The Psychology of Aging

Lecture Part II: Personality

Lecture Part III: Dementia

   
   
   

Introduction

This week, we shall consider how individual personality matures over time. Three theories concerning the personality of older adults are discussed as well as a more contemporary account of personality maturation. This chapter concludes by examining two of the more prominent psychological disorders experienced among the aged: anxiety and depression.

   
   
   

Stage Theory of Personality 

In the 1961 book "Growing Old," Cumming and Henry suggested that older adults purposely withdraw from society in preparation of death. Disengagement occurs as older adults retire from work and decrease their social participation. Society fosters this disengagement by providing fewer opportunities for older adults to participate in the workforce and in social situations. Cumming and Henry suggested that this mutual disengagement of the individual from society and society from the individual is the optimal form of aging.

Cumming and Henry outlined nine postulates of Disengagement theory. The first postulate states that "although individuals differ, the expectation of death is universal and decrement of ability is probable. Therefore a mutual severing of ties will take place between a person and others in his society." A second postulate is that the disengagement process reduces the number of normative expectations placed on older adults and essentially frees them from social responsibilities. Disengagement is a universal event, experienced across gender and cultures.

Cumming and Henry argued that their theory adequately explained why older adults demonstrated a reduction in work, a decrease in social interactions, a lack of interest in new activities, and an increased amount of introspection. This theory was grounded in the University of Chicago's Kansas City Study of Adult Life and conclusions were drawn from observations of older adults' social participation, ego energy, and self-awareness.

In contrast, other social psychologists offer the Activity theory which suggests that healthy aging corresponds with continued psychological engagement and social participation throughout older age. Older adults should actively compensate for the age related changes in their biological, psychological, and social experiences, and individuals must continue to engage in and modify the activities that they pursued in their middle age. These gerontologists thus conclude that disengagement is not compatible with optimal aging.

Rather than suggesting that older adults can be characterized by a single characteristic such as disengagement, Erik Erikson argued that individuals pass through eight maturational stages over the course of their life. These stages closely follow biologically driven events such as puberty and aging. Further, each state involves a conflict between two extreme characteristics and the resolution of this conflict shapes the individual personality.

In old age, Erikson argued that individuals must pass through a stage which is characterized by a psychological conflict between ego integrity and despair. In this stage, older adults reflect upon their life and then assess their self worth. A positive appraisal of their life course experience results in ego integrity while a negative self appraisal results in despair. Older individuals with ego integrity go on to acquire wisdom, acknowledge the universal conditions of humanity, and accept their mortality. Those who fall into despair suffer with what Kierkegaard referred to as the sickness unto death. Despairing individuals may become withdrawn and ambivalent or hostile and destructive in their old age.

These theories of personality provide some insights into the process of growing old. Older adults may indeed retire from the workplace because they sense their mortality and do not wish to spend their last days in work. They desire to disengage and prepare for death. Activity theory explains why some older adults, like Bob Dole and Jimmy Carter, remain employed and actively participate in work and social events. Erikson's stage theory provides insight into why some older adults may appear to be at peace with growing old while others appear fearful.

Despite the intuitive appeal, these stage theories of personality have not been supported by research findings. Maddox (1965) found no support for disengagement theory after examining an independent group of older adults. Furthermore, Neugarten could not replicate Cumming and Henry's findings with a sample drawn from the same Kansas City study.

Lemon, Bengtson, and Peterson (1972) did not find a relationship between the activity level of older adults and life satisfaction.  The Activity theory is clearly cannot explain optimal aging, and simple, one dimensional explanations do not do justice to the complexity of the personalities of older adults.

In summary, the personality of older adults cannot be captured by postulating a stage experience such as disengagement, activity, ego integrity, or despair. Personality and the personality of older adults is a more complex, multi-dimensional construct.

   
 

 
   

Personality Traits

In contrast to the proposition that adults pass through distinct stages which shape their personality, more contemporary psychological researchers have argued that personality is defined as a set of traits that follow the individual throughout the life course. Personality is made of five traits which dispose an individual to particular thoughts, feelings, and behaviors. These traits are: (a) neuroticism, (b) extroversion, (c) openness to experience, (d) agreeableness, and (e) conscientiousness.

