Psychological Treatment of Older Adults An Introductory Text

Psychological Treatment of Older Adults An Introductory Text

The Plenum Series in Adult Development and Aging SERIES EDITOR: Jack Demick. Suffolk University, Boston, Massachusetts ADULT DEVELOPMENT, THERAPY, AND CULTURE A Postmodern Synthesis Gerald D. Young THE AMERICAN FATHER Biocultural and Developmental Aspects Wade C. Mackey PSYCHOLOGICAL TREATMENT OF OLDER ADULTS An Introductory Text Edited by Michel Hersen and Vincent B. Van Hasselt

Psychological Treatment of Older Adults An Introductory Text Edited by Michel Hersen and Vincent B. Van Hasselt Nova Southeastern University Fort Lauderdale, Florida Springer Science+Business Media, LLC

Library of Congress Cataloging-in-Publication Data On file ISBN 978-1-4899-0297-9 DOI 10.1007/978-1-4899-0295-5 ISBN 978-1-4899-0295-5 (ebook) Springer Science+Business Media New York 1996 Originally published by Plenum Press, New York in 1996 Softcover reprint of the hardcover 1st edition 1996 10987654321 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher

Contributors RON ACIERNO, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina 29425-0742 STEPHEN J. BARTELS, Departments of Psychiatry and Community and Family Medicine, Dartmouth Medical School, Concord, New Hampshire 03301 GARY R. BIRCHLER, Psychology Service, Veterans Affairs Medical Center, and Department of Psychiatry, University of California, San Diego, California 92161 LOUIS D. BURGIO, Center for Aging, Division of Gerontology and Geriatric Medicine, and Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama 35294 ELLEN M. CO'ITER, Center for Aging, Division of Gerontology and Geriatric Medicine, and Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama 35294 LEAH P. DICK, Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Palo Alto, California 94304, and Stanford University School of Medicine, Stanford, California 94305 BRAD DONOHUE, Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, Florida 33314 LARRY W. DUPREE, Department of Aging and Mental Health, Florida Mental Health Institute, University of South Florida, Tampa, Florida 33612 BARRY EDELSTEIN, Department of Psychology, West Virginia University, Morgantown, West Virginia 26506-6040 WILLIAM FALS-STEWART, Harvard Families and Addiction Program, Harvard Medical School, and Department of Psychiatry, Veterans Affairs Medical Center, Brockton, Massachusetts 02401 DOLORES GALLAGHER-THOMPSON, Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Palo Alto, California 94304, and Stanford University School of Medicine, Stanford, California 94305 v

vi Contributors SmRLEY M. GLYNN, West Los Angeles Veterans Affairs Medical Center and Department of Psychiatry, University of California at Los Angeles, Los Angeles, California 90073 BENJAMIN GRABER, Graber Psychiatric Associates, 12711 Davenport Plaza, Omaha, Nebraska 68154 C. V.IIALDIPUR, Department of Psychiatry, State University of New York Health Science Center, Syracuse, New York 13210 MICHEL HERSEN, Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, Florida 33314 KIMBERLY D. KALISH, Department of Psychology, West Virginia University, Morgantown, West Virginia 26506-6040 LINDA A. LEBLANC, Department of Psychology, Louisiana State University, Baton Rouge, Louisiana 70803 JOHNNY L. MATSON, Department of Psychology, Louisiana State University, Baton Rouge, Louisiana 70803 WILEY MrrrENBERG, Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, Florida 33314 KIM T. MUESER, Departments of Psychiatry and Community and Family Medicine, Dartmouth Medical School, Concord, New Hampshire 03301 BENOIT H. MULSANT, Division of Geriatrics and Neuropsychiatry, Western Psychiatric Institute and Clinic, Department of Psychiatry, University of PiUs burgh School of Medicine, Pittsburgh, Pennsylvania 15213 LYNN EMER NORTHROP, Department of Psychology, West Virginia University, Morgantown, West Virginia 26506-6040 WILLIAM T. Q'DONOHUE, Department of Psychology, University of Nevada Reno, Reno, Nevada 89557 ROGER L. PATI'ERSON, Mental Hygiene Clinic, Veterans Affairs Outpatient Clinic, Daytona Beach, Florida 32117 WILLIAM HARRy PE'ITIBON, Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, Florida 33314 LAWRENCE SCHONFELD, Department of Aging and Mental Health, Florida Mental Health Institute, University of South Florida, Tampa, Florida 33612 NATALIE STAATS, Department of Psychology, West Virginia University, Morgantown, West Virginia 26506-6040 ALAN B. STEVENS, Center for Aging, Division of Gerontology and Geriatric Medicine, and Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama 35294

