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Hohls JK, König HH, Hajek A. Trajectories of generalized anxiety disorder, major depression and change in quality of life in adults aged 50 + : findings from a longitudinal analysis using representative, population-based data from Ireland. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1201-1211. [PMID: 36224379 PMCID: PMC10366232 DOI: 10.1007/s00127-022-02373-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/02/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To investigate the longitudinal association between trajectories (incidence, remission) of generalized anxiety disorder (GAD), major depression (MD) and change in quality of life (QoL) in adults aged 50 + , and to assess the symmetry in these relationships using observational study data. METHODS Data were derived from two waves of The Irish Longitudinal Study on Aging (2014-2015, wave 3: n = 6400; 2016, wave 4: n = 5715), a nationally representative cohort of community-dwelling adults aged 50 +. GAD and MD were assessed by means of the short form of the Composite International Diagnostic Interview. QoL outcomes were assessed using the Control, Autonomy, Self-realization, and Pleasure scale (CASP-12 with two domains control/autonomy and self-realization/pleasure). Covariate-adjusted, asymmetric fixed effects panel regressions and post-estimation Wald tests were used for statistical analysis. RESULTS Regarding incident disorders, only incident MD was significantly associated with a reduction in QoL over time (control/autonomy domain: b = - 0.74, SE: 0.30). Regarding remission, both remission of MD (b = 0.61, SE: 0.20) and remission of GAD (b = 0.61, 0.26) were significantly associated with an increase in the self-realization/pleasure domain over time. Subsequent Wald tests of the estimates were not significant, indicating symmetric effects. CONCLUSION Particularly the remission of GAD and MD was associated with a significant improvement in one of the QoL domains, indicating domain- and trajectory-specific differences. However, symmetric effects observed in this study indicate that gains and losses in QoL associated with remission and incidence of GAD and MD are of similar magnitude in adults aged 50 +.
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Affiliation(s)
- Johanna Katharina Hohls
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Gonzalez-Senac NM, Somoza-Fernandez G, Ocaña Ramirez E, Romero-Estarlich V, Ortiz-Alonso FJ, Serra-Rexach JA, Vidan MT. Effects of reminiscence therapy on anxiety and depression during acute hospitalization in older patients: Controlled study. J Am Geriatr Soc 2023; 71:36-45. [PMID: 36302724 DOI: 10.1111/jgs.18063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 08/31/2022] [Accepted: 09/03/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND/OBJECTIVES Hospitalization due to acute illness in older patients is often associated with anxiety or depressive symptoms. In these circumstances, given that pharmacologic treatment should be avoided to reduce interactions with ongoing medication regimes, psychotherapy techniques should be considered. The purpose of this study was to evaluate the effectiveness of group reminiscence therapy (RT) on the reduction of anxiety and depressive symptoms in acutely hospitalized older patients. METHODS Controlled and prospective study conducted on the Acute Geriatric Unit of a university hospital. Patients included in the intervention group (RT Group) attended a group session focused on RT, whereas those included in the control group (UC) received usual hospital care. Exclusion criteria were severe cognitive impairment, impossibility to mobilize, and clinical/hemodynamic instability. The intervention was based on a multi-task daily group session of reminiscence activities. The severity of anxiety (Hamilton Anxiety Rating Scale, HAM-A), depressive symptoms (15-item Geriatric Depression Scale, GDS-15), loneliness (ESTE-II social loneliness scale), and fear of death (Collet-Lester scale) was assessed at admission and discharge in both groups. RESULTS The intervention was effective in reducing the proportion of patients with anxiety and depressive symptoms during hospitalization. The proportion of patients with moderate-severe anxiety at discharge was 32.1% in the UC and 13.4% in the RT Group (p < 0.001), whereas the proportion of patients with depressive symptoms at discharge was 49.1% in the UC and 19.5% in the RT Group (p < 0.001). The intervention was independently associated with benefits on anxiety levels (RR 2.45, 95% CI 1.83-3.28) and depression (RR 3.71, 95% CI 2.22-6.19) at discharge. No differences were found in loneliness or fear of death. CONCLUSIONS A group reminiscence activity reduces the proportion of patients with anxiety and depressive symptoms during hospitalization for an acute disease. Absolute changes in both anxiety and depression scores, even though significant, were relatively small.
