Aging and Mental Health

Daniel L. Segal, Sara Honn Qualls, Michael A. Smyer

• Publisher: Wiley-Blackwell
• Year: 2017
• ISBN:
  9781119133155
• Edition: 3
• Topic: Psychology
• Subtopic: Developmental Psychology
• Index: Psychology

Fully updated and revised, this new edition of a highly successful text provides students, clinicians, and academics with a thorough introduction to aging and mental health.

The third edition of Aging and Mental Health is filled with new updates and features, including the impact of the DSM-5 on diagnosis and treatment of older adults. Like its predecessors, it uses case examples to introduce readers to the field of aging and mental health. It also provides both a synopsis of basic gerontology needed for clinical work with older adults and an analysis of several facets of aging well.

Introductory chapters are followed by a series of chapters that describe the major theoretical models used to understand mental health and mental disorders among older adults. Following entries are devoted to the major forms of mental disorders in later life, with a focus on diagnosis, assessment, and treatment issues. Finally, the book focuses on the settings and contexts of professional mental health practice and on emerging policy issues that affect research and practice. This combination of theory and practice helps readers conceptualize mental health problems in later life and negotiate the complex decisions involved with the assessment and treatment of those problems.

• Features new material on important topics including positive mental health, hoarding disorder, chronic pain, housing, caregiving, and ethical and legal concerns
• Substantially revised and updated throughout, including reference to the DSM-5
• Offers chapter-end recommendations of websites for further information
• Includes discussion questions and critical thinking questions at the end of each chapter

Aging and Mental Health, Third Edition is an ideal text for advanced undergraduate and graduate students in psychology, for service providers in psychology, psychiatry, social work, and counseling, and for clinicians who are experienced mental health service providers but who have not had much experience working specifically with older adults and their families.

Part I
Introduction

1
Mental Health and Aging
An Introduction

Consider the following case description:

Grace, director of a Senior Center in your area, calls you about Mr. Tucker. Although Mr. Tucker used to come to the center three or four times a week, he hasn’t come at all since the death of his good friend, Ed, four months ago. Grace had called Mr. Tucker at home to say how much he’d been missed. When she asked if he wasn’t coming because he was still upset over Ed’s death, he denied it. Instead, Mr. Tucker said that he wanted to return to the center, but he was in terrible pain. In fact, he was in so much pain that he really couldn’t talk on the phone and he abruptly hung up. Grace was worried that Mr. Tucker might not be getting the medical attention that he really needed. She asked you to make a home visit, which you agreed to do. You call Mr. Tucker and set up an appointment.

As you prepare to visit Mr. Tucker, what are the basic questions you might ask about him and his situation? Which factors do you think are important to explore with Mr. Tucker? How would you assess Mr. Tucker’s functioning?

Your answer to these simple inquiries reflects your implicit model of mental health and aging. In this book, especially in Part II, we will illustrate several different conceptual models of mental disorders and aging. In doing so, we will emphasize the links between one’s starting assumptions and one’s subsequent strategies for assessment and intervention. You will come to see that your philosophical assumptions about mental health, mental disorder, and aging shape the interpretive process of working with older adults and their families.

Mr. Tucker’s current functioning raises a basic question: Is his behavior simply part of normal aging or does it represent a problem that requires professional attention? Our answer represents implicit and explicit assumptions regarding the continuum of functioning that runs from outstanding functioning through usual aging to pathological patterns of behavior.

What Is Normal Aging?

The starting point for mental health and aging must be a general understanding of gerontology, the multidisciplinary study of normal aging, and geriatrics, the study of the medical aspects of old age and the prevention and treatment of the diseases of aging. In Mr. Tucker’s case, we want to know if his reaction is a part of a normal grieving process or an indication of an underlying mental health disorder (e.g., a mood disorder, such as major depressive disorder). To answer this requires a starting definition of normal aging.

