PSYC 306 Chapter 18
At any given time, as many as what percent of elderly individuals in the United States experience at least one of the anxiety disorders?
11. Surveys indicate that generalized anxiety disorder is particularly common. The prevalence of anxiety also increases throughout old age.
Overall, as many as what percent of people become depressed at some point during old age?
20 percent of people become depressed at some point during old age. The rate is highest in older women. This rate among the elderly is about the same as that among younger adults—even lower, according to some studies. However, it climbs much higher (32 percent or more) among aged people who live in nursing homes, as opposed to those in the community
Surveys find that what percentage of older people have alcohol use disorder in a given year?
3 to 7 percent of older people, particularly men, have alcohol use disorder in a given year. Men under 30 are four times as likely as men over 60 to display a behavioral problem associated with excessive alcohol use, such as repeated falling, spells of dizziness or blacking out, secretive drinking, or social withdrawal. Older patients who are institutionalized, however, do display high rates of problem drinking.
the time between onset and death for Alzheimer's is typically?
3 to 8 years. It usually begins with mild memory problems, lapses of attention, and difficulties in language and communication. As symptoms worsen, the person has trouble completing complicated tasks or remembering important appointments. Eventually sufferers also have difficulty with simple tasks, forget distant memories, and have changes in personality that often become very noticeable.
Research indicates that antipsychotic drugs are currently being given to almost what percent of the total nursing home population in the United States?
30%, despite the fact that many of the residents do not display psychotic functioning. Apparently, these powerful and (for some elderly patients) dangerous drugs are often given to sedate and manage the patients. Indeed, research suggests that 17 percent of new nursing home patients who have never before taken an antipsychotic drug are administered such drugs within 100 days of admission
Aging and Race
82.0 years Hispanic American average life expectancy 78.7 years Non-Hispanic white American average life expectancy 75.1 years African American average life expectancy
Alzheimer's disease is currently responsible for almost how many deaths?
94,000 deaths each year in the United States, a number more than 40 percent higher than it was a decade ago. It is the sixth leading cause of death in the country, the third leading cause among the elderly. In most cases, Alzheimer's disease can be diagnosed with certainty only after death, when structural changes in the person's brain, such as excessive senile plaques and neurofibrillary tangles, can be fully examined
mild neurocognitive disorder
A neurocognitive disorder in which the decline in cognitive functioning is modest and does not interfere with a person's ability to be independent.
major neurocognitive disorder
A neurocognitive disorder in which the decline in cognitive functioning is substantial and interferes with a person's ability to be independent.
Summing Up A Number of Other Causes
A number of other causes have also been proposed for this disease, including high levels of zinc, lead, or other toxins; immune system problems; and a virus of some kind.
Alzheimer's disease is named after?
Alois Alzheimer, the German physician who formally identified it in 1907. Alzheimer first became aware of the syndrome in 1901 when a new patient, Auguste D., was placed under his care
EARLY-ONSET ALZHEIMER'S DISEASE
Alzheimer's disease occurs before the age of 65 in fewer than one percent of cases. This relatively rare form of the disorder typically runs in families. Researchers have learned that it is caused by abnormalities in genes responsible for the production of two proteins—the beta-amyloid precursor protein (beta-APP) and the presenilin protein. Apparently, some families transmit mutations, or abnormal forms, of one or both of these genes—mutations that lead ultimately to abnormal beta-amyloid protein buildups and, in turn, to plaque formations
viral theory
Because Alzheimer's disease resembles Creutzfeldt-Jakob disease, another type of neurocognitive disorder that is known to be caused by a slow-acting virus, some researchers propose that a similar virus may cause Alzheimer's disease. Such a virus has not been consistently detected in the brains of Alzheimer's victims, but there is some evidence that it may be present in the brains of people who have a particularly fast-moving form of the disease
How Does Brain Structure Relate to Alzheimer's Disease?
