What are the causal factors in the psychoses of old age?

Initial research affirmed brain damage as the only important factor in the causation of both seniliform dementia and disorders with cerebral arteriosclerosis. However, with the advent of increased interest and attention devoted to mental disorders of old age those early beliefs have undergone considerable review.

Although cerebral damage may provide marked mental symptoms, it has become evident that the organic changes are only one set of interactive factors to be considered. The prior personality organization of the individual and the stressfulness of the life situation are also of key importance. Since specific brain pathology, personality make up and stress factors vary from person to person different causal factors could exist.

Early studies showed a high incidence of senile and arteriosclerotic brain disease in the family backgrounds of elderly psychotics. However, more recent studies in aging twins suggests that it is unrealistic to consider genetic or constitutional factors as primary causal factors in these mental disorders. However, the role of these factors are not excluded in the rapidity of physiological aging.

In cases involving major strokes, gross disturbances in circulatory and metabolic processes are apparent confusional states and other symptoms may result. It should be noted though that only a small minority of individuals who suffer a severe stroke develop persistent psychotic disorders.

A diminished flow of blood and lower oxygen consumption may accompany senile psychoses, but are no longer considered of primary etiologic significance. Even if prolonged malnutrition, endocrine malfunction and other metabolic factors are indicated in some cases, they are not ordinarily considered.

The extent of brain pathology also does not account for psychotic disorders of old age. With progressive cerebral impairment the degree of residual brain capacity shapes the response in greater measure.

How older individuals react to their changed status and to the difficult stresses of this age period depends heavily on the personality makeup as well as the challenges , rewards and frustrations of their life situations. The majority of old age psychoses depend on psychosocial and sociocultural factors.

The role of the pre-psychotic personality

Individuals who are handicapped psychologically by undesirable personality traits are especially vulnerable to psychoses and other mental disorders in old age. Obsessive-compulsive trends , rigidity, suspiciousness, seclusiveness, social inadequacy and poor adaptability to change are some traits that are prevalent in the backgrounds of these individuals. Negative attitudes toward growing old leading to self-devaluation and a negative self-image could be serious adjustment handicaps during this period of life.

Stresses characteristic in old age

An older person faces numerous peculiar problems and insecurities that are not characteristic of earlier life periods. The unfavourable environmental circumstances of older people are often more hazardous to mental health than are organic brain changes. The well –integrated personality may even break down under the combined assault of cerebral changes.

Retirement and reduced income

The “old age” tag associated with retirement can be quite demoralizing. In fact, older persons are productive workers and prefer to keep on working when they reach retirement age.

We generally depend on our jobs for status, self-identity, for satisfying interpersonal relationships and for meaning in our lives. Retirement will not meet these needs and there is a tendancy to react with the feeling that one’s usefulness and worth are terminated due to rapid physical and mental deterioration.

Retirement usually leads to a substantial reduction in income. Social grants and “nest eggs” does not prevent the inevitable financial adjustment and millions of older citizens will be threatened by poverty.

Fear of invalidism and death

The gradual physical deterioration of our bodily functions and the increased possibility of falling prey to some chronic and debilitating disease will condition these individuals with obsessions concerning health issues and the possibility of failed health. This concern is aggravated when the individual has a history of medical difficulties that would compound with the aging process. Many illnesses among older individuals become chronic and the individual has to adjust to living with them unlike their younger counterparts.

These individuals are also confronted with the inescapable fact of their own impending death. Some react with equanimity, stemming from deep religious faith in the meaningfulness of human existence and the certainty hereafter. While others die as they have lived, with little concern for life or human existence. These individuals would welcome death as a solution to unsolvable problems and a meaningful life. Generally, these individuals have the realization that life is drawing to a close.

Isolation and loneliness

As we grow older we are faced with the inevitable loss of loved ones, friends and contemporaries. Children also tend to grow up, marry and move away, impairment of vision or hearing and various chronic ailments may make social interaction difficult, an attitude of self-pity or an inward centering of interest may alienate friends and family.

These individual would essentially experience the inability to contribute productively and to consider oneself a vital and needed part of the human enterprise until their existence seizes.