Handbook of Assessment in Clinical Gerontology (eBook)

Front Cover 1
Handbook of Assessmentin Clinical Gerontology 4
Copyright 5
Contents 6
List of Contributors 8
Introduction 12
PART 1 -Psychopathologylater in life 20
CHAPTER 1Assessment of Depression andBereavement in Older Adults 22
EPIDEMIOLOGY OF LATE-LIFE DEPRESSION 22
CONCEPTUAL APPROACHES TO ASSESSMENT 23
DEFINITION AND DIAGNOSTIC ISSUES 24
DEPRESSION ASSESSMENT INSTRUMENTS 31
EPIDEMIOLOGY OF BEREAVEMENT 39
DEFINITION AND DIAGNOSTIC ISSUES 40
BEREAVEMENT ASSESSMENT INSTRUMENTS 44
CONCLUSION 47
References 50
CHAPTER 2Assessment of Anxiety in Older Adults 64
EPIDEMIOLOGICAL CONSIDERATIONS 64
SPECIAL CONSIDERATIONS 65
FACTORS INFLUENCING ANXIETY ASSESSMENT IN THE ELDERLY 66
CLINICAL UTILITY OF INSTRUMENTS TO ASSESS ANXIETY IN OLDERADULTS 66
MULTICULTURAL ISSUES IN ANXIETY ASSESSMENT IN THE ELDERLY 72
CLINICAL ILLUSTRATIONS 73
References 75
CHAPTER 3Psychotherapy with Older Adults: The Importance of Assessment 80
RESEARCH AND PSYCHOTHERAPY 81
WHY ASSESS BASELINE FUNCTIONING AND OUTCOMES? 82
PSYCHOTHERAPY MEASURES 85
A MODEL OF OLDER ADULTS IN PSYCHOTHERAPY 89
CAREGIVERS 91
TESTING IN DIFFERENT SETTINGS 93
CULTURAL DIVERSITY AND ASSESSMENT 93
CONCLUSION 100
SHORT FORM HEALTH SURVEY (SF-36) 103
UNIVERSITY OF RHODE ISLAND CHANGE ASSESSMENT 105
CLINICAL INSIGHT RATING SCALE 106
BASIS-32 (BEHAVIOR AND SYMPTOM IDENTIFICATION SCALE) 106
WORKING ALLIANCE INVENTORY 107
References 114
CHAPTER 4Assessment of Personality Disorders in Older Adults 120
OVERVIEW 120
DEFINITIONAL ISSUES 121
EPIDEMIOLOGY OF PERSONALITY DISORDERS 122
STABILITY AND CHANGE 124
PSYCHOMETRIC CONCERNS IN LATER LIFE 125
APPROACHES TO ASSESSMENT OF PERSONALITY DISORDERS 126
SUMMARY AND CONCLUSIONS 133
APPENDIX A: MULTI-SOURCE ASSESSMENT OF PERSONALITYPATHOLOGY (MAPP) 133
APPENDIX B: GERONTOLOGICAL PERSONALITY DISORDERS SCALE (GPS) 137
References 137
CHAPTER 5Assessing Psychosis in Acute and Chronic Mentally Ill Older Adults 142
INTRODUCTION 142
GENERAL ASSESSMENT CONSIDERATIONS 142
SCHIZOPHRENIA AND DELUSIONAL DISORDERS 144
BIPOLAR DISORDER AND PSYCHOTIC DEPRESSION 149
ASSESSMENT OF PSYCHOSIS IN DEMENTIA 151
CONCLUSION 155
POSITIVE AND NEGATIVE SYNDROME SCALE (PANSS) 155
ACKNOWLEDGEMENTS 170
References 170
CHAPTER 6Dementia Syndromes in the Older Adult 174
DEMENTIA 174
DESCRIPTION OF COGNITIVE DOMAINS 175
TYPES OF DEMENTING DISORDERS 176
STANDARD USES AND GOALS OF ASSESSMENT 183
TREATMENT 192
ROLE OF FOLLOW-UP ASSESSMENT 193
CONCLUSION 194
References 195
CHAPTER 7Delirium Assessment in Older Adults 198
HISTORY OF DELIRIUM AS A CLINICAL CONCEPT 198
EPIDEMIOLOGY 199
ETIOLOGY/RISK FACTORS 201
