UNIT I - INTRODUCTION

SCOPE AND DEVELOPMENT OF GERIATRIC PSYCHOLOGY IN THE

20TH CENTURY
INTRODUCTION

Geriatric psychiatry and psychology have their roots in three conceptual sources developed in the
nineteenth century: theories of ageing, neurobiological hypotheses concerning brain sclerosis, and the
realization that specific forms of mental disorder may affect the elderly. Following this, the notion that
ageing should be a science in itself to be studied arose.

This gave birth to the term gerontology, coined in the year 1903 by Elie Metchnikoff, which refers to
the scientific interdisciplinary study of old age and the ageing process. It involves the study of the
social, cultural, psychological, cognitive, and biological aspects of ageing.

Modern pioneers like James Birren began organizing gerontology as its own field in the 1940s, later
involved in starting the National Institute on Aging in the US.

RESEARCH ADVANCES

In the 1960’s, Sir Martin Roth specified diagnostic criteria for syndromes of depression and late
paraphrenia and was among the first clearly to distinguish acute confusion from dementia. Clinico-
pathological studies carried out at the time demonstrated a quantitative relationship between cognitive
level and extent of brain damage, found in Alzheimer's disease and arteriosclerotic dementia. These
findings confirmed his hypothesis separating dementia from functional disorders and led to the birth
of the specialty of psychogeriatrics, and transformed the care of the elderly.

Other research advances such as longitudinal studies examining the processes of ageing also
contributed to the field. While formally begun in 1950, the Iowa State Study sampled from men who
had 1919 entrance exam scores, effectively extending the measurement of cognition to three
occasions (the third in 1961) over 42 years from young to late adulthood. In 1946, the New York State
Psychiatric Institute Study of Aging Twins began its long-term investigation of hereditary aspects of
aging and longevity, following participants’ cognitive performance for 30 years. The 1950s and 1960s
saw a marked increase in studies focused on aging in the United States. The Duke Studies of Normal
Aging (I, 1955, and II, 1968), Baltimore Longitudinal Study of Aging (1958), and Seattle
Longitudinal Study (1956) all followed closely in time the first American National Conference on
Aging (1950) and development of the Federal Council on Aging (1956). In Germany, the Bonn
Longitudinal Study of Aging (1965) followed two 5-year birth cohorts for 15–19 years.

FOUNDING OF GERIATRIC PSYCHOLOGY

Geriatric psychology or geropsychology began in 1978 following the increasing need for elderly care
and clearer classification systems of mental health issues in the elderly. It is a specialization in
psychology dealing with enhancing the welfare and mental health of older adults via the provision of
various psychological services.

The British Psychological Society established a special interest group for psychologists working with
older people in 1980 and practice as well as training in geropsychology took root. The application of
the field was aimed at improving the lives of older adults, their families, and the communities in
which they reside.
THEORETICAL CONSTRUCTS IN GERIATRIC PSYCHOLOGY

James Fries put forth the hypothesis of compression of morbidity in 1980. He assumed that the burden
of lifetime illness may be compressed into a shorter period before the time of death, if the age of onset
of the first chronic infirmity can be postponed, thereby increasing longevity. The evidence to support
this hypothesis is mixed. However, it has led to generational improvements in education and the
increased availability of adaptive technologies and even medical treatments that enhance quality of
life.

Rowe and Kahn introduced the concept of successful ageing in 1987. According to this concept,
successful ageing is defined as high physical, psychological, and social functioning in old age without
major diseases. The main focus in the concept of successful ageing is how to expand healthy and
functional years in the life span.

RECENT DEVELOPMENTS

More recently, improvements in acute geriatric care in hospitals, innovation in the field of delirium
intervention, exercise therapy and HRT as well as general medical advances have contributed to the
improved longevity and quality of life of the elderly population.

IMPROVED MEDICAL CARE AND INCREASE IN GERIATRIC

POPULATION
INTRODUCTION

The average life expectancy has increased from 45 years in 1850 to almost 80 years in recent years, as
a result of medical progress. Scientists also believe that life spans will continue growing though it is
expected to reach a hard limit at some point.  The medical advances that are driving increased
longevity span a wide spectrum including developments in diagnostics, medical devices, procedures,
and prescription drugs. And their impact on overall life expectancy comes in the form of healthier
lifestyles, preventive care, earlier and more accurate medical diagnosis, and increased quality of
treatment after diagnosis. 

TREND IN DISEASE MORTALITY

Statistics demonstrate that deaths from heart disease have decreased by 68% from 1958 to 2010 in the
USA. Similarly, in the same period of time, deaths from stroke have decline by 79%. Deaths related to
cancer have decreased by only 10% for the same period of time. Because of the dramatic decline in
cardiovascular deaths over the last six to seven decades, cancer is emerging as the major cause of
death today that will further increase in the future, while other causes of death will constitute a much
less significant problem.

Over the last couple of centuries, vaccinations, antibiotics, clean water, and other improvements in
hygiene have resulted in the elimination of several infectious diseases with a continuous increase in
life expectancy.

More recently, control of risk factors related to atherosclerosis such as hypertension, hyperlipidemia,
and smoking cessation, as well as an improvement in cardiovascular disease management with
lifestyle modification and the use of pharmacologic agents, have significantly decreased death rates
related to cardiovascular diseases.

ADVANCES IN PHARMACEUTICALS
Medicines are responsible for more than a third of the improvement in life expectancy from 1990 to
2015, demonstrating the crucial role of biopharmaceutical innovation. . For all causes of death, public
health interventions were accountable for 44% of improved life expectancy, while pharmaceuticals
were the second-leading cause of gains in life years at 35%. Notably, improvements in treatment
thanks to biopharmaceutical innovation accounted for the majority of mortality changes in several
disease areas: 76% of improvements in mortality for patients with HIV, 60% of improvements in
mortality for patients with breast cancer, 52% of improvements in mortality for patients with heart
disease.

