Handbook of Mental Health and Aging 3rd edition by Nathan Hantke, Amit Etkin, Ruth O’Hara ISBN 0128001363 9780128001363

1 Concepts and issues in mental health and aging

Critical issues in mental health

Mental health disorder in older adults

The interplay of neurobiology, cognition, and psychiatric symptoms

A reflection on intervention

Psychotherapy

Summary

References

2 Epidemiology of selected mental disorders in later life

Introduction and scope of the chapter

Psychiatric epidemiology in later life

Selected disorders

Depressive disorders

Description of the disorder

Epidemiology

Associations and suspected risk factors for depression in later life

Neurocognitive disorders

Description of the disorder

Epidemiology

Associations and suspected risk factors for neurocognitive disorders in later life

Anxiety disorders

Description of the disorder

Epidemiology

Associations and suspected risk factors for anxiety disorders in later life

Bipolar disorders

Description of the disorder

Epidemiology

Associations and suspected risk factors for bipolar disorders in later life

Posttraumatic stress disorder

Description of the disorder

Epidemiology

Associations and suspected risk factors for posttraumatic stress disorder in later life

Substance use disorders

Description of the disorder

Epidemiology

Associations and suspected risk factors for substance use in later life

Suicide

Description of the disorder

Epidemiology

Associations and risk factors for suicide in later life

Summary and future directions

Acknowledgments

References

3 Culture and ethnicity in the mental health of older adults

Culture and ethnicity in the mental health of older adults

Cultural factors associated with mental health

Racial/ethnic discrimination

Cultural adaptation

Cognition and ethnicity

Religion and spirituality

Access to mental health care

Mental health stigma and negative attitudes toward treatment

Structural barriers to care

Discussion

References

Further reading

4 Stress, mental health, and aging

Introduction

Biological impact of stress in late life

Cellular aging and stress

The immune system and inflammation

Neuroimaging and stress in later life

Genetics, stress, and aging

Stress on cognitive health in older adults

Stress and objective cognitive functioning

Day-to-day stress fluctuations and cognition

Stress and subjective cognitive complaints

Early and midlife stress on late-life cognitive functioning

Dementia worry

Impact on everyday functioning

The impact of stress on quality of life in older adults

Chronic health conditions and quality of life

Mental health and quality of life

Alzheimer’s disease caregivers—a use-case example of how stress directly impacts mental health i

Stress-related anxiety disorders in older adults

Posttraumatic stress disorder in older adults

Generalized anxiety disorder in older adults

The special case of the veteran population

Protective role of positive psychological traits

Stress and social support

Stress and resilience

Interventions to improve mental health and stress

Future directions for research and conclusions

References

5 Structural changes in the aging brain

Introduction

Gray matter structure

Gray matter volumetry

Gray matter cortical thickness

Ventricular changes

White matter structure

White matter hyperintensities

Other white matter vascular pathology

White matter structure—volumetric measures and diffusion tensor imaging

Clinical translation and utility of neuroimaging data

References

6 Sleep-dependent cellular chemical changes in the aging brain

Introduction

Plasticity, synapses, aging, and sleep

Amyloid beta and the Fragile X mental retardation protein

Amyloid, astrocytes, and the glymphatic system

Cellular metabolism and the astrocytes

Sleep, chromosome dynamics, and DNA repair in neurons

Animal models for aging and neurochemical changes

Conclusion

References

7 Biomarkers of cognitive impairment in late-life depression

Introduction

Cognitive impairment in late-life depression

Neuroimaging findings

Inflammatory changes in late-life depression

Neurotrophic factors in late-life depression

The insulin signaling cascade/glycogen synthase kinase 3β in late-life depression

Multiplex biomarker changes related to cognitive impairment in late-life depression

Conclusion

References

8 Accelerated brain molecular aging in depression

Introduction

Neuronal correlates of cognitive changes in depression and aging

Peripheral and central biomarkers of “molecular aging” of the human brain

Deviation of molecular age from chronological age in disease states

Proposed model of age-by-disease interaction

Conclusion

References

9 Cognitive dysfunction in late-life psychiatric disorders: phenotypes, risk factors, and treatment

Using cognitive profiles to refine late-life psychiatric phenotypes

Depression

Anxiety

Schizophrenia and bipolar disorder

Posttraumatic stress disorder

Differentiating anxiety from depression in late life

Differentiating schizophrenia from bipolar disorder in late life

Worry

Neurophysiology associated with cognitive impairment in late-life psychiatric disorders

Depression

Anxiety

Schizophrenia

Schizophrenia and accelerated aging

Disentangling late-life psychiatric symptoms from prodromes of other neurodegenerative disorders

