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Abstract
This study investigated depression and anxiety among Chinese elderly earthquake survivors, addressing relevant correlations. We sampled one earthquake-prone city, utilising the Geriatric Depression Scale and Beck Anxiety Inventory. In addition, explorative factor analysis and structural equation model methods were used. Results indicated elderly earthquake survivors exhibited symptoms of moderate depression and anxiety; depression and anxiety are highly positively correlated. The overlap between these two psychological problems may be due to subjective fear and motoric dimensions; subjective fear and motoric dimensions of Beck Anxiety Inventory are more strongly related to Geriatric Depression Scale domains. The two scales exhibit high reliability and validity.
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Kutscher EC, Leloux MR. Psychopharmacology concerns in older individuals. Ment Health Clin 2012. [DOI: 10.9740/mhc.n107159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The geriatric population is continually growing in the United States, and the number of individuals over the age of 65 is expected to double by the year 2050. Changes in the pharmacokinetic profiles of elderly patients make appropriate medication dosing more challenging for health care providers. The Beers Criteria is a validated, consensus-based screening tool to help identify potentially inappropriate medications in geriatric patients. This article reviews recent updates to the Beers Criteria, as well as other screening tools which have been developed for this purpose.
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Abstract
The ageing of the population brings particular challenges to psychiatric practice. Although the clinical presentation of common psychiatric disorders such as mood and psychotic disorders is largely similar to those in younger adults, late life presentations tend to be more complex as co-morbidity with dementia and physical illness is common. Suicide tends to increase with age in most countries. In this chapter we argue that the aetiology of disorders may be best understood within a stress vulnerability model in which neurobiological and psychosocial factors interplay. We further present that management strategies need to be comprehensive, incorporating physical, social, pharmacological, and psychological treatments appropriate to each case. We close with a call for the use of specialised multi-disciplinary services to improve the overall quality of care.
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Affiliation(s)
- C Wijeratne
- School of Psychiatry, University of New South Wales, Sydney, Australia
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Spanemberg L, Nogueira EL, da Silva CTB, Dargél AA, Menezes FS, Cataldo Neto A. High prevalence and prescription of benzodiazepines for elderly: data from psychiatric consultation to patients from an emergency room of a general hospital. Gen Hosp Psychiatry 2011; 33:45-50. [PMID: 21353127 DOI: 10.1016/j.genhosppsych.2010.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 12/08/2010] [Accepted: 12/08/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of this study is to compare the use and prescription of psychotropic drugs, with emphasis on benzodiazepines, in elderly and non-elderly patients who are assisted at the emergency room by a psychiatric consultation of a university teaching hospital. METHOD This is a cross-sectional study. We analyzed all records of psychiatric consultation in an emergency room of a general hospital from March 2009 until March 2010. Sociodemographic and clinical variables were compared between the group of elderly and non-elderly in two cutoff points (≥60 and ≥65 years), with emphasis on the use and prescription of benzodiazepines. RESULTS Five hundred seventy-five records were found with 71 elderly and 504 nonelderly for the first cutoff point and 51 elderly and 524 nonelderly in the second. Differences between groups were found in all sociodemographic variables (gender, marital status, education, current occupational status). Elderly patients treated at emergency rooms used more psychotropic drugs, particularly antidepressants and benzodiazepines, than non-elderly. About 25% of the patients received benzodiazepine treatment in the emergency setting, and there was no statistical difference between age groups. CONCLUSION There is a wide prevalence of benzodiazepine use among elderly patients in a psychiatric emergency service. Despite the recommendations for its judicious use, benzodiazepines were the most commonly used drug by psychiatrists on duty, regardless of patient's age. These results call for caution in prescribing these drugs and require alternatives to the treatment of psychiatric disorders in the elderly.
