HOW IS PSYCHOPATHOLOGY
ASSESSED
IN
OLDER
ADULTS?
American Psychological Association
Table of Contents
Why Practitioners Need Information
- Since geriatric and subclinical variants of some of the major psychological disorders exist, comparing the individual's particular scores on a continuum with the relative performance of the older age group (e.g., dimensional analysis) is preferable to the use of strict cutoffs (e.g., categorical analysis).
- No widely used self-report measures of anxiety have been specifically developed for older adults. The Beck Anxiety Scale is brief and easily administered, but results should be viewed with caution in the assessment of frail and less educated older adults.
- A variety of good screening measures exists for depression (e.g., Hamilton Depression Rating Scale, Beck Depression Inventory). The Geriatric Depression Scale (GDS) was specifically developed for older adults. The GDS is useful because it (1) has age-related norms; (2) can be administered in oral and written form, thus allowing for more accurate assessment of persons with mild cognitive impairment; and (3) omits somatic items that can elevate depression scores for clients who may be manifesting somatic symptoms associated with medical problems and not depression.
- The CAGE and Michigan Alcoholism Screening Test-Geriatric Version are instruments that have demonstrated potential as alcohol screening tools with older adults.
- Broad-based measures of psychopathology that have been normed on older people are available. The MMPI-2 is a widely used self-report instrument that was normed on persons up to 84 years of age. However, in view of its length and required reading level, it may not be practical for very old, less educated, or visually or cognitively impaired adults. The Brief Psychiatric Rating Scale is a clinician-rated scale encompassing primary domains of psychopathology and has been found to be useful with older adults.
- Assessment of personality features can be important in planning treatment strategies. Unfortunately, there are no measures of personality disorder (PD) specifically developed for use with older adults. Current structured PD scales are lengthy, and their routine use with older adults is impractical.
- The Rorschach Inkblot Test should only be used with caution in assessing the personality or disordered thinking of older adults. Age-related norms have not been established for the widely used Exner system, and psychopathology can easily be overdiagnosed by inexperienced examiners testing older adults who are not comfortable with unstructured tasks.
- The Thematic Apperception Test has been used extensively with older adults in research studies and clinical settings. It yields geriatric themes with the same frequency as the Senior Apperception Test and Gerontological Apperception Test. Information from these measures is sometimes useful in identifying life issues that need to be addressed in psychotherapeutic interventions.
THE GERIATRIC DEPRESSION SCALE (GDS) WAS
SPECIFICALLY DEVELOPED FOR OLDER ADULTS. THE GDS IS USEFUL BECAUSE IT...
- - Has age-related norms
- - Can be administered
in oral and written form, thus allowing for more accurate assessment of
persons with mild cognitive impairment
- - Omits somatic items that can elevate depression scores for clients who may be manifesting somatic symptoms associated with medical problems and not depression