New York University Intimate Relationship Violence Discussion Select 2 of the following prompts How is culture an important factor in understanding intimat

New York University Intimate Relationship Violence Discussion Select 2 of the following prompts How is culture an important factor in understanding intimate relationship violence?What are the characteristics of marriage in later life?What are the repercussions associated with widowhood?What is the Elder Justice Act?What is AIDS dementia complex?What is the prevalence of anxiety disorders? Why are they common in older people? CHAPTER TEN
Clinical Assessment, Mental Health,
and Mental Disorders
Mental Health and the Adult Life
Course
• Learning Objectives
– How are mental health and psychopathology
defined?
– What are the key dimensions used for categorizing
psychopathology?
– Why are ethnicity and aging important variables
to consider in understanding mental health?
Mental Health and the Adult Life
Course
• Defining Mental Health and Psychopathology
– What is the difference between mental health and
mental disorder?
• Characteristics of mentally healthy people:
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Positive attitude toward self
Accurate perception of reality
Mastery of the environment
Autonomy
Personal balance
Growth and self-actualization
– For older people, what would be considered abnormal
may be adaptive under some circumstances.
• Isolation
• Passivity
• Aggressiveness
Mental Health and the Adult Life
Course
• A Multidimensional Life-Span Approach to
Psychopathology
– Viewing adult’s behavior from a lifespan perspective
• Psychological forces
– Normative changes can mimic mental disorders.
– Nature of personal relationships
• Sociocultural forces
– Being paranoid may be adaptive in certain circumstances.
– Cultural differences must be taken into account.
• Life-Cycle Factors
– An older person who wishes to go back to school.
– Resistance to revealing personal information.
– Sleeping patterns
Mental Health and the Adult Life
Course
Mental Health and the Adult Life
Course
• Ethnicity, Gender, Aging, and Mental Health
– Sociocultural influence in assessing behavior
– Older minorities may have experienced:
• Inadequate health care
• Environmental health risks
• Stress of prejudice and discrimination
– Ethnic differences found:
• Older Hispanic men show higher rate of alcohol abuse then
women.
• Older Hispanic women show higher rates of phobias and
panic attacks than men.
• Native American men also have high rates of alcohol abuse.
• Older African-American men have lower rates of depression
than other ethnic groups.
Developmental Issues in Assessment
and Therapy
• Learning Objectives
– What key areas are included in a multidimensional
approach to assessment?
– What factors influence the assessment of adults?
– How are mental health issues assessed?
– What are some major considerations for therapy
across adulthood?
Developmental Issues in Assessment
and Therapy
• Areas of Multidimensional Assessment
– Mental status exams
• Useful as a quick screening of measures of mental
competence
– Mini-Mental Status Exam (MMSE)
– Psychological functioning assessed through:
• Interviews
• Observation
• Test or questionnaires
– Three dimensions of social functioning:
• Ties with social network
• Content of interaction with one’s social network
• Number and quality of interactions
Developmental Issues in Assessment
and Therapy
Developmental Issues in Assessment
and Therapy
• Factors Influencing Assessment
– Negative biases
• Racial
• Ethnic
• Age stereotypes
– Positive biases
• Women do not abuse alcohol.
Developmental Issues in Assessment
and Therapy
• Assessment Methods
– Primary methods:
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Interview
Self-report
Report by others
Psychophysiological
Direct observation
Performance-based assessment
Developmental Issues in Assessment
and Therapy
• Developmental Issues in Therapy
– Medical treatment
• Dosage may be different for older adults.
– Psychotherapy
• Different ages present different problems.
The Big Three: Depression, Delirium,
and Dementia
• Learning Objectives
– What are the most common characteristics of people
with depression? How is depression diagnosed? What
causes depression? What is the relation between
suicide and age? How is depression treated?
– What is delirium? How is it assessed and treated?
– What is dementia? What are the major symptoms of
Alzheimer’s disease? How is it diagnosed? What
causes it? What intervention options are there?
– What are some other major forms of dementia?
– What do family members caring for patients with
dementia experience?
The Big Three: Depression, Delirium,
and Dementia
• Depression
– Myth: most older adults are depressed
• Fact: rates of depression decline from young adulthood
to old age for healthy people.
• Less than 5% of older adults living in the community
show signs of depression.
• For those receiving home health care, the rate is 13%.
• Cohort effect: most recent born have highest rates of
depression.
