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Changes in the expression of worries, anxiety, and generalized anxiety disorder with increasing age: a population study of 70 to 85‐year‐olds
- Authors:
- NILSSON Johanna E., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 34(2), 2019, pp.249-257.
- Publisher:
- Wiley
Objectives: The prevalence of generalized anxiety disorder (GAD) is supposed to decrease with age. Reasons suggested include that emotional control increases and that anxiety and worry are expressed differently in older adults. The aim of this study was to examine how the expression of anxiety and worry changes with age and how this influences diagnoses in current classification systems. Method: Semistructured psychiatric examinations were performed in population‐based samples of 70‐ (n = 562), 75‐ (n = 770), 79/80‐ (n = 603), and 85‐year‐olds (n = 433). Individuals with dementia were excluded. GAD was diagnosed according to DSM‐5 (DSM5 GAD) and ICD‐10 (ICD10 GAD) criteria. Individual symptoms were assessed according to severity and frequency. Functioning was measured with Global Assessment of Functioning (GAF). Results: The prevalence of clinical anxiety, autonomic arousal, muscle tension, and irritability decreased with age, while that of worry and fatigue increased. Concentration difficulties and sleep disturbances remained stable. The prevalence of ICD10 GAD tended to decrease, while that of DSM5 GAD did not change with age. Core symptoms and diagnoses of GAD were related to lower GAF scores. However, in those with autonomic arousal and ICD10 GAD, GAF scores increased with age. Conclusions: The prevalence of ICD10 GAD tended to decrease with increasing age while the prevalence of DSM5 GAD remained stable. This difference was partly due to a decreased frequency of severe anxiety and autonomic arousal symptoms, and that worries increased, suggesting changes in the expression of GAD with increasing age. (Publisher abstract)
Depression symptom ratings in geriatric patients with bipolar mania
- Authors:
- SAJATOVIC Martha, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(11), November 2011, pp.1201-1208.
- Publisher:
- Wiley
There appears to be a paucity of information about standardised ratings of depressive symptoms in geriatric bipolar mania. Baseline data was obtained from the first 100 patients enrolled in a 9-week, randomised, double-blind RCT comparing treatment with lithium or valproate in patients aged 60 years and older with Type I bipolar mania or hypomania. Six academic medical centres in the US enrolled inpatients and outpatients with a total Young Mania Rating Scale (YMRS) score of 18 or greater. Depressive symptoms were evaluated with the Hamilton Depression Rating Scale (HAM-D) and the Montgomery-Asberg Depression Rating Scale (MADRS). The criterion for at least moderate bipolar depressive symptoms was the European College of Neuropsychopharmacology (ECNP) Consensus Meeting definition of HAM-D 17 total score more than 20. Eleven percent of patients had mixed symptoms defined by depression scale severity according to ECNP criteria. Overall, total scores on the two depression scales were highly correlated. Total YMRS scores of this mixed symptom group were similar to the remainder of the sample. The authors conclude that moderate to severe depressive symptoms occur in about one in ten bipolar manic elders. They recommend further studies to more fully evaluate symptom profiles, clinical correlates, and treatments for bipolar older adults with combined manic and depressive symptoms.
Relationship between diagnostic criteria, depressive equivalents and diagnosis of depression among older adults with intellectual disability
- Authors:
- LANGLOIS L., MARTIN L.
- Journal article citation:
- Journal of Intellectual Disability Research, 52(11), November 2008, pp.896-904.
- Publisher:
- Wiley
This study uses the interRAI ID assessment instrument to investigate the relationship between standard diagnostic criteria for depression, depressive equivalents and a diagnosis of depression among older and younger adults with ID in community and institutional settings in Ontario, Canada. Items in the interRAI ID assessment instrument that were representative of The Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) criteria and depressive equivalents were examined among persons with ID in institutional (census-level data) and in community-based (sample) residential settings. Bivariate logistic regression was used to examine the relationship between depressive symptoms and a diagnosis of depression. Descriptive statistics were used to examine the prevalence of depressive symptoms among those who did not have a diagnosis of depression. The results indicate that DSM-IV diagnostic criteria and depressive equivalents were significantly related to a diagnosis of depression among older and younger adults with ID, and that both types of symptoms were exhibited by a non-trivial proportion of individuals without a diagnosis of depression. The depression rating scale embedded in the interRAI ID is helpful in identifying older adults at risk of depression. Contrary to other studies, few significant differences were found in depressive symptoms by age.
