Psychological Factors in Ageing: Difference between revisions

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'''Original Editor '''- [[User:Bhanu Ramaswamy|Bhanu Ramaswamy]] as part of the [[AGILE Project|AGILE Project]].  
'''Original Editor '''- [[User:Bhanu Ramaswamy|Bhanu Ramaswamy]] as part of the [[AGILE Project|AGILE Project]].  
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== Introduction ==
== Introduction ==
[[File:Elderly Woman.jpg|right|frameless]]The increase in the number of [[Older People Introduction|older people]] worldwide, alongside an increase in life expectancy, has led to a more attention to the psychological factors of ageing.<ref>Frontiers Psychological Factors in Physical Activity for Healthy life and Healthy Aging Available:https://www.frontiersin.org/research-topics/29127/psychological-factors-in-physical-activity-for-healthy-life-and-healthy-aging (accessed 30.11.2022)</ref> There is a growing body of evidence suggesting that successful ageing is multidimensional,  including a level of psychological, physical and social, and well-being.<ref>Britton A, Shipley M, Singh‐Manoux A, Marmot MG. Successful aging: The contribution of early‐life and midlife risk factors. Journal of the American Geriatrics Society. 2008 Jun;56(6):1098-105. Available: https://www.sciencedirect.com/science/article/pii/B9780123749376000024<nowiki/>(accessed30.11.2022)</ref>


'''Good Practice'''<div class="goodpracticebox">Although physiotherapy is a profession concerned with identifying and maximising movement potential through education training and rehabilitation, it aims to promote the well being and autonomy of people with a physical dysfunction associated with mental and physical illness. The profession uses a holistic person centred approach to influence the psychological health of individuals regardless of age. </div>
The field of geropsychology is becoming increasingly important as populations age. Geropsychology is a specialty that focuses on understanding, treating, and improving the [[Mental Health|mental health]] of older adults.<ref>Psychology today What Is Geropsychology? Available:https://www.psychologytoday.com/us/blog/lifespan-perspectives/202011/what-is-geropsychology (accessed 1.12.2022)</ref> Currently many seniors with mental health issues may not be receiving the right treatment. Prompt recognition and treatment of mental health issues in older adults is essential. Psychosocial interventions and medicines are recommended.<ref name=":0" />
== Mental state and physical performance ==
There is a relationship between mental state and physical performance; e.g. when we respond to a situation with a physical reaction, concentrate on a task and try not to let our nerves get the better of us, or simply do a job where we are under a certain amount of stress/pressure. <br>The ability to relax mentally and physically is of great benefit to those subjected to worries and anxieties during the course of everyday life. Occasionally, these problems need to be dealt with by someone other than the person him/herself. On the whole, exercise increases general well-being, renewing mental energy and drive, which is where the expertise of physiotherapist is most beneficial.&nbsp;


The four major pathological conditions in the older population are:  
== Mental Health and Psychological Changes  ==
Mental health and well-being are as important in older age as at any other time of life. [[:Category:Mental Health|Mental]] and [[Neurological Disorders|neurological disorders]] among older adults account for 6.6% of the total disability ([[Disability-Adjusted Life Year|DALYs]]) for this age group. Approximately 15% of adults aged 60 and over suffer from a mental disorder.


*Acute confusional state (Delirium). Characteristically occurs over hours or days, usually accompanied by acute physical illness. Levels of alertness fluctuate, being worse at night, with lucid spells during the day, although the person can be disorientated to time and place. They may be fearful, irritable and aggressive. Paranoid ideas are common as are visual and auditory hallucinations. Symptoms generally resolve when the underlying cause is treated.
Psychosocial problems include:
*[[Depression]], characterised by abnormally lowered mood may develop over weeks or months. The signs include loss of interest in life, neglect of personal appearance and hygiene plus expression of recurrent thoughts of death or suicidal ideas. Concentration levels are low, decisions difficult to make as are the carrying out of daily tasks. The person may complain of multiple physical symptoms, sleep (insomnia or hypersomnia) and appetite also become affected with a resultant decrease in energy.
*Paraphrenia is not universally accepted as a distinct syndrome. The person is often female, lives alone, and has evidence of difficult social interactions earlier in life. They report of plots against them, focusing on family members, which are persistent, extreme, and elaborate. Usually, cognitive impairment is not present, but a hearing impairment is common. Although the person is physically independent (diet and hygiene are rarely compromised), social functioning and cooperation with staff members are greatly impaired.
*[[Dementia]] is an umbrella term used for signs and symptoms characterised by a generalised and irredeemable impairment of intellect, memory and personality. The decline is permanent and progressive. The three most common types of dementia are:  
**[[Alzheimer's Disease|Alzheimer’s]] disease: a neurodegenerative disorder with generalised brain cell loss, especially in the cortex, plus extracellular plaques and intracellular neurofibrillary tangles. It has a progressive unremitting course with widespread loss of function and abilities. Alzheimer’s disease is slightly more common in women than in men.
**Vascular dementia: small or large vascular lesions cause focal damage in the brain with resultant focal neurological signs. Stepwise deterioration in cognitive and physical function occurs. It is more common in men than in women, and there is usually past history of cardiovascular pathology (e.g. hypertension).
**Lewy Body dementia: presents with a very different patterns of symptoms including clouding of consciousness, paranoid delusions, complex visual hallucinations, falls, depressive symptoms and auditory hallucinations.


