Characterization of worry according to severity of anxiety in elderly living in the community

Prevalence and relative factors of health anxiety of elders in community healthcare centers

OBJECTIVE

The study's aims were (i) to identify the prevalence of health anxiety (HA) among the elderly in urban community healthcare centers and (ii) to determine whether HA is related to social, physical, or psychological factors.

DESIGN

It is a population-based observational study.

SETTING

Data were collected from urban community healthcare centers in Chengdu, China, from October 2016 to March 2017.

PARTICIPANTS

A total of 893 participants aged ≥ 60 years.

MEASUREMENTS

The Short HA Inventory was used for HA assessment. Mental health status was assessed using the Geriatric Depression Inventory and Mini-Mental State Examination. Other information was collected through face-to-face interviews. Data analysis was performed using SPSS 19.0.

RESULTS

The point prevalence rate of HA was 9.53% (95%CI = 6.99%-12.07%). The number of chronic diseases was a positive factor associated with HA in a regression analysis. As compared with participants without chronic diseases, people with one (OR = 1.796; 95%CI = 0.546-5.909), two (OR = 2.922; 95%CI = 0.897-9.511), and three chronic diseases (OR = 6.448; 95%CI = 2.147-19.363) had higher odds of suffering from HA.

CONCLUSIONS

The prevalence of HA was high in the elderly population. Certain physical conditions, such as having chronic diseases, were significant impact factors. More attention should be paid to the situation of HA in this population.

Expression of Generalized Anxiety Disorder Across the Lifespan

In generalized anxiety disorder (GAD), both the associated symptoms and worry content have been shown to vary as a function of age (Jeste et al., 2005; Portman et al., 2011). However, few studies have conducted analyses beyond mean comparisons and no studies have examined whether the observed differences in worry content and the associated symptoms are due to the lack of measurement invariance across age groups. The current study evaluated whether the measurement and expression of GAD in adults varied as a function of age, using a clinical sample of 375 participants and dimensional measures of GAD. The sample was divided into three age groups (OLDER = 60+, MID = 40-59, YOUNG = 20-39), matched by sex and GAD status. Two associated symptoms were found to exhibit differential item functioning, overall distress/interference as well as fatigue, with higher levels distress/interference and lower levels of fatigue found in the OLDER age group despite equivalent GAD severity levels across groups. When examining the content of reported worries, differential item functioning was found in four worry domains. Holding the latent dimension of worry severity constant: (a) the YOUNG age group was found to have higher reported rate of social worries, and (b) the OLDER age group was found to have higher levels of reported worries about community/world affairs and health of self. The OLDER age group also exhibited lower levels of worry about work and school. These results are discussed with regard to the assessment of GAD across the lifespan.

Assessment of anxiety in older adults: a review of self-report measures

With increasing numbers of older adults in the general population, anxiety will become a widespread problem in late life and one of the major causes of health care access contributing to high societal and individual costs. Unfortunately, the detection of anxiety disorders in late life is complicated by a series of factors that make it different from assessment in younger cohorts, such as differential symptom presentation, high comorbidity with medical and mental disorders, the aging process, and newly emergent changes in life circumstances. This review covers commonly and currently used self-report inventories for assessing anxiety in older adults. For each tool, psychometric data is investigated in depth. In particular, information about reliability, validity evidence based on data from clinical and nonclinical samples of older adults, and availability of age-appropriate norms are provided. Finally, guidance for clinical evaluation and future research are proposed in an effort to highlight the importance of clinical assessment in the promotion of clinically relevant therapeutic choices.

Anxiety Disorders and General Medical Conditions: Current Research and Future Directions

Evidence that anxiety disorders are associated with general medical conditions is growing. While it is known that medical and mental conditions are often comorbid, research demonstrates that there may be underlying causal mechanisms. Furthermore, comorbid anxiety and general medical conditions are associated with poorer patient outcomes than either condition alone. Comorbid general medical and mental disorders not only affect individual patient health but also strain existing medical systems. Growing health care expenditures and increasing time pressures on clinicians create a challenging environment for intensive therapy in traditional settings. Effective screening, diagnosis, and treatment of individuals with comorbid conditions require health systems that are based on interprofessional collaboration, including integrative and collaborative care services. These models encourage the provision of patient care within a network of health care professionals, working together and sharing expertise for more efficient and holistic care. Research on the design and implementation of these systems within the context of anxiety disorders and comorbid general medical conditions is in its infancy. Given the staggeringly high rates of anxiety disorders within the general population and the continued rise of many chronic medical conditions coinciding with the increasing lifespan, mental health and primary care providers should consider how they might implement integrative care methods within their own practice.