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Affiliation(s)
- Lucas Spanemberg
- Departament of Psychiatry, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
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Wolitzky-Taylor KB, Castriotta N, Lenze EJ, Stanley MA, Craske MG. Anxiety disorders in older adults: a comprehensive review. Depress Anxiety 2010; 27:190-211. [PMID: 20099273 DOI: 10.1002/da.20653] [Citation(s) in RCA: 362] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This review aims to address issues unique to older adults with anxiety disorders in order to inform potential changes in the DSM-V. Prevalence and symptom expression of anxiety disorders in late life, as well as risk factors, comorbidity, cognitive decline, age of onset, and treatment efficacy for older adults are reviewed. Overall, the current literature suggests: (a) anxiety disorders are common among older age individuals, but less common than in younger adults; (b) overlap exists between anxiety symptoms of younger and older adults, although there are some differences as well as limitations to the assessment of symptoms among older adults; (c) anxiety disorders are highly comorbid with depression in older adults; (d) anxiety disorders are highly comorbid with a number of medical illnesses; (e) associations between cognitive decline and anxiety have been observed; (f) late age of onset is infrequent; and (g) both pharmacotherapy and CBT have demonstrated efficacy for older adults with anxiety. The implications of these findings are discussed and recommendations for the DSM-V are provided, including extending the text section on age-specific features of anxiety disorders in late life and providing information about the complexities of diagnosing anxiety disorders in older adults.
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Abstract
Anxiety and sleep problems are major barriers to healthy aging and are frequently comorbid conditions in older adults. In the current review, we present recent advances in understanding the extensive overlap among older adults between anxiety and one specific related sleep problem, insomnia. These proposals suggest that anxiety and insomnia may share a common vulnerability to negative emotionality and at times may act as risk factors for each other in older adults. We also highlight developmental shifts in motivation that are likely to impact cognitive-behavioral mechanisms of anxiety and insomnia. Finally, we characterize the current state of treatment for comorbid anxiety and insomnia among older adults and identify future directions for research and clinical practice.
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Rinfrette ES. Treatment of anxiety, depression, and alcohol disorders in the elderly: social work collaboration in primary care. JOURNAL OF EVIDENCE-BASED SOCIAL WORK 2009; 6:79-91. [PMID: 19199138 DOI: 10.1080/15433710802633569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Anxiety and depressive disorders and symptoms are quite prevalent in older adults as are alcohol problems. Older adults tend to minimize psychological problems and consider psychological symptoms to be related to physical illness. Engagement of the older adult in mental health/substance abuse treatment has been found to be more successful if it occurs in collaboration with primary care treatment. Collaboration between social workers and physicians appears to be an obvious solution to meeting the needs of elderly persons with mental health and/or substance abuse problems who present for medical concerns in their physician's office.
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Affiliation(s)
- Elaine S Rinfrette
- School of Social Work, University at Buffalo, Buffalo, New York 14260, USA.
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Pharmacotherapy for older veterans diagnosed with posttraumatic stress disorder in Veterans Administration. Am J Geriatr Psychiatry 2008; 16:804-12. [PMID: 18827226 DOI: 10.1097/jgp.0b013e318173f617] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Despite increasing numbers of older veterans diagnosed with posttraumatic stress disorder (PTSD) in veterans administration (VA), limited research has focused on pharmacotherapy of PTSD among the elderly. DESIGN The authors examined pharmacotherapy provided to patients carrying a clinical diagnosis of PTSD in VA. SETTING Data on outpatients treated at VA nationally were utilized. PARTICIPANTS Patients were veterans over 45 years of age diagnosed with PTSD in FY 2004 (N = 244,947) grouped into five age cohorts with patients 45-55 as the reference group. MEASURES Psychotropic prescriptions were examined. Descriptive statistics and multivariable logistic regression adjusting for confounding characteristics, including receipt of VA service connected disability benefits which may create incentives to artificially maintain historical diagnoses, were used to identify the relationship of age to receipt of psychotropic medications net of these factors. All analyses were repeated using data only from nonservice connected veterans. RESULTS Most older veterans received psychotropic medication and among these, 88.3% were prescribed antidepressants, 61.2% anxiolytics/sedative hypnotics, and 32.9% antipsychotics. A pronounced monotonic trend showed decrease use of any psychotropic medication and of each subclass with age. Medication use was higher among those treated in specialty mental health clinics than among those treated exclusively in primary care or medical clinics and interaction analysis of age by clinic type showed significantly more steeply declining use of medications with age among patients treated in specialty mental health clinics. Data from nonservice connected veterans revealed the same patterns. CONCLUSION Diverse psychotropic medication classes are used to treat veterans diagnosed with PTSD in VA with declining use among older veterans. Medication utilization is greater in mental health clinics but declined more steeply with age, perhaps reflecting the greater sensitivity of specialists to the risks of elderly veterans. Older veterans diagnosed with PTSD appear to receive conservative, cautious treatment although observed patterns of care may reflect some degree of undertreatment.