Content validity analysis of ISD-1: an instrument for social diagnosis in care homes for older persons
- Authors:
- CURY Silvia Patricia, ASTRAY Andres Arias, GOMEZ Jose Luis Palacios
- Journal article citation:
- European Journal of Social Work, 22(3), 2019, pp.526-540.
- Publisher:
- Taylor and Francis
This article presents the validity study for ISD-1 (Instrument for Social Diagnosis), designed to be used in the specialist field of intervention in care homes for older persons. The study has focused on the evidence regarding the validity of its content. The definition of the operative area of ISD-1 (social diagnosis in care homes), and its representativeness and relevance, are decisive aspects for its validity. Two validation procedures were used, with the participation of two independent groups of experts. Both procedures had the objective of obtaining a quantitative measure assessing the representation of the area and of the degree of association between the dimensions and the items of the instrument. This study suggests that there is a sufficient degree of evidence for the representativeness, relevance and usefulness of the content of ISD-1, meaning it may be considered a suitable instrument for the formulation of social diagnoses in care homes for older persons. (Edited publisher abstract)
Adaptation of the Barts Explanatory Model Inventory to dementia understanding in South Asian ethnic minorities
- Authors:
- GIEBEL Clarissa M., et al
- Journal article citation:
- Aging and Mental Health, 20(6), 2016, pp.594-602.
- Publisher:
- Taylor and Francis
Objective: Studies indicate a limited understanding of dementia and its associated symptoms, causes and consequences among South Asian older adults. As a consequence, fewer people from this ethnic group receive a diagnosis of dementia. The aim of this study was to adapt the previously designed Barts Explanatory Model Inventory Checklist (BEMI-C), a tool designed to elicit perceptions of mental illness from people with different cultural backgrounds, for use with people with dementia in the South Asian population. Method: Both a literature review and 25 qualitative interviews were conducted to find themes and perceptions that are relevant to the South Asian culture in recognising and dealing with symptoms of dementia. The emergent themes and perceptions were then added to the BEMI-C through synthesis of findings. Results: The initial four checklists of symptoms, causes, consequences and treatments from the BEMI-C were retained in the new BEMI-Dementia (BEMI-D) and expanded with six additional themes, including 123 new perceptions relevant to the understanding of dementia. All new themes emerged from the qualitative interviews, some of which were also found in the literature. Conclusion: Given the national priority of improving dementia awareness and timely diagnosis, the BEMI-D can serve as a useful tool, in research and perhaps practice, to assess the barriers to dementia service uptake in this population and their understandings of dementia. Based on the detailed methodological description of the adaptation of the BEMI-C, this paper further suggests how this tool can be adapted to suit other ethnic minority groups. (Publisher abstract)
Beside the Geriatric Depression Scale: the WHO-Five Well-being Index as a valid screening tool for depression in nursing homes
- Authors:
- ALLGAIER Antje-Kathrin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 28(11), 2013, pp.1197-1204.
- Publisher:
- Wiley
The aim of the study was to compare criterion validities of the WHO-Five Well-being Index (WHO-5) and the Geriatric Depression Scale 15-item version (GDS-15) and 4-item version (GDS-4) as screening instruments for depression in nursing home residents. Data from 92 residents aged 65–97 years without severe cognitive impairment (Mini Mental State Examination ≥15) were analysed. Criterion validities of the WHO-5, the GDS-15 and the GDS-4 were assessed against diagnoses of major and minor depression provided by the Structured Clinical Interview for DSM-IV. Subanalyses were performed for major and minor depression. Areas under the receiver operating curve (AUCs) as well as sensitivities and specificities at optimal cut-off points were computed. Prevalence of depressive disorder was 28.3%. The AUC value of the WHO-5 (0.90) was similar to that of the GDS-15 (0.82). Sensitivity of the WHO-5 at its optimal cut-off of ≤12 was significantly higher than that of the GDS-15 at its optimal cut-off of ≥7. The WHO-5 was equally sensitive for the subgroups of major and minor depression, whereas the GDS-15 was sensitive only for major depression, but not for minor depression. For specificity, there was no significant difference between WHO-5 and GDS-15, but both instruments outperformed the GDS-4. The WHO-5 demonstrated high sensitivity for major and minor depression. Being shorter than the GDS-15 and superior to the GDS-4, the WHO-5 is a promising screening tool that could help physicians improve low recognition rates of depression in nursing home residents. (Edited publisher abstract)
Depression in Alzheimer's disease: specificity of depressive symptoms using three different clinical criteria
- Authors:
- ENGEDAL Knut, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(9), September 2011, pp.944-951.
