Front Cover

Handbook of Mental Health and Aging

Copyright Page

Table of Contents

Contributors

Preface

Part I: Background

Chapter 1. Concepts and Issues in Mental HeaHh and Aging

I. Introduction

II. A Decade of Research Progress

III. A Bio-Psycho-Social Perspective

IV. Concepts of Mental Health and Mental Illness

V. Intellectual Underpinnings

VI. Future Research Issues

VII. Service System Policy Dilemmas for the 1990s

VIII. Education and the Need for Trained Personnel

IX. Conclusion

References

Chapter 2. The Epidemiology of Selected Mental Disorders in Later Life

I. Introduction

II. Dementia Syndromes

III. Depressive Disorders

IV. Panic Disorder

V. Phobic Disorders

VI. Obsessive-Compulsive Disorders

VII. Syndromes of Dependence and Abuse Involving Alcohol and Other Drugs

VIII. Summary and Future Directions

References

Chapter 3. Culture and Mental Health in Later Life Revisited

I. Introduction: A Field without a Literature

II. Fieldwork and the Limitations of Academic Geropsychology

III. Culture

IV. Decuituration and the Elders

References

Chapter 4. Gender and Ethnicity Patterns

I. Introduction

II. Demographic Considerations

III. Definitions and Conceptual Underpinnings

IV. The Role of Stress, Social Supports, and Coping in Mental Health

V. Prevalence of Mental Health Disorders

VI. Approaches to Community Mental Health

VII. Recommendations for the Future

VIII. Summary

References

Chapter 5. Adult Life Crises

I. Defining Adult Life Crises

II. A First Look: Salience of Life Events on Mental Health Consequences

III. Adult Life Crises and Psychiatric Disorders

IV. Life Crises and Adaptation

V. Adult Crisis as Transformative

VI. Dynamic Theories of Adult Crises: A Child-Centered versus Adult-Centered View

VII. A Cautionary Note

VIII. Clinical Aspects of Crisis

IX. A Summing up

References

Part II: Neuroscience and Aging

Chapter 6. Structural Changes in the Aging Brain

I. Introduction

II. Historical Evolution of Ideas

III. Gross Changes

IV. Microscopic Changes

V. Changes in the Vascular System

VI. Structural Change and Behavioral Change: An Overview

References

Chapter 7. Neurochemical Changes with Aging: Predisposition toward Age-Related Mental Disorders

I. General Anatomical Changes in the Brain with Normal Aging

II. Aging Changes in Synaptic Neurochemistry

III. Usual Aging in the Dopamine System, Schizophrenia, and Parkinson's Disease

IV. The Interaction of Aging with the Pathological Features of Alzheimer's Disease

V. Summary and Conclusions

Acknowledgments

References

Chapter 8. Cerebral Metabolism in Aging and Dementia

I. Introduction

II. Cerebral Metabolism and Aging

III. Dementia of Ihe Alzheimer Type

IV. Other Dementias

V. Future Directions

VI. Summary and Conclusions

References

Chapter 9. The Outcomes of Psychiatric Disorder in the Elderly: Relevance to Quality of Life

