Personality disorder in older adults: Assessment challenges and strategies.

Might some older persons experienced as difficult by their health care providers be exhibiting signs of maladaptive personality functioning? Personality disorder may be a more significant problem among treatment-seeking older adults than was previously believed. Psychologists seeking to assess personality disorder must confront several challenges, including their own beliefs regarding personality and aging, criteria sets of uncertain validity for the older persons, and the limitations of current assessment tools. Empirically informed assessment of personality disorder in older adults may be enhanced by reviewing evidence regarding the prevalence, associated demographic and clinical features, and natural history of personality pathology across the life span. This review also describes how assessing personality disorder in older adults poses unique diagnostic difficulties and proposes practical strategies for evaluating this challenging client group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of depression in low-income older adults.

The purpose of this study was to compare cognitive-behavioral group therapy (CBGT), clinical case management (CCM), and their combination (CBGT + CCM) to treat depression in low-income older adults (60+). Sixty-seven participants with major depressive disorder or dysthymia were randomly assigned and entered into 1 of the 3 treatment conditions for 6 months. They were followed for 18 months after treatment initiation on depression and functional outcomes. CCM and CBGT + CCM led to greater improvements in depressive symptoms than CBGT, but CBGT led to greater improvements in physical functioning. All 3 conditions resulted in similar reduction of needs. Findings suggest that disadvantaged older adults with depression benefit from increased access to social services either alone or combined with psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional complexity in younger, midlife, and older adults.

Questions pertaining to emotional complexity in adult development are being pursued from a number of vantage points. The current studies sought to clarify the study of emotional complexity by comparing and contrasting 2 dominant perspectives on emotional complexity in different age groups (i.e., covariation and absolute-level approaches). Results indicate that emotional complexity is a multifaceted construct and that methodology will impact substantive findings and developmental trends that emerge from the data. Recommendations and considerations for future research are discussed, including, for example, within- versus cross-domain ideas of emotional complexity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral interventions with older adults: Integrating clinical and gerontological research.

Psychotherapeutic interventions utilizing cognitive-behavioral strategies have been used widely with older adults. To appropriately adapt these techniques, characteristics unique to older adults must be taken into account. These factors include aspects of the social environment, cohort effects, cognitive changes with aging, personality, and emotional development, which have been described in an emerging body of research literature from the field of gerontology. In addition, clinical studies have examined the efficacy of cognitive-behavioral interventions in treating older clients for anxiety, depression, insomnia, and other disorders. This review describes current empirical evidence in gerontology and treatment outcome research that informs the practice of psychotherapy in this population and provides recommendations for conducting therapy with older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive consequences of expressive regulation in older adults.

Previous research has suggested that older and young adults are equally able to regulate their outward expressions of emotion and that the regulation of emotional expression in younger adults results in decreased memory for the emotional stimulus. In the current study, we examined whether older adults show this same memory effect. Older and young adults viewed positive and negative emotional pictures under instructions to view the pictures naturally, enhance their facial expressions, or suppress their facial expressions. Older and young adults showed equivalent outward regulation of expression, but suppressing their emotional expressions led to reduced memory for emotional stimuli only in the young adults. The results suggest that older and young adults are achieving control of their expressions through different mechanisms or strategies. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The treatment of depression in older adults in the primary care setting: An evidence-based review.

The objective of this study was to conduct an evidence-based review of treatments for depression in older adults in the primary care setting. A literature search was conducted using PsycINFO and Medline to identify relevant, English language studies published from January 1994 to April 2004 with samples aged 55 and older. Studies were required to be randomized controlled trials that compared psychosocial interventions conducted within the primary care setting with "usual care" conditions. Eight studies with older adult samples met inclusion criteria and were included in the review. Two treatment models were evident: Geriatric Evaluation Management (GEM) clinics and an approach labeled integrated health care models. Support was found for each model, with improvement in depressive symptoms and better outcomes than usual care; however, findings varied by depression severity, and interventions were difficult to compare. Further efforts to improve research and clinical care of depression in the primary care setting for older adults are needed. The authors recommend the use of interdisciplinary teams and more implementation of psychosocial treatments shown to be effective for older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pain assessment and management in older adults: Conceptual issues and clinical challenges.