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Affiliation(s)
- Nicolas M Gonzalez-Senac
- Geriatrics Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Biopathology of Aging Group, Instituto de Investigacion Sanitaria Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gema Somoza-Fernandez
- Geriatrics Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Esther Ocaña Ramirez
- Geriatrics Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Psychosocial Care Team (in colaboration with Fundacion La Caixa), Centro Asistencial San Camilo Tres Cantos, Madrid, Spain
| | | | - Francisco J Ortiz-Alonso
- Geriatrics Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Biopathology of Aging Group, Instituto de Investigacion Sanitaria Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.,Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Jose A Serra-Rexach
- Geriatrics Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Biopathology of Aging Group, Instituto de Investigacion Sanitaria Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.,Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Maria T Vidan
- Geriatrics Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Biopathology of Aging Group, Instituto de Investigacion Sanitaria Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.,Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Screening tools for common mental disorders in older adults in South Asia: a systematic scoping review. Int Psychogeriatr 2022; 34:427-438. [PMID: 33413722 DOI: 10.1017/s1041610220003804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Common mental disorders (CMDs), particularly depression, are major contributors to the global mental health burden. South Asia, while diverse, has cultural, social, and economic challenges, which are common across the region, not least an aging population. This creates an imperative to better understand how CMD affects older people in this context, which relies on valid and culturally appropriate screening and research tools. This review aims to scope the availability of CMD screening tools for older people in South Asia. As a secondary aim, this review will summarize the use of these tools in epidemiology, and the extent to which they have been validated or adapted for this population. DESIGN A scoping review was performed, following PRISMA guidelines. The search strategy was developed iteratively in Medline and translated to Embase, PsychInfo, Scopus, and Web of Science. Data were extracted from papers in which a tool was used to identify CMD in a South Asian older population (50+), including validation, adaptation, and use in epidemiology. Validation studies meeting the criteria were critically appraised using the Quality Assessment of Diagnostic Accuracy Studies - version 2 (QUADAS-2) tool. RESULTS Of the 4694 papers identified, 176 met the selection criteria at full-text screening as relevant examples of diagnostic or screening tool use. There were 15 tool validation studies, which were critically appraised. Of these, 10 were appropriate to evaluate as diagnostic tests. All of these tools assessed for depression. Geriatric Depression Scale (GDS)-based tools were predominant with variable diagnostic accuracy across different settings. Methodological issues were substantial based on the QUADAS-2 criteria. In the epidemiological studies identified (n = 160), depression alone was assessed for 82% of the studies. Tools lacking cultural validation were commonly used (43%). CONCLUSIONS This review identifies a number of current research gaps including a need for culturally relevant validation studies, and attention to other CMDs such as anxiety.
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Zhai T, Bailey PE, Rogers KD, Kneebone II. Validation of the Geriatric Anxiety Inventory in younger adults. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2022. [DOI: 10.1177/01650254211064348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study investigated the psychometric properties of the Geriatric Anxiety Inventory (GAI) in younger adults. Participants were 212 younger adults age M = 22 (range = 17–53) years. They completed a demographic information questionnaire and self-report measures: the GAI, the Depression Anxiety Stress Scales (DASS), the Generalized Anxiety Disorder–7 (GAD-7), the Patient Health Questionnaire–9 (PHQ-9), the Penn State Worry Questionnaire (PSWQ), and the Worry Behaviors Inventory (WBI). Data from the GAI were collected at two time points, one week apart, and data from other self-report measures were collected once via Qualtrics, an online survey platform. The internal consistency and test–retest score reliability of the GAI were excellent. It had good congruent validity with other anxiety measures, limited divergent validity with depression measures, and sound convergent validity with worry measures. The GAI showed good discrimination between probable cases and noncases of generalized anxiety disorder (participants who scored ⩾8 on the GAD-7) and its optimal cutoff score for probable cases of GAD was ⩾12. A unidimensional component structure of the GAI best fit this study’s data. This study has provided preliminary evidence that the GAI is reliable and valid for use in an Australian sample of younger adults.
