ADULT & GERIATRIC

PSYCHOLOGY

Bhavika Nagpal
PG I year
Prosthodontics
 CONTENTS

 Terminologies  Geriatric Psychology

 Ageism
 Introduction  Physical Changes
 Cognitive Changes
 Ageing & Diseases
 Adult Psychology
 Life events of elderly
 Early Adulthood
 Fears of elderly
 Middle Adulthood
 Triple Ds of elderly
 Late Adulthood
 Healthy Ageing
 Life Expectancy

 Gerodontics

 Common oral conditions in GERIATRICS

 Just to add facts

 Conclusion
TERMINOLOGIES
Ageing : Itis defined as natural phenomenon mediated
by genes and physiological changes.
(A guide to elderly care, by Dr. O.P. Sharma )

 Ageing is a progressive deterioration of physiological

function, an intrinsic age-related process of loss of
viability and increase in vulnerability.
(Magalhaes JP de, Integrative Genomics of Ageing group,
2001, 2004, 2005, 2008)
 Dental Geriatrics :

The branch of dental care involving problems peculiar to

advanced age and aging; 2. dentistry for the aged patient;

syn, geriatric dentistry,GERODONTICS,GERODONTOLOGY

(GPT 9)

From the Greek

"geron" meaning "old man" + " iatreia" meaning "the treatment of
disease.".
 Psychology : the science dealing with human mind and
behaviour.

Also refers to application of such knowledge to various

spheres of human activity including issues related to everyday
life and treatment of various health problems.
 An adult is a person older than 19 years of age
unless national law defines a person as being an
adult at an earlier age .
(WHO)
Geriatric Syndromes :

Older age is characterized by the emergence of several

complex health states that tend to occur only later in life
and that do not fall into discrete disease categories.
These are commonly called geriatric syndromes.

(WHO)
INTRODUCTION
 Erik Erikson's Stages Of Psychosocial
Development

The stages that make up his theory are as follows:

 Stage 1 - Trust vs. Mistrust

 Stage 2 - Autonomy vs. Shame and Doubt
 Stage 3 - Initiative vs. Guilt
 Stage 4 - Industry vs. Inferiority
 Stage 5 - Identity vs. Confusion
 Stage 6 - Intimacy vs. Isolation
 Stage 7 - Generativity vs. Stagnation
 Stage 8 - Integrity vs. Despair
Adult Psychology
 ERIK ERIKSON’S THEORY

The adolescence and adult stages are as follows (the ages

for each stage are very approximate):

Stage 5. Adolescence (13 –19 years): avoid role confusion

and develop a sense of identity; social focus is on peer
groups

Stage 6. Early adulthood (20–30 years): most adults

commit themselves to a love relationship and to
intimacy; other adults develop a sense of isolation;
social focus in this stage is on friendships
 EARLY ADULTHOOD

 Developing the ability to share intimacy, seeking to form

relationships.

 Career choices

 Experiencing & Learning = how people handle the good

times and how they handle the bad times

 Marriage

 Children
 ERIKSON’S THEORY (CONTINUED)

Stage 7. Middle adulthood (30–60

years most adults commit
themselves to productive and
socially valuable work (including
bringing up their own children
and being concerned with others
within society), or they become
stagnant and self -centered

Erikson described these two

extremes as generativity and
stagnation.

Generativity refers to “the interest

in establishing and guiding the
next generation.” The social focus
is on the household.
 MIDDLE ADULTHOOD

 Robert Havighurst lists seven major tasks in the

middle years:

1. Physiological changes, such as menopause

2. Satisfaction in one's occupation
3. Caring for aging parents
4. Helping teenage children to become responsible
adults
5. Achieving adult social and civic responsibility
6. Relating to one's spouse as A person
7. Developing leisure-time activities
 MIDLIFE CRISIS

 While a midlife crisis is not regarded as a universal

phenomenon, during one's 40s and 50s comes the
recognition that more than half of one's life is gone.

 That recognition may prompt some to feel that the clock is

ticking and that they must make sudden, drastic changes in
order to achieve their goals, while others focus on finding
satisfaction with the present course of their lives.
 ERIKSON CONTINUED

 Stage 8. Old age (60 years onwards): Adults in this stage

try to make sense of their lives. If they are successful in
doing so, they gain wisdom; if they cannot do this, then they
experience despair. The social focus is on humankind.
 Geriatric Psychology

Theories of successful aging.

