[Instability of personality characteristics and personality disorders during the lifespan: effects for assessment in older adults]. / Temporele instabiliteit van persoonlijkheidskenmerken op oudere leeftijd. Een literatuuronderzoek met diagnostische implicaties.

The instability of personality characteristics and personality disorders during the lifespan is the topic of this literature search. It concerns the effects of this instability for personality assessment in older adults. Five longitudinal studies, based on the Big Five model of Costa & McCrae, support the hypothesis that personality characteristics change during the lifespan. Neuroticism, extraversion and openness decrease with age. In contrast, altruism and conscientiousness increase with age. One longitudinal and three cross-sectional studies of personality pathology indicate age-specific changes in the expression of (mal) adaptive personality characteristics. Besides that, nearly one third of the DSM criteria for Axis II personality disorders are insufficiently applicable to older people, based on a large cross sectional study. Therefore the temporal instability of personality characteristics and the limited validity of the Axis II criteria complicate personality assessment in older adults. Improvements could be found in major standardization studies of personality questionnaires in elderly patients in mental health care and nursing home care. Significant changes in the DSM, such as the development of an age specific and multidimensional approach to personality disorders is also recommended.

[Personality disorders in older adults: a Delphi-study conducted among Dutch and Belgian experts concerning specific diagnostic and therapeutic aspects]. / Persoonlijkheidsstoornissen bij ouderen: delphi-onderzoek onder Nederlandse en Vlaamse experts over specifieke diagnostische en therapeutische aspecten.

BACKGROUND: In psychiatry for older adults (> 60 years) personality disorders play an important part in diagnosis and treatment and in the advice given to health professionals and carers on how to deal with this age group. So far, however, research in this area has been inadequate. AIM: To investigate age-related diagnostic and therapeutic aspects of personality disorders occurring in adults over the age of 60. METHOD: A Delphi-study was conducted among 35 Dutch and Belgian experts in the field of personality disorders in older adults. This multidisciplinary panel consisted of psychiatrists, psychologists, psychotherapists, geriatricians and psychiatric nurses. In four rounds 21 gerontological statements to be assessed on a 5-point Likert scale were presented to the panel of experts. Agreement was said to be reached when at least two thirds of the experts agreed or fully agreed with a statement.RESULTS Satisfactory agreement was reached in the case of 20 of the 21 diagnostic and/or therapeutic statements about older adults with personality disorders. CONCLUSION There seem to be various age-specific aspects in the diagnosis and treatment of personality disorders in older adults. Therefore, it is advisable to pay more attention to this highly complex group of older adults when guidelines and protocols are being drawn up and scientific research is being planned or conducted.