Psychological status makes an important contribution to the overall balance between individual resilience and vulnerability, and thus to our wellbeing, throughout our lives. It can relate to many aspects of life including spiritual, emotional and cultural.
The psychological domain can be particularly influential upon our overall quality of life in older age, but it takes time, patience and understanding to identify and appreciate the impact, influence and interrelationships of the various factors within this domain.
The psychological domain includes specific conditions or states such as:
- Cognitive impairment
Sometimes these conditions might have been formally recognised or diagnosed in the older person concerned (for example dementia), but very often they can also be present without a formal diagnosis having yet been made.
The psychological domain also includes elements that tend to be described more in terms of symptoms rather than as conditions or states, such as:
- Difficulty sleeping;
- Short-term memory loss.
A further group within this domain covers a more descriptive and subjective set of issues, including such things as:
- Feelings of a loss of confidence or motivation;
- Feeling the loss of the ability to cope with daily life;
- Feeling under pressure;
- Feeling low;
- Feelings of emptiness or sadness.
These different factors can exist alone or combination for any individual older person, and can often be linked to each other. For example, a loss of motivation can be linked to depression, while anxiety, difficulty sleeping and a feeling of the loss of the ability to cope with things can all co-exist and be interrelated.
It is also easy to misinterpret or misunderstand the underlying issues in this domain. For example, somebody who is anxious or fearful might superficially appear to be angry or impatient, whilst somebody who is experiencing depression and / or low motivation might appear to be disinterested and uncooperative. Empathy, understanding and excellent communication skills are all needed in order to appropriately recognise and interpret the various elements and interactions within the psychological domain for each particular individual.
The psychological domain of frailty has close interactions and interrelationships with the other domains of frailty. Vulnerability within the psychological domain can have an adverse impact upon an older person’s functional status and increase their vulnerability in other domains, for example:
- A loss of motivation, or the presence of anxiety, can make somebody less likely to maintain social contacts;
- Cognitive impairment can have an adverse effect upon compliance with treatment for long-term conditions.