The MCMI-III, PDQ-4+, CATI, MMPI-2, and NEO PI-R have all been widely used in clinical research and practice with diverse types of individuals, including older adults. One issue is that older persons with visual impairments may have difficulty reading items in the administration booklets, and big print versions of the tests or audiocassette versions should be used when available. A common limitation of the personality disorder inventories (i.e., MCMI-III, PDQ-4+, or CATI) as they apply to older adults is that they are all essentially tied to DSM criteria, which may not necessarily capture the unique presentation of some personality disorders in later life. Another significant source of concern with use of these instruments among older adults is that test items may be perceived and interpreted differently by older respondents compared to younger ones due to generational changes in language use, different educational experiences, or age-graded shifts in the relevance of DSM criteria (Mroczek et al., 1999).
The clinician should also be aware of some general problems associated with using self-report personality disorder inventories as isolated or stand-alone instruments in clinical practice, including the higher number of false-positive diagnoses and the concern that results, may be more state dependent compared to structured interviews. Advantages of self-report inventories include that they are easy to administer and take less time and clinical expertise than structured interviews. Whereas a significant amount of research has examined the application of the MMPI-2 and NEO PI-R across the adult life span, the limited number of studies applying the MCMI-III, PDQ-4+, and CATI to older populations represents a serious gap in the research literature. Much research is required to establish relevant cutoff scores for these measures with older adult respondents, perhaps by comparing self-report data to that generated by semi-structured interviews. Perhaps the best conclusion to be drawn is that self-report inventories can be very useful for the screening of personality disorders among older adults. However, diagnostic hypotheses must be confirmed by other assessment data, typically an interview assessment.
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