Assessment of anxiety in older home care recipients

Detection of anxiety symptoms and disorders in older adults: a diagnostic accuracy systematic review

BACKGROUND

Anxiety symptoms and disorders are common in older adults and often go undetected. A systematic review was completed to identify tools that can be used to detect anxiety symptoms and disorders in community-dwelling older adults.

METHODS

MEDLINE, Embase and PsycINFO were searched using the search concepts anxiety, older adults and diagnostic accuracy in March 2023. Included articles assessed anxiety in community-dwelling older adults using an index anxiety tool and a gold standard form of anxiety assessment and reported resulting diagnostic accuracy outcomes. Estimates of pooled diagnostic accuracy outcomes were completed.

RESULTS

Twenty-three anxiety tools were identified from the 32 included articles. Pooled diagnostic accuracy outcomes were estimated for the Geriatric Anxiety Inventory (GAI)-20 [n = 3, sensitivity = 0.89, 95% confidence interval (CI) = 0.70-0.97, specificity = 0.80, 95% CI = 0.67-0.89] to detect generalized anxiety disorder (GAD) and for the GAI-20 (n = 3, cut off ≥ 9, sensitivity = 0.74, 95% CI = 0.62-0.83, specificity = 0.96, 95% CI = 0.74-1.00), Beck Anxiety Inventory (n = 3, sensitivity = 0.70, 95% CI = 0.58-0.79, specificity = 0.60, 95% CI = 0.51-0.68) and Hospital Anxiety and Depression Scale (HADS-A) (n = 3, sensitivity = 0.78, 95% CI = 0.60-0.89, specificity = 0.76, 95% CI = 0.60-0.87) to detect anxiety disorders in clinical samples.

CONCLUSION

The GAI-20 was the most studied tool and had adequate sensitivity while maintaining acceptable specificity when identifying GAD and anxiety disorders. The GAI-20, GAI-Short Form and HADS-A tools are supported for use in detecting anxiety in community-dwelling older adults. Brief, self-rated and easy-to-use tools may be the best options for anxiety detection in community-dwelling older adults given resource limitations. Clinicians may consider factors including patient comorbidities and anxiety prevalence when selecting a tool and cut off.

The traditional Chinese version of the Geriatric Anxiety Inventory: Psychometric properties and cutoff point for detecting anxiety

The study aimed to translate the Geriatric Anxiety Inventory into traditional Chinese (GAI-TC), examine its psychometric properties, and identify the optimal cutoff point. This research recruited 337 older adults from two community activity centers. Structured questionnaires were used, including demographic information and characteristics, the GAI-TC, and the State-Trait Anxiety Inventory (STAI). Cronbach's α of the GAI-TC was 0.93. The intraclass correlation coefficient was 0.90. The content validity index was 1.0. An exploratory factor analysis revealed that three factors in the GAI-TC, including cognition anxiety, impact of anxiety, and somatic anxiety, explained 59.46 % of the variance. The criterion-related validity showed a significant positive correlation between the GAI-TC and STAI, with an optimal cutoff of 9/10 for detecting anxiety in older persons living in the community. The GAI-TC had good reliability and validity and can provide professionals with a tool for the early identification of anxiety among older adults.

Evaluation of an exercise program incorporating an international cycling competition: a multimodal intervention model for physical, psychological, and social wellbeing in residential aged care

BACKGROUND

The transition into residential aged care is frequently associated with a reduction in physical activity, social engagement, and emotional wellbeing. Our aim was to evaluate the impact of a 26-day international cycling competition (Road Worlds Competition for Seniors), incorporating elements of exercise, audiovisual cycling footage, social engagement, and gamification, on the physical, psychological, and social well-being of aged care residents. We aimed to use findings to inform the development of a multi-modal intervention model to maximise wellbeing for older adults.

METHODS

Residents (N = 32) participated in a mixed-methods single-group intervention pilot study that compared pre-and post-competition measures for the following wellbeing domains; physical, psychological, and social. In addition, interviews were conducted with residents (n = 27) and staff (n = 6) to explore their experiences.

