Contextual Adult Life Span Theory for Adapting Psychotherapy with Older Adults

Our aging population is growing in size and diversity. To integrate different views on aging and make explicit the role of culture as a contextual factor, we modified Knight’s (Psychotherapy with older adults, 2004) Contextual, Cohort-based, Maturity, Specific Challenge (CCMSC) model of psychotherapy with older adults into the Contextual Adult Lifespan Theory for Adapting Psychotherapy (CALTAP). This article describes various components of the CALTAP, which serves as a meta-theoretical framework in guiding an integrated psychotherapy approach for the aging population. The interaction between environmental factors like cohort differences and socio-cultural contexts and individual factors such as maturation and age-related specific challenges not only shapes the experience and presentation of older adults in clinical settings, but also highlights special considerations in adapting psychotherapy for older adults.     

老年抑郁个体注意偏向的发生阶段

本研究以老年抑郁量表、自评抑郁量表和汉密顿抑郁量表为工具筛选出老年抑郁个体和老年正常对照组为研究对象,通过空间线索化范式,以及分离的情绪Stroop范式考察了刺激呈现时间、线索呈现条件对老年抑郁个体注意偏向的影响,并探讨了老年抑郁个体注意偏向的发生阶段。研究结果表明：（1）在空间线索任务中,当刺激呈现时间为250ms或500ms时,老年抑郁组与老年正常组的返回抑制效应在各种情绪刺激下均无显著差异（P>0.05）,即老年抑郁个体没有呈现出对任何情绪刺激类型的注意偏向现象;当刺激呈现时间为750ms或1000ms时,老年抑郁组的返回抑制效应在不同情绪刺激条件下差异显著,F(2, 66)=3.22,P=0.046,而老年正常组则不存在返回抑制效应在情绪刺激类型上的差异（P>0.05）,提示老年抑郁组对不同情绪类型的刺激注意返回抑制能力不同;进一步检验得知：返回抑制效应在悲伤条件下,存在组间差异,分别是F(1, 33)=10.03,P=0.003;F(1, 33)=18.21,P=0.000,即老年抑郁组的返回抑制效应弱于老年正常组。（2）在Stroop实验中,老年抑郁组在单中性、双中性与单悲伤面孔、中性悲伤面孔、双悲伤面孔线索类型下的反应时差异显著;且当线索类型为单悲伤面孔、中性悲伤面孔、双悲伤面孔时,老年抑郁组与老年正常组的反应时差异均显著,即老年抑郁组的反应时明显长于老年正常组,F(1, 41) = 5.37,P=0.026;F(1, 41) = 7.08,P=0.011;F(1, 41) = 7.28,P=0.010;而当线索类型为单中性和双中性面孔时,老年抑郁组与老年正常组的反应时差异不显著（P>0.05）;提示抑郁组可能在自动化注意选择分配期存在注意偏向。研究认为,老年抑郁个体的注意偏向可能发生在注意初始分配阶段和解释阶段,且受加工深度的影响。在刺激呈现时间较长的条件下,注意偏向的效应更明显。     

Age effects on the control of dynamic balance during step adjustments under temporal constraints

This study investigated the age effects on the control of dynamic balance during step adjustments under temporal constraints. Fifteen young adults and 14 older adults avoided a virtual white planar obstacle by lengthening or shortening their steps under free or constrained conditions. In the anterior–posterior direction, older adults demonstrated significantly decreased center of mass velocity at the swing foot contact under temporal constraints. Additionally, the distances between the ‘extrapolated center of mass’ position and base of support at the swing foot contact were greater in older adults than young adults. In the mediolateral direction, center of mass displacement was significantly increased in older adults compared with young adults. Consequently, older adults showed a significantly increased step width at the swing foot contact in the constraint condition. Overall, these data suggest that older adults demonstrate a conservative strategy to maintain anterior–posterior stability. By contrast, although older adults are able to modulate their step width to maintain mediolateral dynamic balance, age-related changes in mediolateral balance control under temporal constraints may increase the risk of falls in the lateral direction during obstacle negotiation.     

Facilitators,barriers and needs in the use of adaptive driving strategies to enhance older drivers’ mobility: Importance of openness,perceptions, knowledge and support

This study aimed to explore facilitators, barriers and needs for the use of adaptive driving strategies (i.e., means used to adjust driving for diminished abilities) which can optimize the community mobility of older drivers. An exploratory qualitative clinical research design was conducted with 11 older drivers, 7 relatives and 14 driving professionals. Five focus group discussions were audio recorded, transcribed and analyzed. Facilitators for the use of adaptive driving strategies were: being a woman; perceiving dangers; recognizing the usefulness of strategies and abilities as diminished; having disabilities or discomfort when driving; experiencing complex driving situations; receiving help of relatives and services of professionals; and having other transportation options. Barriers were: not knowing strategies; being proud; lack of self-criticism; unwillingness of relatives and physicians to intervene; having costs to the use of adaptive strategies; recognizing driving as important; perceiving the complexity of using other transportation options; and lack of proximity to facilities and services. To foster the use of adaptive strategies, TV, radio, newspapers and information sessions need increasing older drivers’ awareness about the age-related changes, the community resources, and the strategies themselves, including their importance in safe driving. Furthermore, to support older drivers in changing their driving habits and using adaptive strategies, results demonstrated that it is important to involve their relatives and professionals. While promoting safe driving and the prevention of collisions and injuries on the road, knowledge about facilitators, barriers and needs for the use of adaptive driving strategies could ultimately allow seniors to optimize their community mobility.     

