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PSY4408 > Module 6: Psychological Challenges of Older Adulthood > Flashcards

Module 6: Psychological Challenges of Older Adulthood Flashcards

1
Q

Primary or normal aging

A

o typical changes most people experience with increasing age (biological and physical deterioration).
o Most closely reflects chronological age

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2
Q

 Secondary or pathological aging

A

o encompasses changes that accrue with or are causally linked to disease and disability.
o often considered as time disabled as it reflects periods and changes where the person’s functioning is affected by disease or disability

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3
Q

 Tertiary or mortality-related aging

A

o accelerated functional deteriorations that manifest shortly (months, maybe years) before death.
o These tertiary changes are not so much correlated with age, but with impending death.

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4
Q

 Functional Age

A

what a person can do; age at which a particular level of skill is found

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5
Q

 Social age

A

what we expect a person to do

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6
Q

 The ‘third age’

A

refers to active and independent lifestyle in later life

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7
Q

 the ‘fourth age’

A

to a (final) period of dependence on others – represents negative elements of ageing

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8
Q

What do psychodynamic theories of aging propose/

A

internal processes play a crucial role in adult development.
E.g. Jung’s concept of individuation and Adler’s notion of inferiority

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9
Q

What is Erikson’s Stages of Psychosocial Development

A

o Ageing involves the developmental challenge of integrity vs despair.
o Reflection on life gives rise to recognition that one’s life had meaning, purpose and order (integrity) or was unproductive and meaningless (despair).

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10
Q

What is integrity, despair and wisdom (Erikson’s)?

A

o Integrity = acceptance of ones life.
o Despair = sense of failure/sadness
o Wisdom = the combined knowledge gained from previous psychosocial challenges faced throughout the lifespan

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11
Q

What is Schaie and Willis Stage Theory of Cognition?

A

o 7 stages representing adult cognitive development.
o Early stages based on Piaget’s stages and acquiring knowledge
o Middle age is characterised as the responsible phase – the mastery of cognitive skills to monitor your own behaviour and a sense of social responsibility
o Stages relevant to older adults include:
Re-organisation
 ages 60-65, reflecting a re-organisation of intellectual energies and meaningful pursuits after retirement.
Re-integration and legacy creation
 cognitive reintegration - people only seek information and apply knowledge that is meaningful or functional to them. Also involves planning for the future (e.g., funeral arrangements) and a life review (e.g., oral history, written memoirs).

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12
Q

What are the stages in Schaie and Willis relevant to old age?

A

o Re-organisation
 ages 60-65, reflecting a re-organisation of intellectual energies and meaningful pursuits after retirement.
o Re-integration and legacy creation
 cognitive reintegration - people only seek information and apply knowledge that is meaningful or functional to them. Also involves planning for the future (e.g., funeral arrangements) and a life review (e.g., oral history, written memoirs).

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13
Q

What is Levinson’s transition theory?

A

o view that major life transitions are influenced by ongoing physical, psychological and role-oriented changes.
o Aspects of the theory relating to old age are poorly developed, but generally seen as a period of declining power and autonomy.
 developmental phases into ‘eras’, and into ‘periods’ within these eras
 each period demands a successful completion of the previous one before the developmental sequence can continue.

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14
Q

What is the most important concept in Levinson’s theory

A

life structure.
• This is the basic pattern, the design, the fabric of a person’s life at a given time, within which both the self and society are interwoven. How the self is engaged in the world can be analysed by looking at the life structure.
• consists of three elements: the socio-cultural world and its impact on the individual, the self, and the self’s participation in the world.

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15
Q

What are the 4 eras in Levinson’s theory?

A 
•	childhood and adolescence (age 0-22)
•	early adulthood (17-45)
•	middle age, (40-65) 
o	mid life crisis happens here
•	late adulthood (60-plus). 
•	Potential fifth era: Late, late adulthood (60+)
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16
Q

What are Cohen’s Human Potential Stages?

A

 Liberation – characterised by a sense of needing to act, a time for engaging in innovative and new activities (aged 55-75).
 Summing-up – characterised by enhanced wisdom, search for meaning, wanting to give back/altruism (aged late 60’s – 90s).
 Encore – personal reflection, reaffirming and celebrating major themes in one’s life (aged late 70’s to end of life).

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17
Q

What is big C and little c?

A

Big c = creative achievement that could change the course of one’s community or culture
Little c = creative accomplishment that could change the life course for self or family

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18
Q

What is - Disengagement theory (Cumming and Henry).?

A

o Posits that older adults undergo a process of disengagement with society, both in terms of activity and relationships.
o As the individual becomes less engaged and more focused on their own situation, society also withdraws from them.
o Research has argued this theory is not that good and just generalized
o older people are released from social obligations and this allows them a new kind of licence.

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19
Q

What is Activity Theory (Havighurst)?

A

o Argues people best adjust to the changes of older life (e.g., retirement, illness, loss of friends) through keeping busy through voluntary and leisure activities (both intellectual and physical).

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20
Q

What is Continuity theory?

