_____ UNIT 1: INTRODUCTION _____

1. Demographic changes
- Gerontology: (Multidisciplinary) Is the Study of the aging process. Includes physical, mental, social, cultural and
economic aspects. The inf. is used to develop strategies for improving the lives of older people.
- Geriatrics: Branch of medicine specialized in the care of older people. Concerned with the diagnosis, treatment and
prevention of disease in older people and the problems specific to aging.
- Biomedical model: focused on the study and treatment of diseases
- Biopsychosocial model: Three main factors: Physical, Social and Physiological.
- Psychogerontology: branch of Psychology specialized with the study of aging and the psychological aspects of the
elderly. Psychogerontologists apply this knowledge to promote the well-being of the elderly and their caregivers.
• Increase Life expectancy (The world is aging)
• In the past: largest percentage of the population distributed in the childhood years (pyramide)
• Today: increasing percentage of middle age and older adults (vertical rectangle)
• Higher number of people suffering from dementia (main cause of dependency)

• Declining fertility and Decreasing mortality (children)

2. Myths and stereotypes about aging

- GAINS à STABILITY à LOSSES = FALSE (We experience gains and losses in each stage of the life span)
- Children acquire many cognitive skills +, lose self-esteem and more vulnerable to depression -
- Elderly people > 60 years old score higher on verbal fluency tests compared to adults.
- All older people are the same
- Older people are sick, have functional dependence and are fragile
- Older people are lonely and isolated
• Increase the quality of interpersonal relationships more than the quantity
• Satisfaction with social relationships does not diminish
- Older people present cognitive decline and cannot acquire new knowledge or abilities
- Old people are rigid and cannot adapt to changes

- They don’t have sexual relationships

3. The concept of aging.

Aging: a continuous, heterogeneous, universal and irreversible process that is associated with a progressive decrease in
adaptive homeostatic responses of the organism.
- Chronological age: Passage of time from birth onwards (Easy to measure).
- Biological age: Presence or absence of physical disease, functional, or cognitive impairment. Better marker of health
status than chronological age.
- Subjective age: people experience themselves as younger or older than their chronological age.

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 - Medical professions: Old age = disease
- Critics:
• Age increase prevalence of disease, but incidence is reduced in advanced age
• Age related diseases appear in younger adults (e.g. MCI, dementia, cancer)
• Age related diseases do not appear in all old people.

- The Activity theory: old age presents the opportunity for positive change, new developments.
• Medical perspective: decrease in morbidity, physical illness, and functional impairment.
• Social perspective: ability to adapt to changes in society, to maintain role and status.
• Psychological perspective: maintenance of mental competences and well-being.
- Active aging: “the process of optimizing opportunities for health, participation and security in order to enhance
quality of life as people age”. Two frameworks: economic (older workers) and social (whole life course). Societal
participation receives more emphasis
- Successful aging: leading lives that allow them to avoid disability and disease, thus allowing individuals to remain
productive and engaged in society. Continuing activity in older age and retaining values typical of individuals in
middle age by continuing to consider themselves productive even after leaving the workforce. Clinical and medical
criteria are prioritized, more individualistic perspective.

4. Theories of aging.

Psychosocial theories of aging

- Disengagement theory: Aging is gradual disengagement from society and social relationships. The withdrawal
serves to maintain a social equilibrium that is both satisfying for the individual and society.
Controversies: many are working past retirement age or initiate part-time Jobs in a new field; many are actively
engaged in volunteer projects that benefit their community

- Activity theory: Staying active and involved is necessary for having a satisfying late-life and successful ageing. Being
active helps to prolong mid age and delay the adverse effects of old age.
Critics: choices often limited by physical capabilities, access to social resources and finances; staying active does
not necessarily delay the onset of the negative effects of aging