Certain brain structures seem to be especially important in memory. Among the most important structures in short-term memory is the prefrontal cortex. When animals or humans acquire new information, their prefrontal cortex becomes more active, enabling them to hold information temporarily and to continue working with the information as long as it is needed. Among the most important structures in transforming short-term memory into long-term memory are the temporal lobes (which include the hippocampus and amygdala) and the diencephalon (which includes the mammillary bodies, thalamus, and hypothalamus). Research indicates that Alzheimer's disease involves improper functioning of one or more of these brain structures
COGNITIVE-BEHAVIORAL TECHNIQUES
Cognitive-behavioral treatments have been used in cases of Alzheimer's disease, with some degree of success. In Japan, for example, a number of people with the disease meet regularly in classes, performing simple calculations and reading essays and novels aloud. Similarly, research suggests that cognitive activities, including computer-based cognitive stimulation programs, sometimes help prevent or delay the onset of Alzheimer's disease
What is one of the most common mental health problems of older adults?
DEPRESSION is one of the most common mental health problems of older adults. The features of depression are the same for elderly people as for younger people, including feelings of profound sadness and emptiness; low self-esteem, guilt, and pessimism; and loss of appetite and sleep disturbances. Depression is particularly common among those who have recently undergone a trauma, such as the loss of a spouse or close friend or the development of a serious physical illness
There are many things about aging that may heighten the anxiety levels of certain people
Declining health, for example, has often been pointed to, and in fact, older persons who have significant medical illnesses or injuries report more anxiety than those who are healthy or injury-free. Researchers have not, however, been able to determine why some people who face such problems in old age become anxious while others in similar circumstances remain relatively calm
What can cause delirium?
Fever, certain diseases and infections, poor nutrition, head injuries, strokes, and stress (including the trauma of surgery). So may intoxication by certain substances, such as prescription drugs. Partly because older people face so many of these problems, they are more likely than younger ones to experience delirium. If a clinician accurately identifies delirium, it can often be relatively easy to correct. However, the syndrome typically fails to be recognized for what it is
other neurocognitive disorders may be caused by?
HIV infections, traumatic brain injury, substance abuse, or various medical conditions such as meningitis or advanced syphilis.
What Biochemical Changes in the Brain Relate to Alzheimer's Disease?
In order for new information to be acquired and remembered, certain proteins must be produced in key brain cells. Several brain chemicals—for example, acetylcholine, glutamate, RNA (ribonucleic acid), and calcium—are responsible for the production of the memory-linked proteins. If the activity of any of these chemicals is disturbed, the proper production of proteins may be prevented and the formation of memories interrupted. In fact, animal researchers have been able to impede short-term memory by blocking the activity of glutamate, and they have interrupted the formation of long-term memories by blocking the cellular production of RNA and calcium. Researchers have further linked abnormal activity by these various chemicals to Alzheimer's disease. Studies have found deficient activity levels of acetylcholine and glutamate in the brains of Alzheimer's victims, as well as irregularities in the breakdown of calcium
current generation of young adults should take a health-maintenance, or wellness promotion, approach to their own aging process
In other words, they should do things that promote physical and mental health—avoid smoking, eat well-balanced and healthful meals, exercise regularly, engage in positive social relationships, and take advantage of psycho-educational, stress management, and other mental health programs. There is a growing belief that older adults will adapt more readily to changes and negative events if their physical and psychological health is good.
Summing Up Key Issues
In studying and treating the problems of old age, clinicians have become concerned about three issues: the problems of elderly members of racial and ethnic minority groups, inadequacies of long-term care, and the need for health maintenance by young adults.
Summing Up Disorders of Cognition
Older people are more likely than people of other age groups to experience delirium, a fast-developing disturbance marked by great difficulty focusing attention, staying oriented, concentrating, and following an orderly sequence of thought.
autoimmune theory
On the basis of certain irregularities found in the immune systems of people with Alzheimer's disease, several researchers have speculated that changes in aging brain cells may trigger an autoimmune response (that is, a mistaken attack by the immune system against itself) that helps lead to the disease
The psychological problems of elderly people may be divided into two groups
One group consists of disorders that may be common among people in all age groups but are often connected to the process of aging when they occur in an elderly person. These include depressive, anxiety, and substance use disorders. The other group consists of disorders of cognition, such as delirium, mild neurocognitive disorders, and major neurocognitive disorders that result from brain abnormalities. These brain abnormalities are most often tied to aging, but they also can sometimes occur when people are younger. Elderly people with one of these psychological problems often display other such problems.
