Diagnostics of the emotional state in the elderly. Methods for diagnosing the development of elderly and senile people. Cardiology diagnostics: who needs it and why

The article is devoted to the description of the program for optimizing the psychological health of the elderly.

The methods of working with the elderly, the thematic plan and blocks of the developmental program are determined. The results of approbation of the program are given. The role of the given methods of work in the formation of the components of psychological health is considered.

Keywords Keywords: old age, psychological health, life satisfaction, subjective well-being, values.

The relevance of the problem under study is due to a number of interrelated factors:

Firstly, the current socio-demographic state of Russia is such that society is aging, therefore right now it is necessary to overcome the stereotype of passive and unhappy old age, both in the whole society and in the minds of the elderly themselves. The way of life of the elderly, their values, experience and wisdom form an important basis of modern Russian culture. The process of social adaptation of older people in our country is characterized by: social instability, conflicts of normative ideas about the relationship between the individual and society, the growth of social risks and social tension, increased social stratification, and the crisis of social regulation mechanisms. All this makes it difficult for older people to adapt to their age-related changes, to the age of “social losses” (status, work, roles, etc.), to the social situation in the country as a whole. All of the above factors affect and often reduce the level of psychological health of older people.

Secondly, modern scientific literature does not sufficiently reflect the vision of an elderly person as the owner of psychological health, and not an object of social protection, methods, means, ways, directions, ways of optimizing the psychological health of an elderly person are not fully disclosed.

Thirdly, the ambiguity and inconsistency in the assessment of the resources of the representatives of the third age for the development of their psychological health is explained by the lack of mechanisms for unlocking and realizing the potential of the older generation, transferring the resources of older people into quality of life.

The term "mental health" is used in psychology synonymously with such concepts as: "self-actualization" of the personality (A. Maslow); mastering the meaning of one's own life (Sh. Buhler); the adequacy of life realities to existential needs (V. Frankl); the appearance of age-related neoplasms (L.S. Vygotsky) and the satisfaction of the basic needs of age (E. Erickson).

An analysis of the literature suggests that psychological health can be described as a system that includes axiological, instrumental, and need-motivational components.

With the help of theoretical analysis, we outlined a range of factors that affect the psychological health of a person of the “third age”: health status; the level of material well-being, the need for self-realization and the satisfaction of this need, achievement motivation, the need for communication; desire for self-actualization, positive self-esteem, internal locus of control.

As a result of the ascertaining experiment, a program for optimizing the psychological health of the elderly "Happy longevity" was developed and implemented.

Target group. The program is designed for senior citizens of retirement age from 56 to 70 years old.

The purpose of the program is to increase the level of satisfaction with the life of older people.

Tasks:
- to promote the formation of self-regulation skills;
- inform about the psychological characteristics of the elderly;
- increase self-esteem;
- reduce the level of anxiety;
- to train the technologies of psychological support;
- to help overcome communication barriers.

Expected results: participants will increase their level of satisfaction with life, as gain knowledge about the psychological characteristics of the elderly; increase self-esteem; get acquainted with new methods of self-regulation; increase the level of development of reflection; learn the technology of psychological support, which, ultimately, will lead to a decrease in anxiety.

Unfortunately, the pantry of modern psychotherapy is not rich in methods designed specifically for the elderly. The methods addressed to earlier ages, but adapted to the psychological characteristics of later ages, are more known and widespread. Currently, in Russian psychology, undeservedly little attention is paid to the development of methods for psychotherapy of the elderly.

When conducting developmental classes, it is important for the leader to consider the following points:
. brevity. The so-called "inputs" justified themselves in the trainings - capacious in content and concise in form, the leader's messages, not exceeding 10-15 minutes in time.
. Simplicity. Feedback from the training participants showed their high satisfaction with the fact that the complex material was presented in an accessible, expressive language.
. visibility. It is advisable to use drawings, diagrams, slides, etc.
. Relevance. The information material offered to the attention of the group should be directly or indirectly related to the topic being covered and enrich the picture as a whole, making more voluminous and thorough the knowledge and skills that the participants “take with them” from the training.
. Availability. All key points of the content blocks of the training should be printed out and given to each individual for further study.
. Metaphorical. Skillful incorporation of parables, metaphors, humor, various surprises into the message enlivens the process, makes it more exciting and memorable.
. existential factors. The author's experience shows that in the training groups of older people it is possible and necessary to touch upon existential issues in the information block, if the leader himself is sufficiently ready for this. People are constantly confronted with basic existential givens: death, loneliness, freedom, meaninglessness. Discussion of this topic helps to understand that support and care from other people and the leader has limits, that there are things that only the participants themselves can do, that each person is the author and master of his inner world, that is, responsible for his behavior. Only with the awareness of responsibility do any changes become possible, since only the creator himself can change anything.

The structure of each lesson includes:

I. Introductory part, which includes mandatory elements:
1. Greeting and warm-up, the goal is to equalize the functional state of the group, introduce participants into the training atmosphere, and raise the general tone of the group.
2. The rules of group work, which are introduced at the first lesson and updated at the next.
3. Reflection of the previous lesson.
4. Collection of participants' expectations, which allows you to clarify the tasks of each participant for the lesson.
5. Verbal and non-verbal expression of the mood of the participants.

II. The main part, in which the following blocks can be distinguished:
1. Informational (theoretical) block (mini-lectures, informing).
2. Developing block: the formation and consolidation of effective interaction skills, the development of reflection, enables participants to understand the psychological meaning of the skill being studied through the experience of their own experiences, provides opportunities for active self-knowledge.

III. The final part, which includes: reflection of the lesson, verbal and non-verbal expression of the mood of the participants, homework.

Table 1

Thematic lesson plan for the program "Happy Longevity"

The structure of the program includes the following blocks.

table 2
Blocks of the program "Happy Longevity"

The proposed classes were attended by 20 men and women working in the same organization - organizationally, this also did not present any difficulties. Before and after the developmental program, we carried out psychodiagnostic methods (method of subjective assessment of situational and personal anxiety by Ch.D. Spielberger and Yu.L. Khanin (anxiety test by Spielberger Khanin); diagnosis of affiliation motives (A. Mekhrabian); test of meaningful life orientations (SZhO) (DA. Leontiev), the method "Index of life satisfaction" (N.V. Panina), the method "The level of correlation of" value "and" accessibility "in various areas of life" (E.B. Fantalova).

Table 3
Assessment of the reliability of differences in situational and personal anxiety using the Spielberger-Khanin technique "Situational and Personal Anxiety Scale" of subjects in the control and experimental groups at the control stage

Analyzing the results of indicators of situational and personal anxiety according to the Spielberger-Khanin method at the ascertaining and control stages of the experiment, it can be noted that the indicators of anxiety (both situational and personal) decreased, statistical analysis using the Wilcoxon T-test reveals a shift at a significance level of 0.01. Those. with a probability of 99%, it can be assumed that the detected changes in anxiety indicators did not arise by chance, but are the result of purposeful changes that occurred in a developmental program with training elements.

According to the methodology "Index of life satisfaction" (N.V. Panina), we obtained the following results (shown in Figure 1):

Rice. 1. Average values ​​of satisfaction for the sample at the ascertaining and control stages of the experiment

The following changes occurred in the group: the indicators “consistency in achieving goals”, “consistency between the set and achieved goals”, (for these indicators, the shifts according to the Wilcoxon T-test are significant at the level of 0.01) “positive assessment of oneself and one’s results”, “ general mood background” (differences are significant at the level of 0.05). It should be noted that a shift at the level of 0.01 was also found in the overall satisfaction index.
The results obtained indicate that in the experimental group, as a result of the impact of a developmental program with elements of training aimed at reducing anxiety, increasing self-esteem, developing self-regulation skills (an emotional component of labor activity), the ability to self-realization (a semantic component of labor activity), there were significant changes that according to the figurative expression of L.I. Antsyferova can be called an increase in behavior of the "warm autumn" type in the activity of older people.

According to the method of SJO D.A. Lentiev (the results are presented in the histogram in Figure 2), carried out in the experimental group of the sample, there are significant shifts in indicators of meaningful life orientations: goals in life became more meaningful after participating in a developmental program for four people compared to the ascertaining stage of the experiment (according to Wilcoxon T = 2.682), there were also significant changes in the “Process Orientation” indicator: for two people, the results changed from low to average, six people moved from average to high (T = 2.913), which indicates an increasing role of process motivation (Disi, Ryan), a certain dedication to the cause.

