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Master’s Advanced
Curriculum (MAC) Project
Field Instructor Training
Acknowledgement: The development of
this PowerPoint was made possible through a
Gero Innovations Grant from the CSWE GeroEd Center’s Maser’s Advanced Curriculum
(MAC) Project and the John A. Hartford
Foundation.
Learning Objectives
At the end of this training participants will be
able to:
 Identify two common changes related to the
aging process that are part of normal aging.
 Identify 2 components of the presentation of
depression in older adults.
 Identify 3 ways in which the presentation of
dementia differs form the presentation of
depression in older adults.
 Identify the role of function in the
assessment of older adults.
Effective Clinical Work with Older
Adults:
 The Pathway to Our Future
Introduction
 Social attitudes Regarding Older Adults
 Successful aging
 Physiology of normal aging
Assessment of Problem Areas
 Functionality
 Cognition
Ageism
• Systematic stereotyping and
discrimination against people because
they are old
• Result of a lack of information about older
adults
Aging Well
 Bad things in life don’t doom us
 Good people at any age facilitate an
enjoyable old age
Aging Well
 Keys to healing
 Gratitude
 Forgiveness
 Letting others in
Aging Well
 A good marriage at age 50 predicted
positive aging at 80
 Alcohol abuse predicts unsuccessful aging
 Play, create, make younger friends
Aging Well
 Health concerns okay if one feels well
 Motivations
 Generativity
 Keeping the meaning
Normal Age-Related Changes
 Mobility
 Decrease in muscle mass
 Loss of bone strength
 Strategy
 Regular EXERCISE
Autonomic Nervous System
 Impaired response to extremely hot and
cold environmental temperatures
 Altered sleeping pattern
 Strategy
 Careful attention to weather conditions
 Good sleep hygiene
Sensory Function
 Changes in vision
 Decrease in
 hearing
 taste
 smell
The Brain
 Longer time to process new, complex
information
 Difficulty remembering newly acquired
information such as names
The Brain
 Higher order thinking improves
 Intelligence based on experience and
education improves
The Brain
 Strategy
 Active & inquisitive lifestyle with
stimulating environments
 Memory improvement strategies
 Regular EXERCISE
Sexual Function
 Age-related changes do not diminish
enjoyment or desire
 Incidence of HIV/AIDs infections growing
fastest among older adult age group
Assessment of Older Adults
 Function
 Cognition
Function
FUNCTION is the lens through
which all assessments must be
filtered
Function
 Activities of Daily Living
 Self Care
 Eating
 Dressing and grooming
 Bathing
 Toileting
 Ambulation
 Transferring
Function
 Instrumental Activities of Daily Living
 Meal preparation
 Laundry
 Shopping
 Arranging for transportation
 Money management
 Use of the telephone
Cognition
 Domains of cognition
 Attention
 Orientation
 Language comprehension
 Expressive language
 Visual-spatial
 Memory
 Calculations
 Abstract reasoning
 Judgment
Common problems that are NOT
normal age related changes
 DEPRESSION
 DEMENTIA
 DELIRIUM
Depression
 Depression is NOT a normal part of aging
 Depression in the elderly is quite
treatable
Depression in Older Adults
 Somatic concerns more prominent
 Focus on bowel or urinary dysfunction
 Peculiar tastes
 Dizziness
 Nonspecific aches and pains that do not
align with any physical diagnosis
 Unshakeable belief of being ill
Depression in Older Adults
 Dysphoria less prominent
 Older adults may be unaware or deny
feelings of sadness, hopelessness or guilt
Depression in Older Adults
 Depression can look like dementia
 “pseudo dementia”
 Inability to concentrate may be expressed
as “failure” of memory
 Many complaints about loss of memory
Depression in Older Adults
 High number of “I don’t know” responses
 Able to perform tasks
Depression in Older Adults
 Medications
 Assess for depression as side effect to
current medications
 Antidepressant medications
 Counseling
 Social supports
 Environmental modifications
Dementia
 Global decline of mental functions in a
conscious individual sufficient to interfere
with the person’s daily functioning
 Loss or recent memory is the hallmark
symptom
Dementia
 Alzheimer’s disease is most common form
 Multi-infarct or vascular dementia caused
by many small strokes and is second
most common form
Dementia
 Early symptoms
• Forgetfulness
• Confusion and disorientation
• Impaired judgment
• Personality changes
 Diagnosis includes ruling out all treatable
conditions and includes physician workup
and evaluation
Dementia
 Concerns include
• Proper diagnosis and treatment
• Future planning of legal and financial
concerns
• Caregiver arrangements
• Safety and supervision
• Behavior management
Delirium
 Sudden, REVERSIBLE change in mental status
 Infection or illness
 Medications
 Delirium is A MEDICAL EMERGENCY
 Medical treatment should be sought immediately
Delirium
 Disturbance in consciousness with
• reduced ability to focus, sustain or shift
attention
• change in cognition
• agitation
• perceptual disturbance that occurs over
short periods of time and tends to
fluctuate over the course of the day
 Sudden onset
The Distinction Between
Depressive Dysfunction and
Alzheimer’s
Depressive Dementia
Alzheimer’s
Clinical Course
 Onset dated only within
Onset can be dated with
some precision.
Symptoms of relatively short
duration.
History of previous
psychiatric illness of similar
kind common.
Relatively rapid progression
of symptoms after onset.
Family usually very aware of
the dysfunction and its
severity.
broad limits.
 Symptoms of longer
duration before medical
help sought.
 Previous psychiatric
history unusual.
 Slow progression of
symptoms throughout
course.
 Family usually unaware of
the dysfunction and its
severity.
Clinical Features
Depressive Dementia
Alzheimer’s

