Mental Health Issues in the 1990s

An overview is presented of issues facing mental health professionals in the 1990s. Issues and problems addressed include: diagnostic dilemmas, civil rights issues, use of plea of innocent by reason of insanity, consequences of deinstitutionalization, growing disparity between the rich and the poor, AIDS, alcohol and other drug abuse, changes in traditional sex roles, increasing number of single-parent families and blended families, changes in abortion statutes, and an increasing number of elderly persons.     

Association of suicide rates of elderly persons with fertility rates

A negative correlation between societal suicide rates and social integration has been reported, but rarely specifically examined for suicide rates of the elderly although suicide rates of elderly persons are among the highest. The associations of suicide rates of elderly persons and fertility rates for 81 countries were examined using data from the World Health Organisation and United Nations. Fertility rates were considered a proxy measure for social integration. Multiple regression analysis indicated that suicide rates for males and females in the age bands 65-74 years and 75+ years were independently (negative) correlated with fertility rates. Fertility rates, as a measure of social integration, may interact with, modify and mediate the effect of cultural factors on suicide rates of elderly persons.     

The assessed crisis service needs of clients in community-based programs serving persons with developmental disabilities

Crisis services for persons with developmental disabilities who display challenging behaviors is rapidly emerging as a critical need for individuals placed in the community. Many states continue to close their large state facilities for persons with developmental disabilities. Challenging behaviors impedes successful living in the community. A questionnaire providing information on the types of challenging behavior, the availability and perceived need for on-site and off-site crisis-respite support services, and the optimal method of accessing community-based crisis services, was sent to Minnesota residential facilities in the metropolitan and rural areas. The results revealed commonalities between these respondents as well as the differences. As the national trend of deinstitutionalization continues, the information derived from this study will be useful for the development of crisis services in other states. © 1998 John Wiley & Sons, Ltd.     

An exploration of perception of body boundary, personal space, and body size in elderly persons.

A study of 108 elderly persons using the Body Distortion Questionnaire and the personal space simulation technique test did not support hypotheses that elderly persons with a large personal space will have a larger distortion of body boundary, a larger perception of large body size, a smaller perception of small body size, a larger distortion of body size, and a larger body distortion than elderly persons with a small personal space. The analyses with one-tail t tests showed elderly persons with a small personal space have a larger perception of large body size and a larger distortion of body size than elderly persons with a large personal space. When the extremes of personal space were used the results were the same. Males have a larger personal space and greater distortion of skin perceptions than females.     

Familiarity and recognition of faces in old age

Elderly persons exceed young adults in false recognitions of new faces. One account claims there are age-related deficits in memory for context of encounter with faces. Because of these deficits, elderly persons frequently recognize faces on the basis of perceived familiarity (i.e., resemblance to face representations in memory), which is high for some new faces. To test this context-recollection hypothesis, we had young adult and elderly subjects judge whether faces: (1) had been seen previously in a test (though no face was repeated), and (2) were subjectively familiar (though no face was famous). The elderly exceeded the young subjects in seen-before judgements (false recognitions), and only the elderly showed a positive correlation between false recognitions and subjective familiarity. In Experiment 2, this finding was extended from false recognitions to correct recognitions, supporting the view that elderly persons, compared to young adults, rely more on resemblance in recognizing faces.     

Relation of perceived health with psychosocial variables in elderly osteoarthritis patients

Self-perceived health is related to physical health status and frequently assessed in research on elderly persons. The association of perceived health with sociodemographic, psychological, social functioning, and physical functioning variables was examined in 86 elderly osteoarthritis patients. Psychological well-being (especially depression and anxiety), size of household, physical activity, and education were the most important predictors of self-perceived health (R = .70). Poor perceived health may suggest problems in elderly patients in several psychosocial areas, but good perceived health does not rule out psychosocial problems.     