There were also changes in the orientation to the result: two people had an increase in the level (from medium to high) (T=2.825). In the results on the scale "Locus of control - I" in two people the level increased from low to medium, in four people - from medium to high (T=2.506). This result testifies to the internal locus of control, the ability to take responsibility for the situation and results. According to the “locus of control - life” scale, the changes are as follows: in four people, the level changed from medium to high (T = 2.536), which indicates a meaningful and existential attitude to one's own life, recognition of the right to the integrity of life and oneself. In general, the meaningfulness of life increased in four people (T=2.833). These results indicate a more meaningful attitude to their own lives among the subjects of the experimental group after participating in the developmental program, about taking responsibility for the events taking place in it, about being process-oriented, about understanding their own values, about finding the meaning of life. It should be added that all shifts calculated using the Wilcoxon t-test are significant at the p level.<0,01, т.е изменения не случайны, а вызваны целенаправленным воздействием.

Rice. Fig. 2. Distribution of the subjects of the experimental group according to the levels of severity of the scales of the FLS D.A. Lentiev

The method “Diagnosis of affiliation motives (A. Mehrabian) (the results are presented in the histogram in Figure 3) shows that the subjects of the experimental group increased the level of affiliation motivation as a result of the training: the desire to be accepted increased in four people, and the fear of being rejected decreased in two people. The changes shown in the histogram in Figure 3 indicate positive changes associated with the development of communication skills and positive self-acceptance. And although the demonstrated shifts, according to statistical analysis, are insignificant, however, they reveal the above-mentioned trend. In order to significantly affect the indicators of affiliation motivation, more sessions are needed or, perhaps, the change in affiliation motivation has a latent course.

Rice. 3. Representation of affiliation motivation in the experimental group

The results of the EPQ questionnaire (method of G. Eysenck) and the “Tendency to loneliness” method (A.E. Lichko) showed that no changes were found on the scales of the questionnaire.

The methodology “The level of correlation between “value” and “accessibility” in various life spheres” (E.B. Fantalova) made it possible to analyze the discrepancies between the significance of values ​​for older men and women and their accessibility, we noted that in the group of subjects the ratio of subjects experiencing intrapersonal conflict and without intrapersonal conflict (the results are presented in table 4).

Table 4
The ratio of the subjects of the experimental group by the presence of intrapersonal conflict according to the results of the methodology of E.B. Fantalova at the ascertaining and control stages of the study

As you can see, although the changes are not statistically significant (intrapersonal conflict resolved in two women), they exist, which indicates the effectiveness of the developmental program "Happy Longevity". More significant differences in the experimental group can be obtained by continuing to conduct developmental sessions with the sample, because. the sphere of values ​​and motivational orientations requires a deeper and longer impact. These results indicate that the conducted sessions with elements of training contributed to the awareness of one's own values ​​and, possibly, the restructuring of the hierarchy of values, as well as the harmonious relationship between "desired" and "have", which ultimately leads to a general harmonization of the inner world of the subjects of the experimental group , especially in the areas of health, interesting work, active active life, material well-being.

Analyzing the results of the experiment, we come to the conclusion that the indicators have changed as follows: anxiety has decreased, positive self-esteem has increased, the level of desire for self-actualization has increased, the value sphere has become more harmonious, which led to an increase in the level of life satisfaction.

Literature

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3. Malkina-Pykh, I.G. Crises of old age. / I.G. Malkin-Pykh. - M.: Eksmo Publishing House, 2005. - 368 p.
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6. Terelyanskaya, I.V. Psychological analysis of the phenomenon of creativity as a personality characteristic / I.V. Terelyanskaya // World of science, culture, education. - 2012. - No. 4 (25). - Part 2. - S. 103-107.
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· Elderly and senile age is associated with chronic diseases what with lowers overall mental activity and negatively affects the intellectual-mnestic functions.

· Elderly people must understand, what is the survey about. Therefore important problem remains illiteracy or low education and sometimes just misunderstanding of the question which is common among the elderly.

· Often the questioning situation is perceived by older people as a formal exam or as a visit to the doctor. It is necessary that external stimuli, such as noise, interference of any kind, etc., did not distract their attention.

· Desirable, hold meetings with the elderly for the purpose of diagnosis in their their own houses, apartments, places where they live permanently. This will allow older people to fit harmoniously into the interview situation they will perceive it as a conversation about your life, without experiencing internal stress.

· Choosing a conversation topic important to leave for an elderly person showing respect for him. In addition, it is known that independent choice raises the level of self-esteem and overall satisfaction with life.

Often there are difficulties associated with the peculiarities of the behavioral strategies of older people in a situation of diagnosis. For example, they can be reserved and secretive. Sometimes older people choose to simply not give answers they are not sure about.

· The reluctance to respond and the degree of caution shown by the elderly, on the one hand, is a fact of a useful and adaptive self-protection strategy.

· Older people are often indecisive about how qualified they are to rate or comment on proposed questionnaire questions, such as the adequacy or quality of services in a nursing home or social center. On the other hand, dependence on caregivers or family members causes fear of "retaliation" for their possible expressions of dissatisfaction and complaints reflected in the answers.

· You can note the apprehension of older people when answering to say too much, despite the guarantee of anonymity of their responses. Therefore, older people have trend during polls demonstrate satisfaction to literally everyone. In some cases, when answering questions that affect the emotional side of the life of older people, affective, uncontrolled reactions are possible on their part.

· If a diagnostics held in nursing homes, some researchers suggest collect information from residents (residents) those who are not employees. In this case, the residents will feel free and speak frankly. They find it easier to talk to those who are not in charge of their day-to-day care or are not responsible for them.

· Another the reason for the reticence or concealment is the level of difficulty of the test or questionnaire. That's why start with easier tasks or questions and only then complicate them. If an elderly person fails and does not complete the tasks, it will be difficult for him to finish all the work. Failure in the beginning can be stressful for an older person. Often the reluctance to participate in the survey is masked by references to poor health (headache, high blood pressure, etc.).

The elderly often have sensory deficit, which entails two problems. First is that the diagnosis situation requires a good ability to see and hear, so older people should be encouraged to use glasses and hearing aids if necessary. Sometimes it follows in questionnaires and tests intended for older people, use a larger font than usual. Second The problem is that only very few tests are designed specifically for older people with visual and hearing impairments.

· To old people more time is needed to adapt to the interview or testing situation. Such adaptation is necessary in order for the person being interviewed to feel calm and at ease.

It is important to consider polling time. Many researchers believe that older people Several short surveys are better than one lengthy test. End any meeting with an older person on the note of his successful assistance and future cooperation.

· In addition, you should always remember about ethical issues when working with people of advanced age. For example, there are limitations in the study of decision-making processes in important circumstances of life: the choice of life or death; social stressful situations, etc.

The current socio-demographic trend towards an increase in the number of elderly people in the total population of the country gives rise to the need for systematic work of social services with this category of citizens.

The termination or restriction of labor activity for a retired person seriously changes his value priorities, lifestyle and communication, and often causes psychological problems that are specific to older people.

On the other hand, this is a very diverse category of the population, because older people differ both in character traits and in status and condition: they can be people who are single and live in families, with various chronic diseases and practically healthy, leading an active lifestyle and sedentary, interested in what is happening in the outside world and immersed in themselves.

For successful work with this category of the population, it is important for a social worker to be aware of not only the socio-economic situation, but also to have an idea about the characteristics of the character, the state of the person, in order to confidently build a support program in each case.

The complex of psychodiagnostic methods for social work opens up wide diagnostic possibilities for the subsequent organization of assistance to the elderly. One of the main diagnostic tools are complementary methods that determine the level of social isolation and frustration of the individual.

Social isolation is a forced long stay of a person in conditions of limited or even lack of social contacts. With social isolation, there is a loss of the meaning of life, which, in turn, can be the cause of personality degradation and inappropriate behavior. The high level of social frustration is due to the impossibility of meeting the needs in various spheres of relations in society. Accordingly, the identification of a critical level according to the two named parameters aims at work that helps to overcome the social stereotypes of old age, which orient a person to inactivity, break contacts and cause distress, and with it a decline in vitality.

No less significant are studies of the subjective well-being of older people in combination with the study of personality characteristics and manifestations of various conditions. The level of subjective well-being is influenced by two factors: internal, associated with personality traits, and external conditions: income, health problems, the presence or absence of work, relationships in society, leisure, living conditions, and more. As a rule, internal factors often have a greater influence on the feeling of subjective well-being than external ones, therefore it is important not only to determine the level of subjective well-being, but also to explore personality structures that can create negative attitudes and interfere with a meaningful attitude towards life. So with the help of the Cattell questionnaire, you can focus on data on the emotional and volitional manifestations of the personality, as well as on the features of interpersonal interaction. Among other significant factors, tendencies to depression, uncontrollable behavior, etc. can be identified.

No less important diagnostic data that help to make a complete personal analysis is obtained using methods that study the state and individual emotional manifestations (Luscher color test, SAN, Spielberger-Khanin anxiety scale, etc.)