RESULTS

Measures identified significant improvements across multiple wellbeing domains, including functional fitness, depression, self-efficacy, and social network sizes. Findings from the interview data indicated that the multimodal components involved in the program delivery were valued by staff and residents who enjoyed the gamification, audiovisual cycling footage, social engagement, opportunities for reminiscence, and camaraderie between peers, staff, and volunteers.

CONCLUSIONS

Findings highlight a constellation of benefits across physical, psychological, and social domains of wellbeing and inform a model for innovative multidimensional programs in residential aged care. The benefits for residents with varying physical and cognitive abilities support the use of creative strategies that maximise inclusion and engagement for residents.

Short-Term, Community-Based, Slow-Stream Rehabilitation Program for Older Adults Transitioning from Hospital to Home: A Mixed Methods Program Evaluation

Introduction

Shortened hospital stays have shifted the burden of care for older adults to community, informal (ie, family, caregiver) and formal post-acute care and services, highlighting the need for effective post-hospital stay services and programs. As there is a dearth of information related to community-based, slow-stream rehabilitation program models for older adults transitioning from hospital to home in the Canadian context, the paper describes a mixed methods evaluation of such a program.

Materials and Methods

A mixed methods program evaluation, with process- and outcome-related elements, included 1) review and analysis of program documents; 2) observations to examine fidelity. Observation data were coded and summarized using descriptive statistics. Coded information and data were compared to document review data; 3) quantitative assessment of pre-post changes in physical, social, and psychological outcome measure and instrument scores using descriptive statistics, paired t-tests and confidence intervals (p = 0.05); and 4) exploration of acceptability through interviews and focus groups with 41 of the older adult participants and 17 family caregivers. Thematic analysis was used to examine focus group and interview transcripts.

Results

Observational data indicated alignment with the program document information overall. Statistically and clinically significant positive trends in improvement for physical outcome measure scores were observed (6-minute Walk Test, Life Space Assessment, Short Physical Performance Battery, Rapid Assessment of Physical Activity). Participants and family caregivers identified several positives and benefits of the program, ie, improvement in physical, social and mental well-being, decreased caregiver burden; and areas for improvement ie, need for more information about the program prior to enrollment and individualization, several of which aligned with the observation and quantitative data.

Discussion/Conclusion

This mixed methods program evaluation provided a detailed description of a community-based, slow-stream rehabilitation program for older adults who are transitioning to home post-hospital stay and its participants. Evidence of program fidelity, acceptability, and positive trends in improvement in physical outcome measure scores were found. Information about program strengths and areas for improvement can be used by stakeholders to inform program refinement and enhancement.

Validation of the Geriatric Anxiety Inventory in younger adults

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.

Plasma Total Tau and Neurobehavioral Symptoms of Cognitive Decline in Cognitively Normal Older Adults

Depression and related neurobehavioral symptoms are common features of Alzheimer’s disease and other dementias. The presence of these potentially modifiable neurobehavioral symptoms in cognitively intact older adults may represent an early indication of pathophysiological processes in the brain. Tau pathology is a key feature of a number of dementias. A number of studies have found an association between tau and neurobehavioral symptoms. The current study investigated the relationship of a blood-based biomarker of tau and symptoms of depression, anxiety, worry, and sleep disturbances in 538 community based, cognitively normal older adults. Logistic regression revealed no significant relationship between plasma total tau and any measures of neurobehavioral symptoms. To assess the impact of level of tau on these relationships, participants were divided into those in the highest quintile of tau and those in the lower four quintiles. Regression analyses showed a significant relationship between level of plasma total tau and measures of depression, apathy, anxiety, worry and sleep. The presence of higher levels of plasma tau and elevated neurobehavioral symptoms may be an early indicator of cognitive decline and prodromal Alzheimer’s disease. Longitudinal research is needed to evaluate the impact of these factors on the development of dementia and may suggest areas for early intervention.

Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study

Background

Care home staff have a critical bearing on quality. The staff employed, the training they receive and how well they identify and manage residents’ needs are likely to influence outcomes. The Care Act 2014 (Great Britain. The Care Act 2014. London: The Stationery Office; 2014) requires services to improve ‘well-being’, but many residents cannot self-report and are at risk of exclusion from giving their views. The Adult Social Care Outcomes Toolkit enables social care-related quality of life to be measured using a mixed-methods approach. There is currently no equivalent way of measuring aspects of residents’ health-related quality of life. We developed new tools for measuring pain, anxiety and depression using a mixed-methods approach. We also explored the relationship between care home quality, residents’ outcomes, and the skill mix and employment conditions of the workforce who support them.

Objectives

The objectives were to develop and test measures of pain, anxiety and depression for residents unable to self-report; to assess the extent to which regulator quality ratings reflect residents’ care-related quality of life; and to assess the relationship between aspects of the staffing of care homes and the quality of care homes.

Design

This was a mixed-methods study.

Setting

The setting was care homes for older adults in England.

Participants

Care home residents participated.

Results

Three measures of pain, anxiety and low mood were developed and tested, using a mixed-methods approach, with 182 care home residents in 20 care homes (nursing and residential). Psychometric testing found that the measures had good construct validity. The mixed-methods approach was both feasible and necessary with this population, as the majority of residents could not self-report. Using a combined data set (n = 475 residents in 54 homes) from this study and the Measuring Outcomes in Care Homes study (Towers AM, Palmer S, Smith N, Collins G, Allan S. A cross-sectional study exploring the relationship between regulator quality ratings and care home residents’ quality of life in England. Health Qual Life Outcomes 2019;17:22) we found a significant positive association between residents’ social care-related quality of life and regulator (i.e. Care Quality Commission) quality ratings. Multivariate regression revealed that homes rated ‘good/outstanding’ are associated with a 12% improvement in mean current social care-related quality of life among residents who have higher levels of dependency. Secondary data analysis of a large, national sample of care homes over time assessed the impact of staffing and employment conditions on Care Quality Commission quality ratings. Higher wages and a higher prevalence of training in both dementia and dignity-/person-centred care were positively associated with care quality, whereas high staff turnover and job vacancy rates had a significant negative association. A 10% increase in the average care worker wage increased the likelihood of a ‘good/outstanding’ rating by 7%.

Limitations

No care homes rated as inadequate were recruited to the study.

Conclusions

The most dependent residents gain the most from homes rated ‘good/outstanding’. However, measuring the needs and outcomes of these residents is challenging, as many cannot self-report. A mixed-methods approach can reduce methodological exclusion and an over-reliance on proxies. Improving working conditions and reducing staff turnover may be associated with better outcomes for residents.

Future work

Further work is required to explore the relationship between pain, anxiety and low mood and other indicators of care homes quality and to examine the relationship between wages, training and social care outcomes.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 19. See the NIHR Journals Library website for further project information.

Effect of Group Cognitive Behavioural Therapy on Loneliness in a Community Sample of Older Adults: A Secondary Analysis of a Randomized Controlled Trial

OBJECTIVES

Research suggests a link between loneliness, depression, and anxiety. Multiple studies have examined treatment programs for loneliness; however, none have examined the efficacy of Cognitive Behavioral Therapy (CBT) for depression and anxiety in reducing loneliness.

METHODS

Change in loneliness in sixty-two older adults (≥60 yrs; 65% female) who took part in a previously reported randomized controlled trial for the treatment of comorbid depression and anxiety was examined. Older adults were randomized to a 12-week group CBT or waitlist control condition. Participants who took part in CBT were followed-up three months later.

RESULTS

Linear Mixed Model analyses indicated that after controlling for baseline cognition, depression, and anxiety, participants who completed CBT experienced a significant decrease in loneliness while the control group did not. This reduction was maintained at follow-up.