What Are the Genetic Causes of Alzheimer's Disease?
Proteins are fundamental components of all living cells, including brain cells. They are large molecules made up of chains of carbon, hydrogen, oxygen, nitrogen, and sulfur. There are many different kinds of proteins, each with a different function. Collectively, they are essential for the proper functioning of an organism. The plaques and tangles that are so plentiful in the brains of Alzheimer's patients seem to occur when two important proteins start acting in a frenzied manner. Abnormal activity by the beta-amyloid protein is, as you just read, key to the repeated formation of plaques. Abnormal activity by another protein, tau, is key to the excessive formation of tangles. One of the leading theories holds that the many plaques formed by beta-amyloid proteins also cause tau proteins within neurons to start breaking down, resulting in tangles and the death of many neurons
Summing Up Alzheimer's Disease
Researchers are making significant strides at better assessing Alzheimer's disease and other types of neurocognitive disorders and even at identifying those who will eventually develop these disorders. Drug therapy and cognitive-behavioral therapies have been used to treat Alzheimer's disease, with limited success. Addressing the needs of caregivers is now also recognized as a key part of treatment. In addition, sociocultural approaches such as day-care facilities are on the rise. Major treatment breakthroughs are expected in the coming years
Other Explanations of Alzheimer's Disease
Several lines of investigation suggest that certain substances found in nature may act as toxins, damage the brain, and contribute to the development of Alzheimer's disease. For example, researchers have detected high levels of zinc in the brains of some Alzheimer's patients. in some animal studies zinc has been observed to trigger a clumping of the beta-amyloid protein, similar to the plaques found in the brains of Alzheimer's patients. other studies suggest that the environmental toxin lead may contribute to the development of Alzheimer's disease
SOCIOCULTURAL APPROACHES
Sociocultural approaches play an important role in treatment. A number of day-care facilities for patients with neurocognitive disorders have been developed, providing treatment programs and activities for outpatients during the day and returning them to their homes and families at night. There are also many assisted-living facilities in which those suffering from neurocognitive impairment live in cheerful apartments, receive needed supervision, and take part in various activities that bring more joy and stimulation to their lives. Studies suggest that such facilities bring some degree of improvement to the cognitive deficits of residents and enhance their enjoyment of life. In addition, a growing number of practical devices, such as tracking beacons worn on the wrists of Alzheimer's patients and shoes that contain a GPS tracker, have been developed to help locate patients who may wander off
senile plaques
Sphere-shaped deposits of beta-amyloid protein that form in the spaces between certain neurons and in certain blood vessels of the brain as people age. People with Alzheimer's disease have an excessive number of such plaques.
apolipoprotein E (ApoE) gene
The ApoE gene, located on chromosome 19, is normally responsible for the production of a protein that helps carry various fats into the bloodstream. This gene comes in various forms. About 30 percent of the population inherit the form called ApoE-4, and those people may be particularly vulnerable to the development of Alzheimer's disease. Apparently, this ApoE-4 gene form promotes the excessive formation of beta-amyloid proteins, helping to spur the formation of plaques and, in turn, the breakdown of the tau protein, the formation of numerous tangles, the death of many neurons, and, ultimately, the onset of Alzheimer's disease.
Behavior-focused interventions of a different kind have been used to help improve specific symptoms displayed by Alzheimer's patients
The approaches typically focus on changing everyday patient behaviors that are stressful for the family, such as wandering at night, loss of bladder control, demands for attention, and inadequate personal care. The therapists use a combination of role-playing exercises, modeling, and practice to teach family members how and when to use reinforcement in order to shape more positive behaviors.
