III. Mental Health and Aging

COGNITIVE AGING & MENTAL HEALTH Dr. M. C. Sengstock SOC 5760 – Society & Aging

1

MENTAL CAPACITY IN OLD AGE “Intelligence” • Theoretical Limit of an Individual’s Mental Performance • 3 Dimensions: – 1. Content of Knowledge – 2. Operations an Individual Performs Using Knowledge – 3. Products Derived from These Operations

PRIMARY MENTAL ABILITIES Mathematical Reasoning Verbal Meaning Inductive Reasoning Spatial Orientation (Includes “Fluid Intelligence”) Crystallized Intelligence (Includes “Social Judgment”)

CLASSIC MENTAL AGING PROCESS • • • • • •

Based on WAIS: “Wechsler Adult Intelligence Scale” Measures Performance Decline On 11 Sub-Tests After Age 65: 6 Verbal Scales 5 Performance Scales

FACTORS AFFECTING INTELLIGENCE AFTER 65 Chronological Age Physical Health Cohort Differences Structural Changes in the Brain Educational Attainment Sensory Loss Nutritional Deficits Psychological Challenges

LEARNING & MEMORY PROCESSES Primary Memory: Temporary State: Holding & Organizing Information Secondary Memory: 2nd Stage: Information Is Retained Permanently Older People: More Likely to Have Problems With Short Term Memory

PROBLEMS TESTING OLDER ADULTS • Research on Mental Capacity Done on Comparisons With Younger People … • Primarily Students (Easy to Recruit) • Puts Older Adults at a Disadvantage … • Students Used to Taking Tests & Motivated • Older Adults NOT Used to Taking Tests • NOT Motivated to Take Tests!

FACTORS AFFECTING LEARNING & MEMORY FOR OLDER ADULTS • • • • • • •

Lighting Levels – Font Size – Time Constraints Older Adults’ Learning Can Be More Effective: Increase Font Size & Lighting Levels Reduce Time Constraints Make Learning Tasks More Relevant Test More Frequently Provide Comfortable, Relaxed Environment

IMPROVING COGNITIVE ABILITIES IN OLD AGE: “USE IT OR LOSE IT!” • Retraining; Keeping Mind Active – Play Bridge; Line Dancing; Puzzles

• Mnemonics, Verbal Riddles, Codes – Mental Codes to Remember & Learn New Information

• External Aids: – Keep Lists; “To Do” Reminders

• Ginkgo biloba: – Disputed Claims to Improve Brain Circulation, Dementia – Side Effects: Bleeding, G-I Problems; Dizziness

MENTAL DISORDERS AMONG OLDER ADULTS Depression Suicide Alcoholism Drug Abuse Parkinson’s Disease Dementias (Various)

DEPRESSION Primary Emotional Disorder of Old Age Can Lead To Suicide Symptoms Can Be Confused With: • Normal Aging • Losses Associated With Old Age: – Death of Family, Friends – Loss of Valued Home & Other Items

SUICIDE • Older Adults At Greater Risk Than Any Other Age Group • 17% - 25% of Completed Suicides Are 65+ • 2003 Rate Per 100,000: – 11.0 For General Population – 13.5 For 65+ – 18.0% for 85+ – More Prevalent Among Men

PARKINSON’S DISEASE • Neuro-Degenerative Disorder • Begins With Loss of Muscle Control, Tremors in Feet & Hands • Slow & Limited Movement • Can Manifest Dementia-Like Symptoms

ALCOHOLISM & DRUG ABUSE • ALCOHOLISM: • Addiction to Alcohol Less Likely in Persons 60+ • Elderly Alcoholics Were Usually Alcoholics Since Middle Age • DRUG ABUSE: Deliberate or Accidental? • Older Persons Use Disproportionally Large Number of Prescription & OTC Drugs • About 30% of Prescription Drug Expenditures • Many Unneeded/No Longer Needed

DEMENTIA IN OLD AGE • • • •

Damage To Brain Tissue Results in Impaired Cognitive Functioning Inability to Recall Events in Recent Memory Problems With Attention Span, Comprehension, Judgment • Disoriented Re Time, Place, Person • Affects 2-7 Million People 65+ – 75-79: 12%;

85-89: 54%;

90+: 84%

• Some May Be Reversible – Due to Poor Nutrition, Brain Tumors, Alcohol, etc.