CONCLUSIONS

CBT programs for depression and anxiety are likely to be effective at reducing loneliness. This may be due to shared underlying cognitive and behavioral mechanisms between loneliness, depression, and anxiety such as sensitivity to perceived threat and social withdrawal. Further research is needed to understand if specific loneliness interventions are more effective.

CLINICAL IMPLICATIONS

CBT may be effective at reducing loneliness among older adults with depression and anxiety.

A Cross-National Analysis of the Psychometric Properties of the Geriatric Anxiety Inventory

OBJECTIVES

Assessing late-life anxiety using an instrument with sound psychometric properties including cross-cultural invariance is essential for cross-national aging research and clinical assessment. To date, no cross-national research studies have examined the psychometric properties of the frequently used Geriatric Anxiety Inventory (GAI) in depth.

METHOD

Using data from 3,731 older adults from 10 national samples (Australia, Brazil, Canada, The Netherlands, Norway, Portugal, Spain, Singapore, Thailand, and United States), this study used bifactor modeling to analyze the dimensionality of the GAI. We evaluated the "fitness" of individual items based on the explained common variance for each item across all nations. In addition, a multigroup confirmatory factor analysis was applied, testing for measurement invariance across the samples.

RESULTS

Across samples, the presence of a strong G factor provides support that a general factor is of primary importance, rather than subfactors. That is, the data support a primarily unidimensional representation of the GAI, still acknowledging the presence of multidimensional factors. A GAI score in one of the countries would be directly comparable to a GAI score in any of the other countries tested, perhaps with the exception of Singapore.

DISCUSSION

Although several items demonstrated relatively weak common variance with the general factor, the unidimensional structure remained strong even with these items retained. Thus, it is recommended that the GAI be administered using all items.

Feasibility and validation of a web-based platform for the self-administered patient collection of demographics, health status, anxiety, depression, and cognition in community dwelling elderly

The coronavirus disease pandemic has brought a new urgency for the development and deployment of web-based applications which complement, and offer alternatives to, traditional one-on-one consultations and pencil-and-paper (PaP) based assessments that currently dominate clinical research. We have recently developed a web-based application that can be used for the self-administered collection of patient demographics, self-rated health, depression and anxiety, and cognition as part of a single platform. In this study we report the findings from a study with 155 cognitively healthy older adults who received established PaP versions, as well as our novel computerized measures of self-rated health, depression and anxiety, and cognition. Moderate to high correlations were observed between PaP and web- based measures of self-rated health (r = 0.77), depression and anxiety (r = 0.72), and preclinical Alzheimer’s disease cognitive composite (PACC) (r = .61). Test-retest correlations were variable with high correlations for a measure of processing speed and a measure of delayed episodic memory. Taken together, these data support the feasibility and validity of utilization of this novel web-based platform as a new alternative for collecting patient demographics and the assessment of self-rated health, depression and anxiety, and cognition in the elderly.

Examining Depression Symptoms With/Without Coexisting Anxiety Symptoms in Community-Dwelling Persons With Dementia

Depression and anxiety are common in persons with dementia (PWD) and associated with poor outcomes. We explored frequency, pharmacologic management and mental health service use in PWD and depression symptoms with/without coexisting anxiety symptoms. The sample comprised 160 community-dwelling PWD in a trial to prevent development of aggression. Baseline data on depression and anxiety symptoms, psychotropic medications and mental health service use were examined. Regarding participants, 65 (41%) lacked clinically significant depression or anxiety symptoms, 45 (28%) had depression symptoms, 43 (27%) had depression and anxiety symptoms, and 7 (4%) had anxiety symptoms. Comorbid anxiety was associated with more severe depression symptoms. One third with depression symptoms and one half with depression and anxiety symptoms were taking an antidepressant. Mental health service use was very low, regardless of depression symptom severity or coexisting anxiety. Research needs to evaluate therapies for depressed PWD, but treatment of those with comorbid anxiety and depression is more urgent. Clinical Trial Registration for Parent Trial: ClinicalTrials.gov (NCT02380703).