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Affiliation(s)
- Tina Zhai
- University of Technology Sydney, Australia
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Exploring Factors for Predicting Anxiety Disorders of the Elderly Living Alone in South Korea Using Interpretable Machine Learning: A Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147625. [PMID: 34300076 PMCID: PMC8305562 DOI: 10.3390/ijerph18147625] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/17/2022]
Abstract
This epidemiological study aimed to develop an X-AI that could explain groups with a high anxiety disorder risk in old age. To achieve this objective, (1) this study explored the predictors of senile anxiety using base models and meta models. (2) This study presented decision tree visualization that could help psychiatric consultants and primary physicians easily interpret the path of predicting high-risk groups based on major predictors derived from final machine learning models with the best performance. This study analyzed 1558 elderly (695 males and 863 females) who were 60 years or older and completed the Zung’s Self-Rating Anxiety Scale (SAS). We used support vector machine (SVM), random forest, LightGBM, and Adaboost for the base model, a single predictive model, while using XGBoost algorithm for the meta model. The analysis results confirmed that the predictive performance of the “SVM + Random forest + LightGBM + AdaBoost + XGBoost model (stacking ensemble: accuracy 87.4%, precision 85.1%, recall 87.4%, and F1-score 85.5%)” was the best. Also, the results of this study showed that the elderly who often (or mostly) felt subjective loneliness, had a Self Esteem Scale score of 26 or less, and had a subjective communication with their family of 4 or less (on a 10-point scale) were the group with the highest risk anxiety disorder. The results of this study imply that it is necessary to establish a community-based mental health policy that can identify elderly groups with high anxiety risks based on multiple risk factors and manage them constantly.
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Racette BA, Nelson G, Dlamini WW, Hershey T, Prathibha P, Turner JR, Checkoway H, Sheppard L, Searles Nielsen S. Depression and anxiety in a manganese-exposed community. Neurotoxicology 2021; 85:222-233. [PMID: 34087333 DOI: 10.1016/j.neuro.2021.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/24/2021] [Accepted: 05/31/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To characterize the association between residential environmental manganese (Mn) exposure and depression and anxiety, given prior associations among occupationally-exposed workers. METHODS We administered the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI) to 697 study participants in their preferred languages. These participants represented a population-based sample of residents aged ≥40 from two predominantly Black African communities in Gauteng province, South Africa: 605 in Meyerton, adjacent to a large Mn smelter, and 92 in Ethembalethu, a comparable non-exposed community. We investigated the associations between community (Meyerton vs. Ethembalethu) and severity of depression and anxiety, using linear regression, adjusting for age and sex. To document community-level differences in Mn exposure, we measured airborne PM2.5-Mn. RESULTS Meyerton residents had BDI scores 5.63 points (95 % CI 3.07, 8.20) higher than Ethembalethu residents, with all questions contributing to this significant difference. STAI-state scores were marginally higher in Meyerton than Ethembalethu residents [2.12 (95 % CI -0.17, 4.41)], whereas STAI-trait scores were more similar between the communities [1.26 (95 % CI -0.82, 3.35)]. Mean PM2.5-Mn concentration was 203 ng/m3 at a long-term fixed site in Meyerton and 10 ng/m3 in Ethembalethu. CONCLUSION Residence near Mn emission sources may be associated with greater depression symptomatology, and possibly current, but not lifetime, anxiety.
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Affiliation(s)
- Brad A Racette
- Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St. Louis, MO, 63110, USA; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193, South Africa.
| | - Gill Nelson
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193, South Africa.
| | - Wendy W Dlamini
- Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St. Louis, MO, 63110, USA.
| | - Tamara Hershey
- Departments of Psychiatry and Radiology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8225, St. Louis, MO, 63110, USA.
| | - Pradeep Prathibha
- Department of Energy, Environmental, and Chemical Engineering, Washington University, Campus Box 1180, One Brookings Drive, St. Louis, MO, 63130, USA.
| | - Jay R Turner
- Department of Energy, Environmental, and Chemical Engineering, Washington University, Campus Box 1180, One Brookings Drive, St. Louis, MO, 63130, USA.
| | - Harvey Checkoway
- Herbert Wertheim School of Public Health, University of California, San Diego, 9500 Gilman Drive, #0725, La Jolla, CA, 92093, USA.
| | - Lianne Sheppard
- Departments of Biostatistics and Environmental and Occupational Health Sciences, Box 357232, University of Washington, Seattle, WA, 98195, USA.
| | - Susan Searles Nielsen
- Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St. Louis, MO, 63110, USA.