老年结直肠癌的治疗

老年患者占结直肠癌患者的70%,因此老年人是结直肠癌的主要患病人群。为了提高结直肠癌治疗的总体疗效,我们应当特别关注老年性结直肠癌的治疗。以往,手术治疗和化疗的应用随着年龄的增高而明显减少。我们一直以为老年人手术和化疗的效果不令人满意。近期的研究改变了这一认识。证据表明辅助化疗和姑息性化疗对一般情况良好的老年人是有效而安全的。即使存在一些与年龄相关的基础疾病的老年结直肠癌患者仍然能从合理的治疗方案中获益。所以我们尚有许多工作需做,以提高老年性结直肠癌患者的疗效。腹腔镜下结肠癌根治术是对老年人安全有效的手术技术。我们期待随着经腔道的内窥镜手术技术的发展,将来会使老年性结直肠癌患者受益。     

Effects of environment on psychological well-being of elderly persons

This study reports an investigation of the psychological well-being of 90 elderly persons living in independent, retirement, and nursing homes. In previous studies elderly persons have not been matched on high levels of social and physical functioning across these living environments. Analyses indicated significantly that elderly persons living in their own homes or retirement homes reported greater well-being than their matched cohorts in nursing homes.     

The Wisdom Group: a psychotherapeutic model for elderly persons.

This article describes the "Wisdom Group," a therapy devised for the psychotherapeutic treatment of elderly persons. Preliminary work was done with five men of advanced age who were psychiatric in-patients with diagnoses of organicity and depression. The approach was effective in eliciting interaction during the meetings with each other and the group leader. The potential use of this intervention with a greater variety of elderly persons is discussed.     

Inferential processing of context: Studies of cognitively impaired subjects

Language comprehension tasks involving pronoun coreference were administered to a group of demented patients, a group of patients with cardiac disease, and groups of normal elderly persons and young adults. Pronoun coreference was constrained by either lexical, syntactic, or contextual cues. No differences were found between old and young subjects for any task. While the demented patients were impaired on all tasks, the cardiac patients were specifically impaired in the inferential processing of context.     

Issues in Publicly Subsidized Long Term Care Systems and Implications for the Religous Sector

Given the increasing numbers of elderly in need of long term care services and the harsh reality of finite resources, new models are required which define those elderly persons who should remain eligible for publicly subsidized long term care. If, in fact, a method is established for serving only a limited number of older persons, i.e., the truly vulnerable elderly, by way of the public system of long term care, a large constituency of older Americans will be left to exist on the margins. The church as an informal care system may appropriately assume the role of ensuring that the available public funds are used wisely and that service gaps inevitably left bewteen the increasing number of older persons and shrinking public support are bridged. In addition, the church must assist in improving all long term services by contributing to public policy formation.     

Construct validation of the Hand Test with the aged: replication and extension

The Hand Test (HT) was administered to 52 institutionalized elderly adults in an effort to cross-validate previous research dealing with the construct validity of the Hand Test in assessing organic dysfunction as assessed by Mental Status Questionnaire (MSQ) scores. Results suggested that, consistent with previous research, HT scores of Withdrawal and Pathology seem to be valid indicators of cognitive loss, independent of age and length of institutionalization, among elderly persons who reside in long term care facilities. Implications of these data for the care of impaired elderly persons by family and staff are discussed and suggestions for future research are offered.     

Performances on Rey Auditory Verbal Learning Test and Rey Complex Figure Test in a healthy, elderly Danish sample--reference data and validity issues

This study presents Danish data for Rey Auditory Verbal Learning Test (RAVLT) and Rey Complex Figure Test (RCFT) from 100 subjects aged 60-87 years. Education and estimated verbal intelligence (DART score) had a significant impact on the RAVLT trial 1-5 score but not on other RAVLT measures. The RCFT copy score was significantly related to age and the DART score. On RCFT recall a highly significant difference was found between persons who could make a faultless copy and persons with incomplete copy performance. Thus, this study presents separate data for RCFT recall scores according to the subjects' copying performance (in separate tables for age and education groups). For all measures on both RAVLT and RCFT wide distributions of scores were found and the impact of this broad score range on the tests' discriminative validity is discussed. RAVLT performances for elderly were similar to previous published meta-norms, but the included sample of elderly Danes performed better on RCFT (copy and recall) than elderly from the United States.     

