Mental Health (continued) & Social Cognition

1. Mental Health (continued) & Social Cognition November 7th, 2007

2. Tonight’s Lecture • Dementia and its misconceptions • How do older adults adapt and cope with the environment around them? • What factors help adaptation to a new environment such as a nursing home? • How do older adults judge other people? • What stereotypes are associated with aging, and how can they affect older adults?

3. Alzheimer’s Disease: A Daughter’s Experience

4. What Might Be The Causes of AD? • Neurotransmitters: Acetylcholine, serotonin • Cellular changes: Phospoholipids, Beta-amyloid, tau protein • Genes: Chromosome 19: ApoE4 • Metabolism: Glucose & oxygen changes, calcium • Environment: Aluminum, zinc, food toxins, viruses

5. Early Onset vs. Late Onset? • Late onset is probably due to combination of factors previously mentioned. • Early-onset Alzheimer's may be caused by genetic mutations • Autosomal dominant pattern – chromosomal causes • Pick’s disease • Huntington’s disease • Down’s syndrome (Chromosome 21-similar changes with beta-amyloid as AD; Chromosomes 1 & 14 as well)

6. Are There Interventions Possible? • Intervention strategies • Caring for patients with dementia at home • Caregivers have significant problems • Effective behavioral strategies • Differential reinforcement of incompatible behavior (DRI) • Arguing with patient is counterproductive • Respite care and adult daycare

7. Other Forms of Dementia • Other forms of dementia • Vascular Dementia – CVA (stroke) • Frontotemporal Dementia (FTD) • Parkinson’s Disease • Associated with dopamine deficiency • 14% to 40% will develop dementia • Huntington’s Disease • Associated with GABA deficiency • Alcohol Dementia Complex • Wernicke-Korzakoff’s Disease • AIDS Dementia Complex (ADC)

8. You are a physician, and one of your patients, Mrs. So, is a widow living alone in her house. • She has been diagnosed with Alzheimer’s disease last year. • You have concerns that she is not managing her diabetes properly. • What information would you need to gather to know if that is the case? • What are the possible outcomes?

9. Article by Lai & Karlawish (2007) • How do you assess the capacity of an older person to make decisions, especially if they have a cognitive impairment? • Why is the current way of making decisions about competency problematic? • What criteria should be used to decide whether someone can make autonomous decisions?

10. Competency Assessment • Balancing act between safety and independence. • Competency is determined on a context by context basis. • People have to be able to grasp potential advantages and disadvantages of making a decision.

13. How Are Person-Environment Interactions Described? • Kurt Lewin (1936) came up with a formula to describe them. • B = f(P, E) Where: • B = Behavior • P = Person • E = Environment

14. Competence & Environmental Press • Competence is the theoretical upper limit of a person’s capacity to function. • Five domains of competence (Lawton & Nahemow, 1973) • Biological Health • Sensory-perceptual functioning • Motor skills • Cognitive skills • Ego strength • Environmental Press: Environments can be classified on the basis of the varying demands they place on the person. • Interactions between physical, interpersonal & social demands.

15. The Congruence Model • According to Kahana’s (1982) congruence model, people with particular needs search for the environments that meet them best • Can you think of examples? 1. A person without personal transportation seeks a house near a bus route. 2. A handicapped person needs a home adapted to a wheelchair (no steps). 3. An elderly person may need to relocate to an assisted-living facility.

16. Stress & Coping Framework • Interaction with the environment can produce stress (Lazarus, 1984) • Evaluating one’s situation and surroundings for potential threat value • Harmful • Beneficial • Irrelevant • If harmful, what is the coping mechanism and response? Outcome positive or negative?

17. The Loss Continuum Concept • Loss continuum • Children leaving • Loss of social role • Loss of income • Death of spouse/close friends and relatives • Loss of sensory acuity • Loss of mobility accompanied by • Loss of health

18. Common Theoretical Themes and Everyday Competence • Everyday competence is a person’s potential ability to perform a wide range of activities considered essential for independent living. • Broader than just ADL or IADL. • Necessary determinate for whether an elderly person can take care of themselves.

19. What Types of Long-Term Care Facilities Are There? • Nursing homes (most prevalent but costly) • Assisted living • Adult family homes

20. Who is Likely to Live in Nursing Homes? • Characteristics of People Most Likely to Be Placed in a Nursing Home • Over age 85 • Female • Recently admitted to a hospital • Lives in retirement housing rather than being a homeowner • Unmarried or living alone • Has no children or siblings nearby • Has some cognitive impairment • Has one or more problems with IADL

22. How Are Residents Interacting with Nursing Home Environments? • Congruence Approach (Kahana, 1982) • Personal well-being depends not just on facilities, but on congruence of person’s needs and the ability of the facility to meet those needs • 80% of nursing home residents perform below their personal ability because of the lowered expectations of the staff.