As people get older there is an increased likelihood of them experiencing '''bereavement'''. Most come through the experience without the need for professional help, but for some there are longer lasting detrimental effects on physical and mental health. This may leave someone in a pattern of grief and mourning, experience some or all of the following:
# Poor adjustment to role changes.
# Poor adjustment to lifestyle changes.
# Family relationship problems.
# Grief.
# Low self-esteem.
# Anxiety and [[depression]].
# Aggressive behavior.<ref>Short facts What are psychological factors of aging? Available: https://short-facts.com/what-are-psychological-factors-of-aging/ (accessed 30.11.2022)</ref>


'''An initial experience''' of numbness (sense of isolation, withdrawal, loss of appetite) and denial (constant reminiscing, expects the return).  
== Risk Factors ==
Older people may experience the same life stressors common to all people, however they have additional stress in the form of eg a significant ongoing loss in capacities and a decline in functional ability. Older adults may experience reduced mobility, [[Chronic Pain|chronic pain]], [[Introduction to Frailty|frailty]], [[diabetes]], [[Hearing in the Elderly|hearing loss]], [[osteoarthritis]] or other health problems, all requiring some form of long-term care. In addition, older people are more likely to experience events such as bereavement, or a drop in socioeconomic status with retirement. Sadly these stressors can result in isolation, loneliness or psychological distress in older people.


'''In the first 3 months''' it could be anxiety (sense of insecurity, often irrational fears), anger (‘why me’), pain, guilt (self-recrimination)  
Mental health has an impact on physical health and vice versa. For example, older adults with physical health conditions such as [[Coronary Artery Disease (CAD)|heart disease]] have higher rates of depression than those who are healthy. Additionally, untreated depression in an older person with heart disease can negatively affect its outcome.<ref name=":0">WHO Mental health of older adults Available: https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults (accessed 30.11.2022)</ref>


'''From 3 months onwards''', depression is more likely, exacerbating existing personality problems, apathy (neglects own best interests, lack of will) and possible a loss of identity
== Empathy ==
For most of us who are in a general setting, dealing with complex emotions in rehabilitation is vital, as many factors will affect involvement and participation with treatment. Many treatments for those with mental health problems are no different from those used to solve physical problems with client groups elsewhere; however, the approach taken may need to reflect the person’s individual health needs. Overall, patience and empathy are a must (with good listening/counselling skills with both client and carers), as are re-orientation to the individual’s environment, and an understanding of their behaviour.


'''For the first year or more''' we should expect acceptance (can settle into new circumstances, loss no longer felt as an appalling tragedy) and healing when equilibrium is regained. The depression may continue in older people, and if severe is a suicide risk that needs recognition and treatment. Liaison with clinical psychologist, community psychiatric nurse, GP or other mental health professionals is appropriate.
== Elder Abuse ==
[[File:Elder Abuse Task Force report.jpeg|right|frameless|298x298px]]
Elder abuse is a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person. This type of violence amounts to a violation of human rights.<ref name=":1">WHO Elder Abuse Available:https://www.who.int/news-room/fact-sheets/detail/abuse-of-older-people (accessed 1.12.2022)</ref> Older adults are at risk of elder abuse, in its many form eg