One of the most important advances is the development of vaccines. Before the development of
vaccines, diseases such as smallpox and polio killed millions of people each year. Vaccines have
eradicated these diseases in many parts of the world, drastically reducing mortality rates.

Another major advancement is antibiotics, which have been used since the 1940s to treat bacterial
infections. Antibiotics are responsible for an average lifespan increase of about five to ten years
worldwide

ADVANCES IN DIAGNOSTICS AND MEDICAL EQUIPMENT

The use of clinical laboratory test results in diagnostic decision-making forms an integral part of
clinical medicine. Since the 1920s, the menu of laboratory tests available to clinicians has expanded
exponentially into a wide array for diagnosis, monitoring of treatments and therapies, screening, and
research on different diseases. Advancements in medical treatments and equipment are contributing to
improvements in treatment outcomes. One area of advancement is in surgical treatments, with a trend
towards more precise surgical operations and minimally invasive surgical procedures.

New technologies like CT scans help doctors diagnose illnesses before symptoms appear; this allows
them to treat them early on and prevent complications from occurring later on down the road. In
addition, telemedicine is becoming increasingly popular allowing people easier access the medical
treatment and insights they need.

ACCESS TO HEALTHCARE

Adequate access to healthcare is associated with lower risks of mortality at older ages. A study
conducted in China demonstrated the positive benefits of increased access to healthcare. The study
found that in women, the net increase in life expectancy attributable to adequate access to healthcare
was 6% and 8% at ages 65 and 85, respectively. In men, the net increases in life expectancy were
generally greater, 10% and 14% at ages 65 and 85.

Through transportable and telehealth solutions, mobile medicine expands the reach of healthcare well
beyond the traditional hospital and clinic settings. With teleradiology, telepsychiatry, and
telenephrology as just some examples of mobile medicine, there are endless possibilities to its
contribution for the medical industry. 

From medical workstations to telehealth equipment, healthcare professionals are increasingly using
mobile medical devices and equipment to deliver medical care and treatment with patients it needs to
reach, wherever they may be. Advancements in low-cost sensor technologies, repeatability, low power
consumption, and reliability are just some of the critical elements enabling the boom in portable
medical technology and devices.

THE RISE OF OLD AGE HOMES AND THE GERIATRIC CAREGIVER

INTRODUCTION

As per India’s population census of 2011, the country is home to ~104 million senior citizens, aged 60
and above. By 2026, this number is expected to grow to ~173 million. Life expectancy in India
merely 20 years ago was 62.09 years which, by 2019, had increased to 68.7 years.

Owing to breakthroughs in healthcare and the resultant increase in life expectancy in the country,
senior citizens, particularly in urban households, find themselves not only active but also able of an
independent lifestyle. For many such people, depending on their children in their own old age is no
longer the preferred option. Senior Living communities, therefore, are fast gaining popularity in a
society that has shied away from the concept of ‘old-age homes’ for years.

Senior Living is a generic term encompassing residential communities created specifically for senior
citizens and ranging across various levels of care offerings.

• Independent Living typically consists of residential facilities for elders who are able-bodied and do
not require assistance with their daily routines

• Assisted Living describes a housing facility for elders who require help with their activities of daily
living (ADL) due to mental or physical disabilities or simply age

• Nursing Homes are facilities for elders who require a higher degree of intervention from
professional caregivers, many a time medically trained, to be able to carry out their activities of daily
living

THE NEED FOR OLD AGE HOMES

In urban India, with nuclear families on the rise, elder family members oftentimes face loneliness,
neglect or both as their adult children are busy balancing their work and personal lives while the
grandchildren, if any, juggle their own education and extra-curricular activities. Adult children find
themselves unable, and not always unwilling, to extend additional support to their parents. In such
cases, while the elders’ basic needs of shelter, food, clothing and medical attention are certainly met,
their desire for attention, conversation, emotional connect and social life remain unfulfilled.

Geriatric Care facilities essentially fill this gap and help elders live sustainable lives amongst people
like themselves with almost all their physical, social and spiritual needs met in a professional and kind
manner. Geriatric Care or Senior Living communities are increasingly becoming a more acceptable
concept rather than taboo in our society as both elders and their adult children realize the need and
importance of such offerings.

Geriatric Care facilities in the Western World, where the concept is more common and largely
accepted, are increasingly developing into hybrid facilities where residents transition with age from
one care level to another i.e. as the necessity for care and help increases with increasing age for some
residents, the same facility offers the option for residents to shift from basic independent living to the
assisted living model by adding a part-time caregiver and on to a nursing home setup as the next step,
all within the same community.

THE GERIATRIC CAREGIVER

With the increase in the need and prevalence of old age homes, the need for professionals to
assistance in these settings has increased as well.
Geriatric caregivers typically have formal education and experience in nursing, social work,
gerontology or other health service areas. They are expected to have extensive knowledge about the
costs, quality, and availability of services in their communities.

Professional caregivers help individuals, families, and other caregivers adjust and cope with the
challenges of aging or disability by:

 Conducting care-planning assessments to identify needs, problems and eligibility for assistance;
 Screening, arranging, and monitoring in-home help and other services;
 Reviewing financial, legal, or medical issues;
 Offering referrals to specialists to avoid future problems and to conserve assets;
 Providing crisis intervention;
 Acting as a liaison to families at a distance;
 Making sure things are going well and alerting families of problems;
 Assisting with moving their clients to or from a retirement complex, assisted living facility,
rehabilitation facility or nursing home;
 Providing client and family education and advocacy; Offering counseling and support.