OFFICE E-NEWS FEBRUARY

BY CO-CHAIRS:

 Kenneth S. Dellefield, Ph.D.  Cynthia A. Cotter, Ph.D.

MEETING 1/10/22

The Aging Issues Committee (AIC) met on January 10, 2022.  Co-chairs Kenneth S. Dellefield, Ph.D. and Cynthia A. Cotter, Ph.D. presided over the meeting via Zoom. There were nine Committee members in attendance.  Two were present for the first time, Diana Pickett, M.D. Ph.D. and Katherine DiFrancesca, Ph.D., who introduced themselves and their interests in aging.  Dr. Cotter made the Do You Know? presentation that involved discussion of consequences of improper diagnoses for cognitive behavior change in OA.  Dr. Dellefield discussed the need for generating a list of psychologists with experience and expertise in working with OA for referrals.  Dr. Sachs presented a very interesting case of an 85 year old woman with psychiatric history but with rather sudden decline in cognitive ability with bouts of disorientation particularly to time, place and how to do familiar tasks.  Dr. Sachs described great difficulty finding coordinated medical evaluation for this individual so that there is as yet no diagnosis.  The Committee was updated on the progress of the new publication Age in Action. The next meeting will be on Monday, February 7th.

DID YOU KNOW?

As we age, our bodies change and may not be able to process medications the way they used to.  We may not be able to absorb medications as quickly. Liver or kidney problems may impact how quickly medications exit the body. Medications may interact with each other differently in OAs, may be hard on major organs or may produce side effects such as confusion that increases risks for falls.  Some medications may be life threatening for OAs.  

The American Geriatrics Society Beers Criteria (Updated in 2019) is widely used by professionals working with OAs that lists:

1.) Medications that are potentially inappropriate in most older adults
2.) Medications that should typically be avoided in older adults with certain conditions
3.) Medications to use with caution
4.) Drug-drug interactions
5.) Drug dose adjustment based on kidney function

AGING ISSUE:

INTERPRETING MINI-MENTAL STATE EXAM SCORES IN GENERAL PRACTICE: SOME TIPS AND WORDS OF CAUTION

Cynthia A. Cotter, Ph.D.
Kenneth S. Dellefield, Ph.D.

Clinical psychologists sometimes encounter mental status exam scores in their reviews of OA client medical records.  These brief exams are often administered as a screening for dementia.  Psychologists vary, however, in the degree to which they have been trained in assessing cognition.  This article provides several brief tips and cautions for psychologists who are not certain how scores on these exams should be interpreted. 

The most commonly used mental status exam currently is the Mini-Mental State Examination (MMSE)(Folstein et al., 1975).   This instrument has 30-points and takes around ten minutes to administer.   It aims to take a quick snapshot of brain functioning by sampling performances in a number of broad cognitive arenas.  The MMSE contains items in the domains of orientation, registration/recall, attention and calculation, language and copying.   The form for this exam is linked below so you can see the types of questions it includes. 

MMSE Form

1st TIP

Do not rely on broad general categories of scores for interpretation. 

Broad general interpretive categories are often cited in the literature for the MMSE and are sometimes included on the exam form.  An example of these broad general categories would be:

No cognitive impairment – 24 to 30.  
Mild cognitive impairment – 18 to 23.  
Severe cognitive impairment – 0 to 17.   

It is important NOT to rely on broad general categories of scores for interpretation but to instead make use of published norms.  Psychological Assessment Resources (PAR) publishes MMSE norms by age and education that demonstrate the notable impact of these two variables on performance.  For example, the median MMSE score for 18-24 year olds is 29.  The median score for those over age 80 is 25.  The median MMSE score for those with at least 9 years of schooling is 29.  For those with 5-8 years of schooling the median score is 26 and for those with 0-4 years of schooling the median score is 22.  Use of broad general categories of scores rather than published norms would have classified those with low-education as impaired.

2nd TIP

Don’t presume that a low score on the MMSE means the client HAS dementia.

As noted above, increased age and lower education can lower MMSE scores.  In addition, there is evidence that MMSE scores vary with premorbid intelligence, literacy, social class and location of residence (barrio, urban suburbs).  There is speculation that regional differences reflect cultural and/or social factors (e.g. differences in familiarity with the kinds of skills measured by the MMSE, daily stress, assimilation).   Some of the items on the MMSE may be biased with respect to race/ethnicity and education.  There is also evidence that the language of testing may impact performance.  Medical/mental illness or medications can lower performance. Individuals with focal damage from stroke or traumatic brain injury can perform poorly on the MMSE.  

