Psychological assessment with older adults.

Abstract

Everyone ages, albeit in an individual and unique way, with varying degrees of cognitive decline, emotional distress, and decreased physical functioning. Similar to other developmental stages across the life span, those over the age of 65 can be described on a continuum-from successful, to normal, to pathological. The later years of life for some older adults appear easy as they experience good health, maintain their cognitive functioning, and cope with emotional distress. At the other end of the spectrum, another subgroup will experience "pathological" levels of cognitive deficits, emotional turmoil, and poor physical health that will negatively affect their quality of life. Although many older adults will experience obstacles, the majority do not develop psychological disorders (Scott et al., 2008) and fall within the "normal" range of the aging process (Ayis, Paul, & Ebrahim, 2010).Whether for research purposes or for diagnostic and treatment planning, the assessment goal is to increase understanding of the older adult's affect, behavior, personality traits, general functioning, and overall well-being. Unfortunately, this can prove to be quite difficult. Perhaps the challenge of psychological assessment with older adults can be attributed to the heterogeneity of the population as well as the rates of comorbidity of cognitive, physical, emotional, and functional aspects of this population.Although not synonymous with age, older adults are at increased risk for medical conditions (Centers for Disease Control and Prevention, 2007). This may directly affect the testing session, as well as present a more complicated medical history, that may (or may not) be a contributing (or unknown) factor. Differential diagnosis becomes increasingly important regarding questions of delirium or dementia as well as the degree of physical, psychological, chronic, situational, or environmental symptoms.Another obstacle may be the relatively low numbers of assessment instruments that include norms for those over 65 years of age, and even fewer that are developed specifically for older adults. Years ago, Butler (1975) described the area of aging as "the neglected stepchild of the human life cycle" (p. 126). Today, with the relatively limited assessment measures available for those in their later years, perhaps geriatric assessment can best described as a recently added stepchild of the assessment area. The future holds great promise, however, as a quick review of the PsycINFO database suggests that when compared with earlier years, the previous decade brought about almost twice the number of publications in the area of psychological assessment with an older adult population. ASSESSMENT APPROACH WITH OLDER ADULTSPsychological assessment with older adults builds on the principles and techniques required in general assessment. The referral questions must be clarified, followed by the selection of tests, with thought given to psychometric adequacy, relevance, incremental validity, and complementary functions. Issues of integration of data...