DRUG TREATMENT
The drugs currently prescribed for Alzheimer's patients are designed to affect acetylcholine and glutamate, the neurotransmitters that play important roles in memory. Such drugs include donepezil (Aricept), rivastigmine (Exelon), galantamine (Reminyl), and memantine (Namenda). The short-term memory and reasoning ability of some Alzheimer's patients who take these drugs improve slightly, as do their use of language and their ability to cope under pressure. Although the benefits of the drugs are limited and their side effects can be problematic, they have been approved by the FDA. Clinicians believe that they may be of greatest use to people in the early, mild stage of Alzheimer's disease. There is a popular belief that another approach, taking vitamin E, either alone or in combination with one of these drugs, will help slow down some of the cognitive difficulties experienced by people in the mild stage of Alzheimer's disease
Summing Up Disorders of Later Life
The problems of elderly people are often linked to the losses and other stresses and changes that accompany advancing age. As many as 50 percent of the elderly would benefit from mental health services, yet fewer than 20 percent receive them. Depression is a common mental health problem among those in this age group. Older people may also suffer from anxiety disorders. Between 3 and 7 percent exhibit alcohol use disorder in any given year, and many others misuse prescription drugs. In addition, some elderly people display psychotic disorders such as schizophrenia or delusional disorder.
LATE-ONSET ALZHEIMER'S DISEASE
The vast majority of Alzheimer cases develop after the age of 65 and do not typically run in families. This late-onset form of the disease appears to result from a combination of genetic, environmental, and lifestyle factors. However, the genetic factors at play in late-onset Alzheimer's disease are different from those involved in early-onset Alzheimer's disease. The genetic factor that has received the most attention from clinical theorists and researchers is a gene called the apolipoprotein E (ApoE) gene.
What Treatments Are Currently Available for Alzheimer's Disease and Other Neurocognitive Disorders?
Treatments for the cognitive features of Alzheimer's disease and most other types of neurocognitive disorders have been at best modestly helpful. A number of approaches have been applied, including drug therapy, cognitive-behavioral interventions, support for caregivers, and sociocultural approaches. None of these interventions stops the progression of the disorder
neurofibrillary tangles
Twisted protein fibers that form within certain neurons as people age. People with Alzheimer's disease have an excessive number of such tangles.
Some elderly people experience depression as part of?
a bipolar disorder rather than a unipolar type of depressive disorder. Around 1 percent of all persons over 65 years of age display a bipolar disorder in any given year. For more than 70 percent of them, the disorder began well before they reached old age. In most cases, the individuals receive the kinds of treatment that younger individuals with bipolar disorder receive—mood-stabilizing medications and adjunctive psychotherapy
long-term care
a general term that may refer variously to the services offered outside the family in a partially supervised apartment, a senior housing complex for mildly impaired elderly persons, or a nursing home where skilled medical and nursing care is available around the clock. The quality of care in such residences varies widely. At any given time in the United States, only about 4 percent of the entire elderly population actually live in nursing homes (1.5 million people), but as many as 20 percent of people 85 years and older do eventually wind up being placed in such facilities. Thus many older adults live in fear of being "put away." They fear having to move, losing independence, and living in a medical environment. Many also worry about the cost of long-term care facilities.
Delirium
a major disturbance in attention and orientation to the environment. As the person's focus becomes less clear, he or she has great difficulty concentrating and thinking in an organized way, leading to misinterpretations, illusions, and on occasion, hallucinations. Sufferers may believe that it is morning in the middle of the night or that they are home when actually they are in a hospital room.
AN ALTERNATIVE GENETIC THEORY OF ALZHEIMER'S DISEASE
a number of genetic theories of Alzheimer's disease point to gene forms—most often ApoE-4—that produce abnormal beta-amyloid protein buildups and plaque formations. These gene forms, in turn, lead to abnormal activity of tau proteins and the formation of numerous tangles. In recent years, however, some researchers have come to believe that abnormal tau protein activity is not always the result of these abnormal beta-amyloid protein buildups. These researchers have identified other gene forms in Alzheimer's patients that seem to be directly associated with tau protein abnormalities and tangle formations within neurons. Thus it may be that there are multiple genetic causes for the formation of numerous tangle formations and the onset of Alzheimer's disease: (1) gene forms that start the ball rolling by first promoting beta-amyloid protein formations and plaques, and (2) gene forms that more directly promote tau protein abnormalities and tangle formations.