Psychometric properties of the expanded version of the inventory of depression and anxiety symptoms (IDAS-II) in a sample of older adults

Objective: Given the strong relationship often found between self-report measures of anxiety and depression, the Inventory of Depression and Anxiety Symptoms (IDAS) was created and then expanded (IDAS-II) to assess common and unique symptom dimensions of these emotional disorders. Limited research has focused on the use of the IDAS-II with older adults and the purpose of the current study was to provide data on the reliability and validity of the IDAS-II in this population.Method: A sample of 323 participants (age 55-80 years) were recruited online using Amazon's Mechanical Turk (MTurk). They completed the IDAS-II and several other self-report questionnaires of internalizing symptoms, including widely used measures developed specifically for older adults. Internal consistency and validity of the IDAS-II were examined.Results: The IDAS-II demonstrated marginal to excellent internal consistency (α = .68-.91). An exploratory factor analysis indicated three factors: Distress, Positive Mood, and Obsessions. The IDAS-II explained a large amount of variance in the other measures of depression and anxiety (ranging from 52% to 76%) and the IDAS-II Dysphoria scale significantly related to all of the other measures of depression and anxiety (ranging from r = .69 to r = .81).Conclusion: These results support the use of the IDAS-II with older adults as it has good convergent validity with other commonly used measures of depression and anxiety, including those commonly used in the assessment of older adults. Further research can use the IDAS-II with both younger and older adults to examine age-related changes in depression and anxiety symptoms.

A Systematic Review of the Psychometric Properties of the Geriatric Anxiety Inventory

The Geriatric Anxiety Inventory (GAI) and its short form (GAI-SF) are self-reported scales used internationally to assess anxiety symptoms in older adults. In this study, we conducted the first critical comprehensive review of these scales' psychometric properties. We rated the quality of 31 relevant studies with the COSMIN checklist. Both the GAI and GAI-SF showed adequate internal consistency and test-retest reliability. Convergent validity indices were highest with generalized anxiety measures; lowest with instruments relating to somatic symptoms. We detected substantial overlap with depression measures. While there was no consensus on the GAI's factorial structure, we found the short version to be unidimensional. Although we found good sensitivity and specificity for detecting anxiety, cut-off scores varied. The GAI and GAI-SF are relevant instruments showing satisfactory psychometric properties; to broaden their use, however, some psychometric properties warrant closer examination. This review calls attention to weaknesses in the methodological quality of the studies.

Assessment of anxiety in older adults: psychometric properties and relationships with self-reported functional impairment

OBJECTIVE

The current study aimed to examine the psychometric properties of two geriatric anxiety measures: the Geriatric Anxiety Inventory (GAI) and the Geriatric Anxiety Scale (GAS). This study also aimed to determine the relationships of these measures with two measures of functional ability and impairment: the Barkley Functional Impairment Scale (BFIS) and the Everyday Cognition Scale (E-Cog).

DESIGN

Confirmatory factor analyses (CFA) were used to analyze the factor structures of the GAI and GAS in older adults. Tests for dependent correlations were used to examine the relationship between anxiety scales and functioning.

SETTING

Amazon's Mechanical Turk.

PARTICIPANTS

348 participants (aged 55-85, M= 62.75 (4.8), 66.5% female) with no history of psychosis or traumatic brain injury.

RESULTS

CFAs supported the previously demonstrated bifactor solution for the GAI. For the GAS, the previously demonstrated three-factor model demonstrated a good-to-excellent fit. Given the high correlation between the cognitive and affective factors (r =.89), a bifactor solution was also tested. The bifactor model of the GAS was found to be primarily unidimensional. Tests for dependent correlations revealed that the GAS demonstrated stronger relationships with measures of self-reported functional impairment than the GAI.

CONCLUSIONS

The current study provides further psychometric validation of the factor structure of two geriatric anxiety measures in an older adult sample. The results support previous work completed on the GAI and the GAS. The GAS was more strongly correlated with self-reported functional impairment than the GAI, which may reflect differences in content in the two measures.