The Big Three: Depression, Delirium,
and Dementia
The Big Three: Depression, Delirium,
and Dementia
• Depression
– General Symptoms and Characteristics of People
with Depression
• Dysphoria—feeling “down” or “blue”
• Accompanying physical symptoms
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Insomnia
Changes in appetite
Diffused pain
Trouble breathing
Headaches
Fatigue
Sensory loss
The Big Three: Depression, Delirium,
and Dementia
• Depression
– General Symptoms and Characteristics of People with
Depression
– Symptoms must last at least two weeks.
– Other causes must be ruled out.
– Clinician must determine how symptoms are affecting daily life.
– Older ethnic minorities show higher rates of
depression.
• Especially true for Chinese and Mexican Americans
• One fourth of older Latinos show depressive symptoms.
– Gender and Depressive Symptoms
• Women tend to be diagnosed with depression more than
men.
The Big Three: Depression, Delirium,
and Dementia
• Depression
– Assessment Scales
• Beck Depression Inventory
• Geriatric Depression Scale
• Center for Epidemiological Studies—Depression Scale
– Causes of Depression
• Biological
– Genetics, brain changes, neurotransmitters
» Such as low levels of serotonin
• Cognitive-behavioral
– Internal belief systems are affected by experiencing
unpredictable and uncontrollable events
The Big Three: Depression, Delirium,
and Dementia
The Big Three: Depression, Delirium,
and Dementia
• Depression
– Treatment of Depression
• All forms of depression benefit from some form of therapy
• Medication:
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Selective serotonin reuptake inhibitors (SSRI)
Norepinephrine reuptake inhibitors (SNRI)
Norepinephrine and dopamine reuptake inhibitors (NDRI)
Combined reuptake inhibitors and receptor blockers
Tetracyclic antidepressants
• Electroconvulsive therapy (ECT)
• Psychotherapy
– Behavior therapy
– Cognitive therapy
The Big Three: Depression, Delirium,
and Dementia
• Delirium
– Disturbance of consciousness that develops rapidly
– Due to medical conditions, medication side effects,
substance intoxication or withdrawal, exposure to
toxins, or a combination
– Most cases can be cured
• Dementia
– Affects over 37 million globally
– Most older adults are not demented
– About a dozen forms of dementia have been identified
The Big Three: Depression, Delirium,
and Dementia
• Dementia
– Alzheimer’s Disease
• Progressive
• Degenerative
• Fatal
– Neurological Changes
• Rapid cell death
• Neurofibrillary tangles
• Plaques consisting of a core of beta-amyloid, a protein,
surrounded by degenerated fragments of dying or dead neurons
– Symptoms and Diagnosis
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Gradual changes in cognitive function
Declines in personal hygiene and self-care skills
Inappropriate social behavior
Changes in personality
The Big Three: Depression, Delirium,
and Dementia
The Big Three: Depression, Delirium,
and Dementia
• Alzheimer’s Disease (continued)
– Sundowning: symptoms are worse in the evening
– Cause:
• Autosomal dominant inheritance patterns: involve one
gene from either one’s mother or father in order to cause
the condition
• Beta-amyloid cascade hypothesis: the process by which
beta-amyloid creates neuritic plagues that in turn lead to
tangles that cause neuronal death
– Intervention Strategies
• Memory improvement drugs
• Behavioral strategies are more effective than drugs
– One is called spaced retrieval: involves using an implicit-internal
memory intervention
The Big Three: Depression, Delirium,
and Dementia
The Big Three: Depression, Delirium,
and Dementia
• Caring for Patients with Dementia at Home
– Caregivers are at risk for depression.
– Effective Behavioral Strategies
• Include financial plans, rethinking issues such a bathing,
dressing, grooming
• Strategies to prevent wandering
• Incontinence
• Removing items than may be harmful and jewelry that
might become lost
The Big Three: Depression, Delirium,
and Dementia
• Other Forms of Dementia
– Vascular Dementia
• Numerous small cerebral vascular accidents
– Occurs with greater rapidity than Alzheimer’s
– Parkinson’s Disease
• Characteristics
– Slow walking
– Difficulty getting into or out of chairs
– Slow hand tremors
• Treatment
– Levodopa: raises the levels of dopamine in the brain
– Sinemet: a combination of levodopa and carbidopa
– Stalevo: combination of Sinemet and entacapone
The Big Three: Depression, Delirium,
and Dementia
• Other Forms of Dementia (cont.)
– Huntington’s Disease
• Involuntary flicking movement of the arms and legs
• Hallucinations, paranoia, depression, and clear
personality changes
– Alcohol-Related Dementia
• Wernicke – Korsakoff’s syndrome
• Key symptom = confabulation
– AIDS Dementia Complex or ADC
• Encephalitis, behavioral changes, decline in cognitive
function
• Progressive slowing of motor functions
Other Mental Disorders and Concerns
• Learning Objectives
– What are the symptoms of anxiety disorders? How
are they treated?
