Clinical Interviewing With Older Adults

Over the next few decades the older adult population will increase dramatically, and prevalence rates of psychiatric disorders are also expected to increase in the elderly cohort. These demographic projections highlight the need for diagnostic instruments and methods that are specifically tailored to older adults. The current paper discusses the benefits and drawbacks of clinical interviewing with older adults, using two popular interview protocols as illustrative examples. Drawing upon preexisting basic research and our own observations collected in clinical and research settings over a 10-year period, we suggest procedures and suggestions for augmenting existing interview protocols to increase their usefulness with older adults in research and clinical settings. Strategies to optimize interview duration and enhance retrospective data accuracy and the pros and cons of dimensional versus dichotomous response formats, among other relevant topics, are discussed.     

Alcohol Use Among Older Adults

Alcohol use problems among older adults have been called the "invisible epidemic." As the population of older adults continues to grow, there is an increased need to reexamine alcohol use in this population. The authors provide an overview on alcohol use in the over-60 age group. The main areas of focus included research on the prevalence of drinking in that population, as well as comments on the best practices in assessment and psychological treatment. Several screening assessments have been recommended for use with older adults, such as the CAGE questionnaire, Michigan Alcohol Screening Test-Geriatric version, Alcohol-Related Problems Survey, and the Alcohol Use Disorders Identification Test. The authors note age-appropriate psychological treatment interventions that include brief interventions, family interventions, motivational counseling, and cognitive behavioral therapies. Barriers to assessment and treatment are also discussed.     

Cognitive Behavior Therapy With Older Adults

Now that the baby boomer population has passed middle age and has entered the category of “older adults,” greater attention has been placed on how to adapt evidence-based treatments to the unique needs of an aging segment of the population. This introduction describes the contributions to the special series on cognitive behavioral treatment with adults aged 65 and beyond.     

Counseling for Wellness With Older Adults

Resulting from the assumption that older adulthood is a time of decline, there is a dearth of research on the application of wellness counseling with older adults. This article reviews the literature on wellness and older adults, synthesizes wellness with adult development theory, and describes wellness counseling with older adults.     

Recollection Training and Transfer Effects in Older Adults: Successful Use of a Repetition-Lag Procedure

Abstract

We examined an approach aimed at training consciously-controlled recollection, introduced by Jennings and Jacoby (2003) Jennings, J. M. and Jacoby, L. L. 2003. Improving memory in older adults: Training recollection. Neuropsychological Rehabilitation, 13: 417–440. [CSA][CROSSREF][Taylor & Francis Online], [Web of Science ®] , [Google Scholar], for its ability to replicate and generalize. A continuous recognition task, requiring recollection to identify the occurrence of repeated items over gradually increasing lag intervals (number of intervening items between the first and second presentation of a repeated word), was given to a group of older adults twice a week for three weeks. Pre-and-post training performance was assessed on multiple measures and compared with a recognition practice and no contact control group. Recollection training proved successful; accurate identification of repeated items increased across a lag interval of 2 to 18 intervening items. Post-training gains following recollection training were found on n-back, self-ordered pointing, source discrimination and digit symbol substitution, but not with reading span or the CVLT-II. No changes were identified in the other groups. Gains from recollection training seem to transfer successfully in older adults.     

The Use of Solution-Focused Brief Therapy With Older Adults in Mexico: A Preliminary Study

This preliminary study investigated the use of Solution-Focused Brief Therapy (SFBT) with older adults in Mexico. The three session SFBT treatment focused on a self-defined problem, such as relationship issues or psychological well-being. Compared with a waiting list control group, the treatment group showed significant posttest improvements as indicated by the Outcome Questionnaire, the participant and an independent assessor. There was a significant difference between groups on participants' perception of goal achievement and in pre-post change during therapy on the Outcome Questionnaire. This study provides preliminary tentative support for the use of SFBT with the geriatric population in Mexico.     

Ethical Guidelines for Counselors Working With Older Adults

Counselors working with older adults may encounter situations that are not directly addressed by the ethical standards of the American Counseling Association (1995). After an extensive review of the literature, the Standards Committee of the Association for Adult Development and Aging (1998) identified 3 areas of concern: older adults with cognitive impairments, older adults who are the victims of abuse, and older adults with a terminal illness. This article examines the unique needs of older adults with these concerns and proposes guidelines for counselors working with such clients.     

Evidence‐Based Effective Practices With Older Adults

Older persons constitute an increasingly large population with significant mental health challenges. The authors review outcome research for both diagnosable conditions and late‐life transitions as a basis for evidence‐based practice with this population. Implications for clinical practice in professional counseling, counselor education and supervision, and research are considered.     