Delirium may occur in?
any age group, including children, but is most common in elderly people. Fewer than 0.5 percent of the nonelderly population experience delirium, compared with 1 percent of people over 55 years of age and 14 percent of those over 85 years of age. When elderly people enter a hospital—which represents a major change in their environment and routine—to be treated for a general medical condition, 10 percent of them show the symptoms of delirium
Interestingly, cognitive-behavioral strategies that focus primarily on?
behaviors rather than on cognitions seem to be even more useful in preventing and managing this disease. It has become clear across many studies that physical exercise helps improve cognitive functioning—for people of all ages and states of health. There is evidence that regular physical exercise may also help reduce the risk of developing Alzheimer's disease and other neurocognitive disorders. Correspondingly, physical exercise is often a part of treatment programs for people with the disorders.
When diagnosticians administer brain scans, laboratory tests, and other biological tests, they are looking for biomarkers
biochemical, molecular, genetic, or structural characteristics that usually accompany Alzheimer's disease. There are many such biomarkers, but one that is always important, not surprisingly, is the indication of a large number of beta-amyloid proteins and tau proteins, the building blocks for plaques and tangles. It turns out that many of these biomarkers appear in the brain long before the obvious onset of Alzheimer's disease
Assessing and Predicting Alzheimer's Disease
cases of Alzheimer's disease can be diagnosed with absolute certainty only after death, when an autopsy is performed. However, by using a battery of assessment tools—including neuropsychological tests (tests that measure a person's cognitive, perceptual, and motor performances on certain tasks), brain scans, blood tests and other laboratory work, and careful history taking—diagnosticians are usually able to build a very strong circumstantial case and arrive at an accurate diagnosis. In most cases when they are wrong, it turns out that the individual actually was experiencing a different major neurocognitive disorder.
Summing Up Neurocognitive Disorders
characterized by a significant decline in cognitive function, become increasingly common in older age groups. There are many types of neurocognitive disorders, the most common being Alzheimer's disease. Alzheimer's disease has been linked to an unusually high number of senile plaques and neurofibrillary tangles in the brain. According to a leading explanation of late-onset Alzheimer's disease—by far, the most common kind of Alzheimer's disease—people who inherit ApoE-4, a particular form of the apolipoprotein E (ApoE) gene, are particularly vulnerable to the development of Alzheimer's disease. Apparently, the ApoE-4 gene form promotes the excessive formation of beta-amyloid proteins, helping to spur the formation of plaques and, in turn, the breakdown of the tau protein, the formation of numerous tangles, the death of many neurons, and ultimately, the onset of Alzheimer's disease.
antipsychotic drugs may pose more dangers for elderly people than younger people
cognitive impairment, stroke, seizures, given the metabolism changes in older people. In contrast, other elderly people with schizophrenia have been untreated for years and continue to be untreated when they are elderly, winding up in nursing homes, in run-down apartments, homeless, or in jail.
Like younger adults, older people who are depressed may be helped by?
cognitive-behavioral therapy, interpersonal psychotherapy, antidepressant medications, or a combination of these approaches. Both individual and group therapy formats have been used. More than half of elderly patients with depression improve with these various treatments. It is sometimes difficult for older people to use antidepressant drugs effectively and safely because the body breaks the drugs down differently in later life. Moreover, among elderly people, antidepressant drugs have a higher risk of causing some cognitive impairment. Electroconvulsive therapy, applied with certain modifications, has been used for elderly people who are severely depressed and have not been helped by other approaches
The leading such disorders among the elderly are?
delirium, major neurocognitive disorder, and mild neurocognitive disorder.
are elderly people more or less likely to die from suicide than young people?
elderly people are more likely to die from suicide than young people, and often their suicides are related to depression. The overall rate of suicide in the United States is 12.6 per 100,000 people; among those over 65 years of age, it is more than 16 per 100,000, and among those over 75, it is more than 24 per 100,000
Vascular neurocognitive disorder
follows a cerebrovascular accident, or stroke, during which blood flow to specific areas of the brain was cut off, thus damaging the areas. In many cases, the patient may not even be aware of the stroke. Like Alzheimer's disease, this disorder is progressive, but its symptoms begin suddenly rather than gradually. Moreover, the person's cognitive functioning may continue to be normal in areas of the brain that have not been affected by the stroke, in contrast to the broad cognitive deficiencies usually displayed by Alzheimer's patients. Some people have both Alzheimer's disease and vascular neurocognitive disorder.