3rd TIP

Don’t presume that a high score on the MMSE means the client DOES NOT have dementia.  

The MMSE is not considered sensitive to mild cognitive impairment.  Nor is it sensitive to damage to frontal processing.  The latter is because the test is more heavily weighted to language rather than executive functioning skills.  As a result, individuals with vascular ischemic dementia or frontotemporal lobar degeneration (FTLD) may score within the normal range on the MMSE.   Individuals with milder forms of dementia but who have high education may score in the normal range on the MMSE. Alzheimer’s patients on cholinesterase inhibitors may perform in the normal range on the MMSE.  The MMSE tests only very short-delay recall of a very few words.  It is not uncommon for an individual to perform perfectly on this portion of the MMSE yet demonstrate considerable memory impairment when asked to recall more words over much longer delay as is required by the California Verbal Learning Test (CVLT).  

4th TIP

Do not interpret performances on individual items within the MMSE.

A geriatric neuropsychologist will administer a battery of tests to an individual to determine not only whether there is evidence of dementia but to determine the type of dementia based upon characteristic profiles of deficits.  The MMSE has been validated primarily using total scores.  The concordance rates between individual MMSE tasks and neuropsychological tests addressing corresponding cognitive domains can be quite low.  Thus the MMSE should be used to screen for but not diagnose specific types of dementia. 

In summary, the MMSE is simply a brief screening measure.  A psychologist in general practice should never come to conclusions about a client’s cognitive state simply from an MMSE score.  The impact of other factors and the limitations of the sensitivity of the test should be considered.  If dementia is suspected, the client should be referred for further evaluation. 

NEWER MENTAL STATUS EXAMS

While the MMSE is the mental status test the clinical psychologist will most commonly encounter in general practice, there are a number of other mental status tests that have been developed more recently that offer advantages. There is a longer modified version of the MMSE called the 3MS that is considered more diagnostically sensitive. A greater amount of research has been conducted on the 3MS related to race/culture differences.   The Montreal Cognitive Assessment (MoCA) is considered more sensitive to mild cognitive impairment and to damage to frontal processing.  The St. Louis University Mental Status (SLUMS) is another instrument that offers advantages over the MMSE and, unlike the MMSE, 3MS and MoCA, is currently in the public domain.  

Resources:

Lezak, M.D. et al (2012).  Neuropsychological assessment – Fifth Edition.

MEETING MINUTES 1/10/22

BY CO-CHAIRS:

 Kenneth S. Dellefield, Ph.D.  Cynthia A. Cotter, Ph.D.

AIC Minutes 1-10-22.pdf

ACTION PLAN 2022

BY CO-CHAIRS:

 Kenneth S. Dellefield, Ph.D.  Cynthia A. Cotter, Ph.D.

ACTION PLAN 2022 

AIC 2022 Action Plan.pdf

FINAL REPORT 2021

BY CO-CHAIRS:

 Kenneth S. Dellefield, Ph.D.  Cynthia A. Cotter, Ph.D.

FINAL REPORT 2021

AIC 2021 Final Report.pdf 

OFFICE E-NEWS JANUARY

BY CO-CHAIRS:

 Kenneth S. Dellefield, Ph.D.  Cynthia A. Cotter, Ph.D.

MEETING 12/13/21

The Aging Issues Committee (AIC) met on December 13, 2021.  Co-chairs Ken S. Dellefield and Cynthia A. Cotter, Ph.D. presided over the meeting via Zoom.  There were fifteen Committee members in attendance.  Four were present for the first time and introduced themselves and their interests in aging.  Dr. Seifert made the Do You Know? presentation on the findings of a 2009 PEW Research Center study entitled Growing Old in America (see below).  Dr. Dellefield presented a case that, in his opinion, suggested the need for a neuropsychological evaluation.  Dr. Dellefield suggested possible topics for future Office E-News articles.  The Committee discussed the need for development of a data base of resources for OA and the possibility of making this a project of the AIC.  The Committee also discussed doing a publication for members and the community called Age in Action that would be more of a human interest type of piece including interviews with OA SDPA members and members of the San Diego community, etc.  The next meeting will be on Monday, January 10th.