1. Disengagement theory
2. Activity theory
 We’ll Discuss

 Ageism
 Physical changes
 Cognitive changes
 Ageing & Diseases
 Triple Ds of elderly
 Life events of elderly
 Fears of elderly
 Healthy Ageing

Dr. Ravi Soni

DM Geriatric Psychiatry
Consultant Geriatric Psychiatrist
 AGEISM

• Ageism may be defined as the prejudice or discrimination

that occurs on the basis of age.

• Although it can be used against people of all ages, older

people are most frequently its target and it may often result
in forced retirement.

• Stereotyping of the elderly is also an aspect of ageism, as

seen in such a statement as “He drives like a little old lady.”
 PHYSICAL CHANGES

• atrophy of the brain and a decrease in the rate of neural

processes
• Respiratory and circulatory
• Bone mass /osteoporosis.
• Muscles
• Skin
• Hair loss
• decreased sensitivity in all of the sensory modalities,
including olfaction, taste, touch, hearing, and vision
 Ageing And Diseases
Major Mental Health Disorders of older adults are:

 Organic Disorders

 Late Life Functional Diseases:

Mood (Affective) Disorders
Neurotic, Stress Related and Somatoform Disorders
Schizophrenia, Schizotypal and Delusional Disorders

 Functional Psychoses

 Psychoactive Substance Use Disorders

Triple D s In Elderly
(Most Common In Elderly)
 Concerns/Life Events Of Elderly

 Retirement : Lowered Self Esteem

 Economic Insecurity : Loss of Control
 Decreasing Health
 Abuse/Neglect and Isolation
 Dependency
 Loneliness
 Chronic illnesses & So many Medications
 Lack of caregiver
 Boredom
 Reminiscence is normative.

On-time normative incidents do not usually

result in crisis.
FEARS OF ELDERLY

 Pain
 Disability
 Abandonment
 Dependency
 Biggest Fear of elderly ?

DEATH

Elisabeth Kübler-Ross identifies five stages through which dying

persons typically pass:

 Denial,
 anger,
 bargaining,
 depression, and
 acceptance.
Healthy Ageing
 Indicators Healthy Ageing

 No physical disability over the age of 75 as rated by a

physician;

 Good subjective health assessment (i.e. good self-ratings

of one's health);

 Good mental health;

 Objective social support;

Self-rated life satisfaction in different domains;

 Marriage;
 income-related work;
 children;
 friendship and social contacts;
 hobbies;
 community service activities;
 religion and
 recreation/sports.
 LIFE EXPECTANCY

 Life expectancy at birth reflects the overall mortality

level of a population. (WHO)

 The average period that a person may expect to live.

 India recorded an improvement in life expectancy at

birth.

 The life expectancy at birth in 1969 was 47 years and in

2019, it is 69 years.
 GERODONTOLOGY

Source:
Gerodontics: A Boon for the Oral Health of Geriatric Patient
Anil Pandey, Manisha Pandey, Salman Siddique, Shan Nawaz Malik,Mohammad
Khursheed Alam
 Oral health in geriatric patient and its
affect
 Oral health has a critical impact on the functional,
psychological, and economic aspects of the overall quality of
life.

 Oral health affects the elderly with regards to diet and nutrition
intake, psychosocial interaction, and general well-being. The oral
cavity is a portal of entry for microbial infections.

 The experience of pain, endurance of dental abscesses, problems

with eating and chewing, embarrassment about the shape of teeth
or about missing, discolored or damaged teeth can adversely
affect people's daily lives, self esteemed well-being.

 Because of normal processes of ageing, older adults have

particular oral care needs.
 There is progressive loss of soft tissue attachments which
results in root exposure and loosening of the teeth and there
is increasing brittleness, making them more susceptible to
damage.

 Atrophy and loss of the oral muc osa also occurs slowly and
alveolar bone resorption eventually leads to loss of the
height of the alveolar structure and may result in tooth loss.

 There is wastage of the muscles of mastication , owing in

part to muscle disuse which is often compounded by eating a
softer diet which requires minimal chewing and there by
reduces stimulation of muscle tone and the condition of the
oral tissues.
 As a consequence, sugar is retained in the mouth for a
longer period of time which promotes dental caries .

