This article reviews some of the issues and themes in the literature on caregiving in dementia and marriage, which form the basis of a doctoral dissertation being carried out by the author. The study is utilizing both standardized scales and in-depth interviews to investigate the impact of dementia on marital relationships, in particular the in uence on morale of caregiving spouses, of marital intimacy, marital satisfaction, social support from spouse and the experience of pleasant events. The article will refer to some of the qualitative information emerging from the interviews. In the past 30 years the caregiving literature in the elds of psychology, psychiatry and gerontology has focused primarily on the negative consequences of caregiving, such as strain and burden. Although the nature of the relationship between caregiver and care recipient is considered to be a relevant factor, the nature of the marital relationship has received relatively little attention. The impact on aspects of the marital relationship, such as reduced shared activities, loss of emotional support from spouse and a diminution in the quality of verbal communication between the couple may have negative consequences for the morale of caregiving spouses and their perception of changes in marital intimacy and marital satisfaction. When considering caregiving in the future, changing attitudes towards marriage, and intimate relationships in general, need to be taken into account.

Thirty elderly subjects with a clinical diagnosis of dementia were assessed using a neuropsychological test battery and were retested one year later. No significant deterioration in performance on the National Adult Reading Test (NART) was observed. A significant deterioration was noted in performance on the Mill Hill Vocabulary Scale synonym section (MHVS). Expected significant decrements in Clifton Assessment Procedures for the Elderly (CAPE) Information/Orientation and Physical disability scales were observed. The data provide supportive evidence for the view that performance on the NART remains relatively unaffected by the dementing process.

Objectives: Fear of falling is common amongst older adults with and without a prior experience of falling. It is related to decreased quality of life, isolation, and institutionalisation. It also poses a risk for future falls when activity is avoided because of fear of falling and muscle deconditioning occurs. Relatively little is known about the psychological factors underpinning fear of falling. This study explored the relationship between emotion regulation and fear of falling in community dwelling older adults. Method: A sample of 117 older adults (>65 years) were recruited from community based exercise classes, falls reduction classes, NHS and charity organisations. Self-reported measures included the Falls Efficacy Scale-International (FES-I), the Fear of Falling Behaviour Questionnaire (FFABQ), the Difficulties in Emotion Regulation Scale (DERS) and the Hospital and Anxiety Depression Scale (HADS). Results: A significant positive correlation was found between emotion regulation and fear of falling, as well as between emotional regulation and fear-related avoidance behaviour. A regression model found that after controlling for depression and age, emotion regulation was no longer significantly related to fear of falling. Conclusions: Fear of falling is associated with emotion regulation difficulties in community dwelling older adults. However, this link no longer exists once depression is controlled for. The key clinical implication is the importance of the assessment of depression in older adults with a fear of falling. Future research should use a longitudinal design to further unpick the causal relationships between these variables.

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People are living longer and healthier than ever before, but older people are still seen as net burdens on society rather than net contributors to it (WHO, 2000). The ageing of the world's population means the age distribution of society is undergoing change. This is important for psychotherapists as it means that the types of cases seen by therapists working with older people will also change, with the potential for an increase in complexity in presentation and format. The psychological expectations of the baby boomer generation mean that upcoming cohorts of older people will be more sophisticated about using psychotherapy. The mental health needs of older people have often been neglected but as people are living longer pressures on services will change to reflect the relative increase in the numbers of older people in society. The need for effective psychological treatments for older adults will become more rather than less important. With the result that more psychotherapists will come into contact with older people and understanding gerontology may become an essential part of the curriculum for psychotherapists in training. This paper looks at the consequences of demographic change for psychotherapists working with older people.