----------------------

DID YOU KNOW?
Presented by Katrin Seifert, Ph.D.

In 2009, PEW Research Center conducted a telephone survey entitled Growing Old in America with a nationally representative sample of approximately 3,000 adults.  The study questioned participants on a variety of issues related to aging.  Some of the results of this survey are presented below.

Generally: 

The older people get the younger they feel.

About 25% of OAs report memory loss and 21% report serious illness.

With regard to the benefits of getting older, about 64% of OAs report more financial security, 59% report less stress, and 59% report more respect.

When asked at what age does a person become old, those aged 18-29 said on average age 60.  Those aged over 65 said on average age 74.

About 10% of OAs live in an age-restricted community, 41% live alone and 92% live in their own homes or apartments.

About 51% of OAs report that they have given money to their kids in the past year; 36% have helped with childcare.  About 42% of OA say that their kids have helped them with errands/getting to and from appointments; about 14% said their kids have helped them financially.

Considering income and racial differences:

The burdens of old age are felt more at the lower end of the income scale. Those with income under $20,000 were more likely to experience memory loss (35%) and were more likely to experience serious illness (31%) and were more likely to feel sad/depressed about becoming a burden to others (28% vs. 8% for those with income over $50,000).

Old age is tougher for Hispanic Americans who score significantly higher on 7 of 9 potential problems.

Older Whites  are more likely than older Blacks or Hispanics to say they have people they can rely on for socializing (85% Whites, 76% Blacks, 52% Hispanics).

Older Whites are more likely than Hispanics to report that they have given their children money (53% Whites, 37% Hispanics, 48% Blacks).

Whites and Hispanics are more likely than Blacks to say they worry about becoming a burden to their children.

Whites are more likely than Hispanics to talk about what to do when they can no longer live independently (56% Whites, 50% Blacks, 44% Hispanics).

Link to the survey https://www.pewresearch.org/social-trends/2009/06/29/growing-old-in-america-expectations-vs-reality/

----------------------

AGING ISSUE:
HOW TO THINK ABOUT COGNITIVE DECLINE IN AN OLDER ADULT CLIENT

Cynthia A. Cotter, Ph.D.
Kenneth S. Dellefield, Ph.D.

An older adult client complains to you that they keep forgetting people’s names or that they can’t find their car when they exit a store.  A family member of a client reports to you their concern that your client keeps asking the same questions over and over again.  You hear from others that, very recently, a client has become combative and has been talking to people who are not there.  You notice that a client is starting to display some change in ability to focus during a session or that they seem off balance or their hands have begun to shake.  You notice a change in their ability to communicate with you.  

In order to properly respond to the above types of complaints or observations, a clinical psychologist must first have the ability to consider them in context. This article aims to help by providing a brief birds-eye view of the types of changes in cognitive functioning that tend to occur in the later stages of life. 

In the same way that we become less physically strong and capable with age, so do we become less mentally strong and capable.  This is true of everyone! The particular ways we decline and the degree to which we decline, however, vary greatly by individual.  A good deal of effort has been made by researchers to understand the various causes of brain change with age.   In their book Mild Cognitive Impairment and Dementia: Definitions, Diagnosis, and Treatment (2013), Glenn E. Smith and Mark Bondi present a helpful schema for differentiating those with later life cognitive concerns.

NORMAL (WORRIED WELL)

These are OAs experiencing the normal loss of cognitive functioning that comes with age.  They score worse on cognitive measures relative to younger individuals (they are in fact experiencing memory loss, for example), however, they test within normal range compared to others their own age.  Some OAs adjust very easily to the changes that occur with age, however, others are very sensitive, particularly if they were previously high functioning, and this can lead to stress and to complaint. 

TRANSIENT (DELIRIUM OR PSYCHIATRIC DISORDERS)

An OA may demonstrate a decline from previous baseline mental functioning due to medical illness or surgery that resolves in a short time (hours to days). Delirium is the term used for this type of change that can involve dramatic but temporary changes to attention, level of consciousness, or memory. Psychiatric disorders such as depression or anxiety can also produce fluctuations in cognitive functioning, particularly in frontal processing (attention, working memory, executive functioning).  When an OA client presents with cognitive change, a first step would be to consider the presence of medications that might impact cognition such as acetylcholinergics, benzodiazepines, opiates, etc. or medical conditions such as UTI or B-12/folic acid deficiencies, etc.   A second would be to consider exacerbations in psychiatric conditions that might be at work. 

