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.
This chapter focuses on using humanistic sandtray as a structured play therapy intervention with clients aged 9 years and older. Humanistic sandtray therapy is a type of play therapy that can be used with clients of many ages, from preadolescents to older adults. This approach to sandtray emphasizes the primacy of the therapeutic relationship and views the relationship as the curative factor in therapy. In sandtray, therapists and clients benefit from the symbolic nature of the experience because it increases safety and provides clients with a metaphorical and indirect mode of expression. The chapter illustrates the case example to help clients go deeper into their inner experiencing and awareness so that they might move in the direction of becoming a more fully functioning person. Fully functioning people are moving in the direction of increasingly trusting their inner experiencing and becoming open to a wide range of emotions.
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.
This chapter presents a broad and general overview of the structural and physiological changes that occur with aging as well as the underlying pathophysiology of age-related diseases. The body comprises eleven organ systems that include the integumentary, muscular, skeletal, nervous, circulatory, lymphatic, respiratory, endocrine, urinary/excretory, reproductive, and digestive systems. As such, the ensuing sections are arranged by organ system and structured to cover age-related physiological changes and common disorders. Older adults experience a myriad of physiological changes as they age. While some of these physiological changes are benign, other changes increase the risk of age-associated pathophysiological changes, which can result in significant functional impairment or morbidity. These pathophysiological changes are not to be considered part of the normative aging process. Thus, it is essential that providers distinguish between the two states.
This book fills a gaping void in the selection of textbooks to use in graduate courses on the psychology of aging. It serves as a primer for any graduate student who is going to work in a clinical setting with older adults, or in a research lab that studies some aspect of the psychology of aging. The book introduces students to the background knowledge needed in order to understand some of the more complex concepts in the psychology of aging. Additionally, it provides clear explanations of concepts (e.g., genetics of aging research, neuroimaging techniques, understanding of important legal documents for older adults). The book focuses solely on older adults, providing in-depth coverage of this burgeoning population. It also provides coverage on cognitive reserve, neurocognitive disorders, and social aspects of aging. The book is intended for graduate students or upper-level undergraduate students in psychology, biology, nursing, counseling, social work, gerontology, speech pathology, psychiatry, and other disciplines who provide services for, or perform research with, older adults. It is organized into four sections. Section I presents introduction to the psychology of aging. Section II gives a core foundation in biological aspects of aging. It covers general biological theories of aging, common physical health problems in older adults, and normal changes that occur to the brain with aging. Section III describes the psychological components of aging such as changes in personality and emotional development, mental health aspects of aging, normal changes in cognitive functioning, cognitive reserve and interventions for cognitive decline, neurocognitive disorders in aging, aging's impact on relationships and families, and working in late life and retirement. The final section presents the social aspects of aging, which includes death, bereavement, and widowhood, aging experience in ethnic and sexual minorities, and lastly, aging and the legal system.