To truly understand how important and central memory is to us, it is important to understand what life is like for people who experience memory loss, or amnesia. This chapter examines the amnestic syndrome, which has been widely studied and the knowledge of which has significantly influenced theories of memory. The abilities and nonabilities of those with amnestic syndrome demonstrate that there are multiple independent systems of memory. The chapter also examines two controversial diagnoses, the main feature of which is memory loss dissociative identity disorder (DID) and psychogenic or dissociative amnesia. It discusses a form of memory loss that does not fit the technical definition of amnesia because it eventually affects not just memory but all cognition: Alzheimer’s disease (AD). AD is common among older adults and demonstrates how a worsening loss of memory and cognition can lead to a complete disruption of everyday life.
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The importance of the field of geropsychology (psychology of aging) is seen in the ever-increasing demographics of older adults. A psychologist needs to understand the various life stages that define different cohorts of older adults. Older adults are affected by the forces of stigma and ageism, which are of four types: personal, institutional, intentional, and unintentional. A majority of older adults experience age discrimination and stigmatization after the age of 65. The use of medical model of psychopathology causes contradictions and distortions, one of which is the use of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Assessment of deficits in olfactory functioning are potentially useful for a psychologist who is attempting to differentiate between cognitive disturbances of normal aging and mild cognitive impairment (MCI). Sexual interest remains high throughout old adult developmental stages, but sexual activity declines in most men as they age. While older adults are more likely to avoid illicit substances, many older adults having chronic pain from cancer or arthritis need opioid medications. Older adult abuse is a multifactorial phenomenon as the abuse may be emotional, financial, physical, sexual, or self-induced. Environmental geropsychology is based on Lewin’s field theory model Lawton and Nahemow’s ecological model, and an environmental geropsychologist focuses on the environmental component to develop interventions to change older adults’ interpersonal and intrapersonal experiences. Heightened awareness of coming of death results in an existential crisis for many older adults causing a loss of their sense of purpose for their lives.
A psychologist must confront many prejudices against older adults that are manifested in most people in non-older adult cohorts. Clinical psychologists specializing in geropsychology work with individual older adults; family members of older adults, including spouses/partners, siblings, and adult children; and caregivers when treating the psychological problems experienced by older adults and dealing with issues of caregiving to older adults experiencing mental illness, dementia, and/or psychological reactions to co-occurring medical illnesses. Unfortunately, despite the fact that older adults are affected by the forces of ageism and stigma, and the fact that community psychologists strive to understand and improve social inequalities and to enable empowerment of marginalized people, there is a significant dearth of research in the field of community psychology. There are four types of ageism: personal, institutional, intentional, and unintentional. The majority of older adults have experienced age discrimination and stigmatization at some time after the age of 65.
This chapter talks about psychoactive substances that are commonly misused or abused by older adults. It is important for a psychologist to understand the psychopharmacological dynamics of each substance, how they are administered by an older adult, the symptoms of intoxication and withdrawal, and the psychosocial consequences experienced by the older adult misusing or abusing psychoactive substances. Unlike younger adults, older adults are more likely to avoid illicit substances such as cocaine, heroin, methamphetamine, psychedelics such as lysergic acid diethylamide (LSD) or mescaline, and designer drugs. Historically, the psychoactive substance of choice was alcohol. There are two general types of opioid psychoactive substances: naturally occurring opioids and synthetic opioids. Naturally occurring opioids include opium and its derivatives morphine and codeine, and heroin, which is a chemical manipulation of morphine. Unfortunately, many older adults suffer with chronic pain from cancer, arthritis, or injuries, causing a need for opioid medications.