PERSISTENT

Dementia is the term that has been used most commonly to describe cognitive loss that interferes with daily functioning and that is not due to delirium or the presence of another mental disorder (see above).  Note that the DSM-5 no longer uses the term dementia for diagnosis as its meaning has been so confused in the general public.  Instead Major Neurocognitive Disorder is used to describe the same set of symptoms.  Dementia is not an illness.  It describes symptomatology caused by pathological agents that vary greatly in how they impact the brain and in the course they take.  

Reversible vs. Nonreversible 

Pathological agents underlying dementia may be reversible or nonreversible in type.  An example of reversible dementia would be normal pressure hydrocephalus (NPH) that is caused by blockage in the flow of cerebral spinal fluid through the brain.  Treatment might involve shunting to release the blockage.  Other examples of reversible dementias would be ones due to autoimmune or metabolic disorders or consumption of toxic substances that might be treated.

Most pathological agents underlying dementia are considered nonreversibleand are further divided into those with static or degenerative impact.  Examples of static types of dementia would be those due to stroke or head injury.  Once the damage to the brain has occurred, the condition may not become worse with time and may actually improve somewhat once injured neurons begin to recover. 

The most common and most well-known forms of dementia are degenerativein type.  Four different degenerative pathologies underlie ninety five percent of dementia cases, Alzheimer’s disease (AD), vascular disease (VaD), Lewy body disease (DLB), and frontotemporal lobar degeneration (FTLD).  Each causes breakdown of different processes within the brain.  For example, AD is known for its frank impact on memory.  The impact of the other three is generally more frontal or frontal/subcortical, however, each presents with a different pattern of frontal symptomatology.  The courses the four degenerative dementias take may differ.  FTLB patients tend to have the shortest life span whereas individuals with AD can live many years with the disease.  As the pathological agents differ between the degenerative dementias, treatment approaches investigated by researchers vary considerably.  Once a dementia diagnosis has been confirmed, clients may have opportunity to participate in ongoing clinical trials relative to their particular dementing illness.

DIAGNOSIS

Diagnosis of dementia is most properly made by a neurologist based upon evaluation of motor/sensory systems and results of brain scans and blood tests.  Diagnosis is often benefitted by neuropsychological evaluation as brain scans or blood tests are often not definitive.  Dementing pathologies produce distinctive profiles on cognitive testing.

The take-away for the clinical psychologist is to recognize that change in cognitive functioning in an OA client can indicate a number of different problems occurring for that individual.  It is important that a proper diagnosis be made by a qualified professional so that the correct medical and psychological treatments can be implemented.

STAYED TUNED FOR FUTURE AGING ISSUES ARTICLES

Early Stage Dementia – How the Clinical Psychologist Can Be of Help
What Can You Learn from Mental Status Exams
Ways in Which Your Brain Improves with Age

MEETING MINUTES 12/13/21

BY CO-CHAIRS:

 Kenneth S. Dellefield, Ph.D.  Cynthia A. Cotter, Ph.D.

AIC Minutes 12-13-21.pdf 

OFFICE E-NEWS DECEMBER

BY CO-CHAIRS:

 Kenneth S. Dellefield, Ph.D.  Cynthia A. Cotter, Ph.D.

The second meeting of the Aging Issues Committee (AIC) was held on November 8, 2021.  Co-chairs Cynthia A. Cotter, Ph.D. and Ken S. Dellefield, Ph.D. presided over the meeting via Zoom.  There were nine committee members in attendance.  Dr. Dellefield presented Do You Know? information about what life was like in the early 1900s to provide perspective on how OA may have such differences in life perspective and experience.  The Committee decided that it would remain on Zoom for the present with perhaps two to three meetings a year in person in pot luck type formats.  Dr. Dellefield presented a case involving conflict between an OA and a son determined to get his mother to exercise, socialize and see doctors more often all to his mother's deep resentment and chagrin.  The Committee discussed the AIC article included in the recent Office E-News along with plans for future articles.  Lively discussions were had on the topics of what does the word "normal" mean later in life relative to cognition and how dementia is so often misconceptualized and misunderstood by the public.  Dr. Cotter proposed development of a quarterly e-blast called Age in Action that would include interviews with inspiring older adults, interesting activities for seniors in San Diego, etc.  The next meeting will be on Monday, December 13th.