 Abrasion, attrition, and erosion of teeth usually increase

with advancing age.

 The dental pulp becomes smaller because of secondary

dentin and pulp stone formation, and sometimes root
canals become totally sclerosed.
 Common oral conditions in
GERIATRICS
 Dental caries
 Gingivitis
 Periodontitis
 Xerostomia
 Candidiasis
 Denture stomatitis
 Oral cancer
 Treatment planning depends on:

 Social & Behavioral information

 Psychological considerations
 Systemic health status
 House Classification Of Mental Health
In CD Patients, 1950

1. Philosophical

2. Exacting

3. Hysterical

4. Indifferent
 Psychological Considerations

 Body schema: Unconscious performance of one’s own body.

 Body image: Conscious awareness of one’s own body .

 Iatrosedation: Relief of patient’s anxiety through dentist’s

behavior i.e. psychotherapeutic intervention .
Patience with Patients.

 Trepidation, Interview & Trust

 ‘Prima digestico fit in ore.’

i.e. The first digestion is in the mouth.

Triad
Aging

Nutrition Edentulism

Boucher’s 13th ed.

 Nutrition

Aging is a physiologic process.

Resulting in:
 Reduced muscle mass
 Increase in fat
 Reduced renal & liver function
 Reduced gastric motility
 Increased constipation

Thus to maintain appropriate body functions:

Low calorie intake & Increase in activity is required.
Resulting in decreased nutrition intake in elderly patients.

Apart from aging, social and medical factors can effect nutrition.
 Edentulism
 Not just good food provides good oral health, also good
oral health is important too to provide good nutritional
intake.

 Masticatory efficiency, in spite of rehabilitation never reach

the same as seen with natural dentition.

Prosthodontic replacement Masticatory efficiency

After
20 cycles 40 cycles
Complete denture 12% 31%

Implant 28% 61%

 Oral management in geriatrics

 Geriatric dentistry is a specialized multidisciplinary branch of

general dentistry designed to provide dental services to elderly
patients, which can only be obtained by –
(a) maintaining daily oral health
(b) obtaining professional dental services as required.

 Disease prevention like elimination of acute dental infection

and pain is of most importance for the elderly population.

 Topical application and mouth rinsing with fluorides are

shown to reduce the number of root surface caries.

 Fluoride containing dentifrices are also effective in preventing

both coronal and root surface caries.
 Gingivitis and periodontitis is another common problem with this
age group which should soon be treated by doing oral prophylaxis
and by educating and motivating them to use special oral hygiene
measures, like toothbrush or dental floss and mouthwash daily in
there mouth cleaning resume.

 Rinsing with a chlorhexidine solution tends to reduce gingival

inflammation, pocket depth, and incidence of denture stomatitis.

 Further, chewing chlorhexidine acetate/ xylitol gums may also

reduce denture stomatitis and angular cheilitis in older people
treatment of full denture patients with atrophic alveolar ridges is a
big challenge.

 Denture stomatitis and angular cheilitis should be treated

immediately to provide adequate relief and comfort to the patient.
Common causes of sensitivity
 Lastly oral health programmes aimed to provide dental
health services should be designed to empowerment,
and self-care capacity-building of older people and
enhanced their attitudes, knowledge and oral hygiene
practice.
 just to add…

 The Decade of Healthy Ageing (2020-2030) is an

opportunity to bring together governments, civil society,
international agencies, professionals, academia, the media,
and the private sector for ten years of concerted, catalytic
and collaborative action to improve the lives of older people,
their families, and the communities in which they live.
 THE THEME FOR 2019 WAS
"THE JOURNEY TO AGE EQUALITY".
 Recognizing that universal health coverage means health for
all at all ages.

 On International Day of Older Persons

1 October 2019
 CONCLUSION

As the world struggles to respond to unprecedented gains in

life expectancy and an explosion of new retirees living with
chronic health conditions, this collaboration could not be
more timely. This exceptional resource is, itself, evidence
that physicians and psychologists can work together to
optimize truly patient-centered geriatric care. Here at last is
a scientifically rigorous, evidence -based response to the aging
mind and body from those most expertly trained.
Thank you.