• Depressive symptoms, depletion or developmental change? Multidimensionality in the Geriatric Depression Scale according to contemporary interpretations of the disengagement theory of aging

      Adams, Kathryn Betts; Saltz, Constance Corley (2000)
      Lewinsohn et al. (1991) have noted that some symptoms of depression, such as lack of social interest and greater self-involvement, mirror normal attributes of older adults according to Disengagement Theory (Cumming & Henry, 1961), the early developmental theory of aging which stated that there is a mutual social and affective withdrawal between the older adult and his social environment. Socio-Emotional Selectivity Theory (Carstensen, 1992) and gerotranscendence (Tornstam, 1997) both also describe the narrowing of the older person's social world and decreasing investment in activities and social relationships. The Geriatric Depression Scale (GDS; Brink et al., 1982), a 30-item self-report scale, was developed specifically to screen older individuals for depressive symptoms. Six GDS items, comprising a "Withdrawal/Apathy/[Lack of] Vigor" (WAV) dimension appear to be descriptive of disengagement and may lead to over-identification depression in older adults. The GDS, demographic and health measures, and an index of changes in activity and interest level developed for this study were mailed to 990 members of a large Health Maintenance Organization 65 years of age or older. Respondents returned 327 completed surveys and 163 "Decline" postcards after one mailing. Key findings include that GDS WAV contributed disproportionately to identification of depression. Endorsement rates for the items in WAV were among the scale's highest, whereas those of the 14-item Dysphoria factor were among the lowest, suggesting that WAV items are less likely to be "pathological." WAV's correlation with age was significant; Dysphoria's was not. In a multiple regression on the 28-item disengagement score WAV was the strongest predictor after controlling for age, health and Dysphoria. Approximately one third of the full sample and 60% of those aged 75 and over were identified as having at least moderate disengagement without depression. Disengagement is akin to "depletion of normal aging" and relates to changes in physical health and functioning. Since the six WAV items appear congruent with disengagement or Socio-Emotional Selectivity, particularly in later old age, interpretation of the GDS in clinical or research settings may be improved by considering subscale scores, weighting the items, or figuring in age and health status of the respondent.
    • Late-life suicidal behavior: Complexity, descriptors, level of risk

      Weinreich, Donna Meisel; Saltz, Constance Corley (1997)
      Suicide is disproportionately fatal for older persons compared to other cohorts. Presently, there is an epidemic among those, mostly men, who are 85 years and older, where the rate of suicide has reached an all-time high of 81.6/100,000 resident population ((for white men it is 85.9/100,000) NCHS 1996). The present research builds on previous work (Meisel (Weinreich) 1994) to identify older persons at risk, and incorporates Chaos and Complexity Theory in an effort to address the intractability of the suicidal act. This research sought to formulate a consensus among practitioners and observers who experienced the suicide of an older person. A Q-sort was developed and a Principle Components Analysis (PCA) performed. Confirmation of the existence of a consensus on the descriptors of the suicidal older person was determined. The PCA yielded a five component and a two-component solution. Both solutions met Kaiser's criteria of eigenvalues >1. However, the 5-component solution was not supported by a manual scree test. The 2-component solution was discussed. Component 1, mental health/emotional health, described older persons suffering with some form of emotional distress. Many subjects were clinically diagnosed with major depression or bi-polar disorder. Component 2, physical health, described older persons who, while mentally healthy, possessed mitigating physical ailments that seemed to make life less worth living. Three of the four constructs proposed in this research were supported, namely: subjective physical decline, subjective mental decline, and hopelessness. No support was found for the fourth construct: intolerance for the normal aging process. This research also yielded intriguing support for the possibility to differentiate between young (those under age 55) and old (those 55 and older) persons committing the suicidal act. Several Q-sorts were rejected for the present analysis because subjects were too young. None-the-less, these Q-sorts were loaded specifically to see if respondents describing younger persons would load distinctly differently. This in fact occurred. Although there were too few respondents to be definitive, the Q-sorts produced two additional components. It is believed that, had there been a larger representation of younger persons, strong, separate components may have emerged with distinctly different groupings of terms for younger persons committing suicide.
    • Phenomenology of relapse and lived experience among female opiate addicts

      McAlpine, Catherine Patricia; Saltz, Constance Corley (1995)
      Addiction to heroin and other opiates is a complex, multi-faceted problem that is considered to be resistant to treatment interventions. Addicts use greater quantities of drugs more frequently than social users and are more severely impaired as shown by related social, legal, and interpersonal problems. These individuals consume a disproportionate share of available treatment resources. Traditional approaches to treatment are not effective in maintaining sobriety among chronic addicts. Available information on substance abuse has focused on the experience of men. Little is known of women's experiences as addicts and how societal responses to female addicts differ from those of men. Data on prevalence, differences in progression and consequences of addiction by gender are limited. There is a need for greater intervention into the psychological, social and community systems of the addict's drug use and behavior patterns to promote post-treatment abstinence. The purpose of this study was to identify characteristics of women who are chronic opiate addicts and to explore psychological, social, and life experiences which inhibit abstinence and adaptation to recovery. Data were collected through a series of intensive interviews with four female opiate addicts. The potential for linking understanding of addiction recovery as a psychological process which incorporates predictable phases and transitions of identity with the prevention of relapse is explored. Theories of crisis, loss and grief focus on resolution of the experience as an essential and final phase of the transformation process. Promotion of full retirement from active addiction and acceptance of a sober lifestyle may be enhanced by such a theoretical model. Implications of the study address the potential for more effective and population-specific models of assessment, intervention, and treatment retention for high-risk, hard to reach populations of chronic addicts. The key factors appear to be a sufficient length of time to accomplish this transition and a belief in the ultimate success of such an effort.