A conceptual definition

Discussions of this issue focus attention on three different patterns of aging: normal or usual aging, optimal or successful aging, and pathological aging. Baltes and Baltes (1990) provided classic definitions of normal and optimal aging:

Normal aging refers to aging without biological or mental pathology. It thus concerns the aging process that is dominant within a society for persons who are not suffering from a manifest illness. Optimal aging refers to a kind of utopia, namely, aging under development‐enhancing and age‐friendly environmental conditions. Finally, sick or pathological aging characterizes an aging process determined by medical etiology and syndromes of illness. A classical example is dementia of the Alzheimer type. (pp. 7–8)

Schaie (2016) provides a somewhat different conceptual perspective of the possible trajectories of aging, distinguishing four major patterns. Normal aging is the most common pattern, characterized by individuals maintaining a plateau of psychological functioning through their late 50s and early 60s and then showing modest declines in cognitive functioning through their early 80s, with more dramatic deterioration in the years before death. In contrast, successful agers are characterized by being genetically and socioeconomically advantaged, and maintaining overall cognitive vitality until right before their death. As described by Schaie, “These are the fortunate individuals whose active life expectancy comes very close to their actual life expectancy” (p. 5). The third pattern includes those who develop mild cognitive impairment. Individuals in this group experience declines in cognitive functioning that are more severe than is typical. Some, but not all, in this group progress to having more substantial cognitive problems. Finally, the fourth pattern is those who develop dementia, in which individuals experience severe, dramatic, and diagnosable forms of cognitive impairments. (We fully discuss the dementias and neurocognitive disorders in Chapter 8).

A statistical definition

Distinguishing between normal aging and optimal aging requires us to sort out statistical fact from theoretically desirable conditions. For example, the Baltes and Baltes definition suggests that normal aging does not include “manifest illness.” However, in the United States today, chronic disease is typical of the experience of aging: More than 25% of all adults and 66% of older Americans have multiple chronic conditions. This is an expensive issue: More than two‐thirds of all health care costs in the US are for treating chronic illnesses. For older adults specifically, 95% of health care costs are for chronic diseases (Centers for Disease Control and Prevention, 2013).

Let’s look at a specific condition: arthritis. Current estimates indicate that 22.7% of adults in the US reported having doctor‐diagnosed arthritis, including 49.7% of people 65 years old and older (Barbour et al., 2013). Moreover, among the oldest old groups (75+ or 85+) there are substantially higher rates. Thus, from a statistical perspective, arthritis is certainly modal, and may be considered a part of normal aging. We will return to this theme in Chapter 2.

A functional definition

Another approach to defining normal aging arises from defining “manifest illness.” By focusing not on presence or absence of a chronic disease, such as arthritis, but on the impact of that disease, we may get another depiction of “normal aging.” Here, again, though, the definition of terms can affect our conclusions regarding normal aging.

Consider the prevalence of disability among older adults. Functional disability could be considered one indicator of manifest illness among older adults. So far, so good. However, how shall we define functional disability? The answer may determine our conclusion about what is or is not normal for later life. Again, Mr. Tucker’s situation may help us clarify the issues:

When you get to Mr. Tucker’s house, you find an apathetic, listless, very thin man of 81. He seems to be isolated socially, having few friends and even fewer family members in the area. (He never married and he has no living siblings.) Although he seems physically able to cook, he says that he hasn’t been eating (or sleeping) regularly for quite a while—and he doesn’t care if he never does again.

Is Mr. Tucker functionally disabled? If so, is this normal for someone of his age? According to the US Census Bureau, most persons aged 75 years old and older have a disability: 54% of those 75–79 years old had any type of disability with 38% having a “severe disability” (Brault, 2012). In contrast, Manton, Gu, and Lamb (2006) reported that 78% of the 75–84 age group was “non‐disabled.” How could such differing pictures of older adults emerge?

The answer lies in the definition of disability. The Census Bureau focuses on difficulty with functional activity for its specific definition of disability. The range of functional activities is somewhat broader than traditional definitions: lifting and carrying a weight as heavy as 10 pounds, walking three city blocks, seeing the words and letters in ordinary newsprint, hearing what is said in normal conversation with another person, having one’s speech understood, and climbing a flight of stairs. In contrast, Manton et al. (2006) focused on activities of daily living (ADLs; e.g., taking care of basic hygiene, eating, getting dressed, using a toilet) and instrumental activities of daily living (IADLs; e.g., managing money, doing the laundry; preparing meals; shopping for groceries).

Not surprisingly, these different...