Personality and Everyday Functioning in Older Adults With and Without HIV

Journal of Clinical Psychology in Medical Settings - In a cross-sectional multi-method study of older adults living with and without HIV (n?=?202; 69.8% HIV seropositive), we tested...     

The Beck Anxiety Inventory in Older Adults With Generalized Anxiety Disorder

The authors investigated the psychometric properties of the Beck Anxiety Inventory (BAI) in a sample of 75 older generalized anxiety disorder (GAD) patients and a comparison group of 32 older adults without significant psychopathology. Internal consistency was above .80, and the BAI showed evidence of convergent validity in both groups. Evidence for discriminant validity with respect to measures of depression was weaker. Two items, fearing the worst and nervousness, correctly distinguished 86.5% of patients with GAD and 93.8% of the normal controls. Medical comorbidity was associated with somatic but not cognitive anxiety symptoms in the normal older sample. Overall, results indicate the limitations of the BAI in assessing anxiety symptoms in older adults and suggest the need for use of an instrument focusing on cognitive aspects of anxiety.     

Depression in Older Adults

The purpose of this article is to address selected aspects of depression in older adults. Specifically, symptoms, risk factors, diagnosis, and interventions for depression in older adults are reviewed.     

Production of Inflected Novel Words in Older Adults With and Without Dementia

While cognitive changes in aging and neurodegenerative disease have been widely studied, language changes in these populations are less well understood. Inflecting novel words in a language with complex inflectional paradigms provides a good opportunity to observe how language processes change in normal and abnormal aging. Studies of language acquisition suggest that children inflect novel words based on their phonological similarity to real words they already know. It is unclear whether speakers continue to use the same strategy when encountering novel words throughout the lifespan or whether adult speakers apply symbolic rules. We administered a simple speech elicitation task involving Finnish-conforming pseudo-words and real Finnish words to healthy older adults, individuals with mild cognitive impairment, and individuals with Alzheimer's disease (AD) to investigate inflectional choices in these groups and how linguistic variables and disease severity predict inflection patterns. Phonological resemblance of novel words to both a regular and an irregular inflectional type, as well as bigram frequency of the novel words, significantly influenced participants' inflectional choices for novel words among the healthy elderly group and people with AD. The results support theories of inflection by phonological analogy (single-route models) and contradict theories advocating for formal symbolic rules (dual-route models).     

Functional Mobility in a Divided Attention Task in Older Adults With Cognitive Impairment

ABSTRACT. Motor disorders may occur in mild cognitive impairment (MCI) and at early stages of Alzheimer's disease (AD), particularly under divided attention conditions. We examined functional mobility in 104 older adults (42 with MCI, 26 with mild AD, and 36 cognitively healthy) using the Timed Up and Go test (TUG) under 4 experimental conditions: TUG single task, TUG plus a cognitive task, TUG plus a manual task, and TUG plus a cognitive and a manual task. Statistically significant differences in mean time of execution were found in all four experimental conditions when comparing MCI and controls (p < .001), and when comparing MCI and AD patients (p < .05). Receiver-operating characteristic curve analyses showed that all four testing conditions could differentiate the three groups (area under the curve > .8, p < .001 for MCI vs. controls; area under the curve > .7, p < .001 for MCI vs. AD). The authors conclude that functional motor deficits occurring in MCI can be assessed by the TUG test, in single or dual task modality.     

Acceptance and Commitment Therapy With Older Adults: Rationale and Considerations

Older adults are the fastest growing segment of the population. With these changing demographics, mental health professionals will be seeing more older clients. Additionally, older adults are an underserved population in that most older adults in need of mental health services do not receive treatment. Thus, it is essential that treatments for mental and behavioral health problems are empirically supported with older adults and that mental health professionals are aware of the special needs of older adult populations. Acceptance and Commitment Therapy (ACT) is an emerging approach to the treatment of distress. The purpose of this article is to provide a rationale for using ACT with older adults based on gerontological theory and research. We also review research on ACT-related processes in later life. We present a case example of an older man with depression and anxiety whom we treated with ACT. Finally, we describe treatment recommendations and important adaptations that need to be considered when using ACT with older adults and discuss important areas for future research.     