DID YOU KNOW THAT IN 1902...?

The average life expectancy in the U.S. was 47 years.
Only 14 percent of the homes in the U.S. had a bathtub.
Only 8 percent of the homes had a telephone.
A three-minute call from Denver to New York City cost eleven dollars.
There were only 8,000 cars in the U.S. and only 144 miles of paved roads.
The maximum speed limit in most cities was 10 mph.
The tallest structure in the world was the Eiffel Tower.
The average wage in the U.S. was 22 cents an hour.
The average U.S. worker made between $200 and $400 per year.
More than 95 percent of all births in the U.S. took place at home.
Sugar cost four cents a pound.
Eggs were fourteen cents a dozen.
Coffee cost fifteen cents a pound.
Most women only washed their hair once a month, and used borax or egg yolks for shampoo.
Canada passed a law prohibiting poor people from entering the country for any reason.
The five leading causes of death in the U.S. were (1) pneumonia and influenza; (2) tuberculosis; (3) diarrhea; (4); heart disease; and (5) stroke.
The American flag had only 45 stars.  The population of Las Vegas was 30.
Crossword puzzles, canned beer, and iced tea hadn't been invented.
One in ten U.S. adults couldn't read or write.
Only 6 percent of all Americans had graduated high school.
Marijuana, heroin, and morphine were all available over the counter at the corner drugstores.
There were only about 230 reported murders in the entire U.S.

AGING ISSUE:
HOW CAN FAMILIES OF OLDER ADULTS TALK ABOUT MOVING IN A LOVING BUT HONEST WAY?

Kenneth S. Dellefield, Ph.D.
Cynthia A. Cotter, Ph.D.

One of the greatest challenges an OA may face is the problem of when to move out of a cherished family home into a living environment that will provide a greater amount of care or a greater ease in living.  Psychologists working with OAs are often asked to help these individuals and their families better understand and deal with psychological issues that arise during this time of great change. Kenneth S. Dellefield, Ph.D. and Craig Lambert LCSW have authored a guide entitled To Move or Not to Move: That is the Question – Exploring Ambivalence For Seniors and Their Families.  With their kind permission we have included below an abbreviated and paraphrased excerpt from one of their chapters to help you support elders faced with these very impactful decisions and transitions. 

How can families talk about moving in a loving but honest way?  In most situations, family members have strong feelings about whether a parent, spouse, or sibling should move.  Their strong feelings can lead to misunderstandings and conflict.  Families need assistance to identify ways of communicating with the OA that respects their perspective and feelings.  When a family member is not sure what to do, and it is not an emergency, it is sometimes best to honor the ambivalence and allow more time to consider the matter with the OA.  

It is common for family members to be uneasy in talking about the need for someone to move.  It is such a sensitive issue and can bring up feelings of abandonment on the part of the senior and guilt from the family members.  It can cause anger for all parties.  The senior can feel that they are being pushed to do something that they do not want to do or need to do and family members can feel the senior is insisting on living in a situation that is no longer safe or makes sense.  The challenge is to engage in a process that leads to good problem solving while paying attention to and being respectful of everyone’s feelings.

No one likes to be told what to do.  Adults are entitled to make their own decisions and even have the right to make unwise decisions.  An exception to this right is when the senior is unable to safely care for themselves secondary to a dementia or mental illness.  This situation is not typical.  In most cases, family members must simply act as consultants.   They can advise, recommend, and even attempt to persuade but the decision will be, in most cases, the senior’s.

So how does a family member go about talking to an OA about moving?  The first step is to share the concerns with the senior.  Point out what problems the family member has noticed and ask the senior if they have noticed the problems as well.  It is often at this point that the “facts” become the source of the conflict (I’m eating more than that!”).  If it isn’t the “facts” that are in question it might be the implications of the facts (“So I’m only eating one meal a day, that’s all I need given how little I move around!”).  If this is the case, it is suggested that the family decide to collect the facts together.  The family can agree on a system for monitoring behaviors of concern and evaluating the results. For example, food records can be setup along with appointments for weight monitoring and blood tests to evaluate nutritional status.  In this way, the facts speak for themselves and the family will have minimized the need for blame or for accusations of being unfair or uncaring.