Psychometric properties of worry and anxiety measures in a sample of african american and caucasian older adults

Objective: The aim of our study was to examine the psychometric properties of commonly used anxiety and worry assessment measures in a community-based, low-income sample of African American and Caucasian older adults.Method: African American and Caucasian participants from three community-based clinical trials testing treatments for late-life worry/anxiety were pooled to examine the factor structure, internal consistency reliability, and convergent, discriminant, and predictive validity of the Penn State Worry Questionnaire-Abbreviated (PSWQ-A), Generalized Anxiety Disorder-7 (GAD-7) and Geriatric Anxiety Inventory-short form (GAI-SF).Results: All three measures demonstrated an adequate fit to a one-factor structure. Internal consistency reliability was adequate for the PSWQ-A and GAD-7 in the total sample and racial subgroups but was acceptable for the GAI-SF only in the African American subgroup. The PSWQ-A and GAD-7 demonstrated good convergent, discriminant, and predictive validity. The GAI-SF has adequate convergent and divergent validity in the African American subgroup.Conclusion: Our study offers preliminary evidence for use of the PSWQ-A and GAD-7 for assessment of anxiety in a sample of low-income, predominantly African American participants. These measures may facilitate identification of anxiety symptoms, which are often overlooked in this population. More research is needed to examine the accuracy of these measures in other racial/ethnic groups.

Item response analysis of the Geriatric Anxiety Inventory among the elderly in China: dimensionality and differential item functioning test

BACKGROUND

Anxiety symptoms are pervasive among elderly populations around the world. The Geriatric Anxiety Inventory (the GAI) has been developed and widely used in screening those suffering from severe symptoms. Although debates about its dimensionality have been mostly resolved by Molde et al. (2019) with bifactor modeling, evidence regarding its measurement invariance across sex and somatic diseases is still missing.

METHODS

This study attempted to provide complemental evidence to the dimensionality debates of the GAI with Mokken scale analysis and to examine its measurement invariance across sex and somatic diseases by conducting differential item functioning (DIF) analysis among a sample of older Chinese adults. The data was from responses of a large representative sample (N = 1314) in the Chinese National Survey Data Archive, focusing on the mental health of elderly adults.

RESULTS

The results of Mokken scale analysis confirmed the unidimensionality of the GAI, and DIF analysis indicated measurement invariance of this inventory across individuals with different sex and somatic diseases, with just a few items exhibiting item bias but all of them negligible.

CONCLUSIONS

All these findings supported the use of this inventory among Chinese elders to screen anxiety symptoms and to make comparisons across sex and somatic diseases.

The Iranian version of geriatric anxiety inventory (GAI-P): a validation study

BACKGROUND

Anxiety is one of the most common mental health problems experienced by the elderly that affects quality of life. This study aimed to assess the psychometric properties of the Persian version of the Geriatric Anxiety Inventory (GAI-P) in order to provide a valid instrument for measuring anxiety in this population.

METHODS

Forward-backward translation was used to translate the Geriatric Anxiety Inventory from English into Persian and was tested by 10 elderly to assess its face validity. Then a sample of elderly people attending health centers in Dezful, Iran completed the questionnaire. Validity was assessed using both exploratory and confirmatory factors analysis, known-groups comparison (abused and non-abused elderly) also was administered. The internal consistency of the instrument was assessed using Kuder-Richardson 20 coefficients (KR-20). Afterwards, the reliability and validity through assessing the correlation between the Persian version of the GAI-P and the SF-36, were measured.

RESULTS

In all 720 elderly completed the questionnaire. Of these data from 420 elderly were used for exploratory factor analysis and the data from the remaining 300 elderly were used for confirmatory factor analysis. The exploratory factor analysis showed a three-factor solution (cognitive, arousal and somatic) for the questionnaire that jointly explained 59.48% of the overall variance observed. The confirmatory factor analysis supported the three-factor solution and the second-order latent factor model. The findings indicated a positive and significant correlation between the two measures lending support to its concurrent validity (r = 0.67, p < .001).Ultimately, the Geriatric Anxiety Inventory was found to have a favorable internal consistency.