2 TYPES OF DEMENTIA IN OLD AGE Long-Term Disorders: • Exhibit No Significant Change With Old Age Aged-Onset Mental Disorders: • Originate With Old Age

AGED ONSET MENTAL DISORDERS MULTI-INFARCT (STROKES) • Tissue Death Due to Loss of Blood Flow • Sudden Onset ALZHEIMER’S DISEASE • Apparently Due to Structural Changes in Brain • Most Common Irreversible Dementia in Later Life (45-55% of Late Life Dementias)

ALZHEIMER’S DISEASE Impairments from Alzheimer’s Disease • Intellect (Understanding, Conceptualization) • Judgment (Evaluating, Making Decisions) • Orientation (To Time, Place, Situation) – Urinating in Public; Inappropriate Clothing

• Affect (Lack of Control of Emotions) – Aggression; Behavior Control; Wrong Emotions at Wrong Time

• Sensory-Motor Loss – Impaired Speech, Walking, Bowel/Bladder Control

• Enormous Stress for Family

COMPARATIVE MEMORY LOSS NORMAL FORGETTING ALZHEIMER’S FORGETTING Forget Person’s Name Not Remembering Person When Reminded Forget to Set Alarm Clock

Forgetting HOW to Set Alarm Clock

Forget Where You Parked the Car

Forget Where You Are & How You Got There

GENDER & MENTAL DISORDERS • Men Have More Late Life, Non-Organic Mental Disorders Than Women • But Women Are Seen More Often By Mental Health Professionals • WHY? • Men Are Used to Having Control Over Lives • Men More Disturbed By Lack of Control • Men More Reluctant to Accept Help

MENTAL HEALTH TREATMENTS IN OLD AGE PSYCHOTHERAPY: • Seldom Used With Aged • Why? Aged More Resistant to Psychotherapy? • Psychotherapists’ Reluctance to Treating the Aged?

MENTAL HEALTH TREATMENTS IN OLD AGE MEDICATION: Problems Using Psychotropic Drugs with Aged: • Drugs Tested on Young: Aged Impact Unknown • Aged Have Multiple Drugs  Interactions • Aged Often Over-Medicated for Management • Medicalization of the Social (Wanderers) • Medications Can CAUSE Problems for Elderly – Stupor, Dizziness, Forgetting, Falls

SEXUAL BEHAVIOR IN OLDER ADULTS • Major Issue: Should Elderly Participate in Sex? • People Believed the Old Should Not Have Sex – Sex Was for Procreation  They Couldn’t Do That – Frequent Opposition from Adult Children

• In 1950s & 60s: Nursing Homes Prevented !t! – Considered Sex Among The Old Inappropriate – Had “Male” & “Female” Wings – Prevented Visits Between Wings – Wouldn’t Let Married Couples Share a Room

THE REALITY OF SEX IN OLD AGE • • • •

Sex: More Than Intercourse & Orgasms Also Expression of Feelings: Affection, Loyalty Affirmation of One’s Body & Its Functioning Sex Is: Biological, Emotional, Intellectual, Spiritual, Behavioral, Sociocultural • Research Shows Older Adults Continue Their Interest in Sex • Myths About Sex & Elderly Continue

IMPACTS ON SEXUAL BEHAVIOR IN OLD AGE • • • •

Physiological Changes (Body Can’t Act Same) Physical Fitness Physical/Social Environment (Living Changes) Individual Personal Sexual History, SelfConcept, Self-Esteem • Psychological Meaning Attached to Previous Experience

MYTHS RE SEXUAL ACTIVITY IN OLDER ADULTS Due to Age-Related Physiological Changes … • Older Adults Cannot Engage in Sexual Activity • Older Women Cannot Have Orgasms • Older Men Cannot Achieve An Erection • Age Eliminates Sexual Functioning/Fulfillment • Elderly Have Less Need for Being Touched

REALITIES RE SEXUAL ACTIVITY IN OLDER ADULTS • • • •

Sexual Behavior Fairly Stable Through Life Frequency of Sex Doesn’t Differ By Age It Does Take Longer to Achieve Orgasms Sexual Dysfunction Main Barrier to Sexual Activity – Not Lack of Desire • A Gentle Touch Can Provide Support • Some Nursing Homes Still Take Pains to Keep Male & Female Residents Separate

AGE-RELATED PHYSIOLOGICAL CHANGES: WOMEN • • • • • • •

Most Changes Related to Menopause Concern Re Using HRT-Hormone Replacement Slower Response to Sexual Stimulation Reduction in Vaginal Elasticity, Lubrication Pre-Orgasmic Plateau Phase Longer Fewer, Less Orgasmic Contractions Rapid Return to Pre-Arousal State Post Orgasm

AGE-RELATED PHYSIOLOGICAL CHANGES: MEN • • • •

Erection May Require More Direct Stimulation Erection Slower, Less Full, Disappears Quickly Orgasm More Rapid, Less Intense Longer Period Between Orgasm & Subsequent Erections • Occasional Lack of Orgasm During Intercourse • More Seepage or Retrograde Ejaculation Is Experienced • Impact of Viagra

PSYCHOSOCIAL FACTORS AFFECTING SEXUAL ACTIVITY • • • • • • •

Past History of Sexual Activity Attitudes Toward Non-Intercourse Activities Reactions to Illness or Physiological Changes Availability of Partner (Esp. for Women) Performance Anxiety (Widowed Syndrome) Opportunities for Privacy Societal Attitudes – Particularly Toward Those in Institutions

SUMMARY AGING BRINGS CHANGE IN: Mental Processes, Mental Health, Sexual Activity However, Change Is a Matter of Degree Absent Dramatic Physiological Change … Normally Results in Slow Decline Most Elderly Physically, Mentally Competent Capable of Engaging in All Types of Activities, Including Sex, Until Quite Late in Life