In particular, when diagnosing the elderly, it is necessary to have an idea of ​​the manifestations of anxiety. Personal anxiety largely determines a person’s behavior and his tendency to perceive most situations as threatening, if, at the same time, strategies for overcoming stressful situations are not constructive, then there is a huge likelihood of emotional and neurotic breakdowns, as well as psychosomatic diseases.

Diagnostics of the mental and social status of elderly and senile people is most often carried out according to the following methods:

American experts R. Allen and S. Lindy have developed a very simple test to determine the probable life expectancy. In order to check your prospects, you need to add (or subtract from it) the corresponding number of years to the initial figures (70 for men, 78 for women), answering a series of questions.

2. Scale of self-esteem and anxiety assessment (C. Spielberger) - this technique will be discussed in more detail in the second chapter.

3. Affiliation Motivation Methodology (A. Megrabyan and M. Sh. Magomed-Eminov).

Method (test) A. Mekhrabian modified by M. Sh. Magomed-Eminov. Designed to diagnose two generalized stable motivators that are part of the structure of affiliation motivation - the desire for acceptance (SA) and the fear of rejection (SO). The test consists of two scales, respectively: SP and SO.

If the sum of points on the SP scale is greater than that on the SD scale, then the subject has a desire for affiliation, if the sum of points is less, then the subject has a “fear of rejection” motive. If the total scores on both scales are equal, it should be taken into account at what level (high or low) it manifests itself. If the levels of desire for acceptance and fear of rejection are high, this may indicate that the subject has internal discomfort, tension, since the fear of rejection prevents the satisfaction of the need to be in the company of other people.

1. Test "Egocentric associations"

Purpose: to determine the level of egocentric orientation of the personality of an elderly person. The test consists of 40 unfinished sentences.

The purpose of processing and analysis is to obtain an index of egocentrism, which can be used to judge the egocentric or non-egocentric orientation of the subject's personality. It makes sense to process the results when the subject has fully completed the task. Therefore, during the testing process, it is important to ensure that all proposals are completed. In the case when more than ten sentences are not completed, it is not advisable to process the test form. The index of egocentrism is determined by the number of sentences that contain the pronoun of the first person singular, possessive and proper pronouns derived from it (“I”, “me”, “my”, “mine”, “me”, etc.) . Also taken into account are continued, but not completed by the subject sentences containing pronouns, and sentences in which there is a first person singular verb.

2. Methodology "Tendency to loneliness"

This technique is a fragment of the test of A.E. Lichko She measures the tendency to loneliness.

The tendency to loneliness is understood as the desire to avoid communication and be outside the social communities of people.

The text of the questionnaire consists of 10 statements. The subject must mark on the answer sheet whether he agrees or not with this or that provision.

The greater the positive sum of points, the more expressed the desire for loneliness. With a negative sum of points, he does not have such a desire.

3. The study of wisdom (P. Baltes and others)

Paul Baltes demonstrated the limits of the reserve abilities of older people. In his study, older and younger people with a similar level of education were asked to memorize a long list of words, such as 30 nouns, arranged in a specific order.

In order to assess the amount of knowledge associated with wisdom, P. Baltes asked the participants in the experiment to resolve dilemmas like this one: “A fifteen-year-old girl wants to get married immediately. What should she do? Paul Baltes asked study participants to think the problem out loud. The thoughts of the subjects were recorded on a cassette, transcribed and evaluated on the basis of how much they contained the five main criteria for knowledge associated with wisdom: factual (real) knowledge, methodological knowledge, life contextualism, value relativism (relativity of values), as well as an element of doubt and methods resolution of uncertainty. The participants' responses were then ranked according to the amount and type of wisdom-related knowledge.

Determining problem areas with the help of psychodiagnostics is just the first step in building a strategy for helping the elderly. Even if the diagnostics gives an optimistic forecast and adaptive indicators: the maintenance of social contacts, a low level of frustration, optimism, and more, the social support system should include developmental methods to solve potential problem situations.

Conclusions to Chapter I

Thus, psychodiagnostics is not only a direction in practical psychodiagnostics, but also a theoretical discipline.

Psychodiagnostics in a practical sense can be defined as the establishment of a psychodiagnostic diagnosis - a description of the state of objects, which can be an individual, group or organization.

Psychodiagnostics is carried out on the basis of special methods. It can be an integral part of the experiment or act independently, as a research method or as a field of activity of a practical psychologist, while being directed to the examination, and not to the study.

Psychodiagnostics is understood in two ways:

In a broad sense, it approaches the psychodiagnostic dimension in general and can refer to any object that lends itself to psychodiagnostic analysis, acting as the identification and measurement of its properties;

In a narrow sense, more common - the measurement of individual - psychodiagnostic properties of a person.

In a psychodiagnostic examination, 3 main stages can be distinguished:

· Data collection.

· Data processing and interpretation.

· Making a decision - psychodiagnostic diagnosis and prognosis.

Psychodiagnostics as a science is defined as a field of psychology that develops methods for identifying and measuring the individual psychological characteristics of a person.

Currently, many psychodiagnostic methods have been created and are being used in practice.

The most general classification scheme for psychodiagnostic methods can be represented as the following scheme:

Rice. one. Classification of psychodiagnostic methods

The following methods of psychodiagnostics of elderly people are most often used:

1. Test "Life expectancy" (R. Alen. S. Lindy)

2. Scale of self-esteem and anxiety assessment (C. Spielberger)

3. Affiliation Motivation Methodology (A. Megrabyan and M.Sh. Magomed-Eminov).

4. Test "Egocentric associations"

5. Method "Tendency to loneliness"

6. The study of wisdom (P. Baltes and others)

INTRODUCTION

GENERAL VIEW OF PSYCHODIAGNOSIS

1 Concept and tasks of psychodiagnostics

2 The concept and tasks of psychodiagnostics

PSYCHODIAGNOSTICS OF THE ELDERLY PEOPLE

1 Work of a psychologist with the elderly in a social service center

2 Psychological status of an elderly person as a component of complex rehabilitation

CONCLUSION

LIST OF USED LITERATURE

INTRODUCTION

Relevance of the topic. In the population of not only our country, but throughout the world, the proportion of older people has been increasing over the past decades. This demographic process, characteristic of industrialized countries, has profound social and economic consequences. The socialization of a person in any society takes place in conditions that are characterized by the presence of numerous dangers that have a negative impact on the development of the individual. Therefore, objectively, part of the population becomes or may become a victim of unfavorable conditions of socialization.

In old age, the psychological characteristics of a person's personality are formed, which must be taken into account when developing and implementing individual rehabilitation programs. At this age, a rigid internal order of the personality structure is formed, and people react differently to their internal difficulties. Some older people, denying the existence of problems, suppress their desires that cause them discomfort and dismiss them as unrealistic and impossible. Adaptation in this case is achieved due to the position of the level of claims. The negative side is the denial of what requires effort. An older person can gradually become accustomed to this orientation, really give up the necessary and act as if the need did not exist.

From the point of view of humanistic psychology, the most important condition for self-realization (at any age), personal growth and mental health is a person's positive acceptance of himself, which is possible only with unconditional positive acceptance from significant others. Apparently, for older people, self-acceptance is associated with an unconditional positive acceptance of their life path (family, profession, leisure, life values, etc.). For the majority of the elderly, the possibilities of any serious changes in life are practically exhausted. But an elderly person can endlessly work on himself in an ideal way, internally. It is in this that he needs psychological help, his leading activity is the inner work to accept his life path. We must not forget that older people are "keepers of the fire", bearers of moral norms and values ​​of society. It is not for nothing that support and respect for the elderly prevailed in advanced cultures.

Psychological processes, although they are somewhat rigid in old age and are slightly slower than in adulthood, still provide the necessary level of vital activity. The mental capacity of older people is much higher than is commonly believed. In everyday terms, older people with favorable aging are able to find solutions to conflict and difficult life situations.

In order to find out the needs for psychological assistance and the availability of psychological resources in older people, various studies are being conducted.

Practical psychodiagnostics is a very complex and responsible area of ​​professional activity for psychologists. It requires appropriate education, professional skills and can affect the fate of people.

The development of the theme. This topic is not well developed in the works of domestic scientists and researchers. The study of the mechanisms of mental life in old age is just beginning in full, but already the first works show that this way will not only help to better understand the causes of deviations, but also help in their correction, accelerate and optimize the adaptation of older people to a new age period, as well as at least partially overcome those negative factors that are associated with a negative assessment of one's life path.

The purpose of the course work- Consider the psychodiagnostics of the elderly.

Based on the given goal, the following tasks:

to study the concept and tasks of psychodiagnostics;

consider methods of psychodiagnostics;

on the example of a geriatric center to reveal the psychological status of an elderly patient as a component of complex rehabilitation;

to analyze the work of a psychologist with the elderly in a social service center.

The object of the course work -general psychology

Subject -psychodiagnostics of the elderly.