The Baltimore Longitudinal Study on Aging is regarded as the most definitive study of personality traits. Paul Costa and Robert McCrae tested the personalities of individuals between 19 to 80 years old for over twelve years and specifically measured their levels of neuroticism, extroversion, openness to experience, agreeableness, and conscientiousness. Costa and McCrae concluded that these five personality traits remained relatively stable with age.  Furthermore, trait stability especially characterized individuals after the age of 30.

The first trait, neuroticism, refers to an individual's level of anxiety, hostility, impulsiveness, and self consciousness. Neuroticism is measured by self-reported responses to a variety of statements such as "I often look in the mirror before I go outside." Someone who would strongly agree with this statement, as well as the others which measure this trait, would be identified as having a high amount of neuroticism. In contrast, someone who was neutral or strongly disagreed with these statements would have average to lower levels of neuroticism.

Given the general conclusion that personality traits remain stable after age 30, Costa and McCrae would argue that if a 30 year old woman worried excessively about whether or not her husband's salary was enough to make mortgage payments, then she also is likely to be worried about having saved enough for her children's college tuition when she is 45 and is likely to be worried about the adequacy of her husband's pension income at age 70. Since Costa and McCrae suggest that personality traits remain stable through adulthood a high degree of neuroticism, as reflected by a consistent and excessive level of anxiety and worry, is likely to persist and find new focal points over time.

In regard to the second personality trait, the extroverted personality trait is characterized by assertiveness, excitement seeking, and positive emotional experiences. Costa and McCrae would suggest that extroversion remains stable through adulthood. A thirty five year old oil wildcatter is more likely to be a 75 year old skydiver; conversely, someone who spent the majority of his middle age as an introverted and unassertive biomedical researcher is not likely to become a socially competent and effective university administrator in older age. Such a transformation of personality traits, from introversion to extroversion, is not a normal feature of personality maturation.  

Further, in regards to the third personality trait, individuals who are open to experiences when they are young are also likely to be engaged in novel experiences when they are old. For example, celebrated artists Wilhelm deKooning and Pablo Picasso spent their entire lifetimes exploring and refining new methods of artistic expression.

Moreover, agreeable persons are less likely to become antagonistic as the age. Stubborn, cantankerous, mistrustful older men were likely stubborn and mistrustful in middle age. Similarly, individuals with high levels of conscientiousness in middle age tend to remain ambitious and energetic over time.  

Costa and McCrae were careful to point out that personality traits reflect enduring personal qualities and cannot predict how individuals may respond to any given situation. Extroverted individuals, for example, are not always interested in starting conversations with strangers.  

How personality traits manifest themselves may also vary across individuals and over time. One person with a high degree of openness to novel experiences may actively change jobs but maintain a stable family environment. Conversely, another person who is open to new experiences may keep the same job but engage in several intimate relationships over the life course.

Over time, people with a high level of neuroticism find new reasons to complain, worry, and be dissatisfied. A younger woman may express unhappiness with her suburban homestead in her thirties and find something else to complain about, like her meddling mother-in-law, in her forties. She maintains a high level of trait neuroticism but how exactly this is expressed changes as her life situations change.

In contrast to Costa and McCrae's position that personality traits remain stable over the life course, other researchers including Neugarten, Havinghurst, and Tobin (1968) found that other aspects of personality are modified with age. They argued that gender roles become less distinct as men retire from the workforce and women finish raising their children. Older men may express more emotion than when they were younger and appear more feminine, older women may be more assertive than when they were younger and appear more masculine.

In summary, research suggests that personality traits remain relatively stable over the life course. So, if an older adult appears cantankerous or eccentric, it is probably because he or she was that way as a younger adult. Moreover, Costa and McCrae conceded that their studies were not definitive, and variability across individual personality is possible. Some individuals may become more introverted as they age, others may become less neurotic.

Dramatic alterations in personality traits, however, should not be considered normative. If an individual becomes significantly more depressed or mistrustful as he ages, then it is possible that this change in personality is caused by a non-normative event such as the onset of Alzheimer's disease or vascular dementia.

   
   
   

Mood Disorders

In the following section, two of the more common mood disturbances among older adults are discussed. An individual's mood needs to be distinguished from their personality. An introverted or extroverted individual can be depressed.  Mood and personality do not constitute the same construct: recognizing someone's mood as distinct from their personality is a useful skill to acquire.
   
