Peter A. Lichtenberg

Handbook of Assessment in Clinical Gerontology

New trends in mental healthcare practice and a rapid increase in the aged population are causing an explosion in the fields of clinical gerontology and geropsychology today. This comprehensive second edition handbook offers clinicians and graduate students clear guidelines and reliable tools for assessing general mental health, cognitive functioning, functional age, psychosocial health, comorbidity, behavior deficits, and more. Psychopathology, behavioral disorders, changes in cognition, and changes in everyday functioning are addressed in full, and a wide range of conditions and disorders common to this patient population are covered. Each chapter provides an empirical review of assessment instruments, assessment scales in their totality, a review of how these instruments are used with and adapted for different cultural groups, illustration of assessments through case studies, and information on how to utilize ongoing assessment in treatment and/or treatment planning. This combination of elements will make the volume the definitive assessment source for clinicians working with elderly patients. This is the most comprehensive source of up-to-date data on gerontological assessment, with review articles covering: psychopathology, behavioral disorders, changes in cognition, and changes in everyday functioning. It consolidates broadly distributed literature into single source, saving researchers and clinicians time in obtaining and translating information and improving the level of further research and care they can provide. It includes chapters that directly address the range of conditions and disorders most common for this patient population - i.e. driving ability, mental competency, sleep, nutrition, sexual functioning, demntias, elder abuse, depression, anxiety disorders, etc. It fully informs readers regarding conditions most commonly encountered in real world treatment of an elderly patient population. Each chapter cites case studies to illustrate assessment techniques. It exposes reader to real-world application of each assessment discussed.

Cognitive and psychosocial predictors of subjective well-being in urban older adults

Prior research indicates that physical health and social support have substantial influences on subjective well-being among older adults. However, little research has examined the influences of coping style and cognitive functioning on subjective well-being among older adults. This study investigated cognitive and psychosocial predictors of subjective well-being among 129 adults, ages 65-89 years. Canonical correlation indicated that subjective well-being was characterized by two dimensions: life satisfaction and affective balance (happiness). The use of emotion-focused coping strategies and poor perceived health were associated with diminished perceptions of life satisfaction, whereas task-oriented and avoidance-oriented coping were positively related to happiness. Cognitive functioning was positively related to life satisfaction and pleasant emotions independent of education and income.

Normative data on the boston naming test for elderly adults in a demographically diverse medical sample

Abstract Boston Naming Test normative data for 123 elderly adults are provided for use in urban, demographically diverse, medical settings. Study 1 examined the association between demographic variables and confrontation naming performance. Age, education, ethnicity, and gender were all found to be significant predictors of Boston Naming Test performance. The combined effects of demographic variables accounted for 21% of Boston Naming Test variance beyond that explained by general cognitive abilities. The Boston Naming Test scores obtained from this sample were much lower than those reported in previous samples (e.g., Van Gorp, Satz, Kiersch, & Henry, 1986), with much greater variance. Study 2 examined the utility of the BNT to differentiate the present normative sample from an additional sample of cognitively impaired persons. Despite substantial demographic and health status differences between the present normative sample and previous samples, the BNT discriminated cognitively intact persons from cogni...

Longitudinal Support for the Relationship Between Vascular Risk Factors and Late-Life Depressive Symptoms

OBJECTIVE The authors examined longitudinal support for the vascular depression hypothesis by assessing the extent to which baseline vascular burden was associated with depressive symptoms 6 and 18 months after discharge from inpatient medical rehabilitation. METHODS One hundred consecutive geriatric rehabilitation patients were assessed during their rehabilitation stay and subsequently screened for depression 6 and 18 months after discharge. Baseline vascular burden was entered into logistic-regression analyses predicting depression at 6 and 18 months after controlling for baseline levels of depression, general medical burden, limitations in activities of daily living, cognitive impairment, and demographic variables including age, education, gender, and race. RESULTS Logistic-regression results demonstrated that, after controlling for the covariates described above, baseline vascular burden was associated with increased odds of positive depression screens at 6- and 18-month follow-up assessments. Furthermore, among patients who were not depressed during their rehabilitation stay, vascular burden was predictive of positive depression screens at 6- and 18-month follow-up assessments. CONCLUSIONS Greater vascular burden was positively associated with depressive symptoms over time. These findings provide further support for the vascular depression hypothesis in late life and highlight the need for careful clinical monitoring of this frail group of elderly patients.