Contributors vii LINDA 'feri, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195 GEOFFREY TREMONT, Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73142 VINCENT B. VAN IIASSELT, Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, Florida 33314 MARILYN S. WARD, Department of Psychiatry, State University of New York Health Science Center, Syracuse, New York 13210 BRUCE A. WRIGHT, Division of Geriatrics and Neuropsychiatry, Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213

Preface This multiauthored introductory textbook could not have been conceived or brought to fruition 10 or 15 years ago. Indeed, at that time relatively little attention was accorded to the psychological needs of older adults. The general tenor of the field then was that older adults would not benefit from psychological intervention. As we now know, this was a faulty assumption that has been discredited with empirical data. Indeed, clinical research data adduced, primarily in the last decade, clearly documents that older adults do benefit from specific psychotherapies that are tailored to their unique presentation of symptoms. Given the explosion of interest in this area (as evinced by increased investigatory activity, national funding, and media attention) and the increased number of masters- and doctoral-level courses devoted to this topic, we felt that the time was right for a textbook in the area. Such flurry of activity also has been fueled by statistics showing how our population by the year 2030 will consist of 30% who are senior citizens. Moreover, since 12% of older adults in the community are estimated to have diagnosable psychiatric disorders and 40% to 50% of older adult medical inpatients have a concomitant psychiatric disorder, the task for clinicians in the next century will be overwhelming. Psychological Treatment of Older Adults: An Introductory Text consists of 16 chapters, with 7 chapters in Part I (General Issues) and 9 chapters in Part II (Specific Disorders and Problems). Chapters in Part I examine historical perspectives in clinical geropsychology, social adaptation in older adults, assessment of older adults, clinical neuropsychology of older adults, medical assessment, competence and other legal issues, and treatment in residential settings. Chapters in Part II cover topics such as anxiety-based disorders, late-life depression, depression in Alzheimer's disease, schizophrenia, mental retardation, organic disorders, substance abuse, sexual dysfunction, and marital discord. Chapters in Part II have sections on the description of the disorder or problem, case identification and presenting complaints, history, selection of psychological treatment, concurrent medical treatment, course of treatment, follow-up, overall evaluation, and summary. Many individuals have contributed to the final published product. First of all, we thank our eminent contributors for sharing their thinking with us. ix

x Preface Second, we thank Burt G. Bolton, Christine Apple, and Christine Ryan for their technical expertise. And third, but most important, we once again thank our friend and editor at Plenum Press, Eliot Werner, who makes it all happen. Fort Lauderdale, Florida MICHEL HERSEN VINCENT B. VAN HASSELT

Contents PART I. GENERAL ISSUES 1. Historical Perspectives in Clinical Geropsychology 3 Brad Donohue, Michel Hersen, and Vincent B. Van Hasselt 2. Social Adaptation in Older Adults 11 William Harry Pettibon, Vincent B. Van Hasselt, and Michel Hersen 3. Assessment of Older Adults 35 Barry Edelstein, Natalie Staats, Kimberly D. Kalish, and Lynn Emer Northrop 4. Clinical Neuropsychology of Older Adults 69 Geoffrey Tremont and Wiley Mittenberg 5. Medical Assessment 91 Benoit H. Mulsant and Bruce A. Wright 6. Competence and Other Legal Issues 103 C. V. Haldipur and Marilyn S. Ward 7. Treatment in Residential Settings 127 Louis D. Burgio, Ellen M. Cotter, and Alan B. Stevens PART II. SPECIFIC DISORDERS AND PROBLEMS 8. Anxiety-Based Disorders 149 Ron Acierno, Michel Hersen, and Vincent B. Van Hasselt 9. Late-Life Depression 181 Leah P. Dick and Dolores Gallagher-Thompson 10. Depression in Alzheimer's Disease 209 Linda Teri xi

xii Contents 11. Schizophrenia 223 Shirley M. Glynn, Kim T. Mueser, and Stephen J. Bartels 12. Mental Retardation 245 Johnny L. Matson and Linda A. LeBlanc 13. Organic Disorders 259 Roger L. Patterson 14. Substance Abuse 281 Larry W. Dupree and Lawrence Schonfeld 15. Sexual Dysfunction 299 William T. O'Donohue and Benjamin Graber 16. Marital Discord 315 Gary R. Birchler and William Fals-Stewart About the Editors 335 Author Index 337 Subject Index 349