23. How Are Residents Interacting with Nursing Home Environments? Moos’s Approach • MEAP scales evaluates facilities in the following four aspects: • Physical and architectural • Organizational and administrative staff and policies • Supportive characteristics of staff • Social climate

24. How Can Competence Be Promoted in Residents of Nursing Homes? • Is the medical model best (Langer & Rodin, 1976)? • No. Langer showed that residents who were encouraged to make choices in daily activities were feeling better and were more active. • Mitigation factors: • Decision to enter NH usually not made by the individual • “Nursing home resident” and “patient” has negative connotation • Being overly helpful may actually harm the residents by making them more dependent than need be. • Strict routine is detrimental to well-being.

25. Assisted Living

26. Problematic Forms of Communication With Residents • Patronizing speech • Infantilization or baby “talk” • Inappropriate use of first names • Terms of endearment “Honey” “Sweetie” • Assumption of greater impairment than may be the case • Cajoling to demand compliance

28. Decision-Making Capacity and Individual Choices • How well can a nursing home resident make decisions regarding their care? • Cognitive impairment • Name a substitute decision-maker for health and/or monetary concerns • Provide written information at time of admission concerning their right to make treatment decisions • Living will

29. Social Cognition: How Does Society Perceive Older Adults? • Or do birthday cards say it all? Love & respect vs. jokes about all that you lose as you age. • Are we a youth-oriented culture? Can you think of any examples? • What are some of the stereotypes associated with aging?

30. Birthday Card Study • Ellis & Morrison (2005) in Alberta • 100 out of 150 cards contained negative stereotypes • Let’s look at a few examples…

32. How Do Older Adults Judge Others? • Declines in cognitive processing resources might impact the social judgment process • Research suggests that we make initial snap judgments and later correct or adjust them based on more reflective thinking. • Age-related changes in processing capacity might make older adults more vulnerable to social judgment biases.

33. How Do Older Adults Form Impressions of Others? • When forming an initial impression • Older adults also use less detailed information • Older adults also weigh negative information more heavily in their social judgments than young adults do • In particular, older adults are more willing to change their initial impression from positive to negative • But are less willing to change an initial from negative to positive even in light of new positive information

35. Knowledge Accessibility and Social Judgments • When we are faced with new situations we draw on our previous experiences stored in memory • Social knowledge structures must be available to guide behaviour. • Social information must also be accessible to guide behaviour.

36. A Processing Capacity Explanation for Age Differences in Social Judgments • Declines in cognitive processing resources might impact the social judgment process. • Research suggests that we make initial snap judgments and later correct or adjust them based on more reflective thinking. • Thus, age-related changes in processing capacity might make older adults more vulnerable to social judgment biases.

37. Understanding Age Differences in Social Beliefs • Does the content of our social knowledge and beliefs change as we grow older? • How do our knowledge structures and beliefs affect our social judgments, memory, problem solving, and more?

38. Understanding Age Differences in Social Beliefs Understanding age differences in social belief systems has three important aspects. • We must examine the specific content of social beliefs. • Consider the strength of these beliefs to know under what conditions they may influence behaviour. • We need to know the likelihood that these beliefs are being violated or questioned.

39. Understanding Age Differences in Social Beliefs • Age differences were found in the types of social rules evoked in different types of situations. • The belief “Marriage is more important that a career” increases with age • Compare with “The marriage was already in trouble” (Figure 9.2) • Cohort differences can be profound.

40. Figure 9.2a, page 314

41. Figure 9.2b, page 314

42. What Are Attributional Biases? • Causal attributions • Explanations people construct to explain their behavior • Dispositional attributions • Behavioral explanations that reside within the person • Situational attributions • Behavioral explanations that reside outside the person • Correspondence bias • Relying on dispositional information and ignoring situational information

43. Figure 9.3 Dispositional attributions as a function of age

44. Emotions as a Processing Goal • Older adults avoid negative information and focus more on positive information when making decisions and judgments, and when remembering events • Carstensen and Turk-Charles (1994) memory experiment

46. Emotion in Later Life (Lawton, 2001) • Affect Salience: No age difference • Affect Frequency: • Do not appear to differ in frequency of negative affect, but less positive affect. • Effect of health? • Change in valence less apparent in longitudinal than cross-sectional studies. • Affect Intensity: Mixed evidence • Self-ratings less intense. • Emotion on the spot show no age differences.

47. Emotion in Later Life • Emotion regulation: Perceived control of emotion greater with age. • Theories: • Control theory of late-life emotion (Schulz and Heckhausen, 1998) • Integration of cognition and emotion in late life (Labouvie-Vief et al., 1989) • Blanchard-Fields (1998): Ability to use accommodative strategies. • Socioemotional selectivity theory (Carstensen, 1995)

48. Cognitive Style as a Processing Goal • People with high need for closure and an inability to tolerate ambiguous situations • Prefer order and predictability • Are uncomfortable with ambiguity • Are closed-minded • Prefer quick and decisive answers • It may be that limited cognitive resources and motivational differences are both age-related • Declines in working memory may be related to need for closure