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Use of benzodiazepines and selective serotonin reuptake inhibitors in middle-aged and older adults with anxiety disorders: a longitudinal and prospective study. Am J Geriatr Psychiatry 2008; 16:5-13. [PMID: 18165458 DOI: 10.1097/jgp.0b013e31815aff5c] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the use of benzodiazepines (BZs) and selective serotonin reuptake inhibitors/selective norepinephrine reuptake inhibitors (SSRIs/SNRIs) over nine years of follow-up in middle-aged and older adults with diagnoses of panic disorder with or without agoraphobia, social phobia, or generalized anxiety disorder. SETTING AND PARTICIPANTS Participants in this study were enrolled in the Harvard/Brown Anxiety Research Project (HARP). HARP is a naturalistic, longitudinal, multisite study of adults with anxiety disorders who are recruited from psychiatric settings. The analytic sample consisted of 51 participants with anxiety disorders who were 55 to 70 years old at baseline and a younger cohort of 211 participants added for comparative analysis. DESIGN The authors examined patterns of medication use (BZs and SSRIs/SNRIs) in participants with anxiety disorders as they aged, by assessing the proportion of participants taking these medications using generalized estimating equation modeling. MEASUREMENTS The present data were derived from the structured diagnostic interview administered at enrollment using a combination of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Third Edition-R Non-Affective Disorder, Patient Version, Research Diagnostic Criteria Schedule for Affective Disorders-Lifetime, and subsequent follow-up interviews over a nine-year period using the Longitudinal Interval Follow-up Evaluation-Pharmacia & Upjohn to assess the weekly course of disorders to indicate syndrome severity and document medication use by specific type and dose on a weekly basis. RESULTS Findings showed that rates of BZ use were high among both the older (53% at baseline) and the younger (57.4%) age groups and did not significantly decrease over time, after controlling for time in episode of their anxiety disorders. There was a statistically significant increase in SSRI/SNRI use over time in both groups. At the beginning of the study, 18% of the older group and 21% of the younger group were using SSRIs/SNRIs; however, at the end of the study, the rates increased to 35% and 43%, respectively. CONCLUSIONS Although there was an increase in SSRI/SNRI use in older participants with anxiety disorders over the course of study, at nine years of follow-up, only 35% of participants were utilizing SSRI/SNRI medication, while more than one-half of the same participants were continuing to use BZs. To the authors' knowledge, there are no randomized clinical trials that have addressed comparative efficacy and safety of BZs and SSRIs/SNRIs in this population. However, there is documented evidence of adverse effects of chronic BZ use and the risk of developing dependency in older populations.
