[Therapy for elderly family members and couples: concerning the viability of relationships in later life, the role reversal and 'finishing' amicably]. / Familie- en paartherapie bij ouderen: over leefbaarheid, rolomkering en finishing well.

BACKGROUND: Research shows that in most countries the number of elderly persons is increasing and that close relationships in late life are playing a more important role. Therefore, it is surprising that there have been so few publications about family therapy for the elderly. AIM: To formulate some guidelines for psychotherapy for family members in their later years and to make suggestions regarding further research. METHOD: We summarise the existing literature and focus on important themes about working with the elderly, supplementing major issues with our own clinical experience. RESULTS: Family therapy with the elderly differs from therapy for younger adults in some respects; for instance, the emphasis in the case of the elderly is more on strengthening the viability of a long/standing relationship. The reversal of roles that often accompanies the ageing process and leads to increasing dependency is another factor that affects the elderly more than the younger adults. If the last stage of life is to finish calmly and amicably, therapists need to tackle any tensions or injustices that patients have experienced in the course of their relationships. CONCLUSION: Psychotherapy for the elderly needs to provide clients with constant opportunities for reflection and should initiate discussions about partners' experiences of tensions and injustices in their earlier relationship. However, the increasing number of elderly persons means that more empirical research needs to be done into systematic psychotherapy.

[Neurocognitive disorders in DSM-5: a critical review]. / Neurocognitieve stoornissen in de DSM-5: een kritische bespreking.

BACKGROUND: The APA published the DSM-5 in May, 2013. When compared to dsm-iv, the latest edition incorporates many changes, some relating to neurocognitive disorders. AIM: To review critically the new DSM-5 alterations and adjustments relating to neurocognitive disorders. METHOD: We compared the relevant chapters in DSM-IV-TR and DSM-5 and we searched the literature for articles involving discussions about cognitive disorders in DSM-5. RESULTS: With regard to differential diagnosis of neurocognitive disorders, DSM-5 has more in common with current clinical practice than does the DSM-IV. DSM-5 names ten etiological subtypes for which the diagnostic criteria are based on recent scientific research. However, some researchers and clinicians have reservations about using the term 'major neurocognitive disorder' instead of 'dementia', and are reluctant to make a distinction between 'mild' and 'major' cognitive disorders. CONCLUSION: The alterations and adjustments that appear in DSM-5 in relation to neurocognitive disorders may well mean progress for clinicians and researchers but they will inevitably require greater investment.

[The impact of attachment on behavioral and psychological symptoms in dementia]. / Gehechtheid als beïnvloedende factor van gedrags- en psychologische symptomen bij dementie.

Contemporary research has increasingly acknowledged the importance of attachment on stress-related processes in ageing. Congruent with this, there has been much research on attachment in older adults over the past three decades. In this article, the main findings of this research are summarized, with a focus on attachment and dementia. Results show that, in general, the number of attachment figures decreases in old age. Moreover, their identity changes as adult children, deceased loved ones and God become more prominent. With relation to the quality of attachment, anxiety in close relations appears to diminish as people age, while attachment avoidance remains relatively stable. Individuals with high levels of attachment security also report greater well-being and a more positive attitude towards ageing compared to persons with low levels of attachment security. Furthermore, individuals characterized by insecure attachment show more behavioral and psychological problems in dementia. Also, caregiver burden, depression, as well as the quality of care giving and future caregiver commitment differ depending on the quality of attachment of the caregiver. There is preliminary evidence for the efficacy of attachment-based interventions in dementia. Finally, there is a need for greater methodological uniformity and the use of measures that are validated for an older population.