Post-Stroke and Clinically-Defined Vascular Depression in Geriatric Rehabilitation Patients

OBJECTIVE The authors examined the vascular depression hypothesis by comparing the frequency of post-stroke depression and clinically-defined vascular depression and by examining the relationship between vascular burden and depression. METHODS Data from 670 geriatric rehabilitation patients were incorporated to compare the frequency of depression in three patient groups: 1) those with no evidence of vascular disease or stroke, 2) those with cerebrovascular risk factors (CVRFs) but no evidence of stroke, and 3) patients with stroke. They examined the unique relationship between CVRFs and depression by use of logistic-regression analysis. RESULTS Although the frequency of depression was not significantly different between stroke (36.4%), CVRF (35.2%), and non-vascular patients (28.7%), there was a significant increase in the frequency of depression in patients without stroke as CVRF burden increased. This effect was not observed among stroke patients. CVRF burden predicted depression among patients without stroke even after controlling for general medical comorbidity, cognitive functioning, and ADL limitations. CONCLUSIONS These findings provide empirical support for the vascular depression hypothesis and also indicate that the rates of clinically-defined vascular depression and post-stroke depression are similar in geriatric rehabilitation patients.

Structure of a depression measure among American Indian elders: Confirmatory factor analysis of the CES-D scale

This research examines differences in depressive symptomology among urban, rural off-reservation, and reservation-residing American Indians, age 55 years or older, of the eastern Great Lakes region. It analyzes the measurement structure of one commonly used depression scale, the Center for Epidemiological Studies Depression Scale, and tests alternative models for the full sample (N = 277) as well as the three residential strata. Findings show that a 12-item version developed by Liang et al. for use with Mexican Americans provided a superior fit over the original 20-item version. The shortened scale included items more conceptually valid for this American Indian population. Furthermore, tests of invariance revealed that only the 12-item version had similar factor structures and factor loadings across the three residential strata.

Preliminary normative data on the Boston naming test for an older urban population

Abstract Fifty-seven cognitively intact geriatric medical patients were given the Boston Naming Test in order to provide preliminary normative data on a group of less highly educated older adults than was used in previous studies (e.g., VanGorp, Satz, Evans-Kiersch, & Henry 1986). Analysis of variance revealed significant main effects for age and ethnicity that accounted for over 20% of the Boston Naming Test variance. In addition, the preliminary data in the present study varied widely from previous publications, especially among the African-American subjects.

Urban elders and casino gambling: Are they at risk of a gambling problem?

This study examined gambling among older adults and explored the critical predictors of problem gambling behaviors. Relatively unknown and understudied is the extent, or prevalence, of problem gambling behaviors among urban elders and the factors associated with problem gambling. The sample consisted of 1410 randomly selected participants, aged 60 and older, who reside in the City of Detroit. Mental health, health, demographics, social activities, senior optimism, social support network, and frequency of casino visits were examined in order to predict problem gambling behaviors among elders. The survey implemented the Lie/Bet Questionnaire for Screening Probable pathological Gamblers. The results showed that the prevalence of problem gambling behaviors was 10.4% overall, and 18% of persons reporting any casino visitation. Predictors accounted for 16% of problem gambling behaviors. The findings from this study confirmed that gambling has the potential to become a serious health problem among elders.

A Comparison of Self-Rated and Objectively Measured Successful Aging Constructs in an Urban Sample of African American Older Adults

Sixty-seven (N = 67) urban African American older adults were divided into successful and nonsuccessful aging groups based on objective MacArthur (i.e., physical and cognitive functioning) and on self-rated health criteria. Only 30% of the sample met objective MacArthur criteria for successful aging compared to 63% who rated themselves as successful. Self-rated successful aging was best predicted by regular exercise, whereas objective successful aging was best predicted by demographic characteristics and cognition. Reading ability mediated the relationship between both education and cognition to objectively defined success. Finally, objective successful aging was related to quantity and quality of education, whereas self-rated successful aging was related to a wider variety of variables. Defining successful aging on objective factors alone may limit our understanding of successful aging in urban African American older adults.

Mattis dementia rating scale: Clinical utility and relationship with demographic variables

Abstract The Mattis Dementia Rating Scale (DRS) is an instrument that is widely used to screen for dementia. The relationship of the DRS to demographic variables, however, has not been examined, and previous normative work is largely based on small or poorly described samples. In addition, there is no normative work that has been conducted with older medical patients. The present study utilized 90 cognitively intact and 105 cognitively impaired patients to examine the relationship of the DRS to demographic variables, and to test the clinical utility of the instrument. Within the intact group, age and education significantly correlated with DRS Total Score (DRS-T), but only age predicted unique DRS-T variance. Logistic regression was used to correctly classify 87% of patients overall. We concluded that the results affirmed the importance of considering demographic factors when interpreting DRS results. In addition, the DRS appears to be a useful instrument in screening for dementia among urban medical pati...