When writing the term paper, authors' monographs, textbooks and teaching aids, materials from the periodicals "Psychology of maturity and aging", "Psychological issues", "Psychological journal", "Social service worker", Social service ", etc. were used.

Course work consists of introduction, two chapters, conclusion. At the end of the work is a list of used literature.

1. GENERAL VIEW OF PSYCHODIAGNOSIS

.1

The question of “who is who” is the first question that a psychologist asks himself when starting to work with a client. One of the areas of psychological science - psychodiagnostics - will help to understand and determine the unique personal characteristics of the client, his abilities, motives for actions.

The word "psychodiagnostics" literally means "making a psychological diagnosis", or making a qualified decision about the current state of a person as a whole or about any given psychological property.

The term under discussion is ambiguous, and in psychology, there are two understandings of it. One of the definitions of the concept of "psychodiagnostics" refers it to a special area of ​​psychological knowledge concerning the development and use in practice of various psychodiagnostic tools. Psychodiagnostics in this sense is a science in line with which the following general questions are posed:

.What is the nature of psychological phenomena and the fundamental possibility of their scientific evaluation?

.What are the current general scientific grounds for the fundamental cognizability and quantitative assessment of psychological phenomena?

.To what extent do currently used means of psychodiagnostics correspond to accepted general scientific, methodological requirements?

.What are the main methodological requirements for various means of psychodiagnostics?

.What are the grounds for the reliability of the results of practical psychodiagnostics, including the requirements for various conditions for conducting psychodiagnostics, means of processing the results obtained and methods of their interpretation?

.What are the main procedures for constructing and testing scientific methods of psychodiagnostics, including tests?

The second definition of the term "psychodiagnostics" indicates a specific field of activity of a psychologist associated with the practical formulation of a psychological diagnosis. Here, not so much theoretical as purely practical issues related to the organization and conduct of psychodiagnostics are solved. It includes:

.Definition of professional requirements for a psychologist as a psychodiagnostician.

.Establishing a list of knowledge, skills and abilities that he must possess in order to successfully cope with his work.

.Finding out the minimum practical conditions, the observance of which is a guarantee that the psychologist has really successfully and professionally mastered one or another method of psychodiagnostics.

.Development of programs, tools and methods for the practical training of a psychologist in the field of psychodiagnostics, as well as assessing his competence in this area.

Both sets of questions - theoretical and practical - are closely interconnected.

In practice, psychodiagnostics is used in a variety of areas of a psychologist's activity: both when he acts as an author or participant in applied psychological and pedagogical experiments, and when he is engaged in psychological counseling or psychological correction. But most often, at least in the work of a practical psychologist, psychodiagnostics appears as a separate, completely independent field of activity. ITS goal is to make a psychological diagnosis, i. assessment of the psychological state of a person.

Accurate psychodiagnostics in any psychological and pedagogical scientific experiment involves a qualified assessment of the degree of development of psychological properties.

A specialist engaged in psychological counseling, before giving any advice to a client, must make a correct diagnosis, assess the essence of the psychological problem that worries the client. At the same time, he relies on the results of individual conversations with the client and observation of him. If psychological counseling is not a one-time act, but a series of meetings and conversations between a psychologist and a client, helping him solve his problems and at the same time control the results of his work, then the additional task arises of implementing “input” and “output” psychodiagnostics, i.e. ascertaining the state of affairs at the beginning of the consultation and at the end of work with the client.

Even more urgent than in the process of counseling, psychodiagnostics is in practical psychocorrectional work. The fact is that in this case, not only the psychologist or the experimenter, but also the client himself should be convinced of the effectiveness of the psycho-correctional measures taken. The latter needs to have evidence that, as a result of the work carried out jointly with the psychologist, important positive changes have indeed taken place in his own psychology and behavior. This must be done not only in order to assure the client that he did not waste his time (and money, if the work is paid), but also in order to enhance the psycho-corrective effect of the impact.

Scientific and practical psychology solves a number of tasks typical of it. These include the following:

.Establishing the presence of a particular psychological property or behavior in a person.

.Determination of the degree of development of this property, its expression in certain quantitative and qualitative indicators.

.Description of the diagnosed psychological and behavioral characteristics of a person in cases where this is necessary.

.Comparison of the degree of development of the studied properties in different people.

All four of the listed tasks in practical psychodiagnostics are solved either individually or in a complex, depending on the objectives of the survey. Moreover, in almost all cases, with the exception of a qualitative description of the results, knowledge of the methods of quantitative analysis is required.

Practical psychodiagnostics is a very complex and responsible area of ​​professional activity for psychologists. It requires appropriate education and professional skills. The work of a psychologist-diagnostician should be based on the principle “Do no harm!”.

Thus, psychodiagnostics is a rather complex area of ​​professional activity of a psychologist, requiring special training. The totality of all the knowledge, skills and abilities that a diagnostic psychologist should have is so extensive, and the knowledge, skills and abilities themselves are so complex that psychodiagnostics is considered as a special specialization in the work of a professional psychologist.

1.2 The concept and tasks of psychodiagnostics

In psychology, there are many classifications of psychodiagnostic methods. The most famous of them can be cited as examples.

Classification S.L. Rubinstein (1945)

Main research methods:

.Direct observation (of a person), indirect (of the products of human activity), external (objective).

.Laboratory experiment (simulated); natural (during professional activity); auxiliary (questionnaire, conversation); for training.

Special research methods:

.Genetic (comparison between different age groups).

.Comparative (between norm and pathology).

Classification B.G. Ananyeva (1977)

Organizational Methods:

.Comparative method (comparison of differences within the same age).

.Longitudinal (comparison of differences in any one feature within a fairly large period of time).

.A complex method (the equality or subordination of individual personality traits is determined, the situation is predicted).

Empirical methods:

.Observational - methods of observation and self-observation.

.Experimental - laboratory, natural, teaching, field.

.Praximetric - analysis of activity and its products.

.Modeling (mathematical, cybernetic).

Tests.

.Biographical (analysis of facts and events of life).

Experimental data processing methods:

Quantitative.

quality

Interpretation methods:

.Genetic - determination of patterns of changes.

.Structural - the study of the relationship between personality traits.

Psychodiagnostic methods are divided into:

according to the form of the answer - on oral and written;

by the number of subjects - individual, group;

in terms of homogeneity (heterogeneity) of tasks - into homogeneous and heterogeneous;

by orientation - for speed, for power, for diagnosing interpersonal relationships;

by competence - for single and test batteries;

by appointment - for general diagnostic, professional suitability;

by the influence of the diagnostician on the results obtained - on objective and subjective.

Let us dwell in more detail on the last classification.

All existing methods can be divided into objective and subjective. In objective methods, the influence of the diagnostician on the results is minimal, and in subjective methods, the result directly depends on the experience and intuition of the psychologist.

Objective methods include:

Instrumental, psychophysiological, in which devices determine breathing, pulse, brain biocurrents.

Considering psychophysiological methods of diagnostics, it must be said that this direction arose in our country and has not yet fully entered the world practice of psychodiagnostics. The basis of these methods was the branch in psychophysiology, which studies the features of the course of mental processes in humans. These features are expressed in performance, noise immunity, switchability and other indicators of the course of mental processes.

This type of method differs from others in that it does not contain estimates, since it cannot be said that some properties of the nervous system are better and others are worse.

Apparatus behavioral, registering the speed of reaction, accuracy, coordination.

They are the most reliable. But due to their complexity and cumbersomeness, they are most often used in research work and to prove the accuracy of blank methods.

.Questionnaire tests in which the answer is selected from the proposed options, describing the individual abilities or preferences of the individual.

.Methods of self-assessment, in which the subject himself evaluates any objects (himself, his life in the past, in the future, acquaintances, the world around him).

Among the subjective methods are:

.Observation, survey. They allow you to get extensive information about a person, about interpersonal relationships in the family, at work. Despite their apparent simplicity, these diagnostic methods require special art.

.Analysis of the products of human activity (personal letters, essays, diaries, photographic documents, tools). One way to study such sources is content analysis (content analysis).

.Role-playing games. During the game, a person shows his personal qualities. This gives grounds for a diagnosis.

.Projective methods. They are distinguished from others by the non-standard procedure for conducting and interpreting. In order to work well with projective methods, a practicing psychologist, in addition to a high professional classification, needs to think creatively, have a special approach to each case, and intuition.

The most common method of psychodiagnostics today is tests. But before proceeding to its description, I would like to say a few words about the method of observation.

In appearance, behavior, a lot of what is happening inside him is manifested. Behind the barely noticeable movements of the hands, eyes, body, the psychologist-diagnostician must see the character, mood, aspiration of the subject. Clothing, manner of speaking, construction of phrases can also say a lot about a person. The task of the observer is precisely to see and generalize this much.

