Disorders In Old Age Research Articles

Особенности прагматической функции речи в позднем возрасте: принципы диагностики и пути восстановления

The article shows that taking into account the change in the pragmatic function of the language at a later age can not only improve the health conserve behavior and improve treatment adherence, but also plays an important role in the recognition of qualifications and effective treatment of mental, cognitive, and neurodegenerative disorders. Based on the analysis of foreign studies systematic techniques are often used for the diagnosis of pragmatic competence and presents step-by-step algorithm for estimating of socio-cognitive disorders in old age. It is shown that in normal aging we can observe selective, reversible changes in the verbal, para - and extralinguistic components of the pragmatic functions of language, and metapragmatic abilities. Systematic General symptoms of deficiency in pragmatic functions of language are neatly systematized. The analysis of the causes of changes in pragmatic competence at an elderly age was carried out with the help of deficit and resource approaches. We presented a range of pharmacological and non-pharmacological interventions aimed at improving the pragmatic function of language in old age.

Mood disorders in the elderly: prevalence, functional impact, and management challenges.

Despite the lower prevalence of severe mood disorders in the elderly as compared to younger adults, late-life depression and bipolar disorder (BD) are more strongly associated with negative outcomes related to the presence of medical comorbidities, cognitive deficits, and increased suicide risk and overall mortality. The mechanisms that contribute to these associations are probably multifactorial, involving pathological factors related directly and indirectly to the disease itself, ranging from biological to psychosocial factors. Most of the accumulated knowledge on the nature of these associations derives from naturalistic and observational studies, and controlled data are still scarce. Nonetheless, there has clearly been a recent growth of the scientific interest on late-life BD and geriatric depression. In the present study, we review the most relevant studies on prevalence, clinical presentation, and cognitive/functional impact of mood disorders in elderly. Several clinical–epidemiological studies were dedicated to the study of the prevalence of mood disorders in old age in distinct settings; however, fewer studies investigated the underlying neurobiological findings and treatment specificities in late-life depression and BD. In the present study, we further discuss the implications of these findings on the management of mood disorders in older adults.

Missed diagnosis: The emerging crisis of borderline personality disorder in older people.

Clinical experience suggests a growing prevalence of borderline personality disorder in aged residential care and psychiatric facilities with attendant difficulties in their management. This paper reviews the literature concerning the prevalence, phenomenology and diagnosis of borderline personality disorder in old age. The aim is to elucidate the phenomenological differences in old age and thus improve identification of the disorder. A systematic search was conducted using MEDLINE, PubMed, EMBASE and PsycINFO databases, employing the search terms including 'personality disorder', 'borderline personality disorder', 'aged care', 'gerontology', 'geriatric psychiatry' and 'life span'. The search included articles in English involving participants 65+ years. Long-term prospective studies of borderline personality disorder, long-term follow-up studies and studies involving older adults from 50+ years were also examined. There is a paucity of literature on borderline personality disorder in the elderly. No diagnostic or rating instruments have been developed for borderline personality disorder in the elderly. The phenomenology of borderline personality disorder in the aged population differs in several respects from that seen in younger adults, causing some of the difficulties in reaching a diagnosis. Escalations of symptoms and maladaptive behaviours usually occur when the diagnosis of borderline personality disorder is either not made or delayed. Improved identification of borderline personality disorder in older patients, together with staff education concerning the phenomenology, aetiology and management of these patients, is urgently needed. Diagnostic instruments for borderline personality disorder in the elderly need to be developed. In the interim, suggestions are offered concerning patient symptoms and behaviours that could trigger psychiatric assessment and advice concerning management. A screening tool is proposed to assist in the timely diagnosis of borderline personality disorder in older people. Timely identification of these patients is needed so that they can receive the skilled help, understanding and treatment needed to alleviate suffering in the twilight of their lives.