Depression and Anxiety in Older and Middle‐aged Adults With Diabetes

This study aims to compare rates of depressive and anxious symptoms among older adults with and without diabetes. The study also examines differences in depression, anxiety, and diabetes‐related emotional distress between middle‐aged and older adults with diabetes. A total of 224 participants completed a range of questionnaires measuring depression, anxiety, and diabetes‐related emotional distress (if applicable). One hundred and three adults with diabetes (55 middle‐aged, mean age = 47 years, range 40–59 years and 48 older, mean age = 69 years, range 60–81 years) were recruited from a tertiary diabetes clinic. One hundred and twenty‐one adults without diabetes (72 middle‐aged, mean age = 52 years, range 40–59 years and 49 older, mean age = 65 years, range 60–76 years) were recruited from either a university student pool or a registry of adults aged 50 and above. Older adults with diabetes had significantly higher levels of depression and comparable levels of anxiety with older adults without diabetes. Older adults with diabetes had significantly lower levels of depression, anxiety, and diabetes‐related distress than middle‐aged adults with diabetes. Diabetes is associated with high rates of depression and anxiety, with middle‐aged adults more adversely affected than older adults.     

老年人的朋友参照效应

采用自我参照效应范式探讨老年人朋友参照效应的特点。城市老年人和农村老年人各36人参加实验1, 结果表明：(1)城乡老年人都表现出朋友参照效应; (2)与农村老年人相比, 城市老年人朋友参照效应指标显著高于自我参照效应指标。城市教育程度较高与教育程度较低老年人各36人参加实验2, 结果发现, 与城市教育程度较低的老年人相比, 城市教育程度较高的老年人朋友参照效应指标高于自我参照效应指标, 表明教育程度对朋友参照效应有显著影响。由此推断, 老年人会将朋友包含于自我图式之内, 并且教育程度会影响朋友在自我图式中的地位。     

Translating Research for Professional Development and Effective Clinical Practice With Older Adults

This paper offers a commentary on the articles in the special series on cognitive behavior therapy with older adults (Carmin, 2012-this issue), noting the commonalities found across discussions of diagnostic interviewing and cognitive-behavioral assessment and treatment for late-life insomnia, depression and suicide risk, PTSD, and OCD. These case studies demonstrate best practices in the application of cognitive-behavioral strategies for assessment and intervention with a diverse range of older adults. Clinicians can improve the effectiveness of their work with aging clients by expanding their skills in assessment and managing interprofessional relationships in integrated health-care settings. Reflected by the papers in this series, ongoing professional development and research attention are both essential as clinicians from the mental health disciplines increase provision of CBT with older adults. Treatments for specific disorders and problems will also benefit from the growing literature on successful aging, and the application of positive psychology in our future collaborations with older adults and their care partners.     

The Use and Benefits of External Memory Aids in Older and Younger Adults

We examined the spontaneous use and benefits of external memory aids in older (aged 60–85 years) and younger (aged 17–31 years) adults. In Study 1, participants were or were not given the opportunity to use a memory aid in a phone message recall task. In Study 2, a memory aid was available for one of two similar tasks. Participants' spontaneous use of external memory aids was measured. On the Memory Compensation Questionnaire, older adults reported using external memory aids more frequently but were no more likely than younger adults to take notes on the messages. Older adults benefitted from the availability of notes in both studies; younger adults benefitted when the memory task was more challenging. The results illustrate the value of external memory aids and suggest that older adults may underutilize them. The findings also raise questions about the relation between self‐reported and actual use of strategies in everyday life. Copyright © 2013 John Wiley & Sons, Ltd.     

Strategy-Based Cognitive Training for Improving Executive Functions in Older Adults: a Systematic Review

Given projected increases in dementia prevalence, emphasising earlier stages of cognitive impairment in older adults enables targeted early intervention strategies. Strategy-based cognitive training (SCT) is a remedial approach involving guidance and practice in compensatory techniques to improve cognition, including memory and attention. It may also be effective for improving executive functions (EF) integral to everyday tasks. This review systematically evaluates SCT effects on EF in older adults without dementia. Following PRISMA guidelines, we reviewed eligible trials according to pre-defined criteria, differentiating SCT from other cognitive interventions and stipulating total EF-focused intervention time, study design and target population (healthy older adults or mild cognitive decline). We then evaluated trials according to design, methodological quality and outcomes. Unfortunately, with too few studies in mild cognitive impairment, we refocused our review only on healthy older adults. Thirteen studies with 4120 participants in total were included, primarily targeting inductive reasoning. Despite heterogeneous study designs and SCT programs, 11/13 trials reported significant EF improvements, generally of moderate effect size (Hedges’ g > 0.3). Four studies reported sustained benefits from one month to 10 years. There was some evidence of far transfer. We conclude that there is promising evidence for SCT as a targeted intervention for EF in healthy older adults and preliminary evidence for maintaining effects over time. Fewer trials have investigated far transfer (e.g. improved everyday functioning) or capacity to delay/prevent dementia, which are most relevant to clinical utility. Limitations include the inability to calculate effect sizes for four studies and absence of statistical meta-analysis.