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Haworth JE, Moniz-Cook E, Clark AL, Wang M, Cleland JGF. An evaluation of two self-report screening measures for mood in an out-patient chronic heart failure population. Int J Geriatr Psychiatry 2007; 22:1147-53. [PMID: 17457953 DOI: 10.1002/gps.1807] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the criterion validity of the Hospital Anxiety and Depression Scale (HADS) and the Geriatric Depression Scale 15-item (GDS-15) in a community sample of Chronic Heart Failure (CHF) out-patients. METHODS Eighty-eight of 203 older adults with confirmed CHF responded to a postal survey and participated in a face-to-face interview. The GDS-15 and HADS were compared to diagnoses from the Structured Clinical Interview for DSM-IV (SCID-I), using a receiver operating characteristic (ROC) analysis and positive and negative predictive values, sensitivity and specificity for various cut-off points. RESULTS For all depressive disorders, the area under the ROC curve for the GDS-15 was 0.883 and a cut-off of 5 gave a sensitivity of 0.818 and a specificity of 0.833. The area under the ROC curve for the HADS Depression (D) and Anxiety (A) were 0.889 and 0.941 respectively. At a cut-off of 7, the HADS-A gave a sensitivity of 0.938 and a specificity of 0.847. At a cut-off of 4, the HADS-D gave a sensitivity of 0.864 and a specificity of 0.788. CONCLUSIONS The GDS-15 and HADS are valid screening tools for detecting depression in aged CHF out-patients. However, use of the HADS requires reduced cut-points to ensure that patients with mood disorder are not missed in this population.
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Affiliation(s)
- J E Haworth
- Department of Clinical and Health Psychology, St James's University Hospital, Leeds, UK.
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Owens GP, Baker DG, Kasckow J, Ciesla JA, Mohamed S. Review of assessment and treatment of PTSD among elderly American armed forces veterans. Int J Geriatr Psychiatry 2005; 20:1118-30. [PMID: 16315160 DOI: 10.1002/gps.1408] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The number of elderly combat veterans is steadily increasing in the US and estimates project that a notable percentage of these veterans experience symptoms of posttraumatic stress disorder (PTSD). Limited data exist specifically related to prevalence, assessment, and treatment of PTSD among the elderly veteran population. OBJECTIVE This review summarizes the available research related to difficulties in assessment with the elderly American Armed Forces veteran population. In addition, both psychotherapeutic and pharmacological treatment interventions for PTSD are discussed. METHODS A literature search was conducted using PsycINFO, Medline, and the National Center for PTSD's PILOTS database. RESULTS Evidence suggests that elderly veterans generally present more somatic symptoms of PTSD. Medical and psychological comorbidities, such as depression, substance abuse, or cognitive deficits can further complicate the assessment process. Cut-scores for existing instruments need to be further established with elderly veterans. Use of exposure therapies with the elderly has not been adequately researched and mixed results have been obtained for supportive therapy for treatment of PTSD. Controlled research investigating pharmacological interventions for PTSD with the elderly is also limited. CONCLUSION Evidence suggests that some psychotherapeutic and pharmacological interventions already utilized with younger individuals may be useful with the elderly veteran population. However, research indicates that modifications may be required for working with the elderly population and further research in the areas of assessment and treatment are necessary.
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Affiliation(s)
- Julie Loebach Wetherell
- Department of Psychiatry, University of California San Diego, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116B), San Diego, CA 92161, USA
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Brenes GA, Guralnik JM, Williamson J, Fried LP, Penninx BWJH. Correlates of anxiety symptoms in physically disabled older women. Am J Geriatr Psychiatry 2005; 13:15-22. [PMID: 15653936 PMCID: PMC1343492 DOI: 10.1176/appi.ajgp.13.1.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors describe characteristics that are associated with chronic anxiety symptoms and examine the use of anxiolytic and antidepressant medications in physically disabled women with and without symptoms of anxiety. METHODS Participants were 791 physically disabled women age 65+ years who participated in the Women's Health and Aging Study for 2-3 years. Anxiety symptoms were measured with four questions from the Hopkins Symptom Checklist, and women were categorized as having no anxiety, intermittent anxiety, and chronic anxiety symptoms. Health-related characteristics, medications, physical functioning, physical activity, and psychosocial variables were also measured. RESULTS Forty-nine percent of women reported no anxiety symptoms; 41% reported intermittent symptoms; and 10% reported chronic symptoms of anxiety. Depressive symptoms and lack of emotional support were significant correlates of intermittent anxiety symptoms, whereas depressive symptoms, negative life events, and lack of emotional support were significant correlates of chronic anxiety symptoms. Over the course of 3 years, 20.3% of women with no anxiety, 33.0% of women with intermittent anxiety, and 48.7% of women with chronic anxiety symptoms took anxiolytic and/or antidepressant medications. CONCLUSION Anxiety symptoms are common among disabled older women. Psychosocial variables were significantly different in women with intermittent or chronic anxiety symptoms, versus women without anxiety.