Sometimes, conflicts occur because the elder is unwilling to even consider whether a move is needed.  When this occurs, it is very difficult to know what to do next.  The person has closed their mind and wants to avoid some significant fear related to the move.  Unfortunately, the only way of dealing with a fear is to be exposed to the thing feared to learn that it is less threatening than presumed. The family member should raise the topic, share information, and make appointments to see options…over and over again.  Some senior facilities offer the opportunity for a short “respite” stay to allow the OA to sample the environment prior to making the decision to move.  

The family member should always communicate to the OA in a straight forward, calm manner and not be upset when the reaction from the elder is designed to discourage them.  The family member should be persistent, patient and clear that their goal is simply to explore thoughts and feelings, pros and cons, and to gather information.  The family member should not have a hidden agenda and not be secretly trying to fool a family member to get a particular result.  Honesty and trust from family members are required for an elder to be able to confront their fears and to make the best decision.

The psychologist might consider the following exercises to facilitate the conversation between family members and the OA about moving.  Interview family members individually and ask each to name three reasons why they think the OA should move and three reasons why they think the OA should not move.  Interview the OA and ask them what three things they would like to ask their family to do that would help them be more comfortable either before, during or after the move.  Ask the OA what they would do if they made the move and they did not want to stay.  What do they think would be their options?  Ask family members to identify three possible options that the OA might have if they wanted to make a change.

The most important thing is for the OA and their family members to have greater clarity about what they may be thinking and feeling about the move so that these thoughts and feelings may be properly addressed with the mutual goal of the well being of the elder.

STAY TUNED FOR FUTURE AGING ISSUES ARTICLES!

• Ways in Which Your Brain Improves with Age
  
• Anxiety in Later Life
  

Please let us know if you would like to contribute an article or if you have a topic you would like to see presented!

MEETING MINUTES 11/8/21

BY CO-CHAIRS:

 Kenneth S. Dellefield, Ph.D.  Cynthia A. Cotter, Ph.D.

MEETING MINUTES 

AIC Minutes 11-8-21.pdf 

OFFICE E-NEWS NOVEMBER

BY CO-CHAIRS:

 Kenneth S. Dellefield, Ph.D.  Cynthia A. Cotter, Ph.D.

The inaugural meeting of the Aging Issues Committee (AIC) was held on October 11, 2021. Co-Chairs Cynthia A. Cotter, Ph.D. and Ken S. Dellefield, Ph.D. presided over the meeting via zoom. There were eleven in attendance. Did You Know information about older adults was presented. Attendees provided to the group their interests related to aging and how aging impacts their own private practices. The group discussed broad areas of possible programs for the AIC that included continuing education, consultation, geriatric specialty training, hub for geriatric professionals in the community, government and older adults, and aging psychologists. It was agreed that the AIC would publish an Aging Issues article each month in the SDPA Office E-News along with a section Did You Know. The first article (see below) would be produced by Co-Chairs Dellefield and Cotter. It was agreed that AIC meetings would be held on the second Monday of the month from 5:00 PM – 6:30 PM. Minutes for each meeting will be posted on the website under Committee Updates/Reports just prior to the next meeting. The next meeting will be on Monday, November 8th.

DID YOU KNOW?

Per the U.S. government, approximately 16% of the U.S. population is over the age of 65.  Of these, 9% are African Americans (not Hispanic) and 8% are persons of Hispanic origin (who may be of any race).  There are over 90,000 individuals in the U.S. over the age of 100.  Over the past ten years there has been a 35% increase in the population of age 65 and older.

Per the APA, approximately 62% of licensed psychologists provide services to older adults.  Yet only 1% report professional geropsychology as their primary specialty.

At SDPA, 15.8% of Full Members Licensed are registered in the Aged 70 category.  Of the 420 psychologists listed in Find a Psychologist, 32% report that they provide services to older adults.