Patient complains much of cognitive
loss.
Patient complains little of

Patient makes detailed complaints.
Complaints usually vague.

Patient emphasizes disability.
Patient conceals disability.

Patient highlights failure.
Patient delights in

Patient makes little effort to perform
even simple tasks.
cognitive loss.
accomplishment, however
trivial.
Patient struggles to perform
tasks.

Patient does not try to keep up.

Patient usually communicates strong
sense of distress.
Patient relies on notes,

There is pervasive affective change.
Patient often appears

Nocturnal accentuation of
dysfunction uncommon.
diaries and calendar to keep
up.
unconcerned.
Features of Cognitive Dysfunction
Depressive
Dementia
Alzheimer’s

“Near miss” and
wrong answers
frequent.
Memory gaps for
specific periods of
events common.

Memory gaps for
specific periods
unusual.
Marked variability in
performing tasks of
similar difficulty.

Consistently poor
performance on
tasks of similar
difficulty.

“Don’t know”
answers typical.


Summary
 Our attitudes, beliefs and knowledge base
will guide how we assess older adults
 Evidence guides the comprehensive
geriatric assessment
 Bio
 Psycho
 Social
Summary
 Understanding of normal and successful aging
guides assessment to help us recognize when
problems exist
 Diagnosis is the first step to securing treatment
and remedy
 Treatment is available for common geriatric
syndromes including the 3 “Ds” Depression,
Dementia and Delirium
Summary
 Functional status will guide needed
services and interventions to a far greater
degree than diagnosis or age
 Assessing functional status is crucial for
helping older adults maintain
independence and the guide for viable
planning
Summary
 Markers for successful aging can guide
psychotherapeutic interventions
 Provide guidelines for Reminiscence,
Cognitive and other reflective therapies
with older adults
For More Information
 Services and Programs
• Huntington Senior Care Network,
Resource Center
837 S. Fair Oaks Ave Suite 100
Pasadena, Ca 91105
(626) 397-3110
www.seniorcarenetwork.com
For More Information
 Alzheimer’s Association
5900 Wilshire Blvd # 1100
Los Angeles, CA 90036
(323) 938-3379
www.alz.org
For More Information
 Los Angeles Caregiver Resource Center
(800) 540-4442
www.losangelescrc.org
References
 Mezey, M.D. (Ed.). (2001). The Encyclopedia of Elder
Care. (26). New York, NY: Springer Publications.
 Vaillant, G.E. (2002). Aging Well. New York: Little
Brown & Company.
 Carstensen, L. L., Edelstein, B.A. & Dornbrand, L.
(Eds.). (1996). The practical handbook of clinical
gerontology. Thousand Oaks, CA: Sage
Publications.
 Fitten,J., & Brothers, L. (1986, April). The Sepulveda
GRECC METHOD No 10, Depression. Geriatric
Medicine Today, 5(4).
 Young, R.C, Manley, M.W., & Alexopoulos, G.S.
(1985). “I Don’t Know” Responses in Elderly
Depressives and in Dementia. Journal of the
American Geriatrics Society, 33(4), 253–257.