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The prevalence of anxiety in older adults: methodological issues and a review of the literature
- Authors:
- BRYANT Christina, JACKSON Henry, AMES David
- Journal article citation:
- Journal of Affective Disorders, 109(3), 2008, pp.233-250.
- Publisher:
- Elsevier
A systematic review of literature on anxiety in people over 60, published between 1980 and 2007, finds prevalence rates for anxiety disorders of 1.2% to 15% in community settings, and 1% to 28% in clinical settings. The prevalence of anxiety symptoms is much higher, ranging from 15% to 52.3% in community samples, and 15% to 56% in clinical samples. These discrepancies are partly attributable to conceptual and methodological inconsistencies in the literature. The review finds that Generalised Anxiety Disorder is the most common anxiety disorder among older people, but issues relating to co-morbidity and the nature of anxiety in old age remain unresolved. This hampers the design of interventions and highlights the need for further research with a primary focus on anxiety.
Supporting frail older people with depression and anxiety: a qualitative study
- Authors:
- FROST Rachael, et al
- Journal article citation:
- Aging and Mental Health, 24(12), 2020, pp.1977-1984.
- Publisher:
- Taylor and Francis
Objectives: Depression and anxiety are common in later life, particularly when people are frail. This leads to reduced quality of life, faster decline in physical health and increased health/social care use. Available treatments are commonly not tailored to people with frailty. We explored frail older peoples’ experiences of depression and/or anxiety and how services could be adapted to their needs. Methods: Semi-structured interviews with 28 older people in the UK purposively sampled for practice location and severity of frailty and anxiety/depression. We asked about symptoms, interactions with physical health, help-seeking, treatments and what might help in future. We audio-recorded and transcribed interviews, using thematic analysis to inductively derive themes. Results: Frail older people had low expectations of their wellbeing at this point in life due to multiple physical health issues and so anxiety and mild depressive symptoms were normalised. There was a particular reluctance and uncertainty regarding help-seeking for anxiety. Treatments were considered appropriate where they aligned with coping skills developed over their lifetime, and facilitated independence and problem-solving skills. Most older people felt their knowledge of mental health was limited and relied upon information about and endorsement of therapies from an expert. This was usually their GP, but access was often problematic. Online methods of accessing information and therapies were not popular. (Edited publisher abstract)
Depression: a modifiable factor in fearful older fallers transitioning to frailty?
- Authors:
- MHAOLÁIN Aine M. Ni, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(7), July 2012, pp.727-733.
- Publisher:
- Wiley
It is suggested that fear of falling, one of the most common fears among community-dwelling older people, is as serious a health problem as the falls themselves. It often leads to activity avoidance. The authors believe that understanding fear of falling may help to identify strategies to reduce concern in the vulnerable old. This cross sectional study evaluated the psychological factors associated with fear of falling in a group of fallers transitioning to frailty compared with robust or non-frail fallers. A total of 301 fallers (mean age 75 years) underwent assessment. Fear of falling was measured using the Modified Falls Efficacy Scale, and frailty using the Biological Syndrome Model. Psychological assessment included anxiety, depression, loneliness, personality factors and cognition. Frailer fallers had increased fear of falling compared to robust fallers. Age, female gender and lower cognitive scores were associated with greater fear of falling in the robust group. For frailer fallers, higher depression score was the only factor associated with fear of falling. The odds ratio of having case level depressive disorder if a frail faller was significantly higher than if robust. The authors conclude that fallers at a transitional level of frailty may be particularly vulnerable group psychologically and would benefit most from interventional strategies focussing on depressive symptoms.
Innovations in research for treatment of late-life anxiety
- Authors:
- SHRESTHA Srijana, ROBERTSON Suzanne, STANLEY Melinda A.
- Journal article citation:
- Aging and Mental Health, 15(7), September 2011, pp.811-821.