A

o States many of the core elements of a person (e.g., personality, values, roles, preferences, patterns of behaviour) are relatively stable throughout life, regardless of the changes one experiences.

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21
Q

What is Alzheimer’s Disease (AD)?

A

progressive neurodegenerative disorder that is characterised by memory impairment, cognitive deterioration, neuropsychiatric symptoms, and eventual functional decline

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22
Q

What is AD Pathologically characterized by ?

A

accumulation of amyloid plaques and intraneuronal neurofibrillary tangles, which are associated with neuronal dysfunction and eventual cell death.

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23
Q

what is - Mild cognitive impairment (MCI) ?

A

o used to describe changes that occur in any cognitive function (or across multiple functions) that are noticed by the individual or their loved one.
o The changes are not severe enough to warrant a diagnosis of dementia, yet the individual’s performance on cognitive assessments is beyond the normal range, typically 1.5 standard deviations beyond the mean
o Memory = amnestic MSI
o Cognitive but not memory = non-amnestic MSI

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24
Q

What is the biggest risk factor for AD

A

increasing age

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25
Q

What are the genetic risk factors for AD?

A

o amyloid precursor protein (APP)
o chromosome 21
o presenilin 1 (chrom 14) and 2 (chrom 1)
o apolipoprotein E at chrom 19

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26
Q

What is sporadic late-onset disease?

A

o The vast majority of AD patients have this
o complex etiology attributed to interactions between environmental risk factors and individual genetic susceptibilities.
o Twin studies have estimated the heritability of late-onset sporadic AD to be approximately 76 %.
o The most well-established genetic risk factor for late-onset AD is the apolipoprotein E gene (APOE) - e2, e3, and e4.

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27
Q

Impacted brain areas in AD:

A 
hippocampus
the frontal cortex
occipital cortex
precuneus
lateral parietal lobe.
28
Q

What are beta-amyloid plaques and neurofibrillary tangles ?

A
  • classic biological hallmarks of the disease.
  • Plaques form when specific proteins in the neuron’s cell membrane are processed differently.
  • Neurofibrillary tangles are made when a protein called tau is modified
29
Q

(3) Possible reasons why animal-based research fails in the context of AD ?

A

o a) the animal disease model does not align with the human disease adequately;
o b) the intervention may be effective but is not adequately translated to human use; and
o c) problems with human clinical trial design that contributes to negative findings (e.g., trial duration too short, patients with AD that is too advanced)

30
Q

What are the 3 phases of AD?

A

o The emerging signs of AD (failing memory, confusion, etc)
o Significant decline, which may be rapid, with intellectual and personality changes.
o Terminal phase (profound apathetic dementia, person is usually bedridden)

31
Q

What are 4 other cognitive changes in AD? What is aphasia, apraxia and agnosia?

A 
o	aphasia (i.e., problems with language such as word retrieval, inappropriate tense eventually leading to degraded speech and decreased fluency and possible loss of speech)
o	apraxia (i.e., difficulties with complex motor tasks), 
o	agnosia (i.e., inability to interpret sensory input), 
o	and declining executive function (e.g., losing the ability to plan, organise, and maintain attention)
32
Q

when is Neurodegeneration is estimated to start in AD ?

A

20–30 years before clinical onset.

33
Q
  • The core features of a neuropsychological assessment for AD will include:
A
  • Cognitive testing (mini mental state exam)
  • Memory test
  • Attention, processing speed and executive functions
  • Language
  • Mood and behaviour
  • blood tests
  • neuroimaging
34
Q

What are the medications for AD cognitive changes?

A

donepezil, rivastigmine, and galantamine

35
Q

what are 3 psychological treatments for AD?

A

o Reminiscence therapy
o Reality Orientation
o Behavioural therapy

36
Q

What is Parkinson’s Disease (PD)?

A
  • chronic, progressive disease affecting the central nervous system, particularly degeneration in the neurons of the region of the brain that controls movement.
  • People may also experience postural instability, speech problems, and impaired higher order cognitive difficulties.
37
Q

what is the strongest risk factor of PD?

A

increasing age

38
Q

what are the risk factors of PD?

A
  • age
  • gender (men more)
  • genetics (synuclein)
  • oxidative stress
  • location (rural)
  • environmental exposure (toxins, lead etc)
  • occupation (farmers, welders, teachers)
  • head injury (multiple, TBI)
39
Q

what are the Neurological Foundations of PD?

A
  • basal ganglia (collection of nuclei)
  • the substantia niagra,
  • connections between the substantia niagra and the corpus striatum.
  • dopamine reduction in basal ganglia
40
Q

what neurological pathways are impacted in PD?

A
  • direct movement initiation pathway

- indirect movement inhibition pathway

41
Q

what are 3 animal models emerging for PD?

A

o 1. Neurotoxins that target the dopamine system,
o 2. Manipulation of the α-synuclein protein, and
o 3. Genetic causes.

42
Q

What is the clinical presentation of PD?

