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CHAPTER 3 Psychological aspects of ageing

       Evan T. Schulze1, Phillip Ruppert2, Gayle Heady2, and Lauren Schwarz2

      ¹ Department of Neurology, Saint Louis University School of Medicine, St. Louis, Missouri, USA

      ² Depart of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, Missouri, USA

Introduction

      Ageing is on the rise. The world population aged 65 and older is expected to nearly double from 9% in 2019 to 16% by 2050 (United Nations, 2019). This significant demographic shift will require commensurate increases in attention to health issues in this cohort, particularly aspects of mental health. The importance of attention to the psychological well‐being of the elderly becomes obvious when considering the established links between mental health problems (e.g. depression and life stress) and medical outcomes such as premature mortality, coronary heart disease, diabetes, disability, and other chronic conditions Steptoe (2006). More plainly stated, overall psychological well‐being (i.e. one’s sense of purpose and meaning in life) is strongly associated with longevity. For example, the English Longitudinal Study of Ageing (ELSA) found that almost 30% of those with the lowest levels of psychological well‐being had died by the end of the 8.5 year follow‐up period as compared to only 9% of those with the highest levels of psychological well‐being. Notably, this effect occurred independent of age, gender, demographic factors, and baseline mental and physical health (Steptoe, Deaton, & Stone, 2015). Older adults themselves recognize these effects and have rated preserved cognitive and functional abilities as essential elements to successful ageing (Nosraty, Jylhä, Raittila, & Lumme‐Sandt, 2015; Nosraty, Sarkeala, Hervonen, & Jylhä, 2012). Similarly, having a sense of purpose in life has been found to be associated with a 30% decreased risk of dementia in older adults (Sutin, Stephan, & Terracciano, 2018). Thus, it is apparent that psychological factors may have important implications for preventing chronic medical conditions, increasing longevity, and improving overall quality of life in older age. This chapter covers relevant psychological aspects of ageing that practitioners should be cognizant of when caring for this population. More specifically, we will discuss both normal and abnormal changes in mental health and cognitive function in older adulthood as well as interventions that can help with adapting to these changes and maintaining function.

Psychological development over the lifespan

      When appraising patients’ psychological well‐being, it can be helpful to take a lifespan perspective and contextualize the individual against the typical developmental challenges of their current stage in life. Such perspective often provides insight into typical psychological conflicts that an individual might be struggling with. One of the most cited psychological theories of lifespan development proposed that individuals progress through eight distinct psychosocial stages (Erikson & Erikson, 1998). Each stage is defined by a basic conflict that purportedly must be resolved in order to move to the next stage. Erikson’s theory states that younger years are concerned with developing a basic understanding of the self in the world and developing personal identity. Age 40 marks the beginning of the middle adulthood stage, where the concern is to create something that is valuable and provides good in the world. These are typically the years of having families and developing a career. By their mid‐60s, individuals enter into the stage of ‘Maturity’. This is a period of reflecting on the prior events of their lives, both celebrating achievements and coming to terms with regrets, all in search of a sense of fulfilment. Meaning‐making is undertaken retrospectively. When life is perceived positively, feelings of satisfaction arise. However, when life is perceived negatively, a sense of despair and bitterness can prevail, which may lead to depression. These stages provide a larger framework within which to view individual characteristics and personality traits.

Personality changes in older adulthood

      Attention to normal personality development also offers insight to those caring for older adults. Human personality is one of the longest‐studied topics in psychology, and contemporary theory has settled on the idea that most of the

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