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van der Veen DC, Gulpers B, van Zelst W, Köhler S, Comijs HC, Schoevers RA, Oude Voshaar RC. Anxiety in Late-Life Depression: Determinants of the Course of Anxiety and Complete Remission. Am J Geriatr Psychiatry 2021; 29:336-347. [PMID: 33414001 DOI: 10.1016/j.jagp.2020.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Studies on the course of depression often ignore comorbid anxiety disorders or anxiety symptoms. We explored predictors of complete remission (no depression nor anxiety diagnoses at follow-up) and of the course of comorbid anxiety symptoms. We additionally tested the hypothesis that the course of anxiety disorders and symptoms in depressed patients is explained by negative life-events in the presence of high neuroticism or a low sense of mastery. METHODS An observational study of 270 patients (≥60 years) diagnosed with major depressive disorder and 2-year follow-up data, who participated in the Netherlands Study of Depression in Older persons (NESDO). Sociodemographic, somatic, psychiatric, and treatment variables were first explored as possible predictors. A multiple logistic regression analysis was used to examine their predictive value concerning complete remission. Subsequently, negative life-events, personality and their interaction were tested as potential predictors. Linear Mixed Models were used to assess whether the personality traits modified the effect of early and recent life-events, and time and their interactions on the course of the anxiety symptoms. RESULTS A total of 135 of 270 patients achieved complete remission. Depressed patients with a comorbid anxiety disorder at baseline less often achieved complete remission: 38 of 103 (37.0%) versus 97 of 167 (58.1%). The severity of depressive and anxiety symptomatology, the presence of a comorbid anxiety disorder, and a poorer physical health at baseline predicted nonremission. In line with our hypothesis, a less favorable course of self-reported anxiety symptoms was associated with more recent negative life-events, but only among patients with a high level of neuroticism or a low level of mastery. CONCLUSION Comorbid anxiety in depression as a negative impact on complete remission at 2-year follow-up. The course of anxiety severity seems dependent on the interaction of personality traits and life-events.
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Affiliation(s)
- Date C van der Veen
- Department of Psychiatry (DCVDV, WVZ, RAS, RCOV), University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology of Emotion regulation (ICPE), Groningen, The Netherlands.
| | - Bernice Gulpers
- Regional Institute for Mental Health Care in Outpatients, RIAGG Maastricht (BG), Maastricht, The Netherlands; Department of Psychiatry and Psychology/MUMC, School for Mental Health and Neuroscience (MHeNS)/Alzheimer Centre Limburg (BG), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Willeke van Zelst
- Department of Psychiatry (DCVDV, WVZ, RAS, RCOV), University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology of Emotion regulation (ICPE), Groningen, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience and Alzheimer Centre Limburg (SK), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hannie C Comijs
- Department of Psychiatry (HCC), Amsterdam Public Health Research Institute, GGZ inGeest/VU University Medical Centre, Amsterdam, The Netherlands
| | - Robert A Schoevers
- Department of Psychiatry (DCVDV, WVZ, RAS, RCOV), University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology of Emotion regulation (ICPE), Groningen, The Netherlands
| | - Richard C Oude Voshaar
- Department of Psychiatry (DCVDV, WVZ, RAS, RCOV), University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology of Emotion regulation (ICPE), Groningen, The Netherlands
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Jhang FH. Changes in trust and trait anxiety: The mediating role of changes in self-rated health among older adults in Taiwan. Geriatr Gerontol Int 2020; 20:833-838. [PMID: 32716599 DOI: 10.1111/ggi.13981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/02/2020] [Accepted: 06/15/2020] [Indexed: 11/27/2022]
Abstract
AIM This study examined whether changes in generalized trust and bonding trust are related to changes in trait anxiety, and whether changes in self-rated health mediate the relationship between changes in two types of trust and trait anxiety among older Taiwanese adults. METHODS A hierarchical regression model and a mediation model were separately used to analyze two-wave panel data on 763 older adults from the Panel Study of Family Dynamics in Taiwan. RESULTS Our findings show that changes in bonding trust (but not changes in generalized trust) are associated with changes in trait anxiety. The results show that sustaining a high level of bonding trust is associated with consistently good health, which in turn decreases anxiety. The relationship between changes in bonding trust and trait anxiety was found to be partially mediated by changes in self-rated health among older people. CONCLUSIONS The results suggest that bonding trust is more beneficial for the promotion of self-rated health and reducing trait anxiety than generalized trust in a given context. Policies aiming to ameliorate anxiety among older adults should take into consideration the importance of the developing bonding trust and promoting health in Chinese societies. Geriatr Gerontol Int 2020; 20: 833-838.