- Continuity theory: follows a life-course perspective to define normal aging. Personality influences the roles we
choose and how we perform them. Personality tends to remain consistent throughout our life.
• Kansas City Study of Adult Life: 4 personality types in older adults:
• Integrated (well-adjusted to aging):
§ a) reorganizers (highly active, numerous commitments);
§ b) focused (medium but very selective activity)
§ c) disengaged (low activity and more isolated life)
• Armored-defended: before old age very focused and oriented towards some objective, worked hard to
achieve their goals. Dynamic style, but rigid and individualistic.
§ a) Conservative (maintains the lifestyle and functions of middle age; good personal
satisfaction)
§ b) Withdrawn (will calculate their effort and activity, giving up certain roles; minor
satisfaction)

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 • Passive dependent personality type:
§ a) Helpseeker (active search for protection and help from other people, highly dependent
elders)
§ b) Passive (apathetic; disinterest in the external world)
• Unintegrated: little activity, present deficits in cognitive and mental functioning. Low personal
satisfaction; fail to cope with aging successfully.

- Person-environment fit theory (Ecological theory): The performance of and comfort with daily necessary and
desired activities is possible when an appropriate match between a person and his/her environment is achieved.
• Zone of maximum performance and comfort = person-environment fit.
• Excessive environmental demand for the level of competence of the individual = stress.
• Low environmental demand = decrease in competencies due to lack of practice.
• The most favorable environment will be the one where the level of demand is at the limit of the
maximum level of competence of the individual.

- Selective optimization with compensation theory: A model for successful aging. Individuals learn to cope with the
functional losses of aging using different strategies:
• Selection: focus on domains that maintain a high functioning and would allow the individual to continue
developing.
• Optimization: focus on behaviors that not only increase the years of life of the elderly but can also
enhance their quality of life.
• Compensation: activated when a person's abilities deteriorate because of old age or when the
environmental demands increase substantially.

Biological theories of aging

§ Stocastic theories
• Free radical theory: people age because of the cumulative result of oxidative damage to the cells and tissues of the
body because of aerobic metabolism (free radicals damage DNA and other celular structures). Emphasis on deficits
in mitochondria à mitochondria create damaging free radicals as a by-product of normal energy
production. Somatic mutations in the DNA of the mitochondria accumulate with age à leads to higher free radical
production, associated with an age-related decline in the functioning of mitochondria à important contributor to
the ageing process. Also, may lead to a range ot disorders (cancer, arthritis, Alzheimer’s disease)

• Wear and tear theory: Cells and tissues have vital parts that wear out resulting in aging; like components of an aging
car, parts of the body eventually wear out from repeated use. The human body undergoes aging due to damage
from accidents, diseases, radiation, toxic substances, food, and other harmful substances when it is utilized for a
long time.

§ Non-stocastic (deterministic) theories

• Evolutionary theory: natural selection hasn’t eliminated many harmful conditions and nonadaptive characteristics
in older adults. Only the genes expressed earlier in life, during the reproductive period are important from the
evolutionary perspective. There should be a balance between the demands of maintaining the body cells and
reproducing. Organisms invest resources into reproduction à mutations and other cellular damage will accumulate
in the soma over time. Species that are likely to die due to predation invest more energy in reproduction than in

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 somatic maintainance because they are unlikely to live long anyway; Humans have fewer predators and can allocate
more resources to repairing physical damage, given the fact that they will be able to reproduce for a longer period
of time.

• Gene/biological clock theory: cells can divide a maximum of 75 to 80 times and with age our cells become less
capable of dividing. Telomeres (DNA sequences that protect chromosomes from DNA damage) become shorter and
shorter each time a cell divides à when telomere sequences are fully lost, the cell’s ability to replicate is lost too
à this leads to cellular senescence

• Neuroendocrine theory: The hypothalamus stimulates and inhibits the pituitary gland, which in turn regulates the
glands of the body (ovaries, testes, adrenal glands, thyroid) and how and when they release hormones into our
circulation. This system becomes less functional with age and can lower resistance to stress à this leads to high
blood pressure, diabetes, cáncer, and sleep abnormalities, among others.