Consider the psychological factor of '''adjustment to physiological change that has left a disability''', e.g. a stroke. It may mean lifestyle changes such as having a bed downstairs, leading to loss of privacy, or having to give up driving, leading to isolation. A major disability may also alter the person's position or status within the family, for example, a change from being a carer to being cared for may lead to low esteem. Healthcare professionals may sometimes overlook the acceptance of these changes as the priority is normally to deal with the physical disability. If the physiotherapist has knowledge of the possible psychological consequences they can refer on to colleagues and ensure a holistic approach to person-centred care is maintained. Occasionally however, the effects of mental health problems can be such that they hinder and limit a person’s participation and progression with physiotherapy, and a different course of management must be sought.<br>
* Physical, verbal, psychological, financial or sexual abuse
== Discussion ==
* Abandonment;  
<div class="discussionpointbox">
* Neglect
For most of us who are in a general setting, dealing with complex emotions in rehabilitation is vital, as many factors will affect involvement and participation with treatment. The range of patients you will see encompasses people with anxieties born of their pathologies of a non-organic nature; e.g. someone with osteoporosis with a great fear of moving in case they fall and fracture a bone.<br>How would your response differ to a patient who has anxiety centred on falling, compared to a person with dementia and anxiety about walking outside?
* Serious losses of dignity and respect.  
</div>
Physiotherapy for mental health problems varies depending on the reason for the condition, and the stage it is at. Some physiotherapists specialise in this clinical area following further post-qualification study. The physiotherapists in mental health are uniquely placed through their knowledge of mental health conditions and their expertise in the management of physical conditions to provide an extensive range of approaches to treatment aimed at relieving symptoms and improving quality of life. They advice and support staff, service users and carers on both the physical manifestations of mental health conditions and on the management of physical conditions in mental health settings.  


== '''Good Practice''' ==
Current evidence suggests that 1 in 6 older people experience elder abuse. Elder abuse can have serious physical and mental health, financial, and social consequences, including, for instance, physical injuries, premature mortality, depression, cognitive decline, financial devastation and placement in aged care facilities.<ref name=":0" /><ref name=":1" />
<div class="goodpracticebox">
Many treatments for those with mental health problems are no different from those used to solve physical problems with client groups elsewhere; however, the approach taken may need to reflect the person’s individual health needs. Overall, patience and empathy are a must (with good listening/counselling skills with both client and carers), as are re-orientation to the individual’s environment, and an understanding of their behaviour. Good practice point for people with mental health problems.  


The physical treatment may involve:  
== Dementia and Depression ==
The most common mental and neurological disorders in older people are dementia and depression, which affect approximately 5% and 7% of the world’s older population, respectively.<ref name=":0" />
#[[Depression]]: may cause great distress and leads to impaired functioning in daily life. Depression is underdiagnosed and undertreated in primary care settings. Symptoms are often missed and untreated because they co-occur with other problems meet by older adults. Older people with depressive symptoms have function worse in comparison to those with chronic medical conditions such as lung disease, hypertension or diabetes. Depression also increases the perception of poor health, the utilization of health care services and costs.<ref name=":0" />
#[[Dementia]] is an umbrella term used for signs and symptoms characterised by a generalised and irredeemable impairment of intellect, memory and personality. The decline is permanent and progressive. It mainly affects the elderly, although it is not a normal part of ageing. It is estimated that 50 million people globally live with dementia with nearly 60% living in low- and middle-income countries. The total number of people with dementia is projected to increase to 82 million in 2030 and 152 million in 2050.<ref name=":0" />


*A thorough assessment of ability, with involvement from other multidisciplinary team members
== Bereavement ==
*Maintenance of range of movement (especially in the later stages when immobility increases), and work on promoting mobility. Improvement of balance, to minimise the risks of falling, as mobility declines
[[File:Grief.jpeg|thumb|Grief]]
*Treatment of any specific injuries sustained
As people get older there is an increased likelihood of them experiencing bereavement. Grief is the natural response to the death of a loved one and is encountered frequently in clinical practice with the elderly. Acute grief normally evolves over time into integrated grief. Sometimes grief may be prolonged, severe and impairing. This failure of adaptation to grief results in Prolonged Grief Disorder (PGD) which has been recently included in ICD-11. The hallmark feature of PGD is intense longing for the deceased or persistent preoccupation with the deceased that lasts longer than 6 months after the death.<ref>Meichsner F, O'Connor M, Skritskaya N, Shear MK. Grief before and after bereavement in the elderly: an approach to care. The American Journal of Geriatric Psychiatry. 2020 May 1;28(5):560-9.Available:https://www.ajgponline.org/article/S1064-7481(19)30590-1/fulltext (accessed 1.12.2022)</ref>  
*Provision of information to help reduce anxieties and fears and assist in carrying out a specific programme designed for that individual
*Teaching of positioning and manual handling in the later stages of some of the disorders.
</div> <div class="furtherreadingbox">
</div>