Examining the Relationship Between Worry and Sleep: A Daily Process Approach

There is growing evidence suggesting that worry and sleep are intimately linked. However, the relationship between these two phenomena over the course of a day remains largely unstudied. It is possible that (a) worry predicts sleep disturbance that night, (b) sleep disturbance predicts worry the following day, or (c) there is a bidirectional relationship between worry and sleep disturbance. The present study examined the daily relationship between worry (both during the day and immediately prior to sleep onset) and sleep in 50 high trait worriers who were randomly assigned to one of two interventions aimed at reducing worry as part of a larger study. A daily process approach was utilized wherein participants completed daily reports of sleep and worry during a 7-day baseline period followed by a 14-day intervention period. Results of repeated measures multilevel modeling analyses indicated that worry experienced on a particular day predicted increased sleep disturbance that night during both the baseline and intervention weeks. However, there was no evidence of a bidirectional relationship as sleep characteristics did not predict worry the following day. Additionally, the type of intervention that participants engaged in did not affect the daily relationship between worry and sleep. Results of the present study are consistent with the cognitive model of insomnia (Harvey, 2002) and highlight the importance of addressing and treating worry among individuals with high trait worry and sleep disturbance.

Differences in anxiety and depression symptoms: comparison between older and younger clinical samples

BACKGROUND

Anxiety and depression symptoms change over the lifespan and older adults use different terms to describe their mental health, contributing to under identification of anxiety and depression in older adults. To date, research has not examined these differences in younger and older samples with comorbid anxiety and depression.

METHODS

One hundred and seven treatment-seeking participants (47 older, 60% female, and 60 younger, 50% female) with anxiety and mood disorders completed the Anxiety Disorders Interview Schedule and a symptom checklist to examine differences in symptom severity, symptom profiles and terms used to describe anxiety and mood.

RESULTS

The findings indicated several key differences between the presentation and description of anxiety and depression in younger and older adults. Older adults with Social Phobia reported fearing a narrower range of social situations and less distress and interference. Older adults with Generalized Anxiety Disorder (GAD) reported less worry about interpersonal relationships and work/school than younger adults, however, there were no differences between age groups for behavioral symptoms endorsed. Further older adults reported phobia of lifts/small spaces more frequently than younger adults. Depressed older depressed adults also reported more anhedonia compared to younger adults, but no differences in terms of reported sadness were found. Finally, older and younger adults differed in their descriptions of symptoms with older adults describing anxiety as feeling stressed and tense, while younger adults described anxiety as feeling anxious, worried or nervous.

CONCLUSIONS

Clinicians need to assess symptoms broadly to avoid missing the presence of anxiety and mood disorders especially in older adults.

An exploration of worry content and catastrophic thinking in middle-aged and older-aged adults with and without Parkinson's disease

OBJECTIVE

Worry is a common and distressing problem in Parkinson's disease (PD). However, little is known about the nature and content of worry in PD and how it might differ to non-PD populations. The study aimed to explore the content and nature of worry in middle-aged and older-aged adults with and without PD.

METHOD

Four groups of participants, 20 PD patients (10 high worry and 10 low worry) and 19 middle-aged and older-aged adults (10 high worry and nine low worry), completed the catastrophising interview (CI) for three worry topics. Worriers were classified (high/low) on the basis of Penn State Worry Questionnaire scores. Data were analysed using framework analysis.

RESULTS

High worriers showed a greater diversity of worry topics than low worriers. Health worries differentiated high and low worriers in the non-PD sample but were common across all PD participants. The CI revealed that the root concern of worry was often different to that initially described. In particular, PD high worriers were more likely to express underlying concerns about negative self-perception and death/severe incapacity.

CONCLUSION

The CI was able to identify the root cause of worry, demonstrating the value of this technique in the exploration and treatment of worry and psychological distress. Exploring worry content may help to distinguish patients with problematic worry, with worries about self-perception and death/severe incapacity characteristic of high worriers. Therapeutic interventions designed to alleviate problematic worry and distress in PD need to take account of the realities of living with PD and the potentially realistic nature of worries that may appear catastrophic in a healthy population.