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Affiliation(s)
- Fang-Hua Jhang
- Department of Law and Social Work, Minjiang University, Fuzhou, Fujian, China
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10
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Affiliation(s)
- Jana Hummel
- , Rheingoldstr 41a, D-68199, Mannheim, Deutschland.
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Anxiety Disorders in the Elderly. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:561-576. [DOI: 10.1007/978-981-32-9705-0_28] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Bakkane Bendixen A, Engedal K, Selbaek G, Benth JŠ, Hartberg CB. Anxiety symptom levels are persistent in older adults with a mental disorder: A 33-month follow-up study. Int J Geriatr Psychiatry 2019; 34:601-608. [PMID: 30609143 DOI: 10.1002/gps.5058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/20/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Anxiety symptoms are common in old age and have been suggested as risk factors for development of cognitive impairment and mortality. The objective of the present study was to investigate whether anxiety symptoms among older adults with a mental health diagnosis are persistent, and severity of anxiety predicts cognitive decline and mortality. METHODS We collected data from 201 patients referred to specialist mental health service in a department of geriatric psychiatry. Of these, 150 were reexamined after 33 months, while 51 patients died before follow-up. Mean age (SD) at baseline among the patients that were reexamined was 73.4 (7.3) years, and 67% were women. The Geriatric Anxiety Inventory (GAI) was used to measure anxiety symptoms at baseline and follow-up. We investigated whether higher GAI scores at baseline were associated with persistence of anxiety. Associations with cognitive decline or mortality were also explored. The associations were estimated by use of trajectory analysis and regression models. RESULTS Seventy-four percentages had the same level of anxiety symptoms, and 29% had a high level of anxiety at baseline and follow-up. GAI score at baseline was not associated with cognitive decline or mortality at 33-month follow-up. CONCLUSION In a longitudinal study of anxiety symptoms among older adults in specialist mental health services, we demonstrate persistent high or low levels of anxiety symptoms. Anxiety trajectories over time were not predicted by patient characteristics. Also the level of anxiety cannot be used as predictor for future cognitive decline or mortality in a clinical population.
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Affiliation(s)
- Anette Bakkane Bendixen
- Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Oslo, Norway.,Vestfold Hospital Trust, Norwegian National Advisory Unit on Aging and Health, Toensberg, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Knut Engedal
- Vestfold Hospital Trust, Norwegian National Advisory Unit on Aging and Health, Toensberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Geir Selbaek
- Vestfold Hospital Trust, Norwegian National Advisory Unit on Aging and Health, Toensberg, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway.,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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Obvious anxiogenic-like effects of subchronic copper intoxication in rats, outcomes on spatial learning and memory and neuromodulatory potential of curcumin. J Chem Neuroanat 2019; 96:86-93. [DOI: 10.1016/j.jchemneu.2019.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/02/2019] [Accepted: 01/02/2019] [Indexed: 12/16/2022]
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Goyal AR, Bergh S, Engedal K, Kirkevold M, Kirkevold Ø. Trajectories of quality of life and their association with anxiety in people with dementia in nursing homes: A 12-month follow-up study. PLoS One 2018; 13:e0203773. [PMID: 30204812 PMCID: PMC6133386 DOI: 10.1371/journal.pone.0203773] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/27/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study aimed to identify possible groups of people with dementia (PWD) in nursing homes with different trajectories of proxy-rated quality of life (QoL), and to explore how anxiety (along with other characteristics) was associated with these trajectories of QoL of PWD in nursing homes at a 12-month follow-up. METHODS We included 298 PWD aged 65 years and older from 17 Norwegian nursing homes. The Norwegian version of the Rating Anxiety in Dementia scale (RAID-N) was used to assess anxiety, defined as RAID-N score ≥12; proxy-rated QoL was assessed by Quality of Life in Late-Stage Dementia (QUALID). The assessments were made at baseline and after a mean follow-up period of 350 days (SD 12.3). A growth mixture model identified two distinct trajectories of QUALID scores. Association between the QUALID score trajectories and demographic and clinical characteristics were analyzed with logistic regression models. RESULTS Trajectory group 1 (206 participants) had a lower proportion of participants with anxiety, and a more stable and better QoL, compared to trajectory group 2 (92 participants) at a 12-month follow-up. In a multivariate logistic regression analysis, more severe impairment in activities of daily living, along with presence of anxiety, depression, agitation, and use of antipsychotics at baseline, were associated with belonging to the trajectory group with proxy-rated poor QoL. SIGNIFICANCES This study reveals that anxiety is associated with proxy-rated poor QoL of PWD at a 12-month follow-up. Efforts should be made to identify anxiety among nursing home residents with dementia to initiate treatment.