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 _____ UNIT 2: STABILITY AND CHANGE IN AGING _____

1. Physical changes
2. Cognitive changes and neuroplasticity

o Lifespan theory of intellectual development: two main categories or components of intellectual

functioning:
• The mechanics of cognition: an expression of the neurophysiological architecture of the mind
as it evolved during biological evolution (Inteligencia fluída).
• The pragmatics of cognition: acquired bodies of knowledge available from and mediated
through culture (Cristalizada).

o Selective attention: ability to focus on the relevant aspects and ignoring the irrelevant. Older adults
slower than younger adults in responding to the targets.
o Sustained attention: the ability to maintain concentration on a task over an extended period of time.
No major differences among adults.
o Divided attention: the processing of two or more sources of information or the performance of two or
more tasks at the same time).
- Decline in the ability to allocate resources appropriately when instructions are given
to vary task priority.
- Slower performance when attention must be switched from one task to another.
o Working memory: limited capacity system that involves the active manipulation of information that is
currently being maintained in focal attention
- Decreased ability to prevent irrelevant information and increased distractibility
o Long-term memory: requires retrieval of information that is no longer present or being maintained
in an active state.
- Episodic memory: personally experienced events that occurred in a particular place and at a
particular time. Very sensitive to cerebral aging and neurodegenerative diseases. Older adults
remember better long-ago events than more recent events
- Semantic memory: one’s store of general knowledge about the world, including factual
information. No significant impairments in semantic memory in older adults; their knowledge
of the world often exceeds that of young people. Older adults take longer to retrieve semantic
information (names and other specific information) (“tip-of-the-tongue” phenomenon)
o Procedural memory: older adults show normal acquisition of procedural skills (motor and cognitive
domains).
• Speech and language: intact in older adults (processing time may be somewhat slower)
- discourse skills improve with age
- more extensive vocabularies

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 3. Social changes
4. Emotional changes
Socioemotional changes: Erikson’s theory: 8 stages of the human lifespan
- Last stage (or crisis): integrity versus despair: reflecting on the past and either completing a positive review or
concluding that one’s life has not been well spent
- Reminiscence therapy: intervention technique used to counsel older people. Involves discussing past activities and
experiences using life histories to improve psychological well-being.

• Socioemotional Selectivity Theory: older adults become more selective about their social networks
- Older adults are motivated to place increasing emphasis on emotionally meaningful goals (prune social networks)
- Spend more time with familiar individuals with whom they have rewarding relationships.
- The theory challenges the stereotype that older adults are in emotional despair and isolation
- Rich and complex emotional experiences and higher prevalence of mixed emotions (poignancy)

Compared with younger adults, older adults:

• Have fewer highs and lows
• Have less extreme joy but more contentment and emotional stability
• React less strongly to negative circumstancies and are better at ignoring irrelevant negative information
• Effective experiences become more stable as people age

Coping strategies in older adults

- Stressors change with age: stress is due to reduced skills arising from aging in older adults
- Losses related to the aging process: loss of health and/or physical capacity, the death of loved ones, reduced social
integration…

5. Changes in personality
Study of personality continuity in middle adulthood and old age cross-sectionally and longitudinally. 445 middle-aged (42-46
years) and 420 older (60-64 years) participants, reassessed after a 4-year interval. Statistically significant cross-sectional age
differences were found for the variance of O and E at both measurement occasions, no longitudinal changes. Longitudinally
à evidence for a small, but significant, decrease in Neuroticism across the 4-year period in both age groups.