Well-being and psychosocial activities in nursing homes : Survey of residents

Assessment and self-assessment frequently differ, e. g. in psychosomatic disorders and complaints. At the same time the prevalence of corresponding disorders in old age is high. This study investigated psychosocial factors from the perspective of nursing home residents and compared this self-assessment with data collected in other scientific studies with assessments by nursing home staff. The aim was to develop specific recommendations for the nursing home sector. In this cross-sectional pilot study 256 nursing home residents (average age 81± 10.3 years, 69 % female, 31 % male) were questioned about their physical, psychological and social activities and well-being in semistructured anonymous interviews. Psychological screening tests were simultaneously implemented to assess symptoms of depression and dementia using the short form of the geriatric depression scale (GDS-K) and the mini mental status test (MMST). The results showed that 44.6 % of the residents had symptoms of depression and 76.1 % revealed signs of development of dementia. More than half assessed their physical health as good to very good. According to comparable studies nursing staff assessed persistent pain in 20.7 % of all nursing home residents while personal interviews with the residents showed that persistent pain (39.8 %) was almost twice as frequent. Life satisfaction showed a significant correlation with the following items from the self-assessment: participation in nursing home activities (r= 0.171, p= 0.008), mobility (r= -0.131; p= 0.045), emotional activity (r= 0.136, p= 0.038), subjectively experienced physical health (r= -0.420, p< 0.001) and persistent pain (r= -0.178, p= 0.006). Life satisfaction correlated highly significantly with symptoms of depression (r= -0.617, p< 0.001) and cognitive performance (r= 0.251, p= 0.001). The findings of this study encourage further research on the characteristic features of satisfied residents and (psycho)therapeutic support in order to promote factors for well-being and a positive quality of life in nursing homes.

Hypopituitarism in the elderly: a narrative review on clinical management of hypothalamic-pituitary-gonadal, hypothalamic-pituitary-thyroid and hypothalamic-pituitary-adrenal axes dysfunction.

Hypopituitarism is an uncommon and under-investigated endocrine disorder in old age since signs and symptoms are unspecific and, at least in part, can be attributed to the physiological effects of aging and related co-morbidities. Clinical presentation is often insidious being characterized by non-specific manifestations, such as weight gain, fatigue, low muscle strength, bradipsychism, hypotension or intolerance to cold. In these circumstances, hypopituitarism is a rarely life-threatening condition, but evolution may be more dramatic as a result of pituitary apoplexy, or when a serious condition of adrenal insufficiency suddenly occurs. Clinical presentation depends on the effects that each pituitary deficit can cause, and on their mutual relationship, but also, inevitably, it depends on the severity and duration of the deficit itself, as well as on the general condition of the patient. Indeed, indications and methods of hormone replacement therapy must include the need to normalize the endocrine profile without contributing to the worsening of intercurrent diseases, such as those of glucose and bone metabolism, and the cardiovascular system, or to the increasing cancer risk. Hormonal requirements of elderly patients are reduced compared to young adults, but a prompt diagnosis and appropriate treatment of pituitary deficiencies are strongly recommended, also in this age range.

The biopsychosocial paradigm in the assessment of mental health of older persons

The vulnerability of patients of late age in psychiatry increases the professional and ethical requirements to the quality of psychiatric and forensic psychiatric help. It must account for the clinical and dynamic features of mental disorders in old age, biopsychosocial determinants of their formation, be based on a conceptual approach and a comprehensive understanding of the involution processes. To identify biopsychosocial determinants of mental disorders in old age and (or) involving patients to the forensic psychiatric examination, we examined 235 late age patients in criminal and civil cases. Revealed: «non-dement» mental disorders – with 45.5%, psychosis – with 7.7%, dementia – with 46,8%. The results of biopsychosocial determinants of involution are determined as follows: biological: sensory and motor deprivation, multicomorbid somatic neurological pathology, specific syndromes and disorders if late age, dementia; socio-psychological: termination of labor activity, living alone and loneliness, problematic relationship with children because of housing disputes and alcohol; legal: conclusion and contestation of legal civil acts, participation in criminal proceedings as victims and defendants, legal illiteracy, legal controversy, lack of legal protection; victimological: physical (assault, abuse), psychological (threats of commitment into social security institutions, involuntary commitment to a psychiatric hospital and examination by a psychiatrist, hold in the psychiatric hospital), financial violence (fraud with housing for older people and deception, manipulation during conclusion of civil-legal acts), violation of rights of older person (unlawful deprivation of legal capacity).Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Depression in old age, part 1 : Origin, clinical symptoms, diagnosis and interaction between depression and dementia

Depression is one of the most frequent mental disorders in old age. A huge variety of very different causal factors can contribute to late life depression as a common final outcome. The pathogenic pathways of depression overlap with those of frequent somatic medical conditions, such as diabetes and ischemic heart disease. Age-specific modulations of symptom presentation are described in this article with special emphasis on subthreshold depression and the complex mutual relationship between depression and dementia is presented.