CLINICAL FEATURES 202
THE IMPORTANCE OF ASSESSING DELIRIUM 204
DIAGNOSTIC CRITERIA 205
REVIEW OF DELIRIUM ASSESSMENT MEASURES 207
CASE STUDIES 217
PSYCHOSOCIAL INTERVENTIONS 219
CONCLUSION 220
APPENDIX A: MEMORIAL DELIRIUM ASSESSMENT SCALE (MDAS) 220
REFERENCES 223
CHAPTER 8Assessment of Cognitive Training 230
INTRODUCTION 230
TOOLS AND TECHNIQUES FOR INITIAL ASSESSMENT OF MEMORY ANDCOGNITION IN LATE ADULTHOOD 231
DIAGNOSTIC ISSUES 234
COGNITIVE TRAINING PROGRAMS AND INTERVENTIONS 235
MEMORY TRAINING TECHNIQUES 236
MEMORY AND COGNITIVE ASSESSMENT AND INTERVENTIONS IN DIVERSEPOPULATIONS 238
USE OF REASSESSMENT IN CLINICAL WORK 239
CLINICAL CASE STUDY 240
CONCLUSION 241
References 241
CHAPTER 9The Assessment of Elder Abuse 248
INTRODUCTION AND HISTORY 248
DEFINITIONS AND SCOPE OF THE PROBLEM 249
EPIDEMIOLOGY OF THE PROBLEM—WHAT WE KNOW AND WHAT WE DON’TKNOW 250
CLINICAL SEQUELAE OF ELDER ABUSE AND NEGLECT 251
SCREENING FOR ELDER ABUSE 254
SPECIAL ISSUES 255
CONCLUSION AND FUTURE DIRECTIONS 256
APPENDIX A 257
APPENDIX B 258
APPENDIX C 259
APPENDIX D 259
ELDER ABUSE SCREENING TEST 259
References 260
CHAPTER 10Assessment of Dementia Family Caregivers 262
BACKGROUND ON ASSESSMENT 263
ASSESSMENT STRATEGY AND PROPOSED MEASURES 264
ASSESSING CONTEXTUAL VARIABLES: THE FAMILY UNIT AND SOCIALSUPPORT 272
THE PRACTICE OF ASSESSMENT 273
CONCLUSION 275
CASE STUDIES 275
APPENDIX A: ZARIT BURDEN INTERVIEW-12 278
APPENDIX B: CAREGIVER ASSESSMENT OF FUNCTION AND UPSET (CAFU) 279
APPENDIX C: POSITIVE ASPECTS OF CAREGIVING 285
References 286
CHAPTER 11Assessment with Late-Life Families: Issues and Instruments 292
INTRODUCTION 292
RATIONALE FOR A CHAPTER ON FAMILY ASSESSMENT 292
DIVERSITY IN LATE-LIFE FAMILIES 294
OTHER RELEVANT DEMOGRAPHIC AND SOCIAL TRENDS 295
KEY ASSESSMENT ISSUES 296
ASPECTS OF FAMILY FUNCTIONING 300
ASSESSMENT INSTRUMENTS 303
CONCLUSION 316
APPENDIX A:FAMILY ASSESSMENT DEVICE 316
INSTRUCTIONS: 316
APPENDIX B: 319
CHECKLIST OF FAMILY RELATIONAL ABILITIES 319
REFERENCES 320
PART 2 - Behavioral Disorders 324
CHAPTER 12Screening, Assessing and Intervening for Alcohol and Medication Misuse in Older Adults 326
INTRODUCTION 326
PREVALENCE OF ALCOHOL AND DRUG USE/MISUSE/ABUSE 326
MENTAL AND PHYSICAL HEALTH RISKS ASSOCIATEDWITH USE/MISUSE/ABUSE 329
DEFINITIONS OF SUBSTANCE USE RISK IN OLDER ADULTHOOD 329
SCREENING: ASKING THE FIRST QUESTIONS 332
BROAD-BASED ASSESSMENT OF ALCOHOL PROBLEMSIN OLDER ADULTS 340
SCREENING AND ASSESSMENT FOR PHYSICAL, MENTAL,AND FUNCTIONAL HEALTH 342
CULTURAL ISSUES IN SCREENING AND ASSESSMENT 345
SUMMARY 345
REFERENCES 345
CHAPTER 13Assessment and Conceptualization of SexualitynbspAmong Older Adults 350
