Emotional disturbances following brain damage have been frequently reported in the literature. However, systematic investigation of these disorders and their specific causes were not common until the last 30 years. However, the number of research studies into this area remains slight compared to the voluminous literature on the cognitive effects of brain injury. The completed research has fallen into 3 major areas: (1) The study of clients with localized brain injuries to evaluate whether the site of the injury predicts the emotional reactions; (2) the effect of time poststroke on personality changes; and (3) the relation of neuropsychological deficits to emotional changes. This paper provides a comprehensive review of the research that has been completed in this area with elderly subjects along with an analysis of the current state of the knowledge in this area. Future directions for research to further our understanding are discussed.
Clinical experience with older adults shows that many will experience PTSD symptoms in older adulthood because of trauma exposure early in life. Some of these patients struggled with PTSD in the distant past and remained symptomfree for decades only to have a recurrence of PTSD in late life. This paper outlines a cognitive aging explanation for the recurrence of PTSD. It is proposed that the age-related decreases in attention make the intrusion of trauma-related memories more likely. The increase in intrusive memories, combined with age-related decreases in working memory, explicit memory, and prospective memory, increases the subjective distress associated with the memories and results in a recurrence of PTSD.
Family members who wish to have their older relatives live with them often encounter obstacles that make such an arrangement unworkable. Proponents of the Elder Cottage, and its variant, the Homecare Suite, suggest that many of these obstacles can be avoided with Elder Cottage use. The purpose of this study was to evaluate the impact of Elder Cottages on a variety of resident and host outcomes. A nonequivalent comparison group design was used. Thirty-one treatment group residents and their hosts received Elder Cottages whereas 24 comparison group residents and their hosts remained on a waiting list. Results showed that residents using Elder Cottages reported significantly greater satisfaction with their housing, increased independence, more telephone contacts with friends and family, improved relationships with hosts, more accessible housing, and less formal service use than those in the comparison group. Similarly, hosts in the treatment group reported significantly greater satisfaction with the residents' housing and less stress in their caregiving roles than those in the comparison group. In addition, fewer Elder Cottage hosts than comparison group hosts engaged in caregiver-related driving. Answers to short-answer questions mirrored the quantitative findings. These results provide substantial optimism with respect to the Elder Cottage as a housing option for older adults, although interviews with housing specialists suggested that families will need financial and caregiving assistance for this option to be viable.
Much of the literature on trauma focuses on the impact of a single traumatic event and its psychological sequelae on a given individual. Little attention has been paid to the effects of multiple traumatic events within one lifetime, or the importance of understanding the relation of the social context of the trauma(s) to the experience of the trauma survivor. This study presents a qualitative analysis of interviews with older survivors of the Nazi attempt to exterminate the Jews (the Holocaust), who had recently migrated from the former Soviet Union to the United States. In-depth depictions of the effects of multiple traumas on the mental health of single individuals are presented. Further emphasis is placed on the specific social context of trauma to more fully understand the older adult trauma survivor.
Distress, coping, and social resources were compared in a sample of 202 Japanese-, Anglo-, African-, and Mexican American spousal caregivers of persons with dementia using a Stress-Coping model. Both ethnicity and gender showed differential effects on the outcome and on the moderating variables. Female caregivers in all ethnic groups reported significantly higher levels of psychiatric symptomatology. All 4 ethnic groups reported high rates of psychological distress, with Mexican Americans reporting significantly higher rates of depression than Anglo or African Americans. Ethnicity was related to (1) the kind of caregiving appraisals (spiritual, pessimistic, and lack of support), (2) coping styles (escape-avoidance and seeking social support), and (3) social support. African Americans were more likely to be spiritual appraisers, to have more positive appraisals, and to have more social support available to them. Gender differences were evident on 4 out of the 6 caregiver appraisals, but none of the coping styles. Although males tended to have more perfectionistic appraisals, they were also more likely to view caregiving with a less negative and more self-efficacious outlook.