- Publisher:
- Taylor and Francis
Late-life anxiety is highly prevalent, with rates exceeding those of depression. Although psychosocial interventions have shown positive outcomes for older adults with anxiety, effects are not as strong as in younger adults. The aim of this review is to examine innovative approaches to the treatment of late-life anxiety that are currently being developed and tested. A systematic search was conducted using electronic databases of funded clinical trials. The principal investigators (PIs) of the studies were contacted for study details and preliminary data, if available. In some cases, the PIs of identified studies acted as referral sources in identifying additional studies. Eleven studies were identified that met the inclusion criteria. These represented 3 areas of innovation: new patient groups; novel treatment procedures; and new treatment-delivery options. These studies, their associated theoretical bases, and their preliminary results are discussed, and shown to represent promising new strategies to facilitate engagement and improve outcomes among unique subsets of older adults with anxiety. Overall, the review reveals a momentum among late-life anxiety researchers to develop tailored treatments for new patient populations, test novel treatment procedures, and examine innovative delivery approaches.
Anxiety and its correlates among older adults accessing aging services
- Authors:
- RICHARDSON Thomas M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(1), January 2011, pp.31-38.
- Publisher:
- Wiley
The Aging Services Network (ASN) is a national system of approximately 30,000 local and state agencies providing human services to older adults and caregivers in the United States. In this study, interviews were conducted with 378 clients aged 60 years or older from a New York State-based ASN, as part of an academic-community partnership for studying the mental health needs of community dwelling older adults. The researchers concluded that clinically significant anxiety is common among older adults receiving ageing services care management, and is associated with social, medical, and psychiatric factors. They suggest that effective treatment requires a multidisciplinary approach.
Worry and rumination in older adults: differentiating the processes
- Authors:
- D’HUDSON Geoffrey, SALING Lauren L.
- Journal article citation:
- Aging and Mental Health, 14(5), July 2010, pp.524-534.
- Publisher:
- Taylor and Francis
Previous studies exploring the factor structure of the adapted Ruminative Response Scale (RRS) have been limited to a small UK sample, and thus remain tentative. This study, comprising of a total of 138 older adults aged between 65 and 97 years, examined the factor structure of the RRS in a large Australian older adult sample, and investigated the overlapping and distinct characteristics of worry, brooding and reflection in relation to coping behaviour which has not previously been examined in older adults. It used a number of instruments to measure worry, rumination, anxiety and coping behaviour, where a three-factor structure comprised of worry, brooding and reflection emerged. Findings indicate no unique relationship between the rumination components, of brooding and reflection, and worry and coping pathways. In conclusion, the authors suggest that the factor structure supports the idea that worry, brooding and reflection are distinguishable constructs in the elderly. However, the lack of differential associations between the rumination components and worry in relation to coping strategies provided evidence that rumination and worry are part of the same theoretical construct of repetitive thought. The implications for the management of anxiety and depression in the elderly are discussed.
Prevalence of anxiety disorders among elderly people
- Authors:
- KIRMIZIOGLU Yalcin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(9), September 2009, pp.1026-1033.
- Publisher:
- Wiley
The objectives of this study are to determine current and lifetime prevalence of anxiety disorders and also to explore the relationship, if any, between possible risk factors and anxiety disorders, amongst elderly people living in the Sivas province of Turkey. The research sample consisted of 462 persons. A Socio-demographic Data Form was given to the participants and the Anxiety Module of SCID-I was applied. Chi-square and Fischer's exact tests were used to evaluate the data obtained. The current prevalence for all types of anxiety disorder was found to be 17.1% overall and the lifetime prevalence was found to be 18.6%. The current prevalence rates for particular disorders were found to be 0.4% for panic disorder, 3.2% for obsessive-compulsive disorder, 1.9% for post-traumatic stress disorder, 2.8% for social phobia, 11.5% for specific phobia, 6.9% for generalized anxiety disorder (GAD). Lifetime prevalence rates for these disorders (except GAD) were 1.1%, 3.2%, 3.0%, 2.85%, 11.5% respectively. Anxiety disorders are more common among elderly people than was previously thought. The lifetime prevalence of specific phobia amongst the elderly is higher than that of general population; the lifetime prevalence ratios of obsessive-compulsive disorder and social phobia are similar to that of the general population in Sivas. In order to improve the delivery of health services, it is recommended that further studies should be conducted among elderly people, both by applying standardized diagnostic tools, but also taking into account socio-economic factors and using convenient therapy methods developed specifically for this group.
