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.     

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.     

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.     

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.     

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.     

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.     

Spiritual Autobiography and Older Adults

Spiritual autobiography groups constitute a form of ministry that can potentially enrich the lives of older adults, their families, and their congregations. Such groups, when competently led, provide participants with an environment in which they can make meaning out of their lives, grieve their losses, and give and receive support. The actions and interactions involved in composing, telling, and hearing life stories are salutary exercises that can increase participants’ experiences of clarity, coherence, and connection to God and to each other. The spiritual wisdom that emerges from such life stories, when shared within congregations, can enhance intergenerational relationships and lead to spiritual growth for members of diverse ages.     

Improving Career Decision Making With Adults: Use of Portfolios

This article provides a model for developing a career portfolio process for use with high school students and adults functioning in various types of learning endeavors as they seek credentials or licenses for various careers.     

Psychoeducational Croups With Older Adults: An Integrative Personal Construct Rationale And Some Guidelines

A psychoeducational approach is proposed as an alternative to exclusively therapeutic work with older adults in recreational settings. An integrative rationale based on personal construct theory and some general guidelines for the group leader are presented. Two possible psychoeducational group formats (guided autobiography and coping skills) are discussed.     

我国老年人的社会支持与服务

鉴于我国老龄化现状,简要地回顾了社会支持的定义与种类,考察了我国传统的孝顺价值观和行为;并着重分析了我国老年人的社会支持与服务,包括老年人的社会支持与幸福感,老年人的家庭支持与照料,老年组织与公共老年服务;以及我国老年人社会支持的城乡差异。     

Sleep and Sleep Disorders in Older Adults

A common but significant change associated with aging is a profound disruption to the daily sleep-wake cycle. It has been estimated that as many as 50% of older adults complain about difficulty initiating or maintaining sleep. Poor sleep results in increased risk of significant morbidity and mortality. Moreover, in younger adults, compromised sleep has been shown to have a consistent effect on cognitive function, which may suggest that sleep problems contribute to the cognitive changes that accompany older age. The multifactorial nature of variables affecting sleep in old age cannot be overstated. Changes in sleep have been thought to reflect normal developmental processes, which can be further compromised by sleep disturbances secondary to medical or psychiatric diseases (e.g., chronic pain, dementia, depression), a primary sleep disorder that can itself be age-related (e.g., Sleep Disordered Breathing and Periodic Limb Movements During Sleep), or some combination of any of these factors. Given that changes in sleep quality and quantity in later life have implications for quality of life and level of functioning, it is imperative to distinguish the normal age-related sleep changes from those originating from pathological processes.     

Self-Compassion and Psychological Well-Being in Older Adults

Self-compassion refers to a kind and nurturing attitude toward oneself during situations that threaten one’s adequacy, while recognizing that being imperfect is part of being human. Although growing evidence indicates that self-compassion is related to a wide range of desirable psychological outcomes, little research has explored self-compassion in older adults. The present study investigated the relationships between self-compassion and theoretically based indicators of psychological adjustment, as well as the moderating effect of self-compassion on self-rated health. A sample of 121 older adults recruited from a community library and a senior day center completed self-report measures of self-compassion, self-esteem, psychological well-being, anxiety, and depression. Results indicated that self-compassion is positively correlated with age, self-compassion is positively and uniquely related to psychological well-being, and self-compassion moderates the association between self-rated health and depression. These results suggest that interventions designed to increase self-compassion in older adults may be a fruitful direction for future applied research.     

The Viability of an Abbreviated Version of the Holtzman Inkblot Technique With Older Adults

Multiple regression analyses of Holtzman Inkblot Technique (HIT; Holtzman, Thorpe, Swartz, & Herron, 1961) factor scores were conducted to empirically determine the viability of a short form of the HIT with older adults. Although R ² values were acceptable, the contribution of individual cards to total factor scores was dubious at best. These data suggest that the development of a short form of the HIT for use with older adults is premature and requires more systematic research to justify its viability.