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 ____ UNIT 3. GEROPSYCHOLOGICAL ASSESSMENT ____

1- Geropsychological assessment:

- Assessment of the elderly

A formal process of obtaining, through scientific methodologies, relevant information on the problem presented by
the elderly person or their relatives, as well as on the possible personal, biological, and environmental conditions that
could explain that problem.
- Multidimensional assessment:
- Biomedical variables (vision, hearing, sleep, mobility, neurological functions, etc.)
- Personal variables (satisfaction with life, hobbies and interests, emotions, etc.)
- Environmental variables (socio-economic level, housing, availability of services, etc.)

• Standardized instruments: compare the performance of the subject with a normative group
• Clinician-patient/client interaction: False conceptions related to old age à impact on the assessment process
• Guidelines for Psychological Practice with Older Adults
- Accurate psychological assessment
- Effective treatment techniques
- Older adults with mental disorders à less likely than younger adults and middle-aged adults to receive
mental health services à a demand for adequately trained geriatric psychologists
- Facilitate and ensure a high-level of professional practice

21 guidelines organized in six main sections:

• Competence in and Attitudes Toward Working With Older Adults
• General Knowledge About Adult Development, Aging, and Older Adults
• Clinical issues
• Assessment
• Intervention, Consultation, and Other Service Provision
• Professional Issues and Education

- Areas of assessment
• Cognitive Functioning
– To detect and measure potential cognitive decline, identifying mental aptitudes profiles
– To detect and measure potential cognitive impairment due to a CNS illness
– In case of decline or impairment, to be able to design an intervention program to optimize
cognitive functioning, to compensate decline and/or to slow down the impairment process
• cognitive screening test
– Increasingly important role in identifying individuals with cognitive impairment and in
determining which individuals should be referred for further neuropsychological assessment
– Useful in identifying cognitive impairment in at-risk populations

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 • Advantages
- Contribute to higher rates of detection of cognitive impairment in older adults in primary care settings,
compared to informal observation alone
- May be administered as part of a routine clinical visit
- Can indicate a need for further evaluation
- Can serve as a baseline measure to determine change in clinical status over time
- Require relatively limited administration time and less staff training
- Well accepted by patients and clinicians

• MMSE: one of the most frequently used cognitive tests both in clinical and research settings. Evaluates
orientation, attention, concentration and calculation, memory, language, and visual-spatial skills
- Limitations
- High influence of sociodemographic factors
- Low sensitivity for people with mild cognitive impairment and early stages of dementia
- Fails to measure relevant areas of cognitive functioning
- Different versions of the test (in Spain at least 3 different versions of MMSE) à makes it
difficult to compare results across studies
• Clock drawing test: a quick screening test for cognitive dysfunction secondary to dementia, delirium, or a
range of neurological and psychiatric illnesses
- Originally used as an indicator of constructional apraxia
- Well accepted by patients
- Solid psychometric properties
- High correlation with other instruments (e.g. MMSE)
• Montreal Cognitive Assessment: brief screening instrument for mild cognitive dysfunction. Evaluates multiple
cognitive domains on a single page and scores range from 0 to 30. Cutoff score of 26: sensitivity of 90% for
detecting MCI subjects and specificity of 87%
• MoCA. Cognitive domains:
- Short-term memory recall task (5 points), Visuospatial abilities, Executive functions, Attention,
concentration, and working memory: a sustained attention task (1 point), Language, Orientation to time
and place (6 points)

• Physical Fitness and Health

• 36-Item Short Form Health Survey (SF-36): measures general health status (physical and mental health)
- Eight health concepts: physical functioning, bodily pain, role limitations due to physical health problems, role
limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue,
and general health perceptions.
• Mini Nutritional Assessment (MNA): 18 variables grouped into 4 areas that cover the different sections of
the assessment: anthropometry, risk situations, dietary survey and self-perception of health. With a
maximum score of 30 points, cut-off point above 23.5. A score below 17 is indicative of malnutrition and
intermediate values are indicative of nutritional risk.