Tests are the most reliable method in psychodiagnostics. Test - a test, a test, a standardized study of various, primarily personal characteristics of a person, involving the performance of certain tasks by him.

According to the form of conducting tests are individual and group; oral and written; blank, hardware and computer; verbal and non-verbal. Any test consists of several parts. It includes instructions, a test book with tasks, stimulus material (if necessary), a form, a template for data processing.

The test results are compared with the norms, which, in turn, are determined empirically. The norm is considered the level of a statistically average person. The results, compared with the norms, are called low, medium or high.

The quality of the test is determined by such characteristics as reliability, validity, reliability.

Thus, psychodiagnostics is a section of psychological knowledge and psychological practice, which is being formed at the junction of fundamental branches of psychology with the practical demands of life.

In the most general sense, psychodiagnostics is the science and practice of making a psychological diagnosis, which means recognizing deviations from normal mental functioning and development, as well as determining the mental state of either a specific object (individual, family, small group), or a particular mental function or process for a particular person.

2. PSYCHODIAGNOSIS OF ELDERLY PEOPLE

.1 The work of a psychologist with the elderly in a social service center

In order for an elderly person to feel like a full-fledged member of society, it is necessary for him to participate in public life, maintain individual, family and other ties. It is believed that two areas are most important for a person: communication and daily activities. Unfortunately, many older people, for various reasons, are deprived of this. As a result, there is psychological discomfort, and a feeling of disorientation in the conditions of modern life. Therefore, to solve the psychological problems and age-related difficulties of the elderly, psychological services are organized in social service centers. The work of a psychologist today is mainly carried out with this category of citizens.

Awareness of a new life status on the eve of old age, understanding the meaning of one's new life, state, largely determines the structure of the emotional experiences of older people. This implies the tasks that a psychologist working with elderly and elderly people in a social service center should solve:

increase in the general background of mood;

increased self-esteem;

the formation of a positive image of old age as a time for inner peace, development, awareness of the importance of the life lived;

discussion of all the good things that are available in the current life situation.

The help of a psychologist involves both individual and group work.

The psychologist, in the course of individual counseling for older people who seek help from the center, reveals to them the concept of life satisfaction in old age, the conditions for achieving it, as well as the conventionality of the concept of “happy old age”; he explains to the elderly man that there is another concept - "successful aging". It involves a constant effort to cope with the loss or lack of manifestations of many aspects of life inherent in the aging process. The psychologist encourages constant and reasonable activity, adequate physical and mental exercises, which provide an elderly person with the necessary skills to deal with ailments, contribute to solving the main tasks of age-related development and are accompanied by an experience of satisfaction with life at this age.

There are cases when an elderly person needs psychological help, but he does not dare to come to a psychologist due to some internal reasons, barriers. He feels much more confident at home. In this case, the effectiveness of psychological counseling at home will be much higher.

The procedure of age-related psychological counseling is built taking into account the characteristics of the client's personality and his strategy for adapting to age-related changes. In order to take into account all the features, a testing procedure is necessary. Another problem may arise here. During the practice of working with the elderly, it turned out that people over 65-68 years of age have certain difficulties. This includes increased psychological fatigue, slowness of perception, reaction and thinking, and weak motivation for activity. All this affects the test data. Changes are also noticeable in the emotional sphere: focus on one's own interests, suspicion, as a result of which the results are not always reliable. Therefore, this method of diagnosing personality is extremely rare. From experience, it became clear that it is much more effective to use a psychodiagnostic conversation with older people. The main thing is to direct it very delicately in the right direction, and we can learn a lot about a person.

A feature of working with the elderly is the principle of activation and reactivation of the client's resources, as unclaimed functions fade away. In this case, the psychologist of the center emotionally influences his clients, saying that every person, despite seeming weakness, has a huge potential, and he is able to solve his problems even, even in hopeless situations. In this case, certain techniques of psychotherapy also help.

The main type of psychotherapy for older people is communication with them. This method of work is universal and is used in almost all cases of contact with customers. Any elderly person needs an interlocutor, he is waiting for sympathy, kind words, encouragement, attention and a desire to listen to him. Therefore, you must always find time for communication, inspire hope and faith, the desire for life.

Psychotherapy can be rational, using the method of persuasion. In this case, the work of the psychologist of the center is reduced to conversations with sick and elderly people, during which the cause of the disease and the nature of the existing disorders are explained. The psychologist urges the elderly person to change their attitude to exciting events in the environment, to stop fixing their attention on the existing psychological symptoms. The advantage of this method lies in the fact that the elderly person actively participates in a process that strengthens his intellect, opens up the opportunity to change his views and attitudes. As practice has shown, this method is quite effective in working with elderly people who have recently retired, that is, between the ages of 55 and 65 years.

Another, no less effective technique in the practice of a psychodiagnostic can be working with memories. For people who have entered the period of aging, this method is the most effective way of individual motivation of life activity and the formation of a tolerant attitude towards aging and the inevitability of death. This method is also universal and suitable for working with completely different older people. It can be quite active clients, as well as bedridden patients. This technique has an undoubted communicative, diagnostic and corrective value and is aimed at enabling a person to realize how his past has determined his present and continues to influence him.

In working with memories, as work with older people shows, it is very important to return, and repeatedly, to positive memories of events in which strong integrity of personality, self-esteem and psychological health appeared.

One of the biggest problems of older people is the loss of meaning in life. The result is depression, aggressive attitude and other behavioral deviations. In this case, logotherapy is used. This technique does not suggest or “prescribe” meanings. It is important to make it clear to the client that it is not a person who raises a question about the meaning of life - life itself raises a question for him, and a person has to constantly answer it, not with words, but with actions.

The training work with the elderly has a very positive effect.

It's no secret that many people still have a very vague idea of ​​what exactly a psychologist does. People do not always know what a psychological problem is and in what cases the help of a professional is simply necessary. But even when a person has a certain idea of ​​the need for psychological assistance, there are many subjective factors that block the need to turn to a psychologist. In order for psychological service to be in demand, it is necessary that people, including the elderly, know not only about its existence, but also about the very essence of the services that it provides. Without dissemination of this knowledge, its effectiveness will decline.

Thus, the task of a psychologist in working with older people is not to perceive them in isolation, outside their life path, but on the contrary, to understand that their current state is a reflection of a multifaceted, multilayered and phased, ongoing process of personality formation. The most important thing is that every elderly person is a person and, as a person, has a value in itself. It is important to convey this to an elderly person so that he understands that the intrinsic value of a person must be fully preserved and he has a chance to regain the lost harmony, and at a higher level.

2.2 The psychological status of an elderly person as a component of complex rehabilitation

The formation of sufficient mental flexibility in the elderly on the basis of an assessment of the psychological status allows you to correctly understand yourself and others, and contributes to adaptation to change. Of particular importance is the mechanism of compensation, primarily compensation for their losses - strength, health, status, support groups. At the same time, rigidity and switching difficulties, which increase at this age, prevent the development of normal compensation. The obstacle is the narrowing of the circle of contacts, the workload of other family members, others, which also does not allow the full implementation of this mechanism. In this case, the dominance of any one of these mechanisms is implied, which begins to manifest itself in all situations, even those that are inadequate for it. So, there is a reluctance to make new contacts, even a fear of them, a desire to isolate oneself from everyone, including close people, emotional coldness, sometimes hostility towards them. This is connected with resentment, conflict, the desire to insist on one's own both in small and in big things. Alienation, withdrawal and aggression, often already manifested as destructiveness (for example, participation in rallies, demonstrations), are an important indicator of emotional and personal instability, which led to fixation on one of the unproductive mechanisms of mental functioning.

In this course work, psychodiagnostics of elderly patients of the gerontological center "Uyut" will be considered.

To study the psychological defenses of elderly patients of the geriatric center, the Plutchik-Kellerman-Conte questionnaire "Life Style Index" (Life Style Index, LSI) was chosen.

psychodiagnostics elderly rehabilitation social

Table 1 - Characteristics of psychological defenses of elderly patients

Psychological defenses% Projection 42.18 Denial 26.64 Rationalization 17.76 Overcompensation 13.32 Substitution 4.44 Repression 4.44 Regression 2.22 Compensation 2.22

From Table 1 it follows that the largest number of examined patients have a leading psychological defense according to the projection principle (42.18%). Its essence lies in the fact that a person alienates unacceptable feelings, desires, and even some aspects of the personality from himself and ascribes to someone else. Projection is the tendency of a person to attribute responsibility to the environment for what originates in himself. People resort to projection when they encounter an inability to accept some of their needs and feelings, and therefore attribute them to objects in the world around them. A person establishes certain relations with the world, characterized by increased tension (anger, irritation, fear, interest, admiration, etc.).

In old age, projection often manifests itself as an attribution to others of negative emotions or character traits that cannot be recognized in oneself, that is, a person, a person who himself has pathological character traits (for example, irritability and resentment), notices them in others.