Psychiatric disorders as a risk factor for subsequent cognitive decline

Cognitive function as a predictor of pharmacologic and psychotherapeutic treatment response

Developing and identifying treatment targets such as cognitive training and augmentation

Offering a window to neurocircuitry and the development of transdiagnostic measures for geriatric ps

Conclusion

References

Further reading

10 Suicide in late life

Prevalence

Suicidal ideation

Suicide attempts and death by suicide

Suicide method

Risk factors

Gender

Race and ethnicity

Socioeconomic status

Social factors

Mental illness

Physical illness and functional impairment

Neurodegeneration, cognition, and suicide

Contemporary psychological theories of suicide

Suicide risk assessment

Management and treatment

Summary and future directions

References

11 Anxiety and its disorders in old age

Introduction

Overview

Anxiety disorders

Common anxiety disorders

Specific phobia

Social anxiety disorder

Generalized anxiety disorder

Panic disorder

Agoraphobia

Anxiety disorders due to substances, medications, or medical conditions

Other specified anxiety disorder/unspecified anxiety disorder

Less common anxiety disorders

Anxiety in the context of neurocognitive disorders

Diagnostic challenges

Assessment of anxiety in older adults

Treatment approaches

Cognitive behavioral therapy

Other psychotherapeutic approaches

Conclusion

References

Further reading

12 Bipolar disorders in older adults

Introduction/epidemiology

Early versus late-onset

Secondary mania

Clinical presentation

Suicide

Psychiatric comorbidity

Physical health

Cerebrovascular disease

Obesity

Cognition

Brain abnormalities

Clinical care

Psychiatric medications

Electroconvulsive therapy

Psychotherapy

Exercise and nutrition

Limitations and future directions

References

13 Positive Psychiatry and successful aging in people with schizophrenia

Introduction

Historical background of positive psychiatry

Schizophrenia

Assessment in positive psychiatry

Positive psychosocial characteristics

Cognition

Successful biopsychosocial aging

Biology

Potential biomarkers of positive psychiatry

Clinical implications

Limitations

Future directions

Conclusion

References

14 Alzheimer’s disease and other neurocognitive disorders

Introduction

Terminology

General diagnostic approach

Alzheimer’s disease

Clinical features

Preclinical disease

Management

Vascular dementia

Clinical features

Diagnosis

Management

Lewy body disease

Parkinson’s disease dementia

Dementia with Lewy bodies

Imaging

Management

Frontotemporal lobar degeneration

Clinical features

Behavioral variant frontotemporal dementia

Primary progressive aphasia

Motor syndromes

Imaging

Treatment

Common psychiatric symptoms in dementia and their management

Apathy

Nonpharmacologic treatments

Pharmacologic treatments

Agitation

Nonpharmacologic treatments

Pharmacologic treatments

Antipsychotics

Antidepressants

Anticonvulsants

Antiadrenergic medications

Dextromethorphan-quinidine

Benzodiazepines

Psychosis

Nonpharmacologic treatment

Pharmacologic treatment for patients without Parkinson’s disease

Pharmacologic treatment for patients with Parkinsons’ disease dementia

Depression

Nonpharmacologic treatments

Pharmacologic treatments

Electroconvulsive therapy and transcranial magnetic stimulation

Anxiety

Nonpharmacologic treatments

Pharmacologic treatments

References

15 Substance use disorders in the elderly

Introduction

Epidemiology

Risk factors for substance use disorders

Cohort and period effects

Biological risk factors

Psychosocial and psychiatric risk factors

Underrecognition of substance use disorders in later life

Comparative prevalence of substance use disorders

Principles of assessment and management

Assessment of substance use disorders

Management and treatment

Alcohol use disorders

Epidemiology

Use, heavy use, and problem use in the elderly

Age versus cohort effects on prevalence

Patterns of alcohol use and abuse

Motives for nonpathological drinking

Therapeutic use and health maintenance value of alcohol

Binge drinking and heavy drinking

Reactive drinking

Early versus late-onset alcohol problems

Family patterns

Clinical features of alcohol use disorders

Essential and associated features

Complications

Alcohol use and cognition

Course

Management and treatment

Prescription psychoactive drug use disorders

Epidemiology of sedative-hypnotic drug use and problems

Introduction

Benzodiazepine use by the community elderly

Institutional benzodiazepine use

Long-term benzodiazepine use and the development of dependence

Other risk factors for benzodiazepine dependence

Limitations of the epidemiologic data

Clinical features and complications of benzodiazepine dependence

Low-dose dependence

High-dose dependence

Acute side effects and toxicity

Chronic toxicity

Complications associated with other disorders

Discontinuation symptoms

Assessment and management of benzodiazepine use disorders

Assessment of dependence and withdrawal