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 • Functionality and Activities of Daily Living (ADL)
- Katz Index of Independence in Activities of Daily Living (Katz ADL): Evaluates the client’s ability to perform
independently basic AD. Six functions: bathing, dressing, toileting, transferring, continence, and feeding. A
score of 6 indicates full function, 4: moderate impairment, and 2 or less indicates severe functional
impairment.
- The Lawton Instrumental Activities of Daily Living Scale (IADL): Measures the ability to perform independently
complex ADL (highest functional level at present time). Eight domains of function: ability to use telephone,
shopping, food preparation, housekeeping, laundry, mode of transportation, responsibility of own
medications,ability to handle finances. A score ranges from 0 (low function, dependent) to 8 (high function,
independent).
- Functional assessment questionnaire (FAQ): for assessing IADL. The informant has to rate patient’s ability
according to the following scoring system: Dependent = 3; Requires assistance = 2; Has difficulty but does by
self = 1; Normal = 0; Never did [the activity] but could do now = 0; Never did and would have difficulty now
= 1.

• Mental Health
• Affect and Control
- To assess mental disorders such as anxiety and depression
- To assess positive mental health
- To assess affect and control
• Geriatric Depression Scale (GDS): used extensively with the older population
- Long form: a 30-item questionnaire, participants are asked to respond by answering yes or no in
reference to how they felt over the past week.
• Short form (15 ítems): more easily used with phisically ill and demented patients.
• Geriatric Anxiety Inventory: easily administered and targeted at older adults (65 and older). 20
“Agree/Disagree” ítems. High reliability.
• Beck Depression Inventory: 21-item self-report, four response options based on the intensity (0-3)
• Positive Affect and Negative Affect Schedule (PANAS): scales to measure mood and emotions
- 20 ítems: 10 items measuring positive affect and 10 items measuring negative affect.
- Items are rated on a five-point Likert Scale, ranging from 1 = Very Slightly or Not at all to 5 = Extremely
• Philadelphia Geriatric Morale Scale (PGCMS): measure emotional adjustments in people aged 70 to 90.
Provides a multidimensional approach to assessing the state of psychological well being of older people. 17
ítems (yes/no answers). Either self- or interviewer- administered. Three factors: agitation, attitude toward
own aging and lonely satisfaction

• Social Functioning
Social support: Attenuates the impact of stressful events, Provides resources to deal with stress situations and
Preventive factor.
• Lubben Social Network Scale—revised (LSNS-R) measures social engagement (Family network, Friends
network, Relationships of help and trust).

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 • Environmental Resources and Quality of Life:
Cutler (2000) defines four characteristics to define a successful universal environment:
(1) supportive, referring to the possibility of providing substitutes for a loss of functioning, with the aim of
promoting independence.
(2) accessibility, regarding possible access, for example, by a person using a wheelchair.
(3) adaptability, such as the possibility to modify the environment to adjust to different levels of disability.
(4) safety, regarding being protected against hazards.

• The Housing Enabler: is an assessment tool for community-dwelling older adults, assesses the housing
accessibility, taking into account personal disabilities and environmental barriers.
• The Multiphasic Environmental Assessment Procedure was developed by Moos and Lemke (1988)
• QoL: “Individuals’ perceptions of their position in life in the context of the culture and value systems in which
they live and in relation to their goals, expectations, standards and concerns”.
• World Health Organization Quality of Life (WHOQOL; WHO, 1995) à developed from an extensive pilot test
of 300 WHOQOL questions in 15 centres around the globe (data testing on over 4.500 subjects) à selection
of the 100 best questions according to set criteria
• Fernández-Ballesteros proposed an integration of this broad concept considering two dimensions:
(1) personal or internal (physical functioning, social status, etc.) vs socio-environmental or external
(residential comfort, health system, etc.); and
(2) subjective (e.g. well-being or perceived health) vs objective (income, physical environment, etc.).
• Short Quality of Life Questionnaire (CUBRECAVI), based on Fernández-Ballesteros’ QoL concept.

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