This article reviews clinical pain assessment and psychological pain management in older persons through the lens of a Communications Model of Pain (Craig, in press; Hadjistavropoulos & Craig, 2002; Hadjistavropoulos, Craig, & Fuchs-Lacelle, 2004; Prkachin & Craig, 1995). The Communications Model of Pain has the advantage of drawing attention to a variety of important factors that come into play when selecting assessment instruments and when making decisions concerning intervention. The authors examine a variety of assessment methodologies (including both self-report and observational approaches) that are suitable for older persons with and without dementia. The authors also review psychosocial pain management methods (e.g., cognitive behavior therapy and applications of behavioral approaches within long-term care facilities) that have potential applications with older persons. The role of psychological service providers is emphasized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Aging and symptoms of anxiety and depression: Structural invariance of the tripartite model.

Negative affect measures were evaluated in a cross-sectional community sample of adults aged 18-93 (N = 335) to examine the structure of neuroticism, anxiety, and depressive symptoms in young, middle, and older adult cohorts. Structural equation modeling was used to contrast 3 nested models: a 1-factor general distress model; a 2-factor high negative-low positive affect model; and a 3-factor "tripartite model" reflecting a higher order Negative Affect factor that is common to depression and anxiety problems and 2 lower order factors, Low Positive Affect (mostly specific to depression) and Arousal (specific to anxiety/panic). As expected, the tripartite model fit best for all age groups. Further, multigroup analyses indicated age invariance for the tripartite model, suggesting the model can be effectively applied with older populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The association of anxiety and depressive symptoms with cognitive performance in community-dwelling older adults.

The authors examined the association of anxiety, depressive symptoms, and their co-occurrence on cognitive processes in 102 community-dwelling older adults. Participants completed anxiety and depression questionnaires as well as measures of episodic and semantic memory, word fluency, processing speed/shifting attention, and inhibition. Participants with only increased anxiety had poorer processing speed/shifting attention and inhibition, but depressive symptoms alone were not associated with any cognitive deficits. Although coexisting anxiety and depressive symptoms were associated with deficits in 3 cognitive domains, reductions in inhibition were solely attributed to anxiety. Findings suggest an excess cognitive load on inhibitory ability in normal older adults reporting mild anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impairment in risk-sensitive decision-making in older suicide attempters with depression.

Suicidal behavior is a potentially lethal complication of late-life depression. In younger adults, suicide has been linked to abnormal decision-making ability. Given that there are substantial age-related decreases in decision-making ability, and that older adults experience environmental stressors that require effective decision-making, we reasoned that impaired decision-making may be particularly relevant to suicidal behavior in the elderly. We thus compared performance on a probabilistic decision-making task that does not involve working memory (“Cambridge Gamble Task”) in four groups of older adults: (1) individuals with major depression and a history of suicide attempt (n = 25), (2) individuals with major depression with active suicidal ideation but no suicide attempt (n = 13), (3) individuals with major depression without suicidality (n = 35), and (4) nondepressed control subjects (n = 22). There was a significant effect of group on quality of decision-making, whereby the suicide attempters exhibited poorer ability to choose the likely outcome, compared with the nonsuicidal depressed and nondepressed comparison subjects. There were no group differences in betting behavior. The suicide attempters differed in several aspects of social problem-solving on a self-report scale. Quality of decision-making was negatively correlated with the score on the impulsive/careless problem-solving subscale. These data suggest that older suicide attempters have a deficit in risk-sensitive decision-making, extending observations in younger adults. More specifically, older suicide attempters seem to neglect outcome probability and make poor choices. These impairments may precipitate and perpetuate suicidal crisis in depressed elders. Identification of decision-making impairment in suicidal elders may help with designing effective interventions. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Growth trajectories of exercise self-efficacy in older adults: Influence of measures and initial status.