INTRODUCTION 350
OLDER ADULT SEXUALITY AND CURRENT TIMES 351
WOMEN, AGING, AND FACTORS AFFECTING SEXUAL FUNCTIONING 351
MEN, AGING, AND FACTORS AFFECTING SEXUAL FUNCTIONING 353
RECENT ADVANCES IN PHARMACOTHERAPY FOR SEXUAL DISORDERS 355
DIVERSITY AND MULTICULTURAL CONSIDERATIONS IN OLDER ADULTS 356
INITIAL STAGES OF ASSESSMENT 359
DEATH, DYING, AND SEXUALITY IN OLDER ADULTS 363
ASSESSMENT TOOLS AND GUIDELINES 364
References 371
CHAPTER 14Nutrition in the Elderly 376
INTRODUCTION 376
PHYSIOLOGICAL CHANGES ASSOCIATED WITH AGING 376
NUTRITION RECOMMENDATIONS FOR OLDER AMERICANS 379
NUTRITIONAL ASSESSMENT FOR THE ELDERLY 381
AGING AND CHRONIC DISEASE STATES 388
MEDICATIONS THAT AFFECT APPETITE AND FOOD INTAKE 392
DIVERSITY ISSUES THAT IMPACT THE NUTRITION STATUS 392
CONCLUSION 396
REFERENCES 396
CHAPTER 15Assessment of Agitation innbspOlder Adults 400
INTRODUCTION 400
WHY ASSESS AGITATION? 402
AVAILABLE METHODOLOGIES FOR THE ASSESSMENT OF AGITATION 402
UTILIZING ASSESSMENTS IN CLINICAL SITUATIONS 412
INFLUENCE OF SETTING ON AGITATION AND ITS ASSESSMENT 416
MULTICULTURAL ISSUES 417
SUMMARY 417
REFERENCES 418
CHAPTER 16Assessing Sleep Problems of Older Adults 424
INTRODUCTION 424
THE STRUCTURE OF SLEEP FOR OLDER ADULTS 424
CAUSES OF SLEEP DISTURBANCE 426
SLEEP ASSESSMENT: MEASURES, METHODS, AND STRATEGY 429
APPENDIX A 435
APPENDIX B 436
APPENDIX C 440
References 441
CHAPTER 17Treatment Adherence in Late-Life 446
INTRODUCTION 446
RATES OF TREATMENT ADHERENCE 446
FACTORS INFLUENCING ADHERENCE 447
MEASURING MEDICATION ADHERENCE 458
INTERVENTIONS 468
CONCLUSIONS 469
References 469
PART 3 -Cognition 478
CHAPTER 18Geriatric Neuropsychological Assessment 480
INTRODUCTION 480
CONTEXTS AND PURPOSES OF GERIATRIC NEUROPSYCHOLOGICALASSESSMENT 480
PRACTICAL CONSIDERATIONS IN THE ASSESSMENT OF OLDER ADULTS 483
AVAILABILITY OF NORMATIVE DATA FOR OLDER ADULTS 486
CLINICAL CONSIDERATIONS IN ASSESSING THE OLDER ADULT 488
MEASURES FOR ASSESSING NEUROPSYCHOLOGICAL FUNCTIONING INOLDER ADULTS 489
CONTEMPORARY ISSUES IN GERIATRIC NEUROPSYCHOLOGY 500
SUMMARY 507
References 508
CHAPTER 19Screening Instruments and Brief Batteries for Dementia 522
INTRODUCTION 522
SCREENING FOR DEMENTIAdTHE LEGACY OF THE MMSE 524
BRIEF BATTERIES 531
CHALLENGES TO THE STANDARD APPROACH 536
APPENDIX 539
REFERENCES 542
CHAPTER 20Cognitive Assessment in Late Stage Dementia 550
INTRODUCTION 550
PROBLEMS IN ASSESSING COGNITION IN LATE STAGE DEMENTIA 550
MEETING THE CHALLENGE: INTERVENTION MODELS 558
SUMMARY AND CONCLUSIONS 569
ACKNOWLEDGMENTS 570
REFERENCES 571
CHAPTER 21Assessing the Personal Preferences of Persons with Dementia 576
INTRODUCTION 576