== Further reading ==
* Unfortunately, older people may be reluctant to discuss their mental health and grief with their family, GP or other care staff. Grief in older people may, consequently, go undetected and untreated. 
In addition to the sites provided in an earlier chapter (page 20), further information can be found at the following sites.
* Older people who have experienced the death of a partner are up to four times more likely to experience depression than older people who have not lost there partner.<ref>Independent age Older bereaved people are up to four times more likely to experience depression, but less likely to receive support, according to new report Available:https://www.independentage.org/news-media/press-releases/older-bereaved-people-are-up-to-four-times-more-likely-to-experience (accessed 30.11.2022)</ref> <ref>NARI Grief in older people and its effect on healthcare use Available:https://www.nari.net.au/grief-in-older-people (accessed 30.11.2022)</ref>


In Scotland, the See Me site provides information and fact sheets to download that explain about the national campaign to end the stigma and discrimination of mental ill-health. They are an alliance of five mental health organisations and fully funded by the Scottish Government launched in 2002. [http://www.scie.org.uk/publications/elearning/mentalhealth/mh08/index.asp http://www.seemescotland.org.uk/]
== Disability ==
Consider the psychological factor of adjustment to physiological change that has left a [[Ageing and Disabilities|disability]], for example:  


The Social Care Institute for Excellence site (SCIE) is still running a page about ageing, discrimination and mental health in older people. Access this and information sheets at: http://www.scie.org.uk/publications/elearning/mentalhealth/mh08/index.asp
# A [[stroke]]. It may mean lifestyle changes such as having a bed downstairs, leading to loss of privacy, or having to give up driving, leading to isolation.
# A major disability may also alter the person's position or status within the family, for example, a change from being a carer to being cared for may lead to low esteem.  


Mind publishes information on many topics relating to mental health. They are grouped into seven broad categories: diagnoses and conditions, treatments, mental health statistics, support and social care, communities and social groups, and society and environment. http://www.mind.org.uk/help/information_and_advice
Healthcare professionals may sometimes overlook the acceptance of these changes as the priority is normally to deal with the physical disability. If the physiotherapist has knowledge of the possible psychological consequences they can refer on to colleagues and ensure a [[Holistic Healthcare Interventions for Children|holistic]] approach to person-centred care is maintained.  
<div class="discussionpointbox">
== Physiotherapy ==
[[File:Taoist Tai Chi class.jpg|thumb|328x328px|Tai Chi, improves well being]]While the majority of attention in the life extension and successful ageing field has concentrated on physical factors, eg. [[Therapeutic Exercise|exercise]], diet, [[Sleep: Older People|sleep]], genetics, we need to increase our knowledge on the interaction between psychology, physical activity and health. In particular  on the benefits of [[Physical Activity|physical activity]] practice on psychological health in the aged.


You can also read the Northern Ireland Association for Mental Health's response to The Commission of the European Communities Green Paper “Improving the mental health of the population. Towards a strategy on mental health for the European Union” (April 2006) http://ec.europa.eu/health/ph_determinants/life_style/mental/green_paper/mental_gp_co062.pdf
Being active is good for mental health. Exercise releases chemicals in the brain increasing a sense of well being eg boosting  self-esteem, helping with concentration, improving sleep. This is an area a physiotherapist have a role, as our  expertise being most beneficial. Simply educating people on the mental health benefits is a starting point.


== Resources ==
For more see&nbsp;
*bulleted list
*x
or


#numbered list
# [[Physical Activity and Older Adults|Physical Activity and Older People]]
#x
# [[Mental Health, Physical Activity and Physical Therapy]]


== References  ==
'''Further Reading'''The Social Care Institute for Excellence site (SCIE) is still running a page about ageing, discrimination and mental health in older people. Access this and information sheets at: http://www.scie.org.uk/publications/elearning/mentalhealth/mh08/index.asp
 
</div>  
<references />
[[File:Elderly Woman.jpg|right|frameless]]  <div class="discussionpointbox">
 
</div>  
'''Previous Page - [[Older People / Geriatrics|Central Nervous System: Special Senses]]&nbsp; &nbsp;|| &nbsp; Next Page - [[Medication and Older People|Medication and Older People]]'''


== References  ==
== References  ==


<references /><br>  
<references /><br>
 
[[Category:Occupational Health]]
[[Category:Older_People/Geriatrics]]  
[[Category:Older_People/Geriatrics]]
[[Category:Older People/Geriatrics - Conditions]]
[[Category:Global_Health]]
[[Category:Global_Health]]
[[Category:Mental Health]]
[[Category:Mental Health]]
[[Category:Occupational Health]]
[[Category:Conditions]]
[[Category:Mental Health - Conditions]]
[[Category:AGILE Project]]

Latest revision as of 02:43, 1 December 2022


Original Editor - Bhanu Ramaswamy as part of the AGILE Project.