CONCLUSION

This study confirmed that the GAI-P is a valid measure of anxiety in elderly population and now can be used in geriatric studies in Iran.

Prevalence of Anxiety Symptoms and Their Association With Loss Experience in a Large Cohort Sample of the Oldest-Old. Results of the AgeCoDe/AgeQualiDe Study

Background: Anxiety in adults is a common mental health problem. However, studies on anxiety in the oldest-old are lacking. We sought to identify the age- and gender-specific prevalence of anxiety symptoms in a large sample of general practice patients. Furthermore, we investigated relevant associations of anxiety specifically with respect to recent experience of loss. Methods: Based on the German Study on Ageing, Cognition and Dementia in general practice patients, a sample of 897 patients aged 82 years and older was assessed. Anxiety was assessed using the short form of the Geriatric Anxiety Inventory (GAI-SF). For the assessment of loss, patients were asked whether there were cases of death in their closer social environment since the last assessment. Descriptive and logistic regression analyses were run. Results: Of the oldest-old individuals (aged 82+ years, mean age: 86.8), 14.5% (95% CI 12.4-16.8) suffered from anxiety symptoms. Highest prevalence rates were found for 82- to 85-year-old women (17.2%, 95% CI 12.6-22.1) and for 86- to 90-year-old patients (both sexes) in general (15.9%, 95% CI 12.6-19.2). Older individuals who experienced cases of death in their close social environment within the last 18 months had almost twice the odds [odds ratio (OR) 1.91, 95% confidence interval (CI) 1.15-3.17] of reporting anxiety compared to those without a recent loss. As expected, depression and impaired cognitive status were associated with the presence of anxiety symptoms. No relation was found between social network, gender, age, frailty, or physical illness and anxiety in regression analysis. Conclusions: This study provides for the first time age- and gender-specific prevalence rates of anxiety symptoms and associated risk factors among a large population-based sample of oldest-old primary care attenders. Anxiety is highly prevalent in individuals aged 82 years and older. Depression, impaired cognitive status, and recent experience of loss are associated with late-life anxiety. Our findings support the idea that recent experience of loss should be taken seriously in the context of clinical practice with respect to diagnosing and treating anxiety in old age.

Dimensions of Anxiety, Age, and Gender: Assessing Dimensionality and Measurement Invariance of the State-Trait for Cognitive and Somatic Anxiety (STICSA) in an Italian Sample

The State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA) is a widely used measure of state and trait anxiety that permits a specific assessment of cognitive and somatic anxiety. Previous research provided inconsistent findings about its factor structure in non-clinical samples (e.g., hierarchical or bi-factor structure). To date, no psychometric validation of the Italian version of the STICSA has been conducted. Our study aimed to determine the psychometric functioning of the Italian version of the STICSA, including its dimensionality, gender and age measurement equivalence, and convergent/divergent validity in a large sample of community-dwelling participants (N = 2,938; 55.9% female). Through confirmatory factor analysis, the multidimensional structure of both State and Trait STICSA scales, with each including Cognitive and Somatic dimensions, was supported. Factor structure invariance was tested and established at configural, metric, and scalar levels for males and females. Additionally, full factorial measurement invariance was supported for the State scale across young, middle age, and old adult groups whereas the Trait scale was partially invariant across age groups. The STICSA also showed good convergent validity with concurrent anxiety measures (State-Trait Anxiety Inventory and Beck Anxiety Inventory), and satisfactory internal discriminant validity with two depression measures (Teate Depression Inventory and Beck Depression Inventory-II). Results provided support for the multidimensionality of the STICSA, as well as the generalizability of the State and Trait scales as independent measures of Cognitive and Somatic symptomatology across gender in the general population. Implications for research and personality and clinical assessment are discussed.