discrimination based on race and ethnicity
has long been a problem in the United States, and many people suffer as a result, particularly those who are old. To be both old and a member of a minority group is considered a kind of "double jeopardy" by many observers. For older women in minority groups, the difficulties are sometimes termed "triple jeopardy," as many more older women than older men live alone, are widowed, and are poor. Clinicians must take into account their older patients' race, ethnicity, and gender as they try to diagnose and treat their mental health problems. Today, around 20 percent of all elderly people live with their children or other relatives, usually because of increasing health problems. In the U.S., this living arrangement is more common for families from racial and ethnic minority groups.
Neurocognitive disorder due to prion disease, also called Creutzfeldt-Jakob disease
has symptoms that include spasms of the body. As we observed earlier, this disorder is caused by a slow-acting virus that may live in the body for years before the disease develops. Once launched, however, the disease has a rapid course.
the long-term use of nonsteroidal anti-inflammatory drugs such as ibuprofen and naprosyn (drugs found in Advil, Motrin, Nuprin, and other pain relievers) may?
help reduce the risk of Alzheimer's disease, although recent findings on this possibility have been mixed
Frontotemporal neurocognitive disorder, also known as Pick's disease
is a rare disorder that affects the frontal and temporal lobes. It has a clinical picture similar to Alzheimer's disease, but the two diseases can be distinguished at autopsy.
Neurocognitive disorder due to Huntington's disease
is an inherited progressive disease in which memory problems, along with personality changes and mood difficulties, worsen over time. People with Huntington's have movement problems, too, such as severe twitching and spasms. Children of people with Huntington's disease have a 50 percent chance of developing it.
Is schizophrenia more or less common in older people than in younger ones?
less. In fact, many people with schizophrenia find that their symptoms lessen in later life. Improvement can occur in people who have had schizophrenia for 30 or more years, particularly in such areas as social skills and work capacity, as we are reminded by the remarkable late-life improvement of the Nobel Prize recipient John Nash, the subject of the book and movie A Beautiful Mind.
Alzheimer's disease
marked most prominently by memory impairment; is the most common type of neurocognitive disorder, accounting for at least two-thirds of all cases. Around 5.4 million people in the United States currently have this disease, a number that is expected to triple by the year 2050. Alzheimer's disease sometimes appears in middle age (early onset), but in the vast majority of cases it occurs after the age of 65 (late onset), and its prevalence increases markedly among people in their late 70s. Altogether, 11 percent of all people over 65 have Alzheimer's disease
Technically, Alzheimer's sufferers receive a DSM-5 diagnosis of?
mild neurocognitive disorder due to Alzheimer's disease during the early and mild stages of the syndrome and major neurocognitive disorder due to Alzheimer's disease during the later, more severe stages
The average cost for a private room in a nursing home in the United States is?
over $90,000 per year; for a semi-private room it is over $80,000. Most health insurance plans available today do not adequately cover the costs of long-term or permanent placement. Worry over these issues can greatly harm the mental health of older adults, perhaps leading to depression and anxiety as well as family conflict.
One of the most frequent reasons for the institutionalization of people with Alzheimer's disease is that?
overwhelmed caregivers can no longer cope with the difficulties of keeping them at home. Many caregivers experience anger and depression, and their own physical and mental health often declines. A number of them are, in fact, "sandwich generation" caregivers, meaning they must care not only for their parents with Alzheimer's disease, but also for their teenage children. Clinicians now recognize that one of the most important aspects of treating Alzheimer's disease and other types of neurocognitive disorders is to focus on the emotional needs of the caregivers, including their needs for regular time out, education about the disease, and psychotherapy. Some clinicians also provide caregiver support groups
Older adults with anxiety disorders have been treated with psychotherapy of various kinds
particularly cognitive-behavioral therapy. Many also receive benzodiazepines or other antianxiety medications, just as younger sufferers do. And a number are treated with serotonin-enhancing antidepressant drugs. Again, however, all such drugs must be used cautiously with older people
delusional disorder
people develop beliefs that are false but not bizarre. This disorder is rare in most age groups—around 2 of every 1,000 persons—but its prevalence appears to increase in the elderly population. Older people with a delusional disorder may develop deeply held suspicions of persecution; they believe that other people—often family members, doctors, or friends—are conspiring against, cheating, spying on, or maligning them. They may become irritable, angry, or depressed or pursue legal action because of such ideas. It is not clear why this disorder increases among elderly people, but some clinicians suggest that the rise is related to the deficiencies in hearing, the social isolation, the greater stress, or the heightened poverty with which many elderly persons contend.