A projection can be regarded as pathological only if it becomes systematic, if it manifests itself as a constant and stereotyped defense mechanism and occurs independently of the actual behavior of other people at a given moment in time. However, a healthy projection is necessary: ​​it is she who will help to establish contact and understand the other person. To imagine what another feels is possible only by standing in his place. Projects for the future are projections of one's own fantasies.

Denial (it is resorted to by 26.64% of those participating in the study) is a form of psychological defense that is characterized by a refusal to be aware of certain events, experiences and sensations that would be painful if they were realized, often by fleeing into dreams, fantasies. Often such a mechanism occurs in relation to some chronic or "terrible" diseases. It is easier and less painful to convince yourself that you are not sick than to accept the fact of having a disease and make efforts to treat it, to worry, to be afraid of not recovering. In this regard, older people do not pay enough attention to the recommendations of doctors.

The mechanisms of rationalization, hypercompensation and substitution prevail much less frequently. Rationalization (predominant in 17.76% of the surveyed) is a form of psychological defense, characterized by a rational explanation by a person of his desires and actions, which in reality are due to irrational drives that are socially or personally unacceptable. An example of rationalization can be an exaggeration of existing values ​​in order to discredit an unattainable desire - "a bird in the hand is better than a crane in the sky." At the early stages of personality development, rationalization is an effective defense mechanism, but in an elderly person, excessively active use of this mechanism can lead to inadequate control of behavior, to a lack of a correct understanding of oneself in the world.

Hypercompensation is designated by A. Adler as a special compensation, the implementation of which not only gets rid of the feeling of inferiority, but also achieves some result that allows you to take a dominant position in relation to others, that is, if it is impossible, for example, to independently perform hard work on home, but with the preservation of fine motor skills, some pensioners begin to engage in some kind of needlework, reaching a high level of skill. Thus, 13.32 of the surveyed have predominantly this protection.

The remaining psychological defenses - substitution, repression, regression and compensation - are the least common among older people.

To study the leading strategy for exiting the conflict, the methodology "Strategy for exiting the conflict" is used.

Table 2 - Characteristic "Conflict exit strategy" in patients of the geriatric center

Strategy%Compromise28.86Avoidance28.86Accommodation13.32Rivalry11.1Cooperation4.44

Of all the examined patients, 28.9% each chose the strategy of "compromise" and the strategy of "avoidance" as the leading strategy for behavior in conflict. A compromise strategy of behavior is characterized by a balance of interests of the conflicting parties at the middle level. Otherwise, it can be called a strategy of mutual concession. It not only does not spoil interpersonal relationships, but also contributes to their positive development. Compromise can exhaust the conflict situation when the circumstances that cause tension change.

The exit strategy (avoidance) is characterized by the desire to get away from the conflict. It is characterized by a low level of focus on personal interests and the interests of the opponent and is mutual. In fact, it is a mutual concession. The strategy is applicable when the conflict is not significant for any of the subjects and is adequately reflected in the images of the conflict situation, or when the subject of the dispute is significant for none of the subjects and is adequately reflected in the images of the conflict situation, or when the subject of the dispute is essential for one or both sides, but the subjects of conflict interaction perceive the subject of the conflict as insignificant. Interpersonal relationships do not undergo major changes when choosing this strategy.

Both of these strategies do not lead to conflict resolution and are productive only in certain situations. However, this study shows that the majority of respondents (57%) choose these two strategies as the most typical strategies of behavior in conflict situations.

Both types of response in a conflict are quite “economical” in terms of emotional “costs”. Their predominance can be explained by the high value of established social ties in old age and the weakening of the emotional-volitional component of the personality - there is not always enough willpower to achieve the desired goal, so older people resort to strategies that are the least painful and lead to the fastest way out of the conflict.

Adaptation as a way to resolve the conflict is preferred by 13.32%. A person who adheres to this strategy also seeks to get away from the conflict. But the reasons for "leaving" in this case are different. The focus on personal interests is low here, and the assessment of the opponent's interests is high, that is, the person who adopts the concession strategy sacrifices personal interests in favor of the interests of the opponent. In this strategy, priority is given to interpersonal relationships.

Sometimes such a strategy reflects the tactics of a decisive struggle for victory. A concession here may turn out to be only a tactical step towards achieving the main strategic goal. A concession can cause an inadequate assessment of the subject of the conflict (understatement of its value for oneself). In this case, the adopted strategy is self-deception and does not lead to conflict resolution. This strategy is typical for a conformist personality.

A detailed analysis of the data for each elderly person showed that the avoidance strategy is typical for those who are dominated by "repression" and "denial". The majority of the surveyed - 61.52% with this leading strategy have a pronounced mechanism of "crowding out"; 30.79% - "denial" and 7.69% - regression. Compromise as a way of conflict behavior is typical for people with the psychological defense of "rationalization", in 90% of the surveyed leading is this psychological defense.

Another component of psychodiagnostics is the level of hope. Hope is considered as a disposition of a person, that is, as a readiness to assess the possible, arising when a person expects some important and hard-to-reach good, as well as a readiness for a consistent behavioral act in order to achieve this good.

When analyzing the choice of a strategy of behavior in a conflict and the level of hope, there is also a connection - older people who are inclined to achieve what they want most often resort to the strategies of "compromise" (47.74%) and rivalry (21.7%). With the "avoidance" strategy and with the "accommodation" strategy 13.02% each, with the "cooperation" strategy 4.34%. Those who are equally prone to planning and achieving their goals more often choose the adaptation strategy - 47.87%, compromise - 28.58%, cooperation and avoidance by 14.29%. Rivalry is not the leading strategy of behavior in conflict for any of those who plan and achieve their goals to the same extent.

Thus, from the obtained diagnostic data, the following conclusions can be drawn:

the leading strategies of behavior in a conflict situation for older people are the strategies of "avoidance" and "compromise";

the most pronounced among the majority of respondents are the destructive psychological defenses “projection” and “denial”;

constructive psychological defenses (“rationalization”, “compensation”, “hypercompensation”) are present only in 38%;

Elderly people, who prefer not only to plan, but also to achieve their goals, choose the “compromise” strategy as the main strategy for responding to a conflict;

older people, equally prone to planning and achieving goals more often, choose the “adaptation” strategy (47.87%)

To conduct a more complete and detailed analysis of the situation and to identify the links between the strategy of behavior in a conflict and the leading psychological defense, additional diagnostic data and observations are required. However, already from the data obtained, it can be concluded that the majority of older people have insufficiently developed compensatory mechanisms, and therefore they are prone to depression, unmotivated aggression, illness, and low social activity. For a normal aging process, first of all, an adequate and complete type of compensation should dominate, that is, this mechanism should function in such a way that the elderly person does not go into imaginary compensation (usually into his illness).

From this point of view, the importance of learning new activities, the development of creativity, the emergence of a new hobby and any form of creativity becomes clear, so with their help, full compensation develops.

CONCLUSION

Thus, as a certain system of applied knowledge, psychodiagnostics allows a practicing psychologist to improve his work with older people, to effectively solve his professional problems.

Psychodiagnostics can be used and is used in various areas of social practice in the course of counseling and psychotherapeutic assistance, to predict the psychological consequences of a change in a person's environment, in the implementation of various types of social work, etc. In each of the areas of social practice where psychodiagnostics is carried out, there are specific conditions for the use of psychodiagnostic means, specific psychodiagnostic tasks are set, specific methods are used that are the subject of private or special psychodiagnostics. However, the foundation of any special psychodiagnostics forms solutions to more general, in its own way, universal questions that are the subject of general psychodiagnostics.

These issues include the identification of methodological, theoretical and specific methodological principles for constructing psychodiagnostic tools and principles for formulating psychodiagnostic conclusions; development of methods and specific techniques for psychodiagnostics of the most universal objects, such as personality traits, abilities, motives, consciousness and self-awareness, interpersonal relationships; problem resolution.

One of the most important methodological principles on which psychodiagnostics is built and which distinguishes it from scientific research is as follows. The psychologist-researcher is focused on the search for not yet established, "unknown patterns" and uses for them "known subjects" that are still predetermined by some sign, deliberately neglecting their individual differences and empirical integrity. For a psychodiagnostic, on the contrary, it is these individual differences and empirical integrity that are objects of interest and identification; in the process of psychodiagnostics, he is focused on searching for already established, “known patterns” in “unknown subjects”.

The main requirements for psychodiagnostic tools, for the techniques and methods used for psychodiagnostics can be formulated as follows: the methods used should allow collecting diagnostic information in a relatively short time compared to the process of its “natural” receipt; this information should be purposeful and reflect as fully as possible the well-defined properties of the diagnosed object (an elderly person), one or another of its features; information should be presented in a way that allows a clear and unambiguous quantitative and qualitative comparison of the individual with other similar objects. Psychodiagnostic information should be useful in terms of both building a development prognosis, the dynamics of a state or situation, and choosing the means of intervention and correction.