Compared to what? The effects of a frame of reference on older adults’ subjective memory

It is often unclear what comparisons older adults make when evaluating their own memory. If thinking about their memory relative to others, they may assess their own abilities differently than if comparing it to their past capabilities. To test the effect of reference frames on memory assessments and memory performance, we randomly assigned 120 older adults to one of three conditions in which we manipulated frames of reference (control, past-self comparison, or other adults comparison) on a memory self-efficacy questionnaire. Participants also completed general and specific memory predictions and an objective memory test. Participants in the past-self condition reported significantly lower global memory self-efficacy compared with the other adults and control conditions. No condition differences emerged for memory predictions, objective memory, or the likelihood of over- or underpredicting memory performance. These findings suggest that reference frames impact global memory self-efficacy, but do not influence the accuracy of subjective memory judgments.     

“The threat is in the head,not in the legs”: Activating negative age stereotypes generates extra cognitive load during walking

ObjectiveActivating negative age stereotypes has been consistently shown to impair cognitive performance in older adults, but not motor performance, especially on mobility tasks. We tested the hypothesis that older adults may still experience stereotype threat, even if mobility performance is not affected. To do so, we examined whether inducing negative stereotypes may increase cognitive load during a walking task.MethodThis question was investigated in a dual-task paradigm: older adults performed simultaneously a walking task and a Stroop task, in stereotype and control conditions.ResultsResults showed that the stereotype induction did not affect walking parameters but decreased performance on the Stroop task, indicating that this induction increased cognitive load during walking.DiscussionThese results suggest that negative age stereotypes may be damaging even if walking parameters are not affected, by altering older adults' attention to their walking environment. We conclude by highlighting theoretical and practical implications.     

The effectiveness of counselling with older people: Results of a systematic review

In 2003 the British Association for Counselling and Psychotherapy (BACP) commissioned a systematic review of the research evidence relating to counselling older people. This paper reports on some of the findings of this review, particularly those which address the effectiveness of counselling with this population. Electronic searches of the research literature spanned six databases and were supplemented by hand‐searches of reference lists and key journals, along with an extensive search of the “grey” literature. The location of papers testing interventions which fall within a definition of counselling set out by the BACP, with samples aged 50 years of age or above resulted in the inclusion of 47 relevant studies. Studies investigated a variety of mental health problems in older people, particularly depression, anxiety, dementia and the psychological impact of physical conditions such as chronic obstructive pulmonary disease. Of the 47 studies, eight tested counselling as a generic treatment, 15 tested cognitive behavioural therapy, 13 tested reminiscence therapy, and 11 tested various other specific approaches. The review concluded that counselling is efficacious with older people, particularly in the treatment of anxiety and depression and outcomes are consistent with those found in younger populations. Evidence as to the efficacy of counselling interventions in the treatment of dementia is weak.     

Finer Distinctions: Variability in Satisfied Older Couples’ Problem‐Solving Behaviors

This study utilized observational and self‐report data from 64 maritally satisfied and stable older couples to explore if there were meaningful differences in how couples approached marital disagreements. Using a typology approach to classify couples based on their behaviors in a 15‐minute problem‐solving interaction, findings revealed four types of couples: (1) problem solvers (characterized by both spouses’ higher problem‐solving skills and warmth), (2) supporters (characterized by both spouses’ notable warmth), (3) even couples (characterized by both spouses’ moderate problem‐solving skills and warmth), and (4) cool couples (characterized by both spouses’ greater negativity and lower problem‐solving skills and warmth). Despite the differences in these behaviors, all couples had relatively high marital satisfaction and functioning. However, across nearly all indices, spouses in the cool couple cluster reported poorer marital functioning, particularly when compared to the problem solvers and supporters. These findings suggest that even modest doses of negativity (e.g., eye roll) may be problematic for some satisfied couples later in life. The implications of these typologies are discussed as they pertain to practitioners’ efforts to tailor their approaches to a wider swath of the population.     

The effect of aging on termination of voluntary movement while standing: A study on community-dwelling older adults

For older adults, falls often occur when transitioning from motion to a complete stop, as the motor control required during this phase is very complex and challenging. The purpose of this study was to clarify the effect of aging on the motor control required to terminate motion. Twenty-five healthy older adults (aged >65 years) and 25 healthy young adults (20–23 years) performed a rapid stopping task while standing on a force plate. The rapid stopping task was conducted by analyzing center of pressure (COP) on the force plate during a visually guided tracking experiment. To assess the ability to terminate motion, we measured the velocity waveform for the COP, along with the reaction, propulsion, braking, and total movement times. Both the reaction and movement times of the older-adult group were significantly longer than those of the younger-adult group (all, p < 0.05). There was no significant difference between the groups in regard to the initial backward propulsion time; however, in the subsequent sequence of backward braking, forward propulsion, and backward braking, all times were longer in the older-adult group than in the younger-adult group (p < 0.05). Our results show that the series of time delays shown by older adults when initiating and terminating motion is due to not only delayed reactions but also delayed stopping. Furthermore, our findings suggest that older adults have not only a diminished propulsion ability but also a diminished braking ability.     

Social anxiety in older adults: phenomenology, prevalence, and measurement

Although phobias represent the most common anxiety disorders among the elderly, little is known about their social nature. The present study provides information about the prevalence, measurement, and phenomenology of social anxiety in older adults (n = 283) and compares results to those of younger adults (n = 318). Analyses revealed that social anxiety is less prevalent in old age than it is within younger cohorts and is associated with different symptomatology. The psychopathological profile of those who reach clinical levels of social anxiety is however similar, irrespective of age. Results regarding the psychometric properties of the SPAI when used for the elderly were promising, but the questionnaire appears to be difficult for some older adults to complete. Results are discussed in terms of explanations for age differences in social anxiety, initial psychometrics of the SPAI in an older adult sample, and suggestions for future research.