Top Contributors - Admin, Lucinda hampton, Kim Jackson, Mande Jooste, Evan Thomas, Amrita Patro, Amanda Ager and Lauren Lopez

Introduction[edit | edit source]

Elderly Woman.jpg

The increase in the number of older people worldwide, alongside an increase in life expectancy, has led to a more attention to the psychological factors of ageing.[1] There is a growing body of evidence suggesting that successful ageing is multidimensional, including a level of psychological, physical and social, and well-being.[2]

The field of geropsychology is becoming increasingly important as populations age. Geropsychology is a specialty that focuses on understanding, treating, and improving the mental health of older adults.[3] Currently many seniors with mental health issues may not be receiving the right treatment. Prompt recognition and treatment of mental health issues in older adults is essential. Psychosocial interventions and medicines are recommended.[4]

Mental Health and Psychological Changes[edit | edit source]

Mental health and well-being are as important in older age as at any other time of life. Mental and neurological disorders among older adults account for 6.6% of the total disability (DALYs) for this age group. Approximately 15% of adults aged 60 and over suffer from a mental disorder.

Psychosocial problems include:

  1. Poor adjustment to role changes.
  2. Poor adjustment to lifestyle changes.
  3. Family relationship problems.
  4. Grief.
  5. Low self-esteem.
  6. Anxiety and depression.
  7. Aggressive behavior.[5]

Risk Factors[edit | edit source]

Older people may experience the same life stressors common to all people, however they have additional stress in the form of eg a significant ongoing loss in capacities and a decline in functional ability. Older adults may experience reduced mobility, chronic pain, frailty, diabetes, hearing loss, osteoarthritis or other health problems, all requiring some form of long-term care. In addition, older people are more likely to experience events such as bereavement, or a drop in socioeconomic status with retirement. Sadly these stressors can result in isolation, loneliness or psychological distress in older people.

Mental health has an impact on physical health and vice versa. For example, older adults with physical health conditions such as heart disease have higher rates of depression than those who are healthy. Additionally, untreated depression in an older person with heart disease can negatively affect its outcome.[4]

Empathy[edit | edit source]

For most of us who are in a general setting, dealing with complex emotions in rehabilitation is vital, as many factors will affect involvement and participation with treatment. Many treatments for those with mental health problems are no different from those used to solve physical problems with client groups elsewhere; however, the approach taken may need to reflect the person’s individual health needs. Overall, patience and empathy are a must (with good listening/counselling skills with both client and carers), as are re-orientation to the individual’s environment, and an understanding of their behaviour.

Elder Abuse[edit | edit source]

Elder Abuse Task Force report.jpeg

Elder abuse is a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person. This type of violence amounts to a violation of human rights.[6] Older adults are at risk of elder abuse, in its many form eg

  • Physical, verbal, psychological, financial or sexual abuse
  • Abandonment;
  • Neglect
  • Serious losses of dignity and respect.

Current evidence suggests that 1 in 6 older people experience elder abuse. Elder abuse can have serious physical and mental health, financial, and social consequences, including, for instance, physical injuries, premature mortality, depression, cognitive decline, financial devastation and placement in aged care facilities.[4][6]

Dementia and Depression[edit | edit source]

The most common mental and neurological disorders in older people are dementia and depression, which affect approximately 5% and 7% of the world’s older population, respectively.[4]

  1. Depression: may cause great distress and leads to impaired functioning in daily life. Depression is underdiagnosed and undertreated in primary care settings. Symptoms are often missed and untreated because they co-occur with other problems meet by older adults. Older people with depressive symptoms have function worse in comparison to those with chronic medical conditions such as lung disease, hypertension or diabetes. Depression also increases the perception of poor health, the utilization of health care services and costs.[4]
  2. Dementia is an umbrella term used for signs and symptoms characterised by a generalised and irredeemable impairment of intellect, memory and personality. The decline is permanent and progressive. It mainly affects the elderly, although it is not a normal part of ageing. It is estimated that 50 million people globally live with dementia with nearly 60% living in low- and middle-income countries. The total number of people with dementia is projected to increase to 82 million in 2030 and 152 million in 2050.[4]