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Affiliation(s)
- Gretchen A Brenes
- Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 25157, USA.
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Nordhus IH, Pallesen S. Psychological treatment of late-life anxiety: an empirical review. J Consult Clin Psychol 2003; 71:643-51. [PMID: 12924668 DOI: 10.1037/0022-006x.71.4.643] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study provides a meta-analytic review of nonpharmacological interventions for late-life anxiety, focusing on treatment efficacy. Included in the analysis are studies in which a comparison was made either to a control condition or to another treatment. A total of 15 outcome studies, published or reported between January 1975 and January 2002, were identified involving 495 participants (mean age exceeding 55.0 years and a grand mean of 69.5 years) and providing 20 separate treatment interventions. The analysis indicated that psychological interventions were reliably more effective than no treatment on self-rated and clinician-rated measures of anxiety, yielding an effect size of .55. Maintenance of treatment gains (a minimum of 6 months follow-up) was insufficiently reported across studies to allow for a reliable demonstration of an overall estimate of long-term efficacy. It is concluded that psychological interventions produce significant improvements, but the analyses must be qualified by data limitations in the research synthesis.
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Hopko DR, Stanley MA, Reas DL, Wetherell JL, Beck JG, Novy DM, Averill PM. Assessing worry in older adults: confirmatory factor analysis of the Penn State Worry Questionnaire and psychometric properties of an abbreviated model. Psychol Assess 2003; 15:173-83. [PMID: 12847777 DOI: 10.1037/1040-3590.15.2.173] [Citation(s) in RCA: 178] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The assessment of worry among older adults typically has involved measures designed with younger cohorts. Because of special concerns in assessing older adults, modifications to existing instruments may be necessary. Addressing equivocal factor analytic data on the Penn State Worry Questionnaire (PSWQ) among younger adults, the authors conducted confirmatory factor analyses to evaluate the generalizability of previous models to older adults with generalized anxiety disorder. Data fit poorly with established single- and two-factor models. The single-factor model was modified, resulting in the elimination of 8 items, strong fit indices, high internal consistency, adequate test-retest reliability, and good convergent and divergent validity. Further psychometric work is required to assess whether the revised model is a more parsimonious method to assess late-life anxiety.
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Affiliation(s)
- Derek R Hopko
- Department of Psychology, University of Tennessee, Knoxville, Room 301D, Austin Peay Building, Knoxville, Tennessee 37996-0900, USA.
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Stanley MA, Beck JG, Novy DM, Averill PM, Swann AC, Diefenbach GJ, Hopko DR. Cognitive-behavioral treatment of late-life generalized anxiety disorder. J Consult Clin Psychol 2003; 71:309-19. [PMID: 12699025 DOI: 10.1037/0022-006x.71.2.309] [Citation(s) in RCA: 169] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study addressed the efficacy of cognitive-behavioral therapy (CBT), relative to minimal contact control (MCC), in a sample of 85 older adults (age 60 years and over) with generalized anxiety disorder (GAD). All participants completed measures of primary outcome (worry and anxiety), coexistent symptoms (depressive symptoms and specific fears), and quality of life. Results of both completer and intent-to-treat analyses revealed significant improvement in worry, anxiety, depression, and quality of life following CBT relative to MCC. Forty-five percent of patients in CBT were classified as responders, relative to 8% in MCC. Most gains for patients in CBT were maintained or enhanced over 1-year follow-up. However, posttreatment scores for patients in CBT failed to indicate return to normative functioning.