– What are the characteristics of people with
psychotic disorders?
– What are the major issues involved with
substance abuse?
Other Mental Disorders and Concerns
• Anxiety Disorders
– Symptoms and Diagnosis
• Physical changes that interfere with functioning.
• Anxiety in older adults may be appropriate to the
situation or are due to underlying health problems.
– Treating Anxiety Disorders
• Medication
– Benzodiazepine (Valium and Librium)
– SSRIs (Prozac, Paxil, and others)
– Buspirone and beta-blockers
• Psychotherapy
– Cognitive behavioral
– Relaxation training
Other Mental Disorders and Concerns
• Psychotic Disorders
– Schizophrenia
• Severe impairment of the thought processes
• Delusions
• Onset occurs most often between ages 16 and 30
– Natural course of the disorder is improvement over the adult
life span
– Treating Schizophrenia
• Emphasizes medication
• Difficult to treat with psychotherapy
• A comprehensive and integrated program can be
effective
–
Other Mental Disorders and Concerns
• Substance Abuse
– Elderly person’s drug of choice is alcohol.
– Alcoholism includes four symptoms:
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Craving
Impaired control
Physical dependence
Tolerance
– Middle age shows effects of earlier alcoholism.
• Disease of the liver and pancreas
• Various types of cancer
• Cardiovascular disease
– Treatment focuses on three goals:
• Stabilization
• Reduction of consumption
• Treatment of coexisting problems
Other Mental Disorders and Concerns
CHAPTER ELEVEN
Relationships
Relationship Types and Issues
• Learning Objectives
– What role do friends play across the adult
lifespan?
– What characterizes love relationships? How do
they vary across cultures?
– What are abusive relationships? What
characterizes elder abuse, neglect, and
exploitation?
Relationship Types and Issues
• Friendships
– Friendships in Adulthood
• Friendship provides many benefits.
• Three broad themes underlie adult friendships:
– Affective or emotional basis
» This includes self-disclosure, expressions of intimacy,
appreciation, affection, and support.
» Based on trust, loyalty, and commitment
– Shared or communal nature
» Friends participate in or support activities of mutual
interest.
– Sociability and compatibility
» Friends keep us entertained and are sources of
amusement, fun, and recreation.
Relationship Types and Issues
• Developmental Aspects of Friendships and
Socioemotional Selectivity
– Why are friends so important to older adults?
• Concerns about being a burden to their families
– Friends help each other foster independence.
• Older adults tend to have fewer relationships than
people in mid-life and young adulthood.
– Socioemotional selectivity
• Social contact is motivated by a variety of goals.
– Information seeking
– Self-concept
– Emotional regulation
Relationship Types and Issues
• Men, Women’s, and Cross-Sex Friendships
– Men’s and women’s friendship tend to differ in
adulthood.
• Women’s friendships are based on intimate emotional
sharing.
• Men’s friendships tend to be based on shared activities and
interests.
• Women tend to have more friendships than men.
– Friendships between men and women
• Beneficial effect, especially for men
• Similar to cross ethnic friendships
• Cross-gender friendships tend to be difficult to maintain.
Relationship Types and Issues
• Love Relationships
– Love through adulthood
• Sternberg has identified three components of love:
– Passion
– Intimacy
– Commitment
» Ideally, good love relationships have all three components.
– Falling in Love
• Assortative mating does the best job explaining the process
of forming love relationships.
– Selecting a mate works best when there are shared values, goals,
and interests.
• Homogamy = the degree to which people are similar
• An increasing number of people meet online
• Culture is a powerful force in shaping mate selection choices
Relationship Types and Issues
• Violence in Relationships
– Abusive relationships occur when one person
becomes aggressive toward the partner.
• Battered woman syndrome = belief that she cannot
leave the abusive situation
– The causes of aggression become more complex
as the level of aggression increases.
– Culture is an important contextual factor.
• Patriarchal societies condone violence more.
Relationship Types and Issues
Relationship Types and Issues
• Elder abuse, neglect and exploitation
– Elder abuse is difficult to define and has several
categories:
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Physical abuse
Sexual abuse
Emotional or Psychological abuse
Financial or material exploitation
Abandonment
Neglect
Self-neglect
– 1 in 4 vulnerable older adults are at risk for abuse,
neglect or exploitation
Lifestyles and Love Relationships
• Learning Objectives
– What are the challenges and advantages of being
single?