Bereavement[edit | edit source]

Grief

As people get older there is an increased likelihood of them experiencing bereavement. Grief is the natural response to the death of a loved one and is encountered frequently in clinical practice with the elderly. Acute grief normally evolves over time into integrated grief. Sometimes grief may be prolonged, severe and impairing. This failure of adaptation to grief results in Prolonged Grief Disorder (PGD) which has been recently included in ICD-11. The hallmark feature of PGD is intense longing for the deceased or persistent preoccupation with the deceased that lasts longer than 6 months after the death.[7]

  • Unfortunately, older people may be reluctant to discuss their mental health and grief with their family, GP or other care staff. Grief in older people may, consequently, go undetected and untreated.
  • Older people who have experienced the death of a partner are up to four times more likely to experience depression than older people who have not lost there partner.[8] [9]

Disability[edit | edit source]

Consider the psychological factor of adjustment to physiological change that has left a disability, for example:

  1. A stroke. It may mean lifestyle changes such as having a bed downstairs, leading to loss of privacy, or having to give up driving, leading to isolation.
  2. A major disability may also alter the person's position or status within the family, for example, a change from being a carer to being cared for may lead to low esteem.

Healthcare professionals may sometimes overlook the acceptance of these changes as the priority is normally to deal with the physical disability. If the physiotherapist has knowledge of the possible psychological consequences they can refer on to colleagues and ensure a holistic approach to person-centred care is maintained.

Physiotherapy[edit | edit source]

Tai Chi, improves well being
While the majority of attention in the life extension and successful ageing field has concentrated on physical factors, eg. exercise, diet, sleep, genetics, we need to increase our knowledge on the interaction between psychology, physical activity and health. In particular on the benefits of physical activity practice on psychological health in the aged.

Being active is good for mental health. Exercise releases chemicals in the brain increasing a sense of well being eg boosting self-esteem, helping with concentration, improving sleep. This is an area a physiotherapist have a role, as our expertise being most beneficial. Simply educating people on the mental health benefits is a starting point.

For more see 

  1. Physical Activity and Older People
  2. Mental Health, Physical Activity and Physical Therapy

Further ReadingThe Social Care Institute for Excellence site (SCIE) is still running a page about ageing, discrimination and mental health in older people. Access this and information sheets at: http://www.scie.org.uk/publications/elearning/mentalhealth/mh08/index.asp

References[edit | edit source]

  1. ↑ Frontiers Psychological Factors in Physical Activity for Healthy life and Healthy Aging Available:https://www.frontiersin.org/research-topics/29127/psychological-factors-in-physical-activity-for-healthy-life-and-healthy-aging (accessed 30.11.2022)
  2. ↑ Britton A, Shipley M, Singh‐Manoux A, Marmot MG. Successful aging: The contribution of early‐life and midlife risk factors. Journal of the American Geriatrics Society. 2008 Jun;56(6):1098-105. Available: https://www.sciencedirect.com/science/article/pii/B9780123749376000024(accessed30.11.2022)
  3. ↑ Psychology today What Is Geropsychology? Available:https://www.psychologytoday.com/us/blog/lifespan-perspectives/202011/what-is-geropsychology (accessed 1.12.2022)
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 WHO Mental health of older adults Available: https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults (accessed 30.11.2022)
  5. ↑ Short facts What are psychological factors of aging? Available: https://short-facts.com/what-are-psychological-factors-of-aging/ (accessed 30.11.2022)
  6. ↑ 6.0 6.1 WHO Elder Abuse Available:https://www.who.int/news-room/fact-sheets/detail/abuse-of-older-people (accessed 1.12.2022)
  7. ↑ Meichsner F, O'Connor M, Skritskaya N, Shear MK. Grief before and after bereavement in the elderly: an approach to care. The American Journal of Geriatric Psychiatry. 2020 May 1;28(5):560-9.Available:https://www.ajgponline.org/article/S1064-7481(19)30590-1/fulltext (accessed 1.12.2022)
  8. ↑ Independent age Older bereaved people are up to four times more likely to experience depression, but less likely to receive support, according to new report Available:https://www.independentage.org/news-media/press-releases/older-bereaved-people-are-up-to-four-times-more-likely-to-experience (accessed 30.11.2022)
  9. ↑ NARI Grief in older people and its effect on healthcare use Available:https://www.nari.net.au/grief-in-older-people (accessed 30.11.2022)


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