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Affiliation(s)
- Alka R. Goyal
- The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
- * E-mail:
| | - Sverre Bergh
- The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Marit Kirkevold
- Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Øyvind Kirkevold
- The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway
- Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Norwegian University of Science and Technology (NTNU) in Gjøvik, Faculty of Health, Care and Nursing, Gjøvik, Norway
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Physical activity attenuates the impact of poor physical, mental, and social health on total and cardiovascular mortality in older adults: a population-based prospective cohort study. Qual Life Res 2018; 27:3293-3302. [DOI: 10.1007/s11136-018-1974-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2018] [Indexed: 12/18/2022]
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The course of anxiety in persons with dementia in Norwegian nursing homes: A 12-month follow-up study. J Affect Disord 2018; 235:117-123. [PMID: 29655072 DOI: 10.1016/j.jad.2018.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/06/2018] [Accepted: 04/02/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Knowledge is scarce about the course of anxiety in persons with dementia (PWD) in nursing homes. This study aimed to describe the course of anxiety, anxiety symptoms, and the correlates of change in the Norwegian version of the Rating Anxiety in Dementia scale (RAID-N) score in PWD in nursing homes. METHODS Using the RAID-N, anxiety was assessed in 298 PWD aged 65 years and above from 17 Norwegian nursing homes. The assessments were made at baseline and after a mean follow-up period of 350 days (SD 12.3). Associations between the change in RAID-N score and demographic and clinical characteristics were analyzed with multilevel regression models. RESULTS At 12 months, 93 participants (31.2%) had died. There was no significant change in the proportion of participants with anxiety, defined as RAID-N score ≥12, from baseline (33.7%) to follow-up (31.2%) (McNemar, p = 0.597). "Motor tension", "frightened and anxious", and "irritability" were the most frequent anxiety symptoms among those with dementia and anxiety. A higher Neuropsychiatric Inventory-Questionnaire (NPI-Q) sub-syndrome affective baseline score and more use of anxiolytics were associated with reduction in RAID-N score, whereas a higher NPI-Q sub-syndrome aroused baseline score and more use of antipsychotics were associated with an increase in RAID-N score at follow-up. LIMITATIONS The study did not control for ongoing treatment or changes of comorbidities. CONCLUSIONS Anxiety and anxiety symptoms are highly prevalent among PWD in nursing homes over a12-month period. The symptoms "motor tension", "frightened and anxious", and "irritability" require attention in screening for anxiety.
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Verger P, Mmadi Mrenda B, Cortaredona S, Tournier M, Verdoux H. Trajectory analysis of anxiolytic dispensing over 10 years among new users aged 50 and older. Acta Psychiatr Scand 2018; 137:328-341. [PMID: 29441519 DOI: 10.1111/acps.12858] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify temporal trajectories of anxiolytic benzodiazepine (A-BZD) use over 10 years among new A-BZD users aged 50 and older and describe treatment patterns and demographic and clinical characteristics associated with each trajectory. METHOD A representative cohort of the French national health insurance fund users was tracked from 2006 through 2015. We used latent class mixed models to identify the trajectories. RESULTS We observed four trajectories among new users (no A-BZD dispensing in 2005) plus one non-use trajectory. The proportion of occasional use among users was 60%; early increasing use, 10%; late increasing use, 17%; and increasing/decreasing use, 13%. Prevalence of occasional use decreased with age in women, but not men. Duration of treatment episodes and doses differed between trajectories. Multiple regression analyses with occasional use as the reference showed that the other three trajectories shared characteristics (age, coprescriptions of other psychotropic drugs, and more general practitioner consultations) but differed by the presence at inclusion or occurrence during follow-up of psychiatric, neurodegenerative, and somatic conditions. CONCLUSION We found four different long-term temporal trajectories in new A-BZD users (occasional, early increasing, late increasing, and increasing/decreasing use). Difficulties quitting or reducing consumption may be very different for each trajectory, requiring tailored care approaches.