A longitudinal examination of anxiety disorders and physical health conditions in a nationally representative sample of U.S. older adults

BACKGROUND

There has been growing interest in the relation between anxiety disorders and physical conditions in the general adult population. However, little is known about the nature of this association in older adults. Understanding the complex relationship between these disorders can help to inform prevention and treatment strategies unique to this rapidly growing segment of the population.

METHODS

A total of 10,409 U.S. adults aged 55+ participated in Wave 1 (2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Lifetime and past-year DSM-IV anxiety, mood, and substance use disorders, and lifetime personality disorders, were assessed in both waves. Participants self-reported on whether they had been diagnosed by a healthcare professional with a broad range of physical health conditions; this study focuses on cardiovascular disease, gastrointestinal disease, and arthritis. Multivariable logistic regressions adjusted for sociodemographics, comorbid mental disorders, and number of physical health conditions assessed: (1) the relation between past-year physical conditions at Wave 1 and incident past-year anxiety disorders at Wave 2 and; (2) the relation between individual lifetime anxiety disorders at Wave 1 and incident physical conditions at Wave 2. A second set of adjusted multinomial logistic regressions examined Wave 1 sociodemographic and physical and mental health risk factors associated with incident physical condition alone, anxiety disorder alone, and comorbid anxiety and physical condition at Wave 2.

RESULTS

Past-year arthritis at Wave 1 was significantly associated with increased odds of incident generalized anxiety disorder at Wave 2. Further, any lifetime anxiety disorder and posttraumatic stress disorder at Wave 1 were significantly associated with increased odds of incident gastrointestinal disease at Wave 2. Differential sociodemographic and physical and mental health predictors were significantly associated with increased odds of incident comorbid anxiety disorder and physical conditions.

CONCLUSION

Results of the current study elucidate the longitudinal bidirectional relationships between anxiety disorders and physical health conditions in a large, nationally representative sample of older adults. These results have important implications for identifying at risk older adults, which will not only impact this growing segment of the population directly, but will also potentially lessen burden on the healthcare system as a whole.

Recognizing and treating late-life generalized anxiety disorder: distinguishing features and psychosocial treatment

Generalized anxiety disorder is a highly prevalent and under-recognized public health problem associated with significant impairment and serious disability. Generalized anxiety disorder is the most common anxiety disorder among adults over the age of 60 years. This article discusses distinguishing features of generalized anxiety disorder, such as disorder-specific worry domains and associated features. The relation of the disorder to normal aging, major depression and health is also discussed. Current psychosocial treatment strategies are outlined, with a particular focus on cognitive behavior therapy.

Health anxiety disorders in older adults: conceptualizing complex conditions in late life

Health anxiety disorders (e.g., hypochondriasis) are prevalent but understudied in older adults. Existing research suggests that severe health anxiety has a late age of onset, perhaps because of comorbidity with physical health conditions that are more likely to occur with aging. Despite being under diagnosed in later life due to a lack of age-appropriate diagnostic criteria, significant positive associations with age suggest that health anxiety disorders are more prevalent in older than younger adults. Preliminary research also highlights the complexity of these disorders in older adults and the potential importance of medical morbidity as a risk factor. This review explores the complexities of health anxiety disorders in later life with a focus on understanding defining features, prevalence rates, correlates, assessment, diagnosis, and treatment. We offer a theoretical model of the development of severe health anxiety among older adults to encourage further research on this important and under-studied topic.

Who worries most? Worry prevalence and patterns across the lifespan

OBJECTIVE

To examine the age-related worry patterns in a population-based sample of self-reported worriers.

METHODS

The National Survey of Mental Health and Well-Being is a multistage stratified epidemiologic survey of mental health conducted in Australia in 2007. Participants were surveyed using the Composite International Diagnostic Interview. All participants who reported a period of pervasive worry were included in this study (N = 3735, 16-85 years of age, 61% female).

