Handbook of Mental Health and Aging

Description

The Handbook of Mental Health and Aging, Third Edition provides a foundational background for practitioners and researchers to understand mental health care in older adults as presented by leading experts in the field. Wherever possible, chapters integrate research into clinical practice. The book opens with conceptual factors, such as the epidemiology of mental health disorders in aging and cultural factors that impact mental health. The book transitions into neurobiological-based topics such as biomarkers, age-related structural changes in the brain, and current models of accelerated aging in mental health. Clinical topics include dementia, neuropsychology, psychotherapy, psychopharmacology, mood disorders, anxiety, schizophrenia, sleep disorders, and substance abuse. The book closes with current and future trends in geriatric mental health, including the brain functional connectome, repetitive transcranial magnetic stimulation (rTMS), technology-based interventions, and treatment innovations. Cover Handbook of Mental Health and Aging Copyright Contents List of Contributors Preface 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 in older adults 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 targets 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 psychiatry 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 disease 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