Drug discontinuation and rehabilitation of the dependent patient

Preventing benzodiazepine use disorder

Opioid use disorder

Prescription analgesic drug use and abuse

Other substances

Illegal drugs

Varieties of drugs and disorders

Prevalence of disorders

Cannabis use disorder

Other drugs

Over-the-counter drugs

Prevalence of use

Factors affecting use and misuse of OTC drugs

Over-the-counter hypnotics

Over-the-counter stimulants

Other drugs

Tobacco use disorder

Prevalence of use

Adverse health consequences of tobacco use

Smoking cessation and its effects on health in the elderly

Smoking cessation methods and outcomes

E-cigarettes

Polysubstance use disorders

Looking ahead

Predicting future case volume

Research directions

Planning services

Prevention

References

16 Sleep disorders and aging

Quantifying sleep

Normal sleep with aging

Sleep disturbance and comorbidities

Sleep disturbance and cognition

Insomnia in late life

Excessive daytime sleepiness in late life

Sleep-disordered breathing in late life

Summary and future directions

References

17 Aging of persons with neurodevelopmental disabilities

Features and diagnostic criteria of neurodevelopmental disorders

Autism spectrum disorder

Down syndrome

Demographic trends

Autism spectrum disorder

Down syndrome

Life expectancy

Autism spectrum disorder

Down syndrome

Cognitive abilities

Autism spectrum disorder

Down syndrome

Physical health

Autism spectrum disorder

Down syndrome

Mental health

Autism spectrum disorder

Down syndrome

Functional abilities

Autism spectrum disorder

Down syndrome

Service use and availability

Autism spectrum disorder

Formal supports

Down syndrome

Family and informal supports

Informal supports

Autism spectrum disorder

Down syndrome

Summary and future directions

References

Further reading

18 Bereavement and grief

Introduction

Terminology: bereavement, grief, and mourning

Historical background

Two forms of “normal” grief: acute and integrated

Acute grief

Integrated grief

Complicated grief

Depression in the context of grief

Posttraumatic stress disorder

Bereavement and medical morbidity

Cognition

Suicide bereavement

Clinical recommendations

Conclusion

References

Further reading

19 Neuropsychology with older adults

Introduction

Cognitive changes associated with aging

Aging and frontal lobe functions

Aging and memory

Summary

Role of neuropsychology in differential diagnosis of pathological cognitive decline

Tracking of preclinical cognitive change

Mild cognitive impairment

Alzheimer’s disease

Vascular dementia

Lewy Body dementias

Frontotemporal dementia

Behavioral variant frontotemporal dementia

Primary progressive aphasia

Cognition and mental health in older adults

Late-life depression and cognitive performance

Late-life depression and cognitive decline

Cognitive models linking late-life depression and cognition

Late-life anxiety and cognitive performance

Late-life anxiety and cognitive control

Anxiety and cognitive decline

Cooccurring anxiety and depression

Cognitive models linking late-life anxiety and cognition

Conclusion

References

Further reading

20 Integrative precision-medicine approach to cognitive assessment in older adults

Introduction

Case description

Beyond-symptoms approach

Brain atrophy and connectivity

An open-science approach

Incorporating technology in the assessment

Use of computerized testing

Ecological Momentary Assessments

Conclusion

References

21 Functional assessment in geriatric mental health

Introduction

Classification and assessment of function in older adults

Conceptual framework for cognitively mediated daily function in older adulthood

Assessment of daily function in normative aging, mild cognitive impairment, and Alzheimer’s diseas

Functional assessment in older adult mental health

Assessment of daily function in older adult depression

Assessment of daily function in older adult schizophrenia

Assessment of daily function in older adult bipolar disorder

Conclusions

References

22 Psychotherapeutic interventions with older adults: now and into the future

Introduction

CALTAP: a transdisciplinary model of working with older adults

Therapeutic modalities

Psychotherapeutic approaches

Psychodynamic approach

Cognitive behavior therapy

Interpersonal psychotherapy

Motivational interviewing

Third-wave therapeutic approaches

Mindfulness

Acceptance and commitment therapy

Dialectical behavior therapy

Problem-solving therapy

Strengths-based approaches

Positive psychology

Reminiscence

Wisdom

Resilience

Future focus

Telehealth modalities

Web-based interventions

Mobile applications (“Apps”)

Gaming and virtual reality

Conclusion

References

Further reading

23 Psychopharmacologic treatment

Overview

Basic psychopharmacological principles

Pharmacokinetics

Absorption

Distribution

Metabolism

Elimination

Pharmacodynamics

Issues specific to psychotropic drug prescribing in older adults

Diagnostic issues

Late-onset primary psychiatric disorder or harbinger of a physical illness?