Profils de routinisation différents chez les personnes âgées : entre adaptation et vulnérabilité

IntroductionThe purpose of the present investigation is to study the routinisation process in elderly persons according to physical, functional, psychological and cognitive resources.MethodsA person-centered approach revealed six profiles of resources in 235 elderly French participants from the 13-year follow-up of PAQUID cohort study.ResultsDifferent functioning profiles were highlighted and were significantly associated with different degrees and functions of routinisation. For the most routinised persons, the routinisation was associated with adaptive functioning. Instead for the less routinised persons, the routinisation was defined as a vulnerability marker. It seems also that this adaptive strategy was less used in persons with dementia.DiscussionThe adaptive attitudes, in particular the routinisation, would be less effective at higher levels of vulnerability.     

Grasp force control in older adults

Diminished tactile sensibility and impaired hand dexterity have been reported for elderly individuals. Reports that younger adults with severely impaired tactile sensibility use excessive grasp force during routine grasp and manipulation tasks raise the possibility that elderly persons likewise produce large grasp forces that may contribute to impaired dexterity. Impaired pseudomotor functioning also occurs in elderly subjects and may yield a slipperier skin surface that enhances the possibility for excessive grasp force. The present study measured grasp force in 10 elderly and 9 young adult individuals, during grasp and vertical lift of a small object, using a precision (pinch) grip of the thumb and index finger. The slipperiness of the object's gripped surfaces was unexpectedly varied. Skin slipperiness was estimated by also measuring the grasp force at which the object slipped from grasp. The older subjects employed grasp forces that were, on average, twice as large as those of the young subjects, with some producing forces many times greater than the young subjects' average grip force. Grip forces also were significantly more variable across trials in older subjects. This increased variability was not caused simply by the elderly subjects' increased grip force. A portion of the increased force was due to increased skin slipperiness. The grip force that the elderly subjects produced in excess of the slip force (the "margin of safety" against object slippage) was larger than would have been predicted from their skin slipperiness, however. It is suggested that, in part, the excessive grasp forces represent a strategic response to tactile sensibility impairment. Twopoint discrimination limina in the older subjects averaged about four times greater than in the younger subjects. Increased grasp forces in elderly persons may result from other factors, such as increased variability in grip force production. The contributions of excessive grasp forces to impaired dexterity in older persons still need to be addressed experimentally.     

Service planning for chronic mental patients: some principles

Services for chronic mental patients in this era of deinstitutionalization present a major challenge to clinicians and planners alike. The complexity of these patients' clinical and other programmatic needs requires that an array of viable comprehensive services be made available to them. Following certain established principles of service planning will help facilitate patients' longitudinal, psychological, financial, and geographical access to care.     

Possible relation of suicide rates of elderly with societal crime: a cross-national study

There are few studies examining the relationship between elderly suicides and societal crime. Therefore, a cross-national study examining the relationship between suicide rates of elderly persons and the percentage of the population victimised by different categories of crime was undertaken by using cross-national data from the World Health Organisation and United Nations databases. The main finding was a negative correlation between suicide rates in elderly men age 75+ years and women in both the elderly age-bands with the percentage of the population victimised by the crime of robbery. The findings were at variance with the study's hypothesis and may be explained by several factors, including methodological issues. Individual-level case-control or cohort studies of suicides and attempted suicides by elderly persons are suggested to examine the relationship of suicides by elderly and experience of being victimised by crime.     

The Rorschach Inkblot Method (RIM) Is Not a Test: Implications for Theory and Practice

Previous work with the Geriatric Hopelessness Scale (GHS; Fry, 1984, 1986) suggests that it may be a useful measure of pessimism for a variety of domains among elderly persons. One hundred seven community-residing aged persons were individually administered the GHS and a variety of personality and cognitive functioning measures in an effort to further refine and validate the GHS. Results suggest very modest internal consistency and a poorly defined factor structure for the GHS, in contrast to earlier findings. Although the GHS failed to differentiate elderly persons by age, it was nonetheless related to self-esteem, depression, self-rated health, internality, morale, and life satisfaction. Taken together, these data indicate that the research and clinical utility of the GHS with community-residing aged persons may be more limited than previously believed.     

Narcissistic Crises of Aging and Suicidal Despair

After reviewing some of the dangers inherent in oversimplifying the nature of suicide for public education purposes, a model (the “wedding-cake model”) of elderly suicide is outlined. This model is derived from a community-based psychological autopsy study. It is hypothesized that elderly persons who die by suicide have a lifelong character fault that remains invisible until aging life-changes force the issue into the open.