A

o rest tumour
o bradykinesia
o rigidity
o postural instability and gait dysfunction

43
Q
  • What strategies can help with rehearsal and retrieval in PD?
A

o 1. Rehearsal (working mem) in Frontal circuits
 Semantic elaboration (e.g. make it a story)
 Make it personally salient
 Write it down (where it can be found later) – calendar, electronic reminders, daily list

o 3. Retrieval in frontal circuits
 Avoid noise or other distractions when concentrating
 Think of related information
 Refer back when needed

o	Daily memory skills:
	Cultivate organisation and routine
	Support visual spatial processing 
	Make important possessions visually distinct 
	Nightlife or reflector tapes
44
Q

Psych techniques to maximise thinking skills and modd in PD?

A 
	Memory techniques
	Physical exercise 
	Heart health 
	Relaxation
	Reduce medication
45
Q

older adults experiencing psychosis as belonging to one of three groups:

A

o 1. People with pre-existing schizophrenia,
o 2. Newly-diagnosed schizophrenia (sometimes termed late-life schizophrenia or late paraphrenia)
o 3. Hallucinations and delusions being produced due to another condition (e.g., dementia, delirium, mood disorders and paranoid personality disorder)

46
Q

Risk factors for psychosis in elderly?

A 
o	Female (2x as likely)
o	Poor social supports 
o	Organics risk factors 
o	 Substance withdrawal 
o	higher levels of adverse life events
o	impaired cognitive schemas
o	lower morale
47
Q
  • Organic vs functional psychosis:
A

o organic psychosis = psychosis linked to detectable physiological or structural changes. (e.g. from dementia and PD, TBI etc)
o functional psychosis = no physiological or structural change, and what we consider a purely psychiatric condition.

48
Q
  • What is delirium?
A

 An underpinning physical cause that creates a rapid onset of altered consciousness, disturbed cognition, perceptual abnormalities, and sleep disturbances.
 Hallucinations in 40-67% and delusions in 25-50% of delirium patients.

49
Q
  • The National Institute for Health and Care Excellent (NICE guidelines):
A

o Treatment is partnership
o Manage mental and physical health
o Aim for optimal social functioning
o Consider caregiver needs
o Prompt referral to mental health services
o Combined medication and psychological intervention

50
Q

What is Thanatology

A

scientific study of death, dying, grief, and loss

51
Q

what is grief

A

an individual’s subjective responses to loss.

52
Q

what is Disenfranchised grief

A

o Ken Doka
o grief that few people recognise and openly discuss.
o 4 types:
where death is stigmatised (suicide, HIV)
relationship is stigmatised (extramarital affair),
relationship is not seen as significant (pet, miscarriage),
non-death loses (mental illness, substance abuse)

53
Q

what is anticipatory grief?

A

o grief experienced in anticipation of eventual loss.

54
Q

what is complicated grief?

A

for some individuals the experience of grief can become debilitating and result in impairment in daily functioning.

55
Q

what is Developmental or maturational grief?

A

o grief over life transitions.

56
Q

Theories of grief - Psychoanalysts

A

mourning as a process of detaching from the lost person or object, which would then free the ego for new and healthy attachments.

57
Q

Theories of grief - Psychoanalysts:

Grief psychic rearrangement involved three elements

A

(1) freeing the bereaved from bondage to the deceased;
(2) readjustment to new life circumstances without the deceased;
(3) building of new relationships.

58
Q

Theories of grief: Stages of Grief Kubler-Ross

A

(denial, anger, bargaining, depression, and acceptance

Been disproving to not be a theory

59
Q

Theories of grief: The Dual Process Model of Grief

A

(Stroebe & Schut, 1999)
loss orientation’ the griever engages in emotion-focussed coping
‘restoration orientation’, the griever engages with problem-focussed coping

60
Q

Theories of grief: now

A
  • grief is active process

- grief work

61
Q
  • Most definitions of meaning encompass two concepts:
A

(1) making sense of the loss

(2) finding benefits from the loss

62
Q

“Persistent Complex Bereavement Disorder” (PCBD) diagnosis requires:

A

o at least one of four “separation distress” symptoms (yearning/longing, intense sorrow, preoccupation with the deceased, preoccupation with the circumstances of death),
o at least six out of 12 additional symptoms.
o 12 months

63
Q

how many individuals experience PCBD?

A

10%

64
Q
  • Ageism is defined as:
A

o 1. A set of beliefs originating in the biological variation between people and relating to the ageing process, and
o 2. The actions of corporations, what is said and done by their representatives, and the resulting views that are held by people

65
Q

two broad goals of the positive ageing perspective:

A
  1. promote successful ageing

2. Explore psychological constructs linked to ageing well.

66
Q
  • Components of Rowe and Kahn Model of positive ageing:
A

o Absence of disease/disability
o Engagement with life
o High cognitive and physical functioning

67
Q

Positive aging components (7)

A 
o	cognitive reserve
o	master
o	self-efficacy
o	wisdom (cognitive, affective, reflective)
o	resilience
o	spirituality
o	purposeful engagement/sense of purpose

PSY4408 (5 decks)

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