INCIDENCE OF DEMENTIA AND OTHER COGNITIVE IMPAIRING CONDITIONS 577
EARLY DIAGNOSIS OF DEMENTIA: CHALLENGES AND OPPORTUNITIES 578
UNDERSTANDING PREFERENCES AND DECISION MAKINGFOR EARLY-STAGE FAMILIES 579
INSTRUMENTS THAT ASSESS PERSONAL PREFERENCESAND DESIRES 583
DO PREFERENCES FOR CARE VARY ACROSS DIFFERENT POPULATIONS? 587
ENHANCING DECISION-MAKING AND UNDERSTANDING OF PERSONALPREFERENCES IN DEMENTIA 588
REASSESSMENT OF CARE VALUES AND PREFERENCES AND A LOOK TO THE FUTURE 590
WHERE DO WE GO FROM HERE? 591
ACKNOWLEDGMENTS 591
APPENDIX A: VALUES AND PREFERENCES SCALE (VPS) 592
APPENDIX B: PREFERENCES FOR CARE TASKS (PCT) WORKSHEET & MAGNET BOARD LAYOUT
References 594
PART 4 -Everyday Functioning 598
CHAPTER 22Assessment of Capacity 600
INTRODUCTION 600
WHAT IS CAPACITY? 600
CLINICAL EVALUATIONS OF CAPACITY 606
ADVANCES IN CAPACITY ASSESSMENT 608
A PROCESS FOR CAPACITY ASSESSMENT 612
SPECIAL ISSUES IN CAPACITY ASSESSMENT 613
FUTURE DIRECTIONS 622
APPENDIX A: QUESTIONS TO ADD TO A CLINICAL INTERVIEW 624
APPENDIX B: INTERVENTIONS TO ADDRESS DIMINISHED CAPACITY 625
APPENDIX C: CAPACITY ASSESSMENT TOOLS 629
APPENDIX D: CAPACITY WORKSHEET FOR PSYCHOLOGISTS 630
ACKNOWLEDGMENTS 634
REFERENCES 634
CHAPTER 23Household and Neighborhood Safety, Mobility 638
INTRODUCTION 638
FALLS AND BALANCE ASSESSMENTS 641
HOME SAFETY ASSESSMENTS 649
NEIGHBORHOOD SAFETY AND MOBILITY ASSESSMENTS 659
CONCLUSION 662
REFERENCES 662
CHAPTER 24Pain Assessment and Management in Older Adults 666
INTRODUCTION 666
NEUROCOGNITION AND NOCICEPTION 667
THE PAIN EXPERIENCE 668
CLINICAL PRACTICE GUIDELINES 681
CONCLUDING REMARKS 683
APPENDIX A: PAIN SELF-EFFICACY QUESTIONNAIRE (PSEQ)* 684
APPENDIX B: PAIN CATASTROPHIZING SCALE* 685
APPENDIX C: PAIN DISABILITY INDEX* 687
REFERENCES 688
CHAPTER 25Assessments in Driver Rehabilitation 698
INTRODUCTION 698
OLDER DRIVERS AS A GROUP 698
DRIVER REHABILITATION TEAM AND KEY SERVICES 700
SELF-ASSESSMENTS THAT CAN HELP TO SCREEN DRIVER READINESS 700
HOME-BASED DRIVING SELF-ASSESSMENT TOOLS 703
CLINICAL-BASED SCREENING TOOLS FOR DRIVING FITNESS 705
THE DRIVER REHABILITATION CLINICAL EVALUATION 706
PHYSICAL ASSESSMENT 708
THE ROLE OF VISION IN THE OPERATION OF A MOTOR VEHICLE 713
COGNITIVE SKILLS 716
DRIVING KNOWLEDGE 721
APPENDIX A: ASSESSMENTS THAT COMPRISE THE DRIVERREHABILITATION CLINICAL ASSESSMENT 723
APPENDIX B: INSTRUCTIONS FOR THE TRAIL MAKING TEST PARTS A AND B 725
APPENDIX C: GUIDELINES FOR MOTOR VEHICLE ADMINISTRATORS:LICENSE RENEWAL REQUIREMENTS 727
APPENDIX D: STATE OF MICHIGAN’S DRIVER LICENSING REQUIREMENTSAND REPORTING LAWS 734
APPENDIX E: LICENSING REQUIREMENTS 735
REFERENCES 736
Index 740