Practical psychodiagnostics also involves taking into account the motivation of the subject and knowing how to maintain it; the psychodiagnostician must be able to assess the state of the individual at the time of psychodiagnostics, must have the skills to communicate information to the individual being examined.

In the context of social work, psychodiagnostics is used to identify the psychological characteristics and conditions of social service clients. At the same time, psychodiagnostics is aimed at allowing intervention in the client's social situation in the most useful way for him, taking into account the results of psychodiagnostics.

Psychodiagnostics as a process includes certain steels. At the first stage, he analyzes and, as a rule, reformulates the request received by him. The psychologist, as it were, makes a kind of translation of the problem declared by the client from the language of everyday, everyday ideas into his own special professional language and makes a psychological diagnosis.

At the second stage, the psychologist formulates the goals and objectives of psychodiagnostics, evaluates and selects methods, techniques, conditions and means of influencing an elderly person, and if necessary and possible, then the social situation.

At the third stage, the psychologist carries out the intended impact, which can take place in various forms: conversation, consultation, game, training, etc.

In this course work, the objects of psychodiagnostics were the elderly.

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In the very elderly, especially the very old and infirm, the history and physical examination may be done in multiple sessions, as they get tired quickly.

The elderly have more complex health problems, multiple diseases that may require the use of several drugs at the same time (polytherapy or polypharmacy). Diagnosis and the diagnosis itself can be very difficult for various reasons, and this leads to erroneous or incorrect prescription of medications. Timely detection and correction of the causes of the error can prevent further deterioration and improve the quality of life, sometimes by applying the most simple and inexpensive measures, such as lifestyle changes. Thus, frail or chronically ill elderly patients are best assessed using a specific geriatric scale that includes a comprehensive multidisciplinary assessment of function and quality of life.

Multiple disorders

Older people, as a rule, have at least six simultaneously occurring diseases (polymorbidity, comorbidity, polypathy), but not always diagnosed and treated. Disorders of the functions of one organ or system entail disorders of interconnected organs or systems, as a rule, worsening the general condition, deepening the degree of functional limitation. The multiplicity of disorders makes it difficult to diagnose and prescribe adequate treatment, the negative consequences of which can be exacerbated by social factors, such as isolation and poverty, as by old age, as a rule, the functional and financial resources and support of relatives and peers come to an end.

Therefore, the physician should pay attention to symptoms common in geriatrics resulting from disorders of several systems and organs, such as confusion, dizziness, fainting, falls, mobility problems, loss of weight or appetite, urinary incontinence, etc.

If patients have multiple disorders at the same time, then complex treatment (eg, bed rest, surgery, medications) should be well thought out and integrated; treatment of a single disease without treatment of comorbidities may precipitate a poor outcome. Particular attention should be paid to careful monitoring of the condition, so as not to miss iatrogenic disorders - frequent consequences of interventions of various kinds in the elderly. With complete bed rest, elderly patients can lose 5 to 6% of muscle mass (sarcopenia), strength is lost daily, and death can be a consequence of maintaining only bed rest.

Missed or delayed diagnosis

Diseases that are not diagnosed in a timely manner, but are very common among the elderly, adversely affect the life prognosis, so the doctor must use all traditional examination methods - history taking, physical examination and simple laboratory tests to clarify the diagnosis. It is known that timely diagnosis facilitates treatment and improves prognosis. The success of early diagnosis often depends on the doctor's ability to establish friendly communication with the patient, understanding his mental state, behavior and history of life. In the elderly, mental or emotional disturbances are often the first signs of a physical disorder. If the doctor does not take this pattern into account, then he may mistake the onset of somatic suffering for a manifestation of dementia, which will lead to a belated or erroneous diagnosis and ineffective treatment.

Polypharmacology

Patients taking both prescription and over-the-counter drugs should be carefully monitored, especially when the patient is receiving treatment with drugs that are not specifically designed for the elderly. The simultaneous use of several drugs requires constant monitoring, preferably with the help of computer systems.

Problems related to guardianship

Sometimes the problems of older patients are due to neglect or abuse by the caregiver. Physicians should consider the potential for abuse of an exhausted patient, incl. abuse of various drugs by an aggressive caregiver. In particular, the nature of some damage may indicate this, for example:

• multiple bruises, especially in hard-to-reach places (for example, in the middle of the back);
• grip bruising on the forearms;
• bruises on the genitals;
• peculiar abrasions;
• unexpected fear of his caregiver.

Disease history

Interviewing and assessing elderly patients often takes much longer, in part because these patients often have their own subjective opinion about their health status, which makes it difficult to objectively assess.

• Sensory deficiency. Partial or complete loss of some functions seriously complicates contact - dentures, glasses or a hearing aid must be used by the patient during a conversation. Adequate lighting is necessary for better contact.
• Unmentioned symptoms. Older people may not mention symptoms that they consider part of normal aging (eg, shortness of breath, hearing or vision deficits, memory problems, urinary incontinence, gait disturbance, constipation, dizziness, falls). However, an attentive physician should not attribute any symptomatology to the processes of natural aging until all other causes of their occurrence are excluded.
• Unusual manifestations of disorders. In the elderly, typical manifestations of any disease may be absent. Instead, older patients may report general symptoms (eg, fatigue, confusion, weight loss).
• Aggravation of functional disorder as the only manifestation of the disease. In such cases, standard questioning may not help. For example, when asked about joint symptoms, patients with severe arthritis may not report pain, swelling, or stiffness, but if asked about changes in their activities, they may report that they no longer walk or volunteer at the hospital. Questions about the duration of functional decline (eg, "How long were you unable to shop?") can provide useful information. Finding out when a person began to struggle to perform basic daily activities (ADLs) or effective ADLs (lADLs) can provide more information, adjust treatment, and thereby promote faster recovery of lost function.
• Difficulties in describing your illness. Often, patients forget and hardly remember the features of their disease, the dates and terms of hospitalizations, and the names of drugs. This information can be obtained from family members, a social worker, or medical records.
• Fear. Fear of hospitalization, which older people may associate with death, so they do not report their feelings.
• Age-related diseases and problems. Depression (more common in the very elderly), cumulative loss in old age, and discomfort due to functional disorders can cause older people to be less frank in talking to their doctor about their health. It is generally problematic to obtain any information on self-assessment of health in patients with impaired consciousness.

All information received should be recorded in the medical history.

Interview

The clinician's knowledge of the elderly patient's day-to-day concerns, social circumstances, mental functions, emotional state, and sense of well-being helps guide and guide conversation. Asking patients to describe a typical day reveals information about their quality of life, mental and physiological functions. This approach is especially helpful during the first meeting. Patients should be given time to talk about things of personal importance to them. Doctors should also ask if patients have specific concerns, such as fear of worsening their lives. As a result, rapport can help the doctor communicate better with patients and their families.

An examination of the mental state must be carried out at the beginning of the conversation in order to determine its adequacy and volitional reserve; this examination should be carried out tactfully and in such a way that the patient does not become embarrassed, offended and does not become defensive.

Often, verbal and non-verbal cues become key (eg, how the patient tells the story, rate of speech, tone of voice, eye contact) can provide information on the following:

• Depression - Elderly patients may miss or deny symptoms of anxiety and depression, but give them away by lowering their voice through muted enthusiasm and even tears.
• Physical and Mental Health - What patients say about sleep and appetite can be revealing.
• Weight gain or loss - the doctor should pay attention to any changes related to the way the patient fits clothing or prostheses.

If the mental state has deteriorated, then the patient should be spoken to in private to encourage discussion of personal issues. Clinicians also need to speak with a relative or caregiver in the patient's absence, presence, or both. Such people often give different perspectives on function, mental and emotional state.
The physician must ask the patient's permission before inviting a relative or guardian to attend the interview and must explain that such interviews are a common occurrence. When talking only to the caregiver, the patient should be engaged in some useful activity (eg, completing a standardized assessment questionnaire, answering questions from another member of the interdisciplinary team, etc.).

If there is any suspicion or doubt, the clinician should carefully investigate patient drug abuse and caregiver abuse.

Disease history

History taking should ask about disorders that were once more common (eg, rheumatic fever, polio) and outdated treatments (eg, pneumothorax for cavernous tuberculosis, mercury for syphilis). History of immunization (eg, tetanus, influenza, pneumococcal infection), adverse reactions to immunization, skin test results for tuberculosis (Mantoux test). If patients remember that they had operations, but do not remember which ones, then an extract from the medical history should be requested.

Questioning and examination should be systematized according to the accepted traditional scheme, helping to identify even those disorders that patients may have forgotten to mention.