Depression in Old Age--Challenge of an Ageing Society

Besides dementia, depressive disorders belong to the most common mental disorders in the elderly. Along with the demographic change and the associated increasing proportion of older people aged 65 and more they become a central and urgent challenge. Depressive disorders in old age are treatable, although they involve special features when compared to younger adults. Guidelines are considered to be of great importance in the optimization of treatments. But how will the treatment of depressive disorders in the elderly displayed in the current guidelines? A systematic search for treatment recommendations in current evidence- and consensus-based guidelines regarding psychotherapeutic and psychosocial treatment approaches indicates that this highly relevant patient group has been strongly neglected so far.

Depression associated with dementia

Depression and cognitive disorders, including dementia and mild cognitive impairment, are common disorders in old age. Depression is frequent in dementia, causing distress, reducing the quality of life, exacerbating cognitive and functional impairment and increasing caregiver stress. Even mild levels of depression can significantly add to the functional impairment of dementia patients and the severity of psychopathological and neurological impairments increases with increasing severity of depression. Depressive symptoms may be both a risk factor for, as well as a prodrome of dementia. Major depressive syndrome of Alzheimer's disease may be among the most common mood disorders of older adults. Treating depression is therefore a key clinical priority to improve the quality of life both of people with dementia as well as their carergivers. Nonpharmacological approaches and watchful waiting should be attempted first in patients who present with mild to moderate depression and dementia. In cases of severe depression or depression not able to be managed through nonpharmacological means, antidepressant therapy should be considered.

Classification of Mental Disorders of Late Age

Aging is accompanied by the rise of mental health problems and dementia. Their number by 2050 could reach 120 million people. The absens of classification of mental disorders of late age prevents from their correct diagnosis, forensic psychiatric assessment, promotes ageism. Kraepelin (1900) placed them in the category 'Interior body disease processes', and subdivided into 'arteriosclerotic', 'presenile psychosis of the age reverse development' and 'senile mental disorders'. Bleuler (1920) attributed them to 'Acquired psychosis with gross brain disorders. Organic syndrome'. Sternberg (1977) distinguished functional, vascular and atrophic forms. Shakhmatov (1996) believed that the classification of mental disorders of late age should basically be determined by the presence or absence of dementia. In ICD-9, ICD-10, DSM-5 there is no special section on mental disorders of aging. As a result there is a loss of such unique and specific syndromes of involution, as pseudoparalytic, frontal, paraphrenic disoders, acute and chronic Wernicke presbyophrenia, 'functional', delirium (involutional paranoid) and hallucinatory (Akboma dermatozoic delusion) psychosis of later age. ICD-10 consides a state of R54 'Old Age', but without pairing with category 'Mental disorders'. In the DSM-Y there is no section on mental disorders of old age, the only innovation is ontogenetic approach in the description of mental disorders, depending on different age periods and renaming of dementia into neurocognitive disorders, aimed at destigmatization of patients. The pilot version of the section 'Mental disorder' in the ICD-11 presents the category of 'Old age'. We believe that it is reasonable to classify 'Behavioral and mental disorders of late age' in this variant.

Development and validation of the geriatric depression inventory in Chinese culture.

Depression among older adults is under-recognized either in the community or in general hospitals in Chinese culture. This study aimed to develop a culturally appropriate screening instrument for late-life depression in the non-psychiatric settings and to test its reliability and validity for a diagnosis of depression. Using a Delphi method, we developed a geriatric depression inventory (GDI), consisting of 12 core symptoms of depressive disorder in old age. We investigated its reliability and validity on 89 patients with late-life depression and 249 non-depression controls. Both self-report (GDI-SR) and physician-interview (GDI-RI) versions were assessed. Cronbach's α coefficient was 0.843 for GDI-SR and 0.880 for GDI-RI. Both GDI-SR and GDI-RI showed good concurrent validity with the 15-item Geriatric Depression Scale (GDS-15) (GDI-SR: r = 0.750, p < 0.001; GDI-RI: r = 0.733, p < 0.001). The area under the curve of the receiver operating characteristic (ROC) was 0.938 for GDI-SR and 0.961 for GDI-RI, suggesting good to excellent discrimination of depression versus non-depression. Using a cut-off of three items endorsed, sensitivity and specificity were 92.1% and 81.9% for GDI-SR, and 93.3% and 87.1% for GDI-RI. The GDI, either based on self-report or rater interview, is a reliable and valid instrument for the detection of depression among older adults in non-psychiatric medical settings in Chinese culture.