RESULTS

Compared with younger adults (16-29 years of age; N = 860), older adults (65-85 years of age; N = 639) reported fewer worries [odds ratio (OR) = 0.36, p < 0.01] and a lower likelihood of worrying about interpersonal relations (OR = 0.66, p < 0.01), health (OR = 0.65, p < 0.05), work (OR = 0.39, p < 0.01), and miscellaneous topics (OR = 0.57, p < 0.01), but a higher likelihood of worrying about the health and welfare of loved ones (OR = 2.46, p < 0.01) after adjusting for socio-demographic and clinical factors. Similar patterns were seen in older persons with and without a lifetime history of generalized anxiety disorder as diagnosed by the Diagnostic and Statistical Manual of Mental Disorders.

CONCLUSIONS

The findings indicated an overall decrease in worry count with advancing age, as well as a developmental distribution of worry content, and a quantitative but not qualitative distinction between normal and pathological worriers. Overall, these findings might contribute to the understanding of worry processes and the phenomenology of generalized anxiety disorder in older cohorts.

Improving recognition of late life anxiety disorders in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: observations and recommendations of the Advisory Committee to the Lifespan Disorders Work Group

BACKGROUND

Recognition of the significance of anxiety disorders in older adults is growing. The revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) provides a timely opportunity to consider potential improvements to diagnostic criteria for psychiatric disorders for use with older people. The authors of this paper comprise the Advisory Committee to the DSM5 Lifespan Disorders Work Group, the purpose of which was to generate informative responses from individuals with clinical and research expertise in the field of late-life anxiety disorders.

METHODS

This paper reviews the unique features of anxiety in later life and synthesizes the work of the Advisory Committee.

RESULTS

Suggestions are offered for refining our understanding of the effects of aging on anxiety and other disorders (e.g., mood disorders) and changes to the DSM5 criteria and text that could facilitate more accurate recognition and diagnosis of anxiety disorders in older adults. Several of the recommendations are not limited to the study of anxiety but rather are applicable across the broader field of geriatric mental health.

CONCLUSIONS

DSM5 should provide guidelines for the thorough assessment of avoidance, excessiveness, and comorbid conditions (e.g., depression, medical illness, cognitive impairment) in anxious older adults.

A Twin Study of Lifetime Generalized Anxiety Disorder (GAD) in Older Adults: Genetic and Environmental Influences Shared by Neuroticism and GAD

The nature of Generalized Anxiety Disorder (GAD) and worry across the lifespan remains incompletely understood. We investigated genetic and environmental influences on GAD and the proportion of genetic and environmental variation in GAD that is shared with neuroticism in older adult twins. Participants included 1618 monozygotic and 2291 same-sexed dizygotic twin pairs from the Swedish Twin Registry aged 55 to 74. Participants provided personality information in 1973 and also participated in a telephone screening between 1998 and 2002 that included an assessment for lifetime GAD. Univariate biometric models indicated that both GAD and neuroticism were moderately heritable (.27 and .47, respectively), while the balance of variation reflected environmental factors unique to the individual. Bivariate analyses indicated that approximately one third of the genetic influences on GAD were in common with genetic influences on neuroticism, while individual specific environmental influences were virtually unshared between GAD and neuroticism. Analyses of sex effects suggested that men and women differed in the frequency of lifetime GAD and level of neuroticism; however, no sex differences for genetic and environmental influences for either trait were identified.

Characteristics of generalized anxiety disorder in patients with dementia

BACKGROUND

Overlap of cognitive and anxiety symptoms (i.e., difficulty concentrating, fatigue, restlessness) contributes to inconsistent, complicated assessment of generalized anxiety disorder (GAD) in persons with dementia.

METHODS

Anxious dementia patients completed a psychiatric interview, the Penn State Worry Questionnaire-Abbreviated, and the Rating for Anxiety in Dementia scale. Analyses to describe the 43 patients with and without GAD included the Wilcoxon Mann-Whitney two-sample test, Fisher's exact test. Predictors of GAD diagnosis were identified using logistic regression.

RESULTS

Those with GAD were more likely to be male, have less severe dementia and endorsed more worry, and anxiety compared to patients without GAD. Gender, muscle tension and fatigue differentiated those with GAD from those without GAD.

CONCLUSIONS

Although this study is limited by a small sample, it describes clinical characteristics of GAD in dementia, highlighting the importance of muscle tension and fatigue in recognizing GAD in persons with dementia.

The spectrum of worry in the community-dwelling elderly

OBJECTIVES

In this study, we examine the prevalence and distribution of worry, its content, and its associations with quality of life and depression, based on a large sample of community-dwelling elderly. We will attempt to distinguish between pathological and non-pathological worry based on these associations.