   
   

Anxiety

Anxiety is a normal emotional response to a perceived threat, and anxiety is also a component of the neurotic personality trait. Sheikh (1994) stated that the feeling of anxiety becomes problematic when the emotion causes disruptions to thoughts, behaviors, and physical status. Abnormal amounts of anxiety correspond with illogical thoughts, irrational behaviors, and physical symptoms. Abnormal levels of anxiety cause a person to become distracted, irritable, or hostile; anxiety may cause tightness of the chest, dry mouth, sweating, and hyperventilation.  Anxious individuals can often have panic attacks, a brief, sudden peak in fear that corresponds with readiness to fight or flee.

Individuals often are characterized as having mild, moderate, or high amounts of anxiety. Johnson reported that 17.4% of males had high trait anxiety, while 20.1% of females were characterized as having high trait anxiety.

An individual with high anxiety is more likely to worry, engage in repetitive behaviors, or experience somatic events such as high heart rate or excessive sweating. These symptoms clearly become apparent when the individual is involved in stressful situations. Individuals with high trait anxiety may also perceive a less stressful situation such as taking a quiz as more stressful than an individual with low trait anxiety.

In contrast, an individual with low trait anxiety is less likely to worry consistently or show physical signs of duress during stressful situations.  High levels of anxiety may also develop into a severe psychiatric disorders. The Diagnostic and Statistical Manual characterizes a number of anxiety disorders including phobias (e.g., agoraphobia), obsessive-compulsive disorders, panic disorders, post traumatic stress disorder, and generalized anxiety disorder. Some of these are more common among individuals with high levels of trait anxiety, while other disorders such as post traumatic stress are not necessarily associated with trait level of anxiety.

Regier et al. (1988) reported that 5.1% of the over 65 population experienced a diagnosable anxiety disorder, a rate which is lower than younger adult population. Further, researchers consider anxiety disorders to be developmental--most older adults who are diagnosed with an anxiety disorder have maintained the condition throughout their lives. Few older adults develop an age-related (or late onset) anxiety disorder.

Older adults report more feelings of anxiety than younger adults--feelings which do not always result in a clinical psychological problem but impact the quality of life nonetheless. Indeed, older adults may be confronted by a greater number of anxiety provoking events. Older individuals experience unique physical changes and life changing circumstances such as retirement and the death of significant others.

   
   
   

Treatment of Anxiety

Anxiety can be treated with a number of anti-anxiety medications which can be prescribed by any medical doctor.  Psychological interventions for anxiety include behavioral, cognitive, and psychodynamic therapy. However, Gatz, Fiske, Fox, Kaskie, Kasl-Godley, McCallum, and Wetherell (1997) found a lack of empirical support for any particular psychological treatment for older adults with anxiety. Whether or not feelings of anxiety among older adults can be alleviated by psychological intervention remains to be established.

   
   
   

Depression

Clinical depression results in a significant impairment to an individual's occupational and social functioning, depression exacerbates physical illness as well. Regier et al. (1988) reported that clinical depression affects 1.5 to 3.0% of the older adult population at any given time. This suggests that major depressive disorders become less common with age, a position which counters the stereotype that older people become more clinically depressed simply because they are growing old and facing frailty and death.

The clinical depression that does appear among older adults may develop in several ways. Some depressed older adults experience a life long history of depression and endure recurrent episodes with age. For instance, someone who experienced a major depressive episode as a teenager may also experience clinical depression as a middle aged and older adult.  

In contrast, some older adults are diagnosed with age related clinical depression without having a prior psychological history. These disorders are considered to be non-normative: clinical depression is not common among older adults nor is it a normal feature of growing old.

Biomedical researchers have found that reduced levels of hormones and neurotransmitters cause some older adults to become depressed. Clinical depression may also co-occur with an age related diseases such as cancer, dementia, or Parkinson's Disease. 

Older adults (and younger adults too) may experience clinical depression following the death of a spouse or significant other. If the depression is prolonged, this form of clinical depression is referred to as complicated bereavement, and this is considered distinct from the normal, nonpathological, bereavement process. 

Clinical depression may also be a manifestation of the phenomenological experience of getting old, becoming frail, and facing death. Cumming and Henry argued that older adults disengage from society as a means of preparing for death, Erikson suggested that some older adults may fall into despair after they have reflected on their life course. The losses experienced by older adults may indeed have a significant impact on an individual s affective status. The loss of employment, family and friends, active mobility, and functional independence may create a profound sense of melancholy among some older adults.