- Publisher:
- Wiley
It is not clear whether symptoms of depression in Alzheimer's disease patients differ from those seen in other elderly depressed patients. This study aimed to examine the usefulness of the specific criteria for depression in Alzheimer's disease which have been developed, the Provisional Diagnostic Criteria for Depression in Alzheimer's Disease (PDC-dAD), compared to other existing depression criteria. The study used 112 patients with Alzheimer's disease recruited from 2 hospitals of geriatric psychiatry in Norway. The patients were interviewed by a psychiatrist who diagnosed depression according to a range of scales, and were assessed by trained nurses who also interviewed their caregivers. The researchers found that the most prominent and significant symptoms of depression in patients with Alzheimer's disease are the same symptoms that are considered the core symptoms of depression in older people who do not suffer from dementia. They report that using the PDC-dAD, more patients received a diagnosis of depression than when using other existing depression criteria, and discuss the results and their implications.
Comparison of the diagnostic accuracy of the Cognitive Performance Scale (Minimum Data Set) and the Mini-Mental State Exam for the detection of cognitive impairment in nursing home residents
- Authors:
- PAGUAY Louis, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(4), April 2007, pp.286-293.
- Publisher:
- Wiley
This study aimed to compare the diagnostic accuracy of an outcome measurement scale of the Minimum Data Set of the Resident Assessment Instrument for nursing homes (MDS/RAI-NH), the Cognitive Performance Scale (CPS) and the Mini-Mental State Exam (MMSE) for the detection of cognitive impairment. The Cambridge Examination for Mental Disorders of the Elderly - Revised (CAMDEX-R) was used as the reference standard. This study was part of a larger prospective study (QUALIDEM) involving a diagnostic procedure and two-year follow-up on the quality of primary care for demented patients. CAMDEX-R and MDS/RAI-NH were administered to 198 residents, aged 65 or more, living in 42 low and high care institutions for older people in Belgium. Main outcome measures used were indicators of diagnostic accuracy: sensitivity, specificity, predictive values, likelihood ratios, odds ratio and area under receiver operating characteristics curve (AUC). The CAMDEX-based prevalence of cognitive impairment was 75%. The results found that CPS and MMSE demonstrated similar performance to detect cognitive impairment in nursing home residents.
Design of ISD-1: an instrument for social diagnosis in care homes for older persons
- Authors:
- CURY Silvia Patricia, ASTRAY Andres Arias, GOMEZ Jose Luis Palacios
- Journal article citation:
- European Journal of Social Work, 22(3), 2019, pp.511-525.
- Publisher:
- Taylor and Francis
This article describes the design process and main features of an instrument developed for use in the specialist area of intervention in care homes for older persons. The essential aim of ISD-1 (instrument for social diagnosis) is to permit the correct formulation of social diagnoses and to standardise and define the professional language used by social workers. Its content has been organised into 4 dimensions of social diagnosis, divided into 15 sub-dimensions containing 83 diagnostic categories. This work was performed in Spain, in the 24 care homes of the Madrid Social Care Agency of the Community of Madrid, involving the participation of the 40 social workers practising in these centres. ISD-1 is an easily understood and used tool, of potential use for social workers practising in care homes for older persons and capable of being adapted for use in other institutional environments, as well as being capable of adaptation and translation for its application in other countries. (Edited publisher abstract)
Evaluation of the factor structure and psychometric properties of the brief symptom inventory - 18 with homebound older adults
- Authors:
- PETKUS Andrew J., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(6), June 2010, pp.578-587.
- Publisher:
- Wiley
Homebound older people are at risk for depression and anxiety, and screening may increase identification of these difficulties and assist in service usage. This study investigated the structure, internal consistency, and concurrent validity of the Brief Symptom Inventory – 18 (BSI-18) for use as a screening instrument for depression and anxiety with homebound older people and to investigate if the BSI-18 could be shortened further and exhibit comparable psychometric properties. Participants included 142 older Floridian adults receiving in-home aging services completed interviews that included the BSI-18 and the depression and anxiety modules of the structured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Findings showed that the theorised three-factor, second-order model of the BSI-18 fit the data well. The depression and anxiety scales showed high internal consistency, but the somatic subscale exhibited lower internal consistency. Receiver operator curve (ROC) analyses indicate that the BSI-18 depression and anxiety scales were able to predict those with DSM-IV diagnoses. The short three-item depression scale exhibited comparable psychometric properties to the full scale, while the three-item somatic and anxiety scales exhibited lower internal consistency and sensitivity. The authors concluded that these findings provide initial evidence that the BSI-18 is valid for use with homebound older people.