– Why do people cohabit?
– What are gay male and lesbian relationships like?
– What is marriage like across adulthood?
– Why do people divorce?
– What do people remarry?
– What are the experiences of widows and
widowers?
Lifestyles and Love Relationships
• Singlehood
– People remain single for a variety of reasons.
• Men tend to stay single longer.
– However, fewer men than women remain unmarried
throughout adulthood.
• Ethnic differences in singlehood
– Nearly twice as many African Americans are single during
young adulthood as European Americans.
• The decision to never marry is a gradual one.
Lifestyles and Love Relationships
• Cohabitation
– In committed, intimate, sexual relationships
without marriage
– Becoming an increasingly popular lifestyle choice
– Couples cohabitate for three main reasons:
» Convenience, sharing expenses, sexual accessibility –
part-time or limited cohabitation
» Couples are engaging in a trial marriage with an intent on
marrying – premarital cohabitation.
» Long-term commitment that is a marriage in fact, but
lacking official sanction – substitute marriage.
Lifestyles and Love Relationships
• Gay and Lesbian Couples
– On many relationship dimensions gay male and
lesbian couples are similar to married couples.
• Including finances and household chores
– Gender differences are more important than sexual
orientation.
• Gay men tend to separate love and sex and have more shortterm relationships.
• Lesbian and heterosexual women are more likely to connect
sex and emotional intimacy in fewer, longer lasting
relationships.
• Gay and lesbian couples often report less support from
family members than do married or cohabitating
heterosexual couples.
Lifestyles and Love Relationships
• Marriage
– The median age at first marriage is increasing and
has done so over the last few decades.
– Marital success: an umbrella term referring to any
marital outcomes
– Marital quality: a subjective evaluation of the
couple’s relationship
– Marital adjustment: the degree spouses
accommodate each other
– Marital satisfaction: a global assessment of one’s
marriage
Lifestyles and Love Relationships
Lifestyles and Love Relationships
• Factors influencing marital success
– Age of the two partners at time of marriage
– Homogamy
• Marriage based on similarity
– Feelings of equality
• Exchange theory – each partner contributing something
to the relationship that the other would be hard
pressed to provide
Lifestyles and Love Relationships
• Do Married Couples Stay Happy?
– Marital satisfaction is highest at the beginning of the
marriage, falls until children leave home, and rises in
later life.
– Vulnerability-Stress-Adaptation Model: marital
quality is a dynamic process resulting from the
couple’s ability to handle stressful events
– The Early Years
• Early in a marriage, the couple must adjust to different
perceptions and expectations
• As couples settle in a routine, marital satisfaction tends to
decline.
• Marital satisfaction tends to decline with the birth of a child.
Lifestyles and Love Relationships
Lifestyles and Love Relationships
Lifestyles and Love Relationships
• Marriage at Midlife
– Most marriages improve when the children leave home.
– For some middle-aged couples, however, satisfaction
remains low.
• Married Singles – emotionally divorced and living as house-mates
• Older Couples
– Reduced potential for marital conflict and greater potential
for pleasure.
– Being married in later life has several benefits.
• Caring for a Spouse/Partner
– The division of labor must be readjusted.
– Marital satisfaction is much lower than for healthy couples.
– Providing full-time care for a partner is both stressful and
rewarding.
Lifestyles and Love Relationships
• Divorce
• Who Gets Divorced and Why
– Divorce in the U.S. is common and rates are higher
than in many other countries.
– Gottman and Levenson developed two models to
predict divorce early (within first 7 years) and late
(when first child reaches 14)
• Does not hold for lower-income couples
– Covenant marriage: makes divorce harder to
obtain
Lifestyles and Love Relationships
Lifestyles and Love Relationships
• Effects of Divorce on the Couple
– Divorce may impair well-being even several years
later.
• Divorce Hangover: inability to “let go”
• Divorce in middle- or late life
– If the woman initiates the divorce, they report self-focused
growth and optimism.
– If they did not, they tend to ruminate and feel vulnerable.
• Middle-aged divorced women often face financial
problems
Lifestyles and Love Relationships
• Remarriage
– Despite adjustment problems, the vast majority of
divorced people remarry.
– Usually men and women wait about 3.5 years.
– Few differences between first marriages and
remarriages.
• Second marriages have 25% higher risk of dissolution than
first marriages (except African American marriages).
– Second marriage rates are lower for older divorced
women.
– Remarriage in later life appears to be very happy,
especially if the partners were widowed.
• In…
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