Mental Disorders in Older Adults Fundamentals of Assessment and Treatment

by Zarit, Steven H.; Zarit, Judy M.

• ISBN13: 9781572303683
• ISBN10: 1572303689
• Edition: 1st
• Format: Hardcover
• Copyright: 1998-08-07
• Publisher: The Guilford Press

Summary

This volume presents the foundational knowledge and skills that mental health practitioners need to meet the growing needs of our aging population. Thorough coverage is provided of normal aging processes and their effects on intellectual functioning, memory, personality, and other areas. Common psychological problems are discussed, and a comprehensive framework for evaluation and treatment is delineated. Outlining helpful concepts and approaches to guide psychotherapeutic work with this population, the book describes ways to coordinate psychological interventions with psychiatric treatment and supportive services. A special section is devoted to working with families on alleviating caregiver stress, simplifying the senior's living environment, and weighing difficult decisions about the level of assistance a loved one may need. Other topics covered include working as a consultant in nursing homes and dealing with ethical questions around confidentiality and end-of-life issues. An essential resource for clinicians, this book also serves as a text for courses in psychology and aging, gerontology, and geriatric psychology.

Author Biography

Steven H. Zarit, PhD, earned his doctorate at the University of Chicago in 1972, with an emphasis in adult development and aging. He is Professor of Human Development and Assistant Director of the Gerontology Center at Pennsylvania State University and is also Adjunct Professor at the University College of Health Sciences, Sweden. His research, teaching and clinical practice has focused on issues in later life, particularly dementia and family caregiving. Judy M. Zarit, PhD, earned her doctorate in Clinical Psychology and Aging at the University of Southern California in 1982. She has been in private practice in State College, Pennsylvania since 1986, specializing in neuropsychological assessment of dementia and clinical interventions with older adults. She provides consultation services to nursing homes, dementia units, and assisted living facilities.

Table of Contents

1. Introduction: Concepts and Practice with Older Adults	1	(8)
Emergence of Aging in Mental Health Practice	3	(3)
Purpose and Plan for This Book	6	(3)
2. Normal Processes of Aging	9	(22)
Characteristics of the Older Population	10	(3)
Life-Span Developmental Perspective on Aging	13	(17)
Conclusions	30	(1)
3. Disorders of Aging: Dementia, Delirium, and Other Cognitive Problems	31	(31)
Dementing Illnesses	32	(22)
Delirium	54	(5)
Other Cognitive Disorders: Nonprogressive Brain Injuries	59	(1)
Age-Related Cognitive Decline	59	(2)
Conclusions	61	(1)
4. Functional Disorders in Later Life	62	(30)
Depressive Disorders	63	(14)
Anxiety Disorders	77	(2)
Schizophrenia	79	(4)
Personality Disorders	83	(2)
Alcohol and Substance Abuse	85	(4)
Adjustment Disorders	89	(1)
Conclusions	90	(2)
5. Clinical Assessment	92	(41)
Basic Considerations in Assessment	93	(5)
Differential Assessment	98	(26)
Conclusions	124	(1)
Appendix 5.1. Memory and Behavior Problems Checklist	124	(2)
Appendix 5.2. The Mental Status Examination	126	(3)
Appendix 5.3. Questions from the Delirium Symptom Interview According to Symptom Domain	129	(2)
Appendix 5.4. Face-Hand Test	131	(2)
6. Psychological Testing for Differential Diagnosis and Competence Evaluations	133	(38)
Psychological and Neuropsychological Assessment	133	(13)
Role of the Medical Examination in Assessment	146	(2)
Differentiating Alzheimer's Disease from Other Dementias	148	(2)
Case Examples	150	(6)
Other Issues in Assessment	156	(1)
Competence	157	(10)
Conclusions	167	(1)
Appendix 6.1. Sources and References for Common Tests	168	(1)
Appendix 6.2. Criteria for Clinical Diagnosis of Alzheimer's Disease	169	(1)
Appendix 6.3. Criteria for Diagnosis of Vascular Dementia	170	(1)
7. Basic Issues in Treatment	171	(29)
Planning and Initiating Treatment of Older Clients	172	(9)
Basic Skills in Treatment of Older People	181	(6)
How the Process of Therapy Can Differ with Older Clients	187	(9)
Case Examples	196	(3)
Conclusions	199	(1)
8. Treatment of Depression	200	(41)
Psychotherapy as a Treatment for Depression	200	(13)
Five Components of Treatment with Depressed Older People	213	(17)
Long-Term Outcomes of Late-Life Depression	230	(1)
Clinical Examples of Late-Life Depression	230	(10)
Conclusions	240	(1)
9. Coordination of Mental Health and Aging Services	241	(16)
Maintaining Independence: Using the Principle of Minimum Intervention	241	(5)
Aging Service Network	246	(5)
Specialized Housing for Older People	251	(2)
Coordination of Community and Mental Health Services	253	(3)
Conclusions	256	(1)
10. Paranoid Disorders	257	(20)
Long-Term Paranoid Schizophrenia	260	(1)
Paranoid Symptoms and Personality Disorders	260	(2)
Encapsulated Paranoid Delusion	262	(1)
Paranoid Beliefs and Obsessive-Compulsive Disorders	263	(2)
Sensory Loss as a Contributing Factor	265	(1)
Multiple Etiologies for Paranoid Symptoms	266	(1)
Paranoid Symptoms in Dementia and Delirium	267	(4)
Paranoid or Real?	271	(1)
Co-Occurrence of Lifelong and Late-Onset Paranoid Symptoms	272	(4)
Conclusions	276	(1)
11. Treatment of Dementia	277	(13)
Framework for Treatment of Dementia	278	(1)
Medications for Dementia	279	(3)
Cognitive Stimulation	282	(2)
Behavioral Interventions	284	(2)
Counseling Demented Patients	286	(2)
Conclusions	288	(2)
12. Family Caregiving	290	(30)
Family Stress and Adaptation	291	(5)
Dementia and Family Caregiving: Treatment Approaches	296	(22)
Conclusions	318	(1)
Appendix 12.1. Daily Record of Problem Behaviors	319	(1)
13. Consultation in Institutional Settings	320	(27)
Mental Health Consultation in Nursing Homes	320	(3)
Diversity of Nursing Home Settings	323	(2)
Principles of Consultation in Nursing Homes	325	(7)
Putting the Pieces of the Puzzle Together: Effective Counseling	332	(6)
Environmental and Programmatic Interventions with Dementia Patients	338	(6)
Case Examples	344	(2)
Conclusions	346	(1)
14. Ethical Issues in Geriatric Psychology	347	(18)
Competence of the Clinician	348	(1)
Confidentiality	349	(8)
End-of-Life Issues	357	(5)
Conclusions	362	(3)
References	365	(40)
Index	405