DESIGN

Community survey.

SETTING

Inner-city population.

PARTICIPANTS

A total of 2136 people aged between 65 and 96, of whom 66% were women, were recruited through general practitioners and interviewed in their own homes.

MEASUREMENTS

The GMS-AGECAT structured psychiatric interview was used to rate symptoms which were classified into five levels of severity of worry ranging from simple, non-excessive to generalised anxiety disorder (GAD).

RESULTS

In this study, 79% of the participants reported worrying, 37% worrying excessively, while 20% reported excessive, uncontrollable worry and 6.3% met criteria for GAD. Prevalence of all types of worry declined with age and was lower in men. The prevalence of depressed mood was similar in those without worry and those with non-severe worry (Wald post hoc test, p = 0.06) but rose significantly with each level of severe worry (Wald post hoc tests, all p < 0.05). Major depressive disorder was absent in those who did not worry, and had a prevalence of only 0.2% in those with non-severe worry (p = 0.552, Fisher's exact test). It has a significantly elevated prevalence at all levels of excessive worry, and a significantly higher prevalence in those with GAD. All levels of excessive worry were associated with reduced quality of life.

CONCLUSION

Severe worry is highly prevalent in the elderly; most severe worriers do not meet criteria for GAD, but have a reduced quality of life and an increased prevalence of depression.

Worry in Older Community-Residing Adults

With rising longevity, increasing numbers of older people are experiencing changes in their everyday family and social life, changes in their financial status, and a greater number of chronic conditions affecting their health. We took the opportunity to explore these relationships with worry in a group of volunteer community-living elderly ( n = 310). Findings showed that that those people under 75 years of age had a higher risk of worrying (OR = 1.8, 95% CI = 1.0–3.1) compared to the older age groups. Women worried more than men and an important finding was that those with chronic health conditions such as arthritis of the hip and knee were more prone to worry than those who were healthy or had acute conditions (OR = 3.5, 95% CI = 1.4–8.9). This latter finding suggests the importance placed on the role of the hip and knee in maintaining functional capacity to perform life skills.

Differences between younger and older adults in the structure of suicidal intent and its correlates

OBJECTIVE

To analyze differences in the variables associated with severity of suicidal intent and in the main factors associated with intent when comparing younger and older adults.

DESIGN

Observational, descriptive cross-sectional study.

SETTING

Four general hospitals in Madrid, Spain.

PARTICIPANTS

Eight hundred seventy suicide attempts by 793 subjects split into two groups: 18-54 year olds and subjects older than 55 years.

MEASUREMENTS

The authors tested the factorial latent structure of suicidal intent through multigroup confirmatory factor analysis for categorical outcomes and performed statistical tests of invariance across age groups using the DIFFTEST procedure. Then, they tested a multiple indicators-multiple causes (MIMIC) model including different covariates regressed on the latent factor "intent" and performed two separate MIMIC models for younger and older adults to test for differential patterns.

RESULTS

Older adults had higher suicidal intent than younger adults (z = 2.63, p = 0.009). The final model for the whole sample showed a relationship of intent with previous attempts, support, mood disorder, personality disorder, substance-related disorder, and schizophrenia and other psychotic disorders. The model showed an adequate fit (chi²[12] = 22.23, p = 0.035; comparative fit index = 0.986; Tucker-Lewis index = 0.980; root mean square error of approximation = 0.031; weighted root mean square residual = 0.727). All covariates had significant weights in the younger group, but in the older group, only previous attempts and mood disorders were significantly related to intent severity.

CONCLUSIONS

The pattern of variables associated with suicidal intent varies with age. Recognition, and treatment of geriatric depression may be the most effective measure to prevent suicidal behavior in older adults.

Health anxiety among older people: an exploratory study of health anxiety and safety behaviors in a cohort of older adults in New Zealand

BACKGROUND

Despite a stereotype that characterizes older people as excessively anxious about their health, there is little research into this phenomenon. The present exploratory study examined: (a) whether a cohort of older adults was unduly health anxious, (b) which demographic and health factors predicted health anxiety (HA), and (c) whether an aspect of the cognitive behavioral model of HA was applicable to older adults by investigating the relationship between HA and safety behaviors.