Effect of concurrent physical illness

Importance of a comprehensive evaluation

Medication history and treatment adherence

Confounding effects of substance use

Need for cross-disciplinary expertise

Multimorbidity

Polypharmacy and older adults

Appropriate versus problematic polypharmacy

Prescribing cascade

Nonprescription medication use

Complementary and alternative medications and medical “foods”

Potentially inappropriate medication use in older adults

The drug list approach

Deprescribing in older adults

Sociocultural factors

The patient–caregiver dyad

The impact of ageism

Drug interactions in older adults

Drug–drug interactions

Pharmacokinetic drug–drug interactions

Absorption

Distribution

Metabolism

Elimination

Pharmacodynamic drug–drug interactions

Drug–herb interactions

Drug–food interactions

Drug–disease interactions

Drug–substance interactions

Drug–gene interactions

Pharmacokinetic drug–gene interactions

Pharmacodynamic drug–gene interactions

Drug treatment of common psychiatric disorders in older adults

Psychotic disorders in older adults

Introduction

Drugs for the treatment of psychotic disorders

Anticholinergic activity

Antihistaminic activity

Dizziness and hypotension

QTc interval prolongation

Metabolic syndrome

Extrapyramidal symptoms

Hyperprolactinemia

Tardive dyskinesia

Evidence-based drug treatment of psychotic disorders in older adults

Bipolar disorder in older adults

Introduction

Drugs for the treatment of bipolar disorder

Lithium

Divalproex

Carbamazepine and oxcarbazepine

Lamotrigine

Second-generation antipsychotics

Evidence-based drug treatment of bipolar disorder in older adults

Neurostimulation strategies

Major depressive disorder in older adults

Introduction

Drugs for the treatment of major depressive disorder

Suicide

Hyponatremia

Fractures and osteopenia

Bleeding

Fall risk

Cardiac adverse effects

Evidence-based drug treatment of depressive disorders in older adults

Treatment-resistant depression in older adults

Cognitive symptoms in depressive disorder in older adults

Neurostimulation strategies

The dementias in older adults

Introduction

Drugs for the treatment of cognitive symptoms in the dementias

Evidence-based drug treatment of cognitive symptoms in the dementias in older adults

Neurobehavioral symptoms in the dementias in older adults

Introduction

Drugs for the treatment of neurobehavioral symptoms in the dementias

Evidence-based drug treatment of neurobehavioral symptoms in the dementias in older adults

Anxiety in older adults

Introduction

Drugs for the treatment of anxiety

Benzodiazepines

Buspirone

Antidepressants

Pregabalin

Evidence-based drug treatment of anxiety in older adults

Insomnia in older adults

Introduction

Drugs for the treatment of insomnia

Dual orexin receptor antagonists

H1-receptor antagonists

Nonbenzodiazepine GABAA receptor agonists

Benzodiazepines

Melatonin and melatonin receptor agonists

Trazodone

Evidence-based drug treatment of insomnia in older adults

Summary and conclusions

References

24 Technology-based mental health assessment and intervention

Introduction

Technology considerations for older users

Assessment using technology

Assessment via telehealth

Computerized assessment

Experience sampling method

Other assessment modalities

Smart-home technology

Virtual reality

Interventions

Telephone therapy

Telemental health interventions

Internet-based interventions

Internet-based cognitive behavioral therapy

Other internet-based interventions

Interactive voice response and text message support

Mobile app interventions

Summary

Acknowledgments

References

Further reading

25 Community and home care for mentally ill older adults

Introduction

Who is seeking mental health care?

Where do older adults with mental illness reside?

Residential care options

Conditions most frequently seen/treated in facilities

Opportunities and needs for mental health research—sleep as an example

Conclusion

References

26 Forensic and ethical issues

Competency

Competency in civil law

Financial capacity

Testamentary capacity

Contractual capacity

Surrogate decision-makers

Voluntary informed consent

Competency in criminal law

Confidentiality

Boundary issues

Research consent in the elderly

Conclusion

References

Further reading

27 The economics of geriatric mental health care

Introduction

The impact of health policy on geriatric mental health

Medicare fee-for-service

Medicare hospital insurance (Part A)

Supplemental medical insurance (Part B)

Medicare advantage

Medicaid and dual-eligible populations

Private insurance and out-of-pocket payments

Policy and infrastructure innovation

Conclusion

References

28 The future of mental health and aging

Introduction

Conceptualizing geriatric mental health within neural circuitry

Repetitive transcranial magnetic stimulation

Treatment innovation through technology

Summary

References

Author Index

Subject Index

Back Cover