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Affiliation(s)
- P Verger
- IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix Marseille Université, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - B Mmadi Mrenda
- IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix Marseille Université, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - S Cortaredona
- IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Aix Marseille Université, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - M Tournier
- Pharmacoepidemiology Research Team, UMR 1219, Bordeaux Population Health Research Center, Inserm, University of Bordeaux, Bordeaux, France.,Centre Hospitalier Charles Perrens, Bordeaux, France
| | - H Verdoux
- Pharmacoepidemiology Research Team, UMR 1219, Bordeaux Population Health Research Center, Inserm, University of Bordeaux, Bordeaux, France.,Centre Hospitalier Charles Perrens, Bordeaux, France
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Abstract
Anxiety disorders in later life are some of the most significant mental health problems affecting older adults. Prevalence estimates of anxiety disorders in late life vary considerably based on multiple methodological issues. Current diagnostic criteria may not adequately capture the nature and experience of anxiety in older people, particularly those in ethnic and racial minority groups. This article reviews late-life anxiety disorders. Pharmacologic and psychotherapy approaches to treat late-life anxiety are reviewed, including a summary of current innovations in clinical care across settings, treatment models, and treatment delivery.
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Bentvelzen A, Aerts L, Seeher K, Wesson J, Brodaty H. A Comprehensive Review of the Quality and Feasibility of Dementia Assessment Measures: The Dementia Outcomes Measurement Suite. J Am Med Dir Assoc 2017; 18:826-837. [PMID: 28283381 DOI: 10.1016/j.jamda.2017.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 01/11/2017] [Indexed: 12/19/2022]
Abstract
The diagnosis of dementia and the management of its associated symptoms are aided by high-quality assessment tools. However, there is disagreement on the optimal tools among abundant alternatives and lack of consistent quality standards across the different domains of dementia-related change (ie, cognition, severity, function, behavioral and psychological symptoms, delirium, quality of life). Standardization is difficult because the relevance of a measurement tool for health professionals may depend on the clinical setting and on the dementia type and severity. To address this need, we conducted a comprehensive and clinically relevant evidence-based review of dementia-related tools and present a set of recommended tools, the Dementia Outcomes Measurement Suite. The review revealed that considerable development has occurred in terms of assessment of persons with mild cognitive impairment, executive dysfunction, cognitively mediated functional change, and apathy. More research is needed to develop and validate tools to assess health-related quality of life and specific symptoms of dementia including anxiety, wandering, and repetitive vocalizations. This extensive overview of the quality of different measures may serve as a guide for health professionals clinically and for researchers developing new or improved dementia assessment tools.
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Affiliation(s)
- Adam Bentvelzen
- Dementia Collaborative Research Center (DCRC) Network, University of New South Wales Australia, Sydney, Australia
| | - Liesbeth Aerts
- Dementia Collaborative Research Center (DCRC) Network, University of New South Wales Australia, Sydney, Australia
| | - Katrin Seeher
- Dementia Collaborative Research Center (DCRC) Network, University of New South Wales Australia, Sydney, Australia
| | - Jacqueline Wesson
- Aging Work and Health Research Unit, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Henry Brodaty
- Dementia Collaborative Research Center (DCRC) Network, University of New South Wales Australia, Sydney, Australia; Center for Healthy Brain Aging (CHeBA), University of New South Wales Australia, Sydney, Australia.
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Phytopharmaceutical treatment of anxiety, depression, and dementia in the elderly: evidence from randomized, controlled clinical trials. Wien Med Wochenschr 2015; 165:217-28. [PMID: 26092515 DOI: 10.1007/s10354-015-0360-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/10/2015] [Indexed: 12/13/2022]
Abstract
Based on subgroup analyses of randomized, controlled clinical trials, we review the efficacy of three phytopharmaceutical drugs, respectively of the corresponding active substances silexan® (WS® 1265, lavender oil) in anxiety disorders, WS® 5570 (Hypericum extract) in major depression, and EGb 761® (Ginkgo biloba extract) in Alzheimer, vascular, or mixed type dementia, in elderly patients aged ≥ 60 years. Four trials were eligible in each indication. Meta-analyses and analyses based on pooled raw data showed that the three drugs were significantly superior to placebo in the elderly subset, and that their treatment effects reflected in the main outcome measures (Hamilton Anxiety scale, Hamilton Depression scale, Neuropsychiatric Inventory) were comparable with those observed in the original trials without age restrictions. The results confirm the efficacy of the three herbal active substances in elderly patients of ≥ 60 years of age. In anxiety, depression, and dementia, they thus represent efficacious and well-tolerated alternatives to synthetic drugs.
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