OTHER PROBLEMS ASOCIATED WITH AGE
American Psychological Association
Table of Contents
Why Practitioners Need Information
- Adjustment Disorder. The most common stressor that leads to adjustment disorder in later life is physical illness. Other stressors which often precipitate adjustment disorders among older adults are those associated with late-life losses, e.g., relocation, retirement, financial problems, family problems, and lengthy hospitalization.
- Personality Disorders (PDs). Most PDs, particularly those in Cluster B (i.e., Borderline, Narcissistic, Histrionic, and Antisocial) decline in frequency and intensity with age. However, PD presentation may take a modified form, and these "geriatric variants" are associated with difficulties in medical management and psychotherapeutic treatment. For example, the antisocial behavior of older adults may not be manifested in ways that lead to incarceration as with some younger persons with sociopathy, but may be exhibited as selfish, impulsive behavior towards community caregivers, resulting in abandonment of the older adults.
- Bereavement. Most older adults experience the loss of loved ones including spouses, other family members, and friends. While bereavement is a normal reaction to loss, pathological grief may develop. Symptoms of pathological grief among older adults are essentially the same as those for younger adults and include extensive guilt and preoccupation with death, a pervasive sense of worthlessness, marked psychomotor retardation, and functional impairment. The length of time spent in grieving is culturally determined and is also a function of resources of the individual and the circumstances of the death. In the United States, grief usually requires about 2 years for completion, with a great deal of variation around this average.
- Elder Abuse. Some older adults are vulnerable to mistreatment by spouses, adult children, grandchildren, and caregivers. Elder abuse is much more likely to occur when the older person is experiencing physical, emotional, or cognitive problems. In a recent study, about 3 percent of community residing older adults reported being abused, including physical abuse, neglect, and chronic verbal aggression. This figure probably underestimates the problem because older adults are less likely to report domestic abuse. Sexual abuse is the most underreported form of abuse among older adults.
Because medical practitioners may overlook signs of physical abuse (e.g., bruises or other injuries) or assume they are because of falls, it is important for the mental health professional to question the cause of physical injuries. Most reports involve abuse committed by one spouse against another, sometimes in retaliation for lifelong patterns of abuse. This type of abuse is followed in frequency by an adult child abusing a parent. In comparison to younger individuals, older husbands are abused twice as often as older wives, and the abusers usually are dependent on the person they abuse. Patients with Alzheimer's Disease and other dementing disorders are at greater risk for elder abuse. Late onset spousal abuse is related to substance abuse and psychopathology of both the abused and the abuser. Elder abuse occurs at all economic levels and among all age groups in later adulthood. When abuse occurs in the home, reporting is mandatory in many states by health care, social service, or other professionals who become aware of it. All states require reporting when abuse occurs in an institution. Psychologists working with older adults should be knowledgeable about applicable state laws on reporting elder abuse.
- Age-Related Cognitive Decline. DSM-IV now lists this category (coded 780.9) under "Other Conditions That May Be a Focus of Clinical Attention." It refers to an objectively identified decline in cognitive functioning consequent to the aging process that is within normal limits given the person's age, and it is not attributable to a specific mental disorder or neurological condition.