This study examined relationships between socioenvironmental factors occurring in later-life and current and changing PTSD symptom levels in a sample of 177 community-dwelling World War II and Korean era ex–prisoners of war. Factors examined included negative life events, negative health events, social support, and death acceptance. PTSD was assessed at Time 1. PTSD and the later-life factors were then assessed 4 years later (Time 2). Cross-sectional analysis examined the relationship of the later-life factors to current PTSD symptomatology. Longitudinal analysis examined their relationship to changing PTSD symptomatology over the 4-year interval. Negative health changes, social support, and death acceptance were significantly related to current and changing PTSD symptomatology, but negative life events were not. The authors conclude that health and psychosocial factors that may occur in later-life can be related to PTSD symptom levels even many decades after a traumatic experience.
Interpersonal violence impacts the lives of many women in society. However, despite the proliferation of research in this area, there is limited information about the frequency and impact of interpersonal trauma experiences in late life. This study investigated the relationship between a history of interpersonal trauma and subsequent adjustment difficulties, including psychological distress and physical health, in women over the age of 60. Findings demonstrate that interpersonal trauma has a significant impact on later-life functioning. Additionally, the presence of multiple traumatization experiences was a critical factor in determining which individuals manifested long-term trauma symptoms.
Mental health professionals, in fulfilling their different roles, often become involved with research protocols involving decisionally impaired current or prospective human subjects, many of whom are elderly. The opening section of this paper briefly describes the present regulatory environment regarding human subjects research, followed by an overview of the Institutional Review Board (IRB) process. There then ensues an enumeration of some of the general criticisms of the current regulatory scheme that have been enunciated recently. Particular concerns concerning decisionally impaired persons as research subjects are then addressed, referring when applicable to the recommendations made by the National Bioethics Advisory Commission (NBAC) in its 1998 report on this subject and the implications of those recommendations for mental health professionals.
This descriptive study examined patterns and correlates of family involvement during a short-term geropsychiatric hospitalization. Participants were 32 family members who completed the Brief Symptom Inventory (BSI) and a prehospitalization involvement measure. Involvement data included frequency of family member visits, ratings of family members' overall involvement, and eight measures of family members' involvement with hospital staff. The majority of family members participated in a staff meeting with nursing staff and the physician, made individual contact with the physician, met with the social worker, had phone contact with nursing staff, and consulted with staff during visiting hours. Correlates of involvement included: complexity of patients' needs; family members' scores on the BSI subscales of depression, hostility, psychoticism, and paranoia; family members' awareness of patient's needs; the extent to which discharge plans altered the family members' caregiving role; and the family's degree of enmeshment–disengagement. These family variables deserve attention in future research.
Increasing numbers of retirees spend their leisure time in the ever-growing number of gambling casinos in this country. For most older adults, casino gambling is a new form of excitement and entertainment. However, for some retirees, especially those vulnerable to depression from the changes and losses that can occur in aging, casino gambling can become disordered, problematic, and/or an addiction. Although prevalence studies have examined the incidence of problem gambling in other age groups, little attention has been directed to the impact of casino gambling on older adults. The authors discuss problem and pathological gambling in retired older adults, and provide clinical case examples of a growing number of older adults with problem gambling behaviors seen in an outpatient geriatric psychiatry clinic. Finally, they urge that an evaluation of gambling behaviors be a routine portion of geriatric clinical evaluations.
Older women may respond to conflicts by suppressing anger. Suppressed anger is associated with depression and hypertension. Research on the everyday conflicts of community-dwelling older women has begun to emerge. Such information is not available for women in nursing homes, and is necessary for developing interventions that can help protect women in nursing homes against anger-related illness. Nursing home administrators were surveyed to evaluate women's health promotion programming in general, and the incidence of and institutional response to conflicts of women residents. About 74% of residents were women; yet, women's health promotion programs were rare (offered in 1 out of 25 facilities, or 4%). Ninety percent of administrators identified depression as the most significant women's health problem, but tended to see it as warranting medical rather than programmatic attention. Eighty percent identified strained interpersonal relationships as a significant health problem for women, requiring programmatic attention. In particular, administrators identified the need for programming to help women residents resolve conflicts with roommates and family members. Formal mechanisms for managing conflicts of residents did not exist in sample nursing homes.