neurocognitive disorder
people experience a significant decline in at least one (often more than one) area of cognitive functioning, such as memory, attention, visual perception, planning and decision making, language ability, or social awareness. Those who have certain types of neurocognitive disorders may also undergo personality changes—they may behave inappropriately, for example—and their symptoms may worsen steadily.
Today's leading explanations for Alzheimer's disease center on?
plaques and tangles and on the various factors that may contribute to their formation and excessive buildup.
A leading substance problem in the elderly is the misuse of?
prescription drugs. Most often the misuse is unintentional. In the United States, people over the age of 65 buy more than one-third of all prescription drugs. At any given time, elderly people are taking, on average, 3 to 5 prescription drugs and two over-the-counter drugs. Thus their risk of confusing medications or skipping doses is high. To help address this problem, physicians and pharmacists often try to simplify medications, educate older patients about their prescriptions, clarify directions, and teach them to watch for undesired effects. However, physicians themselves are sometimes to blame in cases of prescription drug misuse, perhaps overprescribing medications for elderly patients or unwisely mixing certain medicines
Geropsychology
the field of psychology dedicated to the mental health of elderly people, has developed almost entirely within the last four decades, and at present only 4.2 percent of clinicians work primarily with elderly persons
Parkinson's disease
the slowly progressive neurological disorder marked by tremors, rigidity, and unsteadiness, can result in neurocognitive disorder due to Parkinson's disease, particularly in older people or those whose cases are advanced. In recent years, it has become clear that many people who used to receive this diagnosis were, in fact, suffering from neurocognitive disorder due to Lewy body disease. Lewy body disease involves the buildup of clumps of protein deposits, called Lewy bodies, within many neurons. In addition to progressive cognitive problems, this disease features significant movement difficulties, visual hallucinations, and sleep disturbances. Once thought to be rare, it is now recognized as the second most common neurocognitive disorder, affecting close to 1 percent of people over age 65
AS THE STUDY AND TREATMENT of elderly people have progressed, three issues have raised concern among clinicians:
the special problems faced by elderly members of racial and ethnic minority groups, the inadequacies of long-term care, and the need for a health-maintenance approach to medical care in an aging world.
OLD AGE IS USUALLY DEFINED in our society as?
the years past age 65. By this account, around 46 million people in the United States are "old," representing 14.5 percent of the total population; this is a 15-fold increase since 1900. It has also been estimated that there will be 70 million elderly people in the United States by the year 2030—21 percent of the population. Not only is the overall population of the elderly on the rise, but also the number of people over 85 will double in the next 10 years. Indeed, people over 85 represent the fastest-growing segment of the population in the United States and in most countries around the world. Older women outnumber older men by almost 3 to 2.
As you will see shortly, the most effective interventions for Alzheimer's disease and other neurocognitive disorders are?
those that help prevent these problems, or at least ones that are applied early. Clearly, then, it is essential to have tools that identify the disorders as early as possible, preferably years before the onset of symptoms. That is what makes the research advances in assessment and diagnosis so exciting.
African Americans and Hispanic Americans are?
twice as likely as non-Hispanic white Americans to develop this disease. The reasons for this significant difference are not known. Some of it may be due to racial/ethnic differences in the genetic factors that relate to Alzheimer's disease, which you will be reading about shortly. A large part of the difference may be due to racial/ethnic differences in general health, particularly cardiovascular disease and diabetes, diseases that appear to heighten a person's risk of developing Alzheimer's disease