   
   
   

Assessment

The diagnosis of clinical depression is made when an individual demonstrates at least five of the following symptoms: 1) persistent depressed mood, 2) diminished interest in activities, 3) significant weight change, 4) insomnia, 5) psychomotor agitation or retardation, 6) fatigue, 7) feeling of worthlessness, 8) guilt, 9) consistent lack of concentration, 10) recurrent thoughts of death, and 11) suicidal ideation. 

Clinical depression is distinguished from feelings of depression by the length or persistence of these symptoms. Someone who is clinically depressed experiences these symptoms continuously for a minimum of two weeks. Someone with a depressed mood experiences these symptoms irregularly or with variable amounts of intensity.

The diagnosis of depression among older adults should carefully consider those symptoms which may reflect normative age related changes. For example, aging corresponds with biological changes which cause an individual to become less active or more easily fatigued. These symptoms do not always indicate depression and the assessment of depression among older adults should be evaluated with an instrument which is sensitive to these age related experiences. The Geriatric Depression Scale, in particular, is designed to distinguish age related symptoms from symptoms of depression.

   
   
   

Treatment

Depression can be treated with a number of antidepressant medications which can be prescribed by a medical doctor. Clinical depression also can be treated effectively with psychological therapy. Cognitively intact, community residing older adults with depression are likely to respond favorably to cognitive, behavioral, and psychodynamic therapy.  Finally, recent research has determined that modified administrations of electro convulsive therapy (ECT) are effective in relieving individuals who experience very severe levels of depression.

   
   
   

Depressive Symptomatology 

Although the diagnosis of clinical depression among older adults is less common, a greater number of older individuals do present symptoms of depression. Between 15 and 20% of the over 65 population present at least one of the symptoms listed earlier. This suggests that more older adults experience a sub-clinical level of depression than younger adults.

Recognizing depressive symptomatology among the older population is important. Depressive symptoms correspond with reduced quality of life, as well as longer time of recovery from physical injuries and surgical procedures. In addition, recognizing depressive symptoms among older adults is a critical facet of suicide prevention. Over 90% of older adults who committed suicide had manifest symptoms of depression, yet they were not identified prior to the act. Suicide rates are highest among older white males.

In summary, anxiety and depression constitute two of the more common psychological disturbances experienced by older adults. Yet, neither of these disorders is a normal feature of aging. Anxiety among older adults may correspond most strongly with anxiety at younger ages. Older worriers were once younger worriers.

However, certain kinds of depression may be age related. Some older adults may become depressed as a consequence of decreasing hormonal and neural activity; others may become depressed in response to the experiences of growing old.

Although these disorders are not as prevalent among the aged, older adults do present more symptoms of anxiety and depression. The quality of an older individuals mood may be significantly different than a younger persons. Older adults undergo a unique transformation to their biological and social self, a transformation that may leave them more anxious or depressed.  

Finally, it is important to recognize that these moods may become problematic and impact the quality of life. Depressed older males, for instance, are more likely to commit suicide than any other age group. Proper psychological assessment and treatment of the aged is just as important as the provision of proper mental health care to any other population.
Critical Thinking E-mail Exercise III

   
   
   

Summary

In this chapter, I presented three different theories about the maturation of personality. One theory suggested that older adults disengage, another said they maintained activity, and the last suggested that they entered a stage where they acquired ego integrity or fell into despair. As intuitively appealing as these theories sound, they are too simplistic and not supported by significant empirical research.

In contrast, a more sophisticated and empirically validated study suggested that personality is composed of distinct traits which remain relatively stable into old age. Extroverted younger adults become extroverted older adults. However, older individuals can experience personality changes, which may be indicative of a pathological condition.

Finally, the chapter discussed two of the more common psychological disorders experienced by older adults: anxiety and depression. Although these disorders decrease with age, related symptoms may increase with age. These symptoms, which appear in conjunction with specific age related events, may be indicative of problems that could be treated with proper mental health care.
Critical Thinking E-mail Exercise IV

   
   
   

Key Points

  • Progression through maturational stages does not define personality.
  • Personality factors that remain stable over the life course are extroversion, neuroticism, openness to new experiences, and conscientiousness.
  • Personality traits remain relatively stable with age, especially after age 30.
  • Older adults experience less anxiety and depression than younger adults.
  • Older adults are capable of benefit from psychotherapy for depression and anxiety.
  • Drastic changes in personality among older adults may be a symptomatic of larger problems.