I. Centrality of the Quality of Life

II. Domains

III. Interactions among Domains

IV. Needed Developments

V. Prospect

Acknowledgment

References

Part III: Behavioral Sciences and Aging

Chapter 10. Aging and the Senses

I. Vision

II. Hearing

III. Taste

IV. Olfaction

V. Cutaneous Sensitivity

VI. Future Considerations

Acknowledgments

References

Chapter 11. Memory, Learning, and Attention

I. Introduction

II. Memory and Learning

III. Attention and Aging

IV. Mental Health Issues

V. Future Research Directions

References

Chapter 12. Intellectual Functioning in Relation to Mental Health

I. Studies of Structure

II. Change In Level

III. Extraneous Influences on Intellectual Performancein the Elderly

IV. Developing New Tests tor the Elderly?

References

Chapter 13. Emotion and Personality

I. Stability and Change of Emotional and Behavioral Dispositions

II. Cognition: Emotion Interactions and Research on Personality and Aging

III. Conclusions

References

Part IV: Psychopathology of Later Life

Chapter 14. Mood Disorders and Suicide

I. Introduction

II. Classification and Clinical Presentation

III. Epidemiology

IV. Prognosis and Course

V. Differential Diagnosis

VI. Laboratory Evaluation

VII. Management

VIII. Suicide

References

Chapter 15. Anxiety and Its Disorders in Old Age

I. Introduction

II. Epidemiological Studies

III. Classification and Phenomenology of Anxiety Disorders

IV. Models of Anxiety and Phobias

V. Evaluation of Anxiety

VI. Mixed Anxiety–Depression Syndromes

VII. Anxiety and Medical Illness

VII. Psychological Treatments

IX. Pharmacological Treatments

X. Knowledge Gaps and Future Directions

XI. Conclusion

References

Chapter 16. Personality Disordersin Old Age

I. Background

II. Classification of Personality Disorders

III. Stability of Personality

IV. Epidemiology of Personality Disorder in Old Age

V. Evolution of Personality Disorder Symptoms with Age

VI. Symptom Expression in the Elderly

VII. Residual and Emergent Personality Disorders

VIII. Special Considerations

IX Research Directions

References

Chapter 17. Schizophrenia and Psychotic States

I. Schizophrenia

II. Late-Life-Onset Schizophrenia

III. Chronic Schizophrenia with Early-Life Onset

IV. Other Conditions

References

Chapter 18. Alzheimer's Disease and Other Dementing Disorders

I. Dementia

II. Alzheimer's Disease

III. Dementia in Parkinson's Disease and the Spectrum of Lewy Body Diseases

IV. Multi-infarct Dementia

V. Pick's Disease

VI. Normal-Pressure Hydrocephalus

VII. Metabolic Dementing Disorders

VIII. Infectious Dementing Disorders

IX Alcoholic Dementia

X. Treatment of Secondary Behavioral Problems in Dementia

XI- Dementia and Depression

XII. The Relationship of Depression in Parkinson's Disease to Dementia in Parkinson's Disease

XIII. Delirium

XIV. Conclusion

References

Chapter 19. Alcohol and Substance-Use Disorders in the Elderly

I. Introduction

II. Epidemiology

III. Principles of Assessment and Management

IV. Alcohol-Use Disorders

V. Prescription Psychoactive Drug-Use Disorders

VI. Other Substances

VII. Looking Ahead

References

Chapter 20. Sleep Disorders and Aging

I. Introduction

II. Sleep and Aging

III. Sleep Disturbances

IV. Clinical and Laboratory Assessment

V. Pharmacologic Treatment Approaches

VI. Nonpharmacologic Treatment Approaches

VII. Conclusions

References

Chapter 21. Aging in Persons with Developmental Disabilities

I. Introduction

II. Population Characteristics and Demographic Trends

III. Age-Related Changes

IV. Formal and Informal Supports

V- Summary

VI. The Need for Future Research: The Mental Health of Older Persons with Developmental Disabilities

References

Part V: Assessment, Treatment, and Prevention

Chapter 22. Neuropsychiatric Assessment

I. Introduction

II. Framework for Assessment

III. Data Acquisition

IV. Differential Diagnosis

V. Conclusion of Assessment

Acknowledgment

References

Chapter 23. Neuropsychological Assessment

I. Introduction

II. Trends in Research and Practice

III. Diagnostic Applications

IV. Treatment Planning and Evaluation

V. Summary and Conclusions

References

Chapter 24. Functional Assessment in Geriatric Mental Health

I. The Conceptual Basis of Functional Assessment

II. The Effect of Mental Illness on Function

III. Functional Assessment Principles

IV. Survey of Functional-Assessment Instruments

V. Discussion and Summary

References

Chapter 25. Behavioral and Psychotherapeutic Interventions

I. Introduction

II. Establishing the Therapeutic Relationship

III. Individual Psychotherapy: Psychodynamic Approaches

IV. Individual Psychotherapy: Behavioral Interventions

V. Individual Psychotherapy: Empirical Investigations

VI. Group Psychotherapy

VII. Marital Therapy

VIII. Multigenerational Family Therapy

IX. Conclusions

References

Chapter 26. Psychopharmacologic Treatment

I. Overview

II. Factors Complicating Prescription of Psychotropic Drugs

III. Age-Related Changes in Pharmacologic Drug Effect

IV. Psychotropic Treatment of Behavior Disorders, Agitation, and Psychosis

V. Treatment of Depression

VI. Treatment of Mania

VII. Treatment of Anxiety

VIII. Treatment of Sleep Disorders

IX Treatment of Memory Loss and Cognitive Dysfunction

X. Summary and Conclusions

References

Chapter 27. Environmental Intervention for Cognitively Impaired Older Persons

I. Introduction

II. TWelve Environment–Behavior Principles

III. Application of These Principles to Institutional Environments

IV. Home Settings: Strategies for Environmental Management

V. Future Directions

References

Chapter 28. Community and Home Care for Mentally III Older Adults

I. Need for Mental Health Services: Heterogeneity of the Mentally III

II. Community-Based Mental Health Services

III. Mental Health Service Use

IV. Home Care of Mentally III Older Adults

V. The Interface between Community Care and Home Care

VI. Conclusions and Recommendations

Acknowledgments

References

Chapter 29. Mental Health and Aging: Hospital Care—A Nursing Perspective

I. Background

II. Admission of the Geriatric Mental Health Patient

III. Specific Behavior Problems in the Older Adult

IV. Formal Assessment

V. Mental Health Interventions for Hospitalized Aged Persons

VI. Summary and Future Research Needs

References

Chapter 30. Nursing Home Care

I. Background

II. Epidemiology of Mental Disorders in Nursing Homes

III. Public Policy Issues

References

Chapter 31. Forensic and Ethical Issues

I. Competency

II. Confidentiality

III. Boundary Issues

IV. Conclusion

References

Chapter 32. Economic Issues and Geriatric Mental Health Care

I. Introduction

II. Economic and Health Policy Issues

III. The Medicare System

IV. Medicaid

V. Private Insurance and Out-of-Pocket Expenditures

VI. Innovative Delivery Models: Cost Containmentand Improved Access

VII. Conclusion

References

Part VI: The Future

Chapter 33. The Future of Mental Healthand Aging

I. Historic Moment in the Field of Mental Health and Aging

II. Concepts Shaping the Direction of the Field

III. Research on Aging—Relevance to All Age Groups

IV. The Significance of Time and the Capacityto Change with Aging

V. Epidemiological Trends in Mental Health and Aging

VI. The Mental Health–Physical Health Interface in Later Life

VII. Public Policy and Social Values—Lessons from Anthropology

VIII. Selected Summary of Mental Health and Aging Trends toward the Future

IX Conclusion

References

Author Index

Subject Index