Psychotherapy on the domestic couch

Despite the high morbidity of mental disorders in old age, psychotherapy take-up, especially by multi-morbid, very old patients, is still negligible, immobility being a significant constraining factor of access. So far, variations of standard psychotherapy adapted to meet these circumstances, such as home visits providing psychotherapy are not widespread and their effectiveness unexplored. An explorative study applying the 'Grounded Theory' method examined medical letters, consultation reports and session protocols of 7 psychotherapies involving 77-89-year-old patients; it also described the setting, nature and content of the therapeutic relationship. Psychotherapy at a patient's home - compared with conventional out-patient therapy - considerably alters the therapeutic relationship in as much as an undifferentiated fullness of experience and information has to be gathered and interpreted by the therapist. Current and previous relationships, as well as the experience of disease and imminent dying are important thematic fields. Within the framework of a supportive, defence-strengthening psychodynamic psychotherapy, clarifications, interpretations, and the accompaniment of existential conflicts and developments are possible. Conflicts of identity, aggression, closeness vs. distance and power can be named. Disease, constraint, dying and death are frequent topics. The therapist is more active, enactments are possible but a reflective attitude towards the patient's inner world can be maintained. Psychodynamic psychotherapy is possible in the patient's domestic environment. Further research on indications, psychotherapeutic attitudes, strategies, techniques and effectiveness of this psychotherapy variation is necessary.

Cognitive training in neurodegenerative diseases: a way to boost neuroprotective molecules?

Cognitive training in neurodegenerative diseases: a way to boost neuroprotective molecules?

Psychotherapeutic work with older patients

Despite the high prevalence of mental illness in Germany, elderly people are significantly under-represented in psychotherapeutic treatment. This is not only due to their own reservations about psychotherapy but also to a greater extent a reflection of the models of old age in our society. Deficit-oriented theories dating back to the origins of psychotherapy in the last century are still widespread leading to fear of contact with consultants and therapists.The specific methods of psychotherapeutic work with older patients are presented. Methodologically, the treatment of elderly patients with depressive disorders has been elaborately worked out. In addition, detailed psychotherapeutic programs have also been developed for anxiety disorders, trauma-related diseases and dementia. Overall, relatively little research has been done in the field of geriatric psychotherapy despite the fact that from the scientific and clinical perspectives, different approaches or methods, such as cognitive-behavioral therapy, interpersonal therapy, psychodynamic therapy, as well as systemic therapy, can be considered effective and may be applied to the entire spectrum of mental disorders in old age.

Evaluation of biochemical markers of renal dysfunction in prostate disorders and healthy controls

Aims and Objectives: Prostate disorders like prostatitis, Benign prostatic hyperplasia (BPH) and prostatitis are the most common disorders of the male population, the latter two being prevalent in the elderly men. PSA being the gold standard parameter to identify these diseases, is not of much importance in the differential diagnosis of prostate disorders. This study focusses on the blood levels of PSA, Urea, BUN, Creatinine BUN/creatinine ratio and eGFR in various disorders of prostate and healthy controls. Methodology: Serum sample obtained from 25 patients each, diagnosed to have prostatitis, BPH and carcinoma prostate were analysed for the parameters mentioned above and compared with 75 age matched controls. Results: The mean values for PSA as well as other markers of renal function included in the study, were statistically significant between cases and controls. Further, significant values in the mean values of all the parameters were also observed in each of the prostate disorders as compared to controls. Conclusion: On the basis of our findings, we conclude that patients with prostate disorders are likely to progress into renal dysfunction. Also, based on the results of BUN /creatinine ratio, BPH and cancer of prostate ,the most common types of prostatic disorders in old age, are more prone to develop renal dysfunction.

Collaborative and home based treatment for older adults with depression: a review of the literature

Due to the demographic development depressive disorders in old age are becoming a central and urgent healthcare challenge. The article reviews effective approaches towards treatment of depression in the elderly. A literature review of complex interventions improving depression care was carried out. Robust evidence exists for the use of collaborative care models which incorporate collaboration between mental health and medical providers in the primary care setting (e.g. general practitioners and specialists), regular monitoring, case management, and evidence-based treatment. Staged treatment approaches seem to be appropriate by which initially use treatment strategies of low intensity. For patients with limited mobility, home-based approaches have proven to be particularly practical and effective. Multidisciplinary and multimodal treatment approaches represent an effective and efficient way of healthcare provision for late life depression. In Germany, only few initiatives inspired by successful international models have so far been identified.