This study reports on the development and validation of a health behavior index in predominantly low socioeconomic status (SES) older adults. In order to develop and validate the index for use in low SES older adults, the 24-item Health and Human Services HealthStyle Self-Test was used for item generation. It was reduced to a relatively brief instrument, the Short HealthStyle (SHS) Index with 13 items that measures four major content areas of lifestyle behaviors among low SES older adults. The SHS Index was administered to a sample of 350 low SES older individuals. Principal component model factor analysis indicated a four-factor structure. Items loading on the first factor appeared to assess fitness and leisure activities, whereas those loading on the second and third factor assessed nutrition practices and stress control, respectively. A fourth factor assessed drinking/eating behaviors. Discriminant validity of the SHS was confirmed using the Instrumental Activities of Daily Living, and other health measures that indicated distinct constructs. Internal consistency for the SHS was .72 using Chronbach's alpha. Overall, the SHS Index displayed good psychometric properties in this sample, suggesting the appropriateness of using it to measure selected health behaviors with low SES older adults.
Persons exposed to traumatic events in childhood and adolescence may suffer from the symptoms of posttraumatic stress disorder (PTSD) well into old age. The aim of this paper is to introduce a structured life-review technique for the treatment of elderly PTSD patients. This technique centers on the discussion and evaluation of each consecutive stage of life. The therapist encourages the patient to reminisce on both positive and negative experiences; positive coping experiences are reinforced. A single session on the traumatic event is integrated into the discussion of the stages of life, which are dealt with in chronological order. In the following, 3 case studies (e.g., survivors of the 1945 Dresden bombing) are presented. Psychometric measures (PTSS-10, IES-R) for the case studies are reported. Finally, the potential and limitations of the pilot study and the new approach are discussed.
The Elder Life Adjustment Interview Schedule (ELAIS) was developed as an age- and culture-sensitive assessment device for depression and 9 environmental, behavioral, and health correlates (Schlatter et al., 1993, J. MARC Res. 1: 27–42). The psychometric adequacy of the ELAIS has been demonstrated with samples of elder Americans of Asian, Caucasian, and Native Hawaiian ancestry (Dubanoski et al., 1996, J. Clin. Gerospsychol. 2: 247–262). This study reports on the reliability and construct validity of a translated Japanese version. Participants were 55 community-dwelling elders living in the areas surrounding Maebashi, Japan. The ELAIS contains 14 scales of which 9 represent theoretical predictors of depression. The 2 Environmental Condition scales measure life events and social support. The 4 Behavioral Competency scales measure recreational activity, assertiveness, self-reinforcement, and perceived control. The 3 Health Factor scales measure perceived health, functional ability, and objective health. The 5 Other scales measure demographics, depression, life satisfaction, cognitive functioning, and response style. Results yielded acceptable internal consistency and stability reliability coefficients for all but 1 of the subscales on the ELAIS (informational social support). Construct validity support was found for the Depression scale and 6 theoretical predictors, including life events, recreational activity, assertiveness, self-reinforcement, functional ability, and objective health. Treatment and prevention implications for the cross-ethnic multivariate assessment of depression among elders are discussed.
The purpose of this study was to test the hypothesis that the Behavioral Dyscontrol Scale (BDS), a measure of the executive cognitive capacity to use an intention to guide purposeful, goal-directed activity would be strongly associated with concurrent functional status after controlling for age, sex, education, severity of pain, medical comorbidity, depression, and general mental status, in a sample of 246 elderly inpatients receiving rehabilitation services following hospitalization for stroke. Functional status was assessed by rehabilitation nurses' ratings of patients on 11 ADL items and on the Barthel Index. The BDS was the strongest predictor for 11 of the 12 dependent variables. Although it correlated significantly with all outcomes, the MMSE entered only one of the regression models. Of the other covariates, only age and severity of pain made an additional contribution to the prediction of functional ability for more than 1 dependent variable. Consistent with prior results in several other samples, the ability to use intentions to guide purposeful behavior appears to be an important contributor to everyday functioning among older adults.
