' outline of modern psychiatry. (4th ed.) New York: John Wiley & Sons. ISBN   978-0-471-96358-5
  2. ↑ Bowden, V.M.; Long, M.J. (1995). "Geriatric psychiatry". Journal of the American Medical Association. 273: 1395. doi:10.1001/jama.1995.03520410091040.
  3. ↑ Harkins, S. (16 April 2003). "Glossary of Terms". Retrieved 2019-04-01.
  4. ↑ "Psychiatry vs. Psychology: What's the Difference?". www.careerprofiles.info. Retrieved 2019-04-01.
  5. ↑ "Geriatric Psychology: Career Options, Job Duties and Requirements". Study.com. Retrieved 2019-04-01.
  6. ↑ "History". www.aagponline.org. Retrieved 2016-12-12.
  7. ↑ Singh, A.; Misra, N. (2009). "Loneliness, depression, and sociability in old age". Industrial Psychiatry Journal. 18 (1): 51–5. doi: 10.4103/0972-6748.57861 . PMC   3016701 . PMID   21234164.
  8. ↑ Hawkley, L. C., & Cacioppo, J. T. (2013). Social connectedness and health. Human bonding: The science of affectional ties, 343-364.
  9. ↑ Harrington, Karra D; Vasan, Shradha; Kang, Jee eun; Sliwinski, Martin J; Lim, Michelle H (2023). "Loneliness and cognitive function in older adults without dementia: A systematic review and meta-analysis". Journal of Alzheimer's Disease. 91 (4): 1243–1259. doi:10.3233/JAD-220832. ISSN   1387-2877. PMC   9983432 . PMID   36617781.
  10. ↑ Adler, Rachel H.; Straud, Casey L.; Peterson, Alan L.; Jeffreys, Matthew D.; Finley, Erin P.; Beaver, Bonnie V.; Copeland, Laurel A.; Young-McCaughan, Stacey; Seawell, Mistie D.; Bridgeman, Courtney H.; Hamilton, Alison; Mata-Galan, Emma L.; Allegretti, Ana Luiza C.; Lara-Ruiz, Jose M.; Allison, Sybil (2024-02-08). "The effect of companion dog adoption on loneliness in veterans with posttraumatic stress disorder: An exploratory study". Traumatology. doi:10.1037/trm0000494. ISSN   1085-9373.
  11. ↑ Banks, M. R.; Banks, W. A. (2002-07-01). "The Effects of Animal-Assisted Therapy on Loneliness in an Elderly Population in Long-Term Care Facilities". The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 57 (7): M428–M432. doi:10.1093/gerona/57.7.M428. ISSN   1079-5006.
  12. ↑ Stanley, Ian H.; Conwell, Yeates; Bowen, Connie; Van Orden, Kimberly A. (2014-04-03). "Pet ownership may attenuate loneliness among older adult primary care patients who live alone". Aging & Mental Health. 18 (3): 394–399. doi:10.1080/13607863.2013.837147. ISSN   1360-7863. PMC   3944143 . PMID   24047314.
  13. ↑ Fiske, Amy; Wetherell, Julie Loebach; Gatz, Margaret (2009-01-01). "Depression in Older Adults". Annual Review of Clinical Psychology. 5: 363–389. doi:10.1146/annurev.clinpsy.032408.153621. ISSN   1548-5943. PMC   2852580 . PMID   19327033.
  14. ↑ Dunietz, G. L., Swanson, L. M., Jansen, E. C., Chervin, R. D., O’Brien, L. M., Lisabeth, L. D., & Braley, T. J. (2018). Key insomnia symptoms and incident pain in older adults: direct and mediated pathways through depression and anxiety. Sleep, 41(9), zsy125.
  15. ↑ "Dementia – Signs, Symptoms, Causes, Tests, Treatment, Care | alz.org". www.alz.org. Retrieved 2016-12-12.
  16. ↑ "Alzheimer's Disease & Dementia | Alzheimer's Association". www.alz.org. Retrieved 2016-12-12.
  17. ↑ Bourdon, Etienne; Belmin, Joël (December 2021). "Enriched gardens improve cognition and independence of nursing home residents with dementia: a pilot controlled trial". Alzheimer's Research & Therapy. 13 (1). doi: 10.1186/s13195-021-00849-w . ISSN   1758-9193. PMID   34134758.
  18. ↑ Kuźma, Elżbieta; Lourida, Ilianna; Moore, Sarah F.; Levine, Deborah A.; Ukoumunne, Obioha C.; Llewellyn, David J. (August 2018). "Stroke and dementia risk: A systematic review and meta-analysis". Alzheimer's & Dementia. 14 (11): 1416–1426. doi:10.1016/j.jalz.2018.06.3061. hdl:2027.42/152961. ISSN   1552-5260. PMC   6231970 . PMID   30177276.
  19. ↑ "Vascular Dementia | Signs, Symptoms, & Diagnosis". www.alz.org. Retrieved 2016-12-12.
  20. ↑ Yi, Yunhao; Qu, Yiwei; Lv, Shimeng; Zhang, Guangheng; Rong, Yuanhang; Li, Ming (2024-07-12). "Comparative efficacy and safety of non-pharmacological interventions as adjunctive treatment for vascular dementia: a systematic review and network meta-analysis". Frontiers in Neurology. 15. doi: 10.3389/fneur.2024.1397088 . ISSN   1664-2295.
  21. ↑ "NINDS | Parkinson's Disease Information Page". www.ninds.nih.gov. Archived from the original on 2016-12-02. Retrieved 2016-12-12.
  22. ↑ Goodwin, Victoria A.; Richards, Suzanne H.; Taylor, Rod S.; Taylor, Adrian H.; Campbell, John L. (2008-04-15). "The effectiveness of exercise interventions for people with Parkinson's disease: A systematic review and meta-analysis". Movement Disorders. 23 (5): 631–640. doi:10.1002/mds.21922. hdl:11250/2494500. ISSN   0885-3185. PMID   18181210.
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