O3.16: Association of cardiovascular risk factors in midlife and cognitive disorders in old age: up to a 49-year follow-up of the Helsinki Businessmen Study

O3.16: Association of cardiovascular risk factors in midlife and cognitive disorders in old age: up to a 49-year follow-up of the Helsinki Businessmen Study

Personality Traits and Personality Disorders in Late Middle and Old Age: Do They Remain Stable? A Literature Review

We reviewed the evidence regarding which personality traits and personality disorders remain stable into later middle and old age (age >60 years of age) and how expressions of (maladaptive) personality traits affect personality assessment among older adults. Our study was a literature review of longitudinal and cross-sectional studies of the Five Factor Model (FFM) or DSM personality disorders in old age, using PsychInfo, Psychlit, and PubMed (period 1980–2012). Combinations of the following keywords were used: personality, development, stability, five factor personality model, big 5, (borderline) personality disorder(s), aging, older adults. Of the 22 relevant articles that were found, 17 longitudinal or cross-sectional studies of the FFM mainly supported the hypothesis that personality characteristics are susceptible to change over a person’s entire lifetime. Neuroticism, Extraversion, and Openness appear to diminish as a person ages, while, conversely, Agreeableness and Conscientiousness appear to increase with age. Two longitudinal studies and three cross-sectional studies of DSM-IV personality disorders suggested there are age-related changes in the ways in which maladaptive personality traits manifest themselves. The temporal instability of personality traits in old age, both adaptive and maladaptive, affects the validity of personality assessment of older adults, especially the face validity. We recommend personality assessment measures that include only age-neutral items. Informant contributions to the personality assessment could also be helpful in improving the reliability in epidemiological research.

General practitioners’ assessment of, and treatment decisions regarding, common mental disorder in older adults: thematic analysis of interview data

ABSTRACTPrimary and secondary care services are charged with failing to adequately detect and treat mental disorder in older adults due to the ‘understandability phenomenon’; the belief that mental disorder in old age is inevitable and therefore not worthy of intervention. Quantitative data appear to support this hypothesis but lack the explanatory power of detailed accounts. Nine general practitioners (GPs) participated in group interviews about their assessment and treatment of older patients, and their expectations and experience of referral to secondary care. Resulting transcripts were subject to Thematic Analysis. Respondents recognised the unique features of these clients, and their impact on the detailed, recursive processes of assessment, clinical decision-making and intervention. GPs described confidence in managing most cases of mental disorder, describing the role of secondary care as one of consultancy in extreme or unusual cases. GPs did view mental disorder as commonly originating in adverse circumstances, and queried the validity of pharmacological or psychological interventions in these cases. They did not, however, equate understandability with acceptability, and called for social interventions to be integrated with health-care interventions to tackle the cause of mental disorder in older adults. At a wider level, findings highlight the discrepancy between assumptions about GP attitudes and actions, and their own accounts. At a local level, findings will assist in focusing secondary care service development where need is perceived, into consultancy and training.

Neuroimaging and neurocognitive abnormalities associated with bipolar disorder in old age

Cognitive dysfunction is prevalent in older adults with bipolar disorder (BD). High white matter hyperintensity (WMH) burden, a marker of white matter disease, detected on T2/fluid-attenuated inversion recovery brain magnetic resonance imaging (MRI) has been consistently reported in BD across all age ranges, including older adults. Yet, whether high WMH burden is related to the excess cognitive impairment present in older adults with BD is unknown. Therefore, we examine whether higher WMH burden is related to worse cognitive function in older adults with BD. This is a cross-sectional study of 27 non-demented BD patients aged ≥50 years and 12 similarly aged mentally healthy comparators (controls). Subjects underwent both brain MRI and comprehensive neurocognitive assessment. We employed correlational analyses to evaluate the burden of WMH and the relationship between WMH and cognitive function. Although BD subjects had worse performance in all cognitive domains, BD subjects had less total WMH burden (t[13.4] = -3.57, p = 0.003). In control subjects, higher WMH was related to lower global cognitive function (ρ = -0.57, n = 12, p = 0.05). However, WMH did not correlate with neuropsychological performance in BD subjects. Further, BD and control subjects did not differ with respect to total gray and hippocampal volumes. Cognitive dysfunction in late-life BD does not appear to be due primarily to processes related to increased WMH or reduced gray matter volume. Future longitudinal studies should examine other potential neuroprogressive pathways such as inflammation, mitochondrial dysfunction, serum anticholinergic burden, and altered neurogenesis.