Journal of Clinical Geropsychology

The purpose of this study was to test the hypothesis that the Behavioral Dyscontrol Scale (BDS), a measure of the executive cognitive capacity to use an intention to guide purposeful, goal-directed activity would be strongly associated with concurrent functional status after controlling for age, sex, education, severity of pain, medical comorbidity, depression, and general mental status, in a sample of 246 elderly inpatients receiving rehabilitation services following hospitalization for stroke. Functional status was assessed by rehabilitation nurses' ratings of patients on 11 ADL items and on the Barthel Index. The BDS was the strongest predictor for 11 of the 12 dependent variables. Although it correlated significantly with all outcomes, the MMSE entered only one of the regression models. Of the other covariates, only age and severity of pain made an additional contribution to the prediction of functional ability for more than 1 dependent variable. Consistent with prior results in several other samples, the ability to use intentions to guide purposeful behavior appears to be an important contributor to everyday functioning among older adults.

The primary research question was whether older adults respond to the contingencies of reinforcement such that they allocate their behavior as predicted by the reinforcement contingencies and discriminative stimuli programmed by the experimenters. Six subjects, ranging in age from 62 to 74 years, participated in 15 experimental sessions. Subjects were instructed to press the “F1” key when they saw a white circle, and to press the “F12” key when they saw a red letter “A.” Responses on the F1 key were reinforced on a variable interval (VI) 30-s schedule (i.e., a VI schedule of reinforcement with 11 arithmetically spaced intervals with a mean of 30 s); F12 key responses were reinforced on a VI 60-s schedule (i.e., a VI schedule of reinforcement with 11 arithmetically spaced intervals with a mean of 60 s). Reinforcers included monetary units (10 cents) and verbal praise. Results indicated positive effects of stimulus control of behavior. Collective false alarms and miss rates represented only 0.05% of the total responses. Also, two thirds of the subjects allocated behavior consistent with the second hypothesis that a denser reinforcement schedule (i.e., the VI 30-s) would cause subjects to respond more quickly to this condition. Implications of the present results for clinical studies of Alzheimer's Disease and dementia, as well as behavior modification strategies with aging individuals, are discussed.

Persons exposed to traumatic events in childhood and adolescence may suffer from the symptoms of posttraumatic stress disorder (PTSD) well into old age. The aim of this paper is to introduce a structured life-review technique for the treatment of elderly PTSD patients. This technique centers on the discussion and evaluation of each consecutive stage of life. The therapist encourages the patient to reminisce on both positive and negative experiences; positive coping experiences are reinforced. A single session on the traumatic event is integrated into the discussion of the stages of life, which are dealt with in chronological order. In the following, 3 case studies (e.g., survivors of the 1945 Dresden bombing) are presented. Psychometric measures (PTSS-10, IES-R) for the case studies are reported. Finally, the potential and limitations of the pilot study and the new approach are discussed.

This paper is a critical overview of the literature on older adults' outcome after traumatic brain injury (TBI). Eighteen outcome studies were reviewed. Results indicated that older patients demonstrated an increased risk for negative outcome following TBI when compared to younger patients with similar injury severity. Poorer outcome was characterized by higher mortality rates, decreased likelihood of returning to preinjury living arrangement, and declines in cognitive and affective functioning. In the studies reviewed, discharge destination, global outcome scales, and standardized neuropsychological tests were the primary measures of outcome from elderly TBI. Conceptual and methodological difficulties including variability in the definition of and inadequate measures of recovery from elderly TBI, inadequate control groups, and poor follow-up were discussed. Recommendations for future outcome research to increase uniformity in defining recovery in order to enhance comparability between studies and to tailor cognitive rehabilitation to the special needs of the older TBI patient were provided.

This paper focuses on the effects of the Holocaust on its survivors more than 55 years after the end of World War II. The emphasis is on survivors who were either adults during the Holocaust and who are now over the age of 70, or survivors who were children during the Holocaust and whose age is now between 56 and 70. The central question was: What kinds of posttraumatic phenomena are seen in older adult survivors? After an overview of the field, the situation of survivors in Israel is presented in 2 ways. Results of a survey of survivors who were referred to Amcha, the National Israeli Center for Psychosocial Support of Survivors of the Holocaust, is provided to give some insight in a clinical population. In addition, 2 case histories of survivors are presented to give a more in-depth perspective. The gap between the data from the questionnaires and the clinical material has relevance for the way in which we conceptualize the late consequences of massive trauma.

It has been hypothesized that some types of personality disorders tend to remit with age whereas others may become more prominent. The present study determined the prevalence and nature of 13 personality disorders with a self-report inventory (Coolidge Axis II Inventory) in an older group of chronically mentally ill inpatients (N = 30, mean age = 63 years) and a younger group of similar patients (N = 30, mean age = 39 years). All patients met DSM-IV criteria for either Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, or recurrent severe Major Depression with psychotic features. The prevalence rate of personality disorders was high for both groups: 58% for the older sample and 66% for the younger group. The younger group was more likely to be diagnosed Antisocial, Borderline, Passive-Aggressive, Sadistic, and Schizotypal, but the groups were not different in the rates of Obsessive-Compulsive Disorder. This study supports the hypothesis that some personality disorders remit with age. However, no evidence was found to suggest that other personality disorders become more prominent in older adult psychiatric populations. Suggestions for future research are offered.

This paper reports findings of a preliminary study of caregivers dependent upon drivers with dementia. Fifteen caregivers who perceived themselves as dependent upon their partner for transportation and 15 who perceived themselves as independent were surveyed. Dependent caregivers were significantly more likely to rely on the cognitively impaired driver for routine daily activities such as shopping, medical appointments, and visiting family and friends. Only 20% of the dependent caregivers believed that the driver with dementia should decrease or discontinue driving. Dependent caregivers were less likely than independent caregivers to take an active approach in encouraging driving cessation. Compared to the independent caregivers, the dependent caregivers believed that if the patient with dementia could no longer drive, it would significantly affect their quality of life. The authors discuss the issues and problems uniquely associated with the dependent caregiver.

This study evaluated the reliability and validity of the Cleveland Scale for Activities of Daily Living (CSADL), a scale designed to measure in detail specific activities of daily living in individuals with dementia. Administered to knowledgeable informants by trained examiners, the CSADL demonstrated good reliability in terms of interrater agreement and internal consistency. The validity of CSADL total scores was shown by its sensitivity to degree of cognitive impairment: All comparisons between means of the healthy elderly group and three groups of AD patients differing in severity were statistically significant. The CSADL was highly correlated with the Blessed–Roth Dementia Scale (DS-ADL) and more highly correlated with Mini-Mental State Exam scores than was the DS-ADL.

We model the effects of disability, functional limitation, and receipt of help on perceived health. This analysis specifies a model with two dimensions of disability and three dimensions of functional limitation, including upper body disability, lower body disability, basic activities of daily living (ADLs), household ADLs, and advanced ADLs. The latent variables of receiving help are modeled for each of the ADLs as intervening between limitations and perceived health. The results show that instrumental social support in the form of receiving help for ADLs has no substantive independent effect on perceived health. In addition, receiving instrumental social support shows a pattern of task-specific responses to individual measures of need. Implications for both caregiver and care recipient are discussed.