Drug use

Previously used drugs should be included in the list, copies of which should be given to the patient, relative or guardian. The list should contain:

• the name of the drug used;
• dosage;
• medication schedule;
• identification of the doctor who prescribed the drug;
  reasons for issuing prescriptions for drugs;
• the exact nature of any drug allergies.

All medications prescribed to the patient should be clearly listed: essential prescription drugs (which must be taken systematically), over-the-counter drugs (the use of which may have side effects due to possible interactions with the main drugs, especially if taken uncontrolled), nutritional supplements and herbal infusions. (many of these can interact with prescription and over-the-counter drugs).

Patients or family members should be asked to bring all of the above medicines and nutritional supplements to the first visit and periodically thereafter. Thus, the doctor can be sure that patients are taking all prescribed medications, but this is not proof that the patient is correctly following the recommendations for taking them. It is necessary to count the number of tablets in each package at each visit to the patient. If someone else, and not the patient himself, controls the intake of drugs, then a conversation with this person is necessary.

The patient should be asked to demonstrate their ability to read labels (often printed in small print), open packages (inaccessible to children) and recognize drugs. Patients should be warned not to place their drugs in the same container.

Alcohol, tobacco and stimulants

Tobacco smokers should be advised to stop smoking, and if they continue to smoke, advised not to smoke in bed because older people tend to fall asleep while smoking.

Patients should be screened for signs of alcohol use, a disorder well diagnosed in old age. Such signs include: confusion at the doctor's appointment, anger, hostility, alcohol breath odor, balance and gait disturbance, tremors, peripheral neuropathy, and malnutrition. A screening questionnaire (such as the CAGE questionnaire) and questions about the amount and frequency of alcohol consumption may help.
Questions about the use and abuse of other stimulant drugs and substances are also pertinent.

Food

The nature, quantity and frequency of food intake are determined. Patients who eat two or less meals a day are at risk of malnutrition. The clinician should ask about the following:

• whether special diets were used (eg, low-salt, low-carbohydrate) or the patient chooses the nature of the diet;
• whether dietary fiber and prescribed or over-the-counter vitamins are consumed;
• whether there is weight loss and changes in clothing size;
• how much money patients have to spend on food;
• accessibility of grocery stores and convenience of kitchen arrangement;
• variety and freshness of products.

Assess the person's ability to eat (eg, ability to chew, chew, and swallow). Often the cause of the latter is xerostomia, which is very common in the elderly. Decreased taste or smell can reduce the enjoyment of eating and also cause malnutrition. Patients with impaired vision, arthritis, limited mobility, or tremors may injure or burn themselves when attempting to cook food. If the patient has urinary incontinence, he can reduce the amount of fluid intake.

mental health

Mental status disorders in older patients are not always easy to detect. Those symptoms that may indicate a mental disorder in younger people (insomnia, changes in sleep patterns, constipation, cognitive dysfunction, anorexia, weight loss, fatigue, preoccupation with bodily functions, increased alcohol consumption) may have a very different course in old age. Sadness, hopelessness, bouts of crying may indicate depression. Irritability may be the primary affective symptom of depression or cognitive dysfunction. Generalized anxiety is the most common psychiatric disorder in older patients and is often accompanied by depression.

Patients should be asked in detail about their delusions and hallucinations (including ongoing psychotherapy, electroshock therapy, etc.), use of psychoactive drugs, and recent changes in lifestyle. Many situations - the recent loss of a loved one, deterioration in hearing and vision, change of residence, loss of independence, etc. - can easily provoke depression.

It is imperative to clarify a person's life position, his spiritual and religious preferences, personal interpretation of aging, perception of deteriorating health and the inevitability of death.

Functional state

The Comprehensive Geriatric Assessment (scale) helps determine whether patients can function independently, whether they need assistance with the core activities of daily living (ADLs) or beneficial activities of ADLs (lADLs), or whether they need assistance entirely. Patients may be asked open-ended questions about their ability to perform an activity, or they may be asked to complete a standardized performance assessment questionnaire and answer questions about specific ADLs and lADLs (eg, the Katz ADLs scale).

social history

The clinician should determine the living conditions of patients, especially where and with whom they live (for example, alone in an isolated home or in a busy residential building), the accessibility of their accommodation (for example, up stairs or uphill), and what modes of transport are available to them. These factors have a decisive influence on the ability of older people to receive nutrition, health care and other livelihood opportunities. Although it is often difficult to organize a home visit, it is this visit that can provide crucial information. For example, a doctor can get an idea of ​​nutrition from the contents of the refrigerator and several ALDS from the state of the bathroom. The number of rooms, numbers and types of telephones, the presence of smoke and carbon monoxide detectors, the condition of the water supply and heating system, the availability of elevators, stairs, and air conditioning are determined. Many risk factors can be easily eliminated, such as poor lighting, slippery bathtubs, loose carpets, worn shoes with high heels, etc. to assess the likelihood of a fall.

Valuable information can be obtained from the patient's description of his or her typical pastime, including activities such as reading, watching TV, working, playing sports, hobbies, and interacting with other people.

The clinician should ask:

• about the frequency and nature of social contacts (for example, friends of the same age or younger), family contacts, religious or spiritual activities;
• driving and access to other modes of transport;
• about relationships with caregivers, relatives, neighbors or community structures, their availability to the patient and the degree of support they provide;
• the ability and ability of family members to help the patient (for example, their employment, health, travel time to the patient's place of residence, etc.);
• the patient's attitude towards family members and their attitude towards the patient (including their level of interest in helping and willingness to help).

The marital status of patients is taken into account. Questions about sexual interests and the possibility of sexual satisfaction should be asked very sensitively and tactfully, but are mandatory. Sexual life with sex partners and the risk of sexually transmitted diseases are determined. Many sexually active older people do not know about safe sex.

Patients should be asked about their level of education, jobs, known exposure to radioactivity or asbestos, current and past hobbies. The economic difficulties that arose after retirement, the amount of fixed or other income after the death of a spouse (s) or civil husband (wife) are discussed. Financial or health problems can easily lead to loss of home, social status or independence. Patients should be asked about past relationships with physicians; it is not uncommon for a long-standing good relationship with a physician to be lost because the physician has either retired or died, or the patient has moved residence.

All interests of the patient, recommended measures for his further life support must be documented. So, for example, patients are asked whether their rights are secured in cases where they become incapacitated, and if nothing has been done, patients will be advised to document these relationships.

Comparative geriatric evaluation

Comprehensive geriatric assessment is a multidimensional process aimed at assessing the functional abilities, health (physical, cognitive and mental), position of older people in the social environment.

A comprehensive geriatric assessment specifically and carefully assesses functional and cognitive abilities, the nature and extent of social support, financial and environmental factors, and physical and mental health. Ideally, regular screening of elderly patients includes many aspects of a comprehensive geriatric assessment, making both approaches very similar. The results of the assessment should be combined with tailored individual interventions (eg rehabilitation, education, counseling, support services).

The cost of geriatric assessment limits its use. This assessment may be used primarily in high-risk, frail, or chronically ill patients (for example, the assessment may be done through individual mailed health questionnaires or through interviews with the patient at home or at appointments). Family members may also request a referral for a geriatric evaluation.

The assessment has the following positive results:

• improved care and clinical status;
• more accurate diagnostics;
• improvement of functional and mental state;
• reduction in mortality;
• reduced use of nursing homes and emergency hospitals;
• getting more satisfaction from care.

If older patients are relatively healthy, the standard of medical evaluation may be sufficient.

A comprehensive geriatric assessment is most successful when performed by a multidisciplinary geriatric team (usually a geriatrician, a nurse, a social worker, and a pharmacist). As a rule, assessments are carried out on an outpatient basis. However, for patients with physical or mental disabilities and chronically ill patients, an inpatient evaluation may be required.

Evaluation of areas of activity

The main assessments of the areas of activity are:

• functional ability. Opportunity for activities of daily living (ADLs) and useful activities for ADLs (lALDs) are assessed. ALDs include eating, dressing, bathing, moving between bed and chair, using the toilet, and controlling bladder and bowel movements. lALDs encourage people to live independently and include cooking, doing housework, taking medication, managing finances, and using the phone.
• Physical health. The history and physical examination should include problems common among older people (problems with vision, hearing, continence/restraint, self-control, gait, and balance).
• Cognition and mental health. Several validated screening tests for cognitive dysfunction (eg, mental health screening) for depression in the elderly (may be used, eg, Older Depression Rating Scale, Hamilton Depression Rating Scale).
• The situation of the socio-environment. The patient's network of social interaction, available social support resources, special needs, safety and convenience of the patient's environment are often determined by the nurse or social worker. Factors that influence the approach to treatment are used. A checklist can be used to assess home safety.

Standardized tools make the evaluation of these areas of activity more reliable and efficient. It also supports the dissemination of clinical information to healthcare professionals and allows monitoring of changes in patient health over time.