Understanding health anxiety among community dwelling seniors with varying degrees of frailty
- Authors:
- BOURGAULT-FAGNOU Michelle D., HADJISTAVROPOULOS Heather D.
- Journal article citation:
- Aging and Mental Health, 13(2), March 2009, pp.226-237.
- Publisher:
- Taylor and Francis
The levels of health anxiety among younger adults and older people, with either low or high levels of frailty were compared. Predictors of health anxiety in older people were explored. Forty-nine seniors with high levels of frailty were compared with 63 seniors with low levels of frailty and 130 younger adults. Comparisons were made on the Illness Attitudes Scale (IAS) and on a Medically Adjusted Illness Attitudes Scale, an adapted version ensuring scores reflect health anxiety, and not greater illness. Seniors also completed measures of frailty, pain, depression, trait anxiety and coping. Results varied depending on the health anxiety measure. Using the traditional IAS, seniors with high frailty experienced greater levels of health anxiety than seniors with low-frailty and younger adults. Using the medically adjusted version, seniors with high frailty experienced similar levels of heath anxiety compared with younger adults; seniors with low frailty had the lowest levels of health anxiety. Using multiple regression analysis, emotional preoccupation and trait anxiety uniquely predicted health anxiety among seniors. Researchers and clinicians should ensure that health anxiety measures actually assess health anxiety and not physical illness. Using an appropriate health anxiety measure, the results suggest seniors with relatively fewer health problems may experience reduced health anxiety compared with other older adults and younger adults. The results are considered in the context of research on aging and anxiety. Implications for clinical practice and future research are discussed.
Knowledge about aging and worry in older adults: testing the mediating role of intolerance of uncertainty
- Authors:
- NUEVO Roberto, et al
- Journal article citation:
- Aging and Mental Health, 13(1), January 2009, pp.135-141.
- Publisher:
- Taylor and Francis
This Spanish study aims to explore the relationship between knowledge about aging and severity of worry in older adults, and to test the potential mediational role of intolerance of uncertainty. The sample was composed of 120 community-dwelling older adults, with a mean of age of 71.0 years. Mediational analyses and structural equation modelling were used to analyze and compare different models. Greater knowledge about aging was negatively related to both intolerance of uncertainty and worry, and its effect on worry was partially mediated by intolerance of uncertainty. The mediational model obtained an excellent fit to the data and clearly had a better fit than alternative models. These results suggest that a good knowledge of the aging process could help decrease aversive uncertainty and thus reduce the level of worry among older adults. Thus, educational programs to increase knowledge about aging could serve as one preventive strategy for anxiety in old age.
Prevalence of depression and anxiety symptoms in elderly patients admitted in post-acute intermediate care
- Authors:
- YOHANNES A. M., BALDWIN R. C., CONNOLLY M. J.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(11), November 2008, pp.1141-1147.
- Publisher:
- Wiley
Depression and anxiety symptoms are common in medically ill older patients. This study investigated the prevalence and predictors of depression and anxiety symptoms in older patients admitted for further rehabilitation in a post acute intermediate care unit, in the North West of England. One hundred and seventy-three older patients (60 male), aged mean (SD) 80 (8.1) years, referred for further rehabilitation to intermediate care. Depression and anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale, and severity of depression examined by the Montgomery Asberg Depression Rating Scale. Physical disability was assessed by the Nottingham Extended ADL Scale and quality of life by the SF-36. Sixty-five patients (38%) were identified with depressive symptoms, 29 (17%) with clinical depression, 73 (43%) with anxiety symptoms, and 43 (25%) with clinical anxiety. 15 (35%) of the latter did not have elevated depression scores (9% of the sample). Of those with clinical depression, 14 (48%) were mildly depressed and 15 (52%) moderately depressed. Longer stay in the unit was predicted by severity of depression, physical disability, low cognition and living alone. Clinical depression and anxiety are common in older patients admitted in intermediate care. Anxiety is often but not invariably secondary to depression and both should be screened for. Depression is an important modifiable factor affecting length of stay. The benefits of structured management programmes for anxiety and depression in patients admitted in intermediate care are worthy of evaluation.