Sources:

 https://acl.gov/aging-and-disability-in-america/data-and-research/profile-older-americans   https://www.apa.org/monitor/2016/01/datapoint

AGING ISSUE:
COMMUNICATING EFFECTIVELY WITH OLDER ADULTS

Kenneth S. Dellefield, Ph.D.
Cynthia A. Cotter, Ph.D.

As a part of normal aging, we experience cognitive, motivational, sensory and physical changes that impact how we receive and process information.  By and large, these changes do not significantly impact functioning and OAs are able to live well regardless.  They are quite capable of adapting to new ways of learning and applying what they learn.  Because so much of therapy involves teaching and learning, therapists can be more effective and more motivating when their teaching skills are tailored to the unique age specific needs of the populations with which they work.  Changes that occur with normal aging are discussed below with tips on how to work most effectively with OAs.

Cognitive

When we are older, we think more slowly (speed), we are less able to hold information in mind while we think (working memory) and we have greater difficulty integrating information in order to make a decision (executive functioning).   We have difficulty staying focused and in multi-tasking.  I came into this room for a reason and now I can’t remember why!  We have trouble remembering names and words for things.  Who was that actress, her name is on the tip of my tongue!  Our visual-spatial skills are reduced.  I turned left when I should have turned right!  Where did I park my car!!  We require cues to help us recall information recently acquired.  I can’t function without my calendar!  We are less mentally flexible. This is the way I have always done it!  Remember, even with these cognitive changes, OAs are quite capable of making significant changes in what they think and how to compensate to minimize overall dysfunction.

Motivational

What is relevant and meaningful for us at age 40 may not be so over the age of 65.  Priorities and interests shift with age as do incentives for communication and learning.  OAs tend to be more interested in information that can have immediate application.  They are more attracted to the practical solution rather than the abstract and what is a practical solution for a younger individual may not feel so to an older adult.  Older adults may have latent depression and situational anxiety that is interfering with interest and motivation. 

Sensory

Changes in vision and hearing have a clear impact on ability to receive and process information.   OAs may suffer blurry or distorted vision from presbyopia, cataracts, macular degeneration, glaucoma and diabetic retinopathy.  They may be less benefitted by light or more impacted by glare. There may be reduced peripheral or color vision.   OAs are often less able to hear speech, particularly when there is background noise.  High-pitched sounds are harder to distinguish.  Some sounds seem overly loud and are annoying.  The fact that this is so may be confusing to family members who view the OA as hearing impaired.  Some experience tinnitus (ringing in the ears) that can decrease focus and efficiency.

Physical

Some over the age of 65 are plagued with medical conditions that cause pain, discomfort or loss of physical functioning that may be distracting and preoccupying.  Medical conditions can sometimes impact orientation that varies throughout the day.  OAs can become fatigued more easily so that they may disengage. 

Tips For Working with OAs

Be sure the OA is physically comfortable in their seating and is not in pain.  If possible, make use of special equipment available on the market (e.g. Roho cushions)(check out spinlife.com). 

Provide the OA with water or their favorite beverage (for instance, have decaf available as well as regular coffee).

Manage the lighting in the room so that there is sufficient light but no glare.

Be sure to choose a quiet room in which to work.

Be sure the OA is wearing their hearing aids or using their glasses as necessary.

Keep spare reading glasses handy for when OAs forget to bring their reading glasses.

Keep equipment available that can enhance hearing.  

Position yourself closer to the OA than you might with others (taking into account COVID restrictions).  

Eliminate unnecessary clutter in the room and on the desk at which the OA will be presented with information.

Determine the OA’s style of learning.  As is the case with younger individuals, some are visual learners (diagram it for me), some verbal (explain it to me) and some kinesthetic (show me).

In general with OAs, use more charts, pictures or diagrams for education.  Use larger print for the material.

Speak and present slowly allowing the OA time to absorb.  Be patient in waiting for the response.

Present material in bite-size pieces one item at a time.  Wait until it is clear that the OA has understood the material before continuing.  Have the OA practice what they are learning through role playing or applying the new skills immediately.

Present information in a number of short sessions rather than in one long.

Provide time in between points for the OA to reflect and to reminisce if so inspired.  OAs often enjoy telling about their earlier experiences and challenges.

Be alert to subtle signs of fatigue and cut short the session if necessary.

Allow the OA to prioritize their goals and concerns, to clarify purposes and motivations in the work.