The medical model of psychopathology currently guides psychiatrists and many psychologists who are treating older adults experiencing psychological problems. Use of this model causes contradictions and distortions for the treating clinician and limits the effectiveness of treatment for older adults experiencing psychological problems. There are three areas of concern that illustrate these contradictions and distortions. The first area of concern is the fact that only two classes of psychiatric diagnoses meet the characteristics of a disease. The second area of concern is how the current use of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) continues a tradition among psychiatry, managed-care companies, and insurance companies that puts pressure on psychiatrists, psychologists, hospitals, and psychiatric rehabilitation facilities to treat in the most cost-effective and short-term manner. The third area of concern is the relationship that has occurred between psychiatry and pharmaceutical marketing forces.
The heightened awareness of coming of death, and the anticipation of dying, results in many older adults experiencing an existential crisis. For some older adults approaching or in the age bracket of 75 to 84 years of age, the expectation of death becomes acute and triggers a need for end-of-life planning, also referred to as advance care planning. Palliative care is considered a good death because it keeps an older adult comfortable, provides counseling, and is a means to control pain that a dying older adult would otherwise experience. There is a significant need for psychologists to provide counseling to older adults experiencing disenfranchised grief because adults experiencing this type of grief suffer from difficulty experiencing their loss when it is not validated by others. Euthanasia is accomplished by an older adult’s request to his or her physician based on the intention of ending pain and suffering when terminally ill.
Psychologists work with micro-level and macro-level orientations. Clinical psychologists with a micro-level orientation focus on individuals, families, and small groups when performing psychotherapy. Community psychologists have a macro-level orientation. The aging population presents many opportunities for psychologists, both those engaged in scholarship and those working clinically with older adults, and for community psychologists addressing issues relating to social structures and organized communities of older adults, economic issues such as poverty and access to medical services, and issues relating to senior housing. Contemporary theory indicates that it is equally important for psychologists working with older adults to focus on the positive aspects of aging when addressing the psychopathological problems older adults are experiencing. Erikson’s stage theory originally had seven stages: basic trust versus basic mistrust; autonomy versus shame and doubt; initiative versus guilt; industry versus inferiority; identity versus role confusion; intimacy versus isolation; and generativity versus stagnation.
The most useful and efficient way of starting one’s sleep program is by understanding their current sleep–wake patterns. The standard measurement tool for insomnia is the “sleep diary”. Sleep diaries are not really diaries, but simple logs, based on one’s recollection of their last night’s sleep. Because they are the expert on their insomnia, they are the best person to report on each night’s sleep in order to measure their sleep problem. In fact, people with insomnia who go to sleep labs usually have trouble sleeping in the lab, which simply confirms their insomnia. Although the sleep information obtained from consumer wearable devices is appealing, at the time of writing this, these trackers are not yet ready for use in Sleep Therapy. This chapter provides a note about personal electronic sleep trackers and discusses logging your sleep with a sleep diary.
After Week 4 of Sleep Therapy, it is recommended that one should check to see if they are now free from insomnia. One can do this by looking at the same things in their current sleep diary, before they started Sleep Therapy. This chapter provides suggestions to find out the experiences of initial insomnia, multiple awakenings, middle insomnia, and terminal insomnia. If a person takes longer than 30 minutes to fall asleep, he/she is experiencing “initial insomnia”. If a person has more than 3 awakenings per night, he/she can describe it as having “multiple awakenings”. If a person awakes each night, (3 nights or more) for greater than 30 minutes, he/she is experiencing “middle insomnia”. If a person wakes up for more than 30 minutes too early on at least 3 mornings, then he/she has “terminal” or “end-of-night” insomnia.
There are things over which one have direct control. So, if they are contributing to poor sleep, they can be addressed right away. One will now be perusing their sleep diary for three things: naps, alcohol, and sleep medication. Not that any of these things is bad, one just wants to make sure that they are not interfering with their nighttime sleep. If they are interfering, it is much easier to deal with them now, before one goes further. If one did nap, were the naps inadvertent or intentional? If they were inadvertent, this can be a sign of “excessive daytime sleepiness”. If the naps were intentional, then look at the timing of each nap. If one is taking sleep medication, it is dangerous to also drink alcohol. So, if one takes sleep medication, be sure to read and follow the instructions on the medication label.