Objective: This study examined differential trajectories of exercise-related self-efficacy beliefs across a 12-month randomized controlled exercise trial. Method: Previously inactive older adults (N = 144; M age = 66.5) were randomly assigned to one of two exercise conditions (walking, flexibility-toning-balance) and completed measures of barriers self-efficacy (BARSE), exercise self-efficacy (EXSE), and self-efficacy for walking (SEW) across a 12-month period. Changes in efficacy were examined according to efficacy type and interindividual differences. Latent growth curve modeling was employed to (a) examine average levels and change in each type of efficacy for the collapsed sample and by intervention condition and (b) explore subpopulations (i.e., latent classes) within the sample that differ in their baseline efficacy and trajectory. Results: Analyses revealed two negative trends in BARSE and EXSE at predicted transition points, in addition to a positive linear trend in SEW. Two subgroups with unique baseline efficacy and trajectory profiles were also identified. Conclusion: These results shed new light on the relationship between exercise and self-efficacy in older adults. They also highlight the need for strategies for increasing and maintaining efficacy within interventions, namely targeting participants who start with a disadvantage (lower efficacy) and integrating efficacy-boosting strategies for all participants prior to program end. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differentiating anxiety and depression in older adults with generalized anxiety disorder.

To examine affect and cognition in differentiating anxiety and depression, 83 older participants with generalized anxiety disorder completed the Cognitive Checklist (CCL) and the Positive and Negative Affect Schedule (PANAS). A 3-factor solution was found for the PANAS: positive affect (PA), anxiety and anger (Negative Affect 1 [NA-1]), and guilt and shame (Negative Affect 2 [NA-2]). A 2-factor structure was noted for the CCL. Correlations with anxiety and depression measures suggested that the CCL Depression (CCL-D) subscale showed stronger correlations with depression, whereas the CCL Anxiety subscale did not uniquely correlate with anxiety. The NA-1 subscale correlated positively with measures of depression and anxiety, whereas the PA subscale showed negative correlations. Hierarchical regression suggested that the CCL-D subscale was a significant predictor of self-reported depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social relationships, social support, and patterns of cognitive aging in healthy, high-functioning older adults: MacArthur Studies of Successful Aging.

This study examines the relationship of social ties and support to patterns of cognitive aging in the MacArthur Studies of Successful Aging (see L. F. Berkman et al., 1993), a cohort study of 1,189 initially high-functioning older adults. Baseline and longitudinal data provide information on initial levels as well as changes in cognitive performance over a 7.5-year period. Linear regression analyses revealed that participants receiving more emotional support had better baseline performance, as did those who were unmarried and those reporting greater conflict with network members. Greater baseline emotional support was also a significant predictor of better cognitive function at the 7.5-year follow-up, controlling for baseline cognitive function and known sociodemographic, behavioral, psychological, and health status predictors of cognitive aging. The findings suggest the potential value of further research on the role of the social environment in protecting against cognitive declines at older ages. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of working with older adults in an Australian psychologist sample: Revisiting the influence of contact.

Despite increasing numbers of older people in most global populations and increasing evidence of the efficacy of psychological therapy in older clinical populations, few psychologists work with older clients as compared with other clinical groups. In the present research, the authors examine potential influences on psychologists choosing to specialize in working in the field of aging. The authors surveyed 1,498 psychologists Australia-wide to examine which factors exerted the most influence on choosing to specialize in clinical work with older clients. Clinical exposure to older clients and age-related course content within training programs, together with further education external to formal training, were significantly correlated with specializing in aged care. Holding a more negative attitude toward one's own aging was another predictor of specialist category membership, with interest in working with older clients also being a significant factor based on direct logistic regression analysis. In contrast to previous work, amount or quality of contact with older persons did not appear to relate to working with older adults. These findings highlight the importance of quality training experiences in influencing attitudes toward working with older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Visual search for change in older adults.