Set goals that are realistic.  Keep returning to the goals and clarifying the purposes of the session.

Be alert for OA distraction and loss of train of thought and guide back to the issues/problems/topics at hand.

Provide the OAs with education in how age-related changes impact how we receive and process information.  Help OAs to have and use tools that will enhance their ability to be effective and efficient in everyday life (notes, tape recorders, calendars, etc.).  

Let OAs know that it is OK to ask that others SLOW DOWN!  DO NOT let others pressure them into making decisions too quickly or into making decisions with which they are not comfortable!

Frequently call the OA by name. 

Show respect for the OA’s age and experience.  BE PATIENT!  Remember that one day you will be an OA yourself!  Also remember that the wisdom of age trumps the speed of youth!!

STAYED TUNED FOR FUTURE AGING ISSUES ARTICLES!

• Communicating Effectively with Older Adults with Dementia
  
• Ways in Which Your Brain Improves with Age
  

MEETING MINUTES 10/11/21

BY CO-CHAIRS:

 Kenneth S. Dellefield, Ph.D.  Cynthia A. Cotter, Ph.D.

MEETING MINUTES 

AIC Minutes 10-11-21.pdf

AGING ISSUES

NEW OPERATING COMMITTEE

BY CO-CHAIRS:

 Kenneth S. Dellefield, Ph.D.  Cynthia A. Cotter, Ph.D.

NEW SDPA COMMITTEE!
AGING ISSUES

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Dear Members:

On 5/20/21, the SDPA Board approved a new operating committee related to aging.  Please let us know if you would be interested in participating!  Most likely our first committee meeting will be this summer.

NAME OF NEW COMMITTEE:  Aging Issues Committee

DESCRIPTION OF PURPOSE OF NEW COMMITTEE:

The purpose of the Aging Issues Committee is to provide members with the opportunity to consult and network with others who work with older adults and to share treatment strategies and expertise.  The Committee also works to offer members and the public continuing education in issues related to aging.

COMMITTEE CO-CHAIRS:

Kenneth S. Dellefield, Ph.D.
Cynthia A. Cotter, Ph.D.

PLAN FOR EVENTS/ACTIVITIES:

The plan for the Aging Issues Committee is to conduct regular meetings.  At these meetings, committee members will discuss their interests, present educational material to other committee members and engage in mutual consultation/collaboration related to working with older adults.  The Aging Issues Committee will develop both informal and formal (CE accredited) courses to present to SDPA members and to the public related to aging and working with older adults.   It is anticipated that the Aging Issues Committee will at some point conduct an all-day workshop for SDPA members on the topic of Working with Older Adults in Clinical Practice.  Some questions that might be addressed in this workshop include:

What are evidence-based treatment models for working with older adults?
How do I know when a client might be developing dementia?
How do older adults respond to medications differently than young adults?
How do older adults uniquely experience depression and anxiety?
What do I do if I suspect elder abuse is occurring?
How can I be of assistance to family of an elderly parent who is struggling with declines in cognition or who is now exhibiting abnormal behavior?
How can I be of help to an elderly person (and/or their family) facing transition from Independent living to a senior facility that provides more assistance?
What are sources of funding (such as Medicare) available for psychology services provided to older adults? What are the unique challenges faced by older adults in the 2020s in the U.S.?

The Aging Issues Committee will advocate for new clinical training sites for students to train in Geropsychology and to provide opportunities for psychologists to practice in this area.

The Aging Issues Committee will undertake programs in support of the elderly in the community.  An example would be to give support to older adults in senior facilities.  So many older adults have been isolated because of COVID and depression is very common. Recent research is showing that regular remote communication with volunteers is effective in improving mental health.  Barriers exist, such as identifying isolated seniors and available volunteers as well as dealing with difficulties/fears seniors have using phones and computers.  The Committee could recruit psychology students to make weekly remote contact with seniors and could recruit help from retirement communities, boards and cares, health care providers, etc. to identify appropriate seniors. 

The Aging Issues Committee will work to ensure that SDPA is providing active representation to community agencies such as County Mental Health, Aging and Independent Services, etc. 

The Aging Issues Committee will provide support for psychologists who are age 65 and older who are facing change in their own lives and practices associated with aging.

Let the SDPA Office know of your interest!!