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Affiliation(s)
- Melinda A Stanley
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, 77030, USA.
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Abstract
Psychological sequelae of interpersonal violence in older adults remain understudied. Existing investigations focused on the clinical presentation of older adults who were traumatized as young adults (e.g., combat veterans). Consequently, little is known about the clinical correlates of trauma in recently victimized older adults. This descriptive study attempt to fill this void by documenting the symptom status and demographic features of 36 treatment-seeking older adult crime victims. Results indicated that older adult crime victims who seek services are a multiply traumatized group. They experienced significant financial, educational, medical, and social stressors that may complicate their clinical picture and treatment progress. Additionally, older adult crime victims experienced moderate-to-severe levels of psychopathology as evidenced by symptoms endorsed on an array of structured clinical interviews and paper-and-pencil measures designed to measure symptoms of Posttraumatic Stress Disorder (PTSD), depression, and panic.
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Affiliation(s)
- Matt J Gray
- National Center for PTSD, Boston VAMC, Charleston, SC 29425, USA
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Quality of life in older adults receiving medications for anxiety, depression, or insomnia: findings from a community-based study. Am J Geriatr Psychiatry 2002. [PMID: 12213691 DOI: 10.1097/00019442-200209000-00010] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Depression and anxiety are associated with substantially reduced health-related quality of life (HRQoL) in healthy and medically ill adults. The authors examined the association between these conditions, as indicated by the use of antidepressant, anxiolytic, or hypnotic medications, and HRQoL parameters in older men and women. METHODS This is a cross-sectional study of white, middle-class, older (median age 75 years) men (n=533) and women (n=826) within a defined community setting. Short Form-36 Health Survey (SF-36) scores were compared between persons currently taking medicine(s) for depression, anxiety, and/or insomnia or none of these. RESULTS The chronic physical illness summary score (dichotomized into scores of less than 2 versus 2 or more) was associated with significantly greater odds of perceiving oneself as ill and was also significantly correlated with poorer HRQoL in both men and women. Taking a psychotropic medication for anxiety, depression, or sleep was associated (in men and in women) with significantly greater odds of perceiving oneself as ill, before and after adjusting for age and chronic physical disorder scores. After these adjustments, use of medications remained significantly associated with lower scores on both the Physical and Mental Composite Scales of the SF-36 in women; a similar but nonsignificant association was seen in men. CONCLUSIONS Among older, community-dwelling adults, anxiety, depression, and insomnia that require pharmacological treatment are associated with reductions in HRQoL that extend beyond the impact of comorbid physical illnesses.
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Abstract
In the population of older adults, anxiety disorders are underdiagnosed and undertreated. Epidemiologic studies have generally found that the prevalence of anxiety disorders declines with age. Recognition of anxiety disorders in older adults is, however, complicated by several age-related factors including the presence of depression, cognitive impairment, and physical illness. A variety of medications have been used to treat anxiety disorders across the life span; however, few studies have evaluated their use specifically in older adults. Choice of medication requires consideration of the effects of aging on safety, tolerability, and adherence. Available data suggest that cognitive and behavioral treatments may be effective for anxiety disorders in older adults. Appropriate medical evaluation and psychosocial interventions are recommended prior to initiating pharmacotherapy. When pharmacologic treatment is warranted, antidepressant medications at low doses may be useful for late-life anxiety disorders; other agents may be considered for augmentation or second-line use in certain types of patients.
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Affiliation(s)
- J A Sable
- University of California, San Diego VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
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