Previous research has demonstrated that younger adults are surprisingly poor at detecting substantial changes to visual scenes. Little is known, however, about age differences in this phenomenon. In the 2 experiments reported here, older adults were slower than younger adults in detecting changes to simple visual stimuli. This age difference was beyond what would be expected given known age-related changes in processing speed. Examination of eye movement behavior during the search for change suggested that age-related changes in the useful field of view and degree of cautiousness play a significant role. Speed of processing and 3 age-related eye movement behaviors explained 85% of the variance in change detection latency, eliminating the effect of age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contextual interference effects in sequence learning for young and older adults.

Practice of different tasks in a random order induces better retention than practicing them in a blocked order, a phenomenon known as the contextual interference (CI) effect. Our purpose was to investigate whether the CI effect exists in sequence learning, such that practicing different sequences in a random order will result in better learning of sequences than practicing them in blocks, and whether this effect is affected by aging. Subjects practiced a serial reaction time task where a set of three 4-element sequences were arranged in blocks or in a random order on 2 successive days. Subjects were divided into 4 groups based on a 2-GROUP (young or old) by 2-ORDER (random or blocked practice) between-subject design. Three days after practice (Day 5), subjects were tested with practiced and novel sequences to evaluate sequence-specific learning. The results replicate the CI effect in sequence learning in both young and older adults. Older adults retained sequences better when trained in a random condition than in a blocked condition, although the random condition incurs greater task switching costs in older adults during practice. Our study underscores the distinction between age-related effects on learning vs. performance, and offers practical implications for enhancing skill learning in older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Serum uric acid and cognitive function in community-dwelling older adults.

Among possible markers of age-related cognitive decline, uric acid (UA) is controversial because it has antioxidant properties but is increased in diseases that often lead to cognitive impairment. In this study of 96 elderly adults, participants with mildly elevated (but normal) serum UA were 2.7 to 5.9 times more likely to score in the lowest quartile of the sample on measures of processing speed, verbal memory, and working memory. Even after controlling for age, sex, race, education, diabetes, hypertension, smoking, and alcohol abuse, the multivariate-adjusted odds of poor verbal memory and working memory remained significant (ps     

Context processing in older adults: Evidence for a theory relating cognitive control to neurobiology in healthy aging.

A theory of cognitive aging is presented in which healthy older adults are hypothesized to suffer from disturbances in the processing of context that impair cognitive control function across multiple domains, including attention, inhibition, and working memory. These cognitive disturbances are postulated to be directly related to age-related decline in the function of the dopamine (DA) system in the prefrontal cortex (PFC). A connectionist computational model is described that implements specific mechanisms for the role of DA and PFC in context processing. The behavioral predictions of the model were tested in a large sample of older (N = 81) and young (N = 175) adults performing variants of a simple cognitive control task that placed differential demands on context processing. Older adults exhibited both performance decrements and, counterintuitively, performance improvements that are in close agreement with model predictions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment and management of pain in the older adult.

Objective: To discuss the unique issues related to pain in older adults and to outline methods for assessment and treatment of geriatric pain. Synthesis: A model for pain assessment and treatment in the older adult is presented. Existing data indicate that cognitive-behavioral treatments are effective for pain management in older adults, although modification in treatment procedures may be needed to optimize treatment outcome. Conclusion: Geriatric pain is an understudied and undertreated problem. Multidisciplinary assessment and treatment should focus on pain reduction, relieving emotional distress, and improving function, with the ultimate goal of reducing disability and improving quality of life. Severe, disabling pain is not part of normal aging and should be assessed and treated. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Verbosity and emotion recognition in older adults.

Previous research suggests that older adults are more verbose than young adults and that general inhibitory difficulties might play a role in such tendencies. In the present study of 60 young adults and 61 older adults, the authors examined whether verbosity might also be related to difficulty deciphering emotional expressions. Measures of verbosity included total talking time, percentage of time spent on-topic, and extremity of off-topic verbosity. Over all 3 measures, older men and women were significantly more verbose than young men and women. Older men's (but not older women's) verbosity was related to poorer emotion recognition, which fully mediated the age effect. The results are consistent with the idea that older men who talk more do so, in part, because they fail to decipher the emotional cues of a listener. (PsycINFO Database Record (c) 2010 APA, all rights reserved)