METHOD

Participants were a convenience sample of adults aged over 65 and living independently in Auckland, New Zealand. Participants (104 women and 41 men) completed an anonymous self-report questionnaire measuring demographic factors, physical health and function, health anxiety, safety behaviors, and medical utilization.

RESULTS

This cohort of adults over 65 were not unduly health anxious. Occurrence of severe HA was similar to that found in younger populations. Decreased physical function and lower education predicted scores on the HA measure. Consistent with the cognitive behavioral model, HA was a unique significant predictor of safety behaviors. HA and decreased physical function predicted medical utilization.

CONCLUSIONS

Generally low levels of HA among this cohort of older individuals challenged the pervasive stereotype of the "hypochondriacal" older person. Factors contributing to HA were similar to those reported in studies with younger cohorts. Findings provided preliminary support for the applicability of the cognitive behavioral model of HA to adults over 65. Implications of the findings and directions for future research were discussed.

Understanding health anxiety among community dwelling seniors with varying degrees of frailty

OBJECTIVE

In this study, we attempted to disentangle the extent to which older age vs physical health problems contribute to health anxiety. Thus, we compared the levels of health anxiety among younger adults and seniors, with either low or high levels of frailty. Predictors of health anxiety in seniors were explored.

METHODS

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

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.

CONCLUSIONS

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

OBJECTIVES

This 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.

METHOD

The sample was composed of 120 community-dwelling older adults, with a mean of age of 71.0 years (SD = 6.3). Mediational analyses and structural equation modeling were used to analyze and compare different models.

RESULTS

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 (i.e. Goodness of fit index (GFI) = 0.995) and clearly had a better fit than alternative models.

CONCLUSION

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.

Distinguishing worry from rumination in older people: a preliminary investigation

Anxiety and depression are common mental health problems in later life. Since worry and rumination are thought to underpin the respective primary cognitive processes in anxiety and depression, we developed a measure to distinguish worry from rumination in later life. The Ruminative Response Scale was adapted to include items that characterise the cognitive features of worry. We examined its properties using 92 clinical and non-clinical participants, aged over 65. Factor analysis demonstrated a three-factor structure: brooding, reflection and worry with internal consistencies of alpha = 0.72, alpha = 0.67 and alpha = 0.55 respectively. We found no evidence for concurrent validity of these factors using the Penn State Worry Questionnaire. Modest but significant associations between reflection and brooding (r = 0.36) and reflection and worry (r = 0.2) were found. Brooding and worry sub-scales remained unrelated. We suggest that it is possible to distinguish worry from rumination in older people and that differentiating between their key underlying characteristics in the assessment of mood problems may enhance the targeting and evaluation of cognitive-behavioural therapy for anxiety and depression in later life. Future research with a substantial clinical sample is needed to explore the underlying dimensions and correlates of worry in later life.

Beliefs about worry in community-dwelling older adults

This study examines the association between several kinds of beliefs about worry and generalized anxiety disorder (GAD) severity in a sample of older individuals recruited from a community setting (N=142, mean age=71.0 years, SD=6.0, range=55-88). Beliefs about worry were assessed with a 17-item scale designed for older adults, including three dimensions: Positive Beliefs, Negative Beliefs, and Responsibility. All three dimensions distinguished between people endorsing GAD symptoms and those without GAD symptoms, and only Negative Beliefs had a significant independent weight when regressed on GAD severity, even after controlling for level of trait worry. Results of this study suggest that negative beliefs appear to be strongly related to pathological worry in older adults. These results are consistent with empirical findings in younger adults and potentially support the use of particular interventions in clinical work with older adults with GAD.

A test of the role of metaworry in the prediction of worry severity in an elderly sample

Wells (Behav. Cogn. Psychother. 23 (1995) 301) proposed a cognitive model, which distinguishes between two kinds of worry: type I worry (focused on external things) and type II worry or metaworry (worry about one's own thoughts and worry). Wells' model assigns a central role to metaworry in the development of excessive worry, and Wells and Carter (Behav. Res. Ther. 37 (1999) 585) found in a college sample that metaworry predicted the level of trait worry after controlling for trait anxiety and type I worry. The present study replicated their investigation with a Spanish elderly sample and supported Wells' predictions that metaworry plays a significant role in the prediction of trait worry in contrast to type I worries, even when trait anxiety or perceived uncontrollability over worry are controlled.