This paper focuses on the effects of the Holocaust on its survivors more than 55 years after the end of World War II. The emphasis is on survivors who were either adults during the Holocaust and who are now over the age of 70, or survivors who were children during the Holocaust and whose age is now between 56 and 70. The central question was: What kinds of posttraumatic phenomena are seen in older adult survivors? After an overview of the field, the situation of survivors in Israel is presented in 2 ways. Results of a survey of survivors who were referred to Amcha, the National Israeli Center for Psychosocial Support of Survivors of the Holocaust, is provided to give some insight in a clinical population. In addition, 2 case histories of survivors are presented to give a more in-depth perspective. The gap between the data from the questionnaires and the clinical material has relevance for the way in which we conceptualize the late consequences of massive trauma.
Anxiety symptoms are fairly common among patients with Alzheimer's Disease (AD). Such symptoms are likely to make patient care more problematic and, therefore, increase the risk of nursing home placement. Anxiety symptoms were evaluated on the basis of physician examinations, in conjunction with caregiver interviews, in 372 community-dwelling AD patients. Patients received annual follow-up for 1–12 years (M = 4.4). Patients who exhibited anxiety symptoms at baseline assessment were significantly more likely to enter nursing homes, regardless of initial cognitive status or other risks for institutionalization. There was a 15% increase in risk for each point on a 0–5 scale. This study supports the hypothesis that anxiety symptoms increase the risk of nursing home placement in patients with AD. Consequently, there is a need for better understanding of the causes of anxiety in AD and for the development of effective methods of assessment and treatment.
Research on the prevalence of traumatic exposure has tended to focus on younger populations, limiting our knowledge about trauma and its effects in older adults. In this study, lifetime trauma exposure was assessed in a sample of 436 male military veterans of World War II and the Korean Conflict (age 59–92). A clinician-administered screening measure, the Brief Trauma Interview, was developed to assess lifetime exposure to 10 categories of trauma using DSM-IV criteria. PTSD was assessed in interview and questionnaires. Despite a high prevalence of trauma exposure, symptom levels were relatively low. Few men met criteria for current or lifetime PTSD. Secondary analyses found that lifetime symptom severity was higher in men who met the DSM-IV A.2 criterion, in contrast with men who did not meet A.2. Findings indicate that trauma is highly prevalent among older men, although many may be asymptomatic.
There appears to be a relative absence of studies that have examined the prevalence of cognitively intact individuals who reside in extended care facilities. Prevalence data were collected on 296 persons who resided in 3 extended care nursing facilities in Central Virginia. Cognitive intactness was evaluated via the Minimum Data Set Cognitive Performance Scale (CPS) and an author-generated survey (i.e., Cognitively Intact Survey [CI Survey]) of select nursing staff members at each facility. The Mini-Mental State Examination (MMSE) was utilized to examine the accuracy of the two measures in identifying cognitive intactness. Findings indicated that prevalence rates of cognitively intact residents varied as a function of the measures utilized to assess intactness. Specifically, a significantly greater proportion of the total sample of residents was judged to be cognitively intact via the CI Survey (34.12%) as compared to the CPS (26.01%). The level of interjudge agreement between the two measures was found to be moderately high (K = 0.68). When the MMSE was employed to verify individuals' levels of intactness, the percentages of residents predicted to actually be cognitively intact were somewhat lower for each measure. Specifically, based on the data obtained via the CI Survey, 22.75% of the total sample were predicted to actually be cognitively intact, whereas 17.85% of the sample were predicted to be intact based on the CPS results. Findings are discussed in light of factors that may have contributed to the differential prevalence rates of cognitively intact individuals obtained across the measures utilized in this study. Concerns regarding the utilization of the MMSE as a criterion measure of cognitive intactness in persons residing in extended care nursing facilities are provided, along with data on the living environments/roommate statuses of those residents judged to be intact via the CI Survey. Implications for the design of future extended care nursing units, as well as future research, are also included.