An investigation of the psychometric properties of the Geriatric Anxiety Scale (GAS) in an Italian sample of community-dwelling older adults

BACKGROUND

The Italian older adult population is increasing and psychiatric problems, such as anxiety among older adults, represent major challenges for public welfare. A strong need exists for instruments specifically developed to assess anxiety among Italian older adults. The Geriatric Anxiety Scale (GAS) is a 30-item self-report questionnaire that evaluates anxiety among older adults and has demonstrated strong psychometric properties in several languages.

OBJECTIVE

The present study aimed to validate an Italian version of the GAS (GAS-I) and to preliminarily investigate its psychometric properties.

METHOD

The translation was performed using a five-stage procedure, following a forward-back process and paying attention to cultural issues. The GAS-I was administered to 231 community-dwelling older adults with other commonly-used questionnaires of anxiety, depression, and quality of life.

RESULTS

Results confirmed good psychometric qualities of the questionnaire. Confirmatory factor analyses evidenced a unidimensional structure of the GAS-I, in accordance with other validated versions. Convergent and discriminant validity were highly satisfactory. The three-factor model also provided an acceptable fit to the data. Receiver operating characteristic curve analyses revealed good discriminatory power of the GAS-I.

CONCLUSION

These findings demonstrate that the GAS-I is a reliable and valid self-report questionnaire to measure anxiety among Italian older adults.

Testing Factor Structure and Measurement Invariance Across Gender With Italian Geriatric Anxiety Scale

Late-life anxiety is an increasingly relevant psychiatric condition that often goes unnoticed and/or untreated compared to anxiety in younger populations. Consequently, assessing the presence and severity of clinical anxiety in older adults an important challenge for researchers and clinicians alike. The Geriatric Anxiety Scale is a 30-item geriatric-specific measure of anxiety severity, grouped in three subscales (Somatic, Affective, and Cognitive), with solid evidence for the reliability and validity of its scores in clinical and community samples. Translated into several languages, it has been proven to have strong psychometric properties. In Italy only one recent preliminarily investigative study has appeared on its psychometric properties. However, sample data was largely collected from one specific Italian region (Lombardy) alone. Here, our aim in testing the items of the GAS in a sample of 346 healthy subjects (50% females; 52% from Southern Italy), with mean age of 71.74 years, was 2-fold. First, we aimed to determine factor structure in a wider sample of Italian participants. Confirmatory factor analysis showed that the GAS fits an originally postulated three-factor structure reasonably well. Second, results support gender invariance, entirely supported at the factorial structure, and at the intercept level. Latent means can be meaningfully compared across gender groups. Whereas the means of F1 (Somatic) and F3 (Affective) for males were significantly different from those for females, the means for F2 (Cognitive) were not. More specifically, in light of the negative signs associated with these statistically significant values, the finding showed that F1 and F3 for males appeared to be less positive on average than females. Overall, the GAS displayed acceptable convergent validity with matching subscales highly correlated, and satisfactory internal discriminant validity with lower correlations between non-matching subscales. Implications for clinical practice and research are discussed.

The assessment of anxiety in aged care residents: a systematic review of the psychometric properties of commonly used measures

ABSTRACTBackground:Assessing anxiety among residential aged care facility (RACF) residents is challenging, and it cannot be assumed that valid and reliable measures used within the community are also appropriate for this setting. This review systematically examined the literature to identify which anxiety measures were most commonly used with older adults in RACFs, and determine whether psychometric data support their use within this population.

METHODS

Using the PRISMA guidelines, five electronic databases were searched using key terms and subject headings. The search was limited to literature published in English. Eligible studies utilized an anxiety measure to assess anxiety symptoms among RACF residents. Based on the findings of this search, a critical review of the research into the reliability, validity, and administrative and respondent burden of the most commonly used measures (i.e. used in four or more studies) was conducted.

RESULTS

In total, 1,771 articles were identified, with 50 studies included in this review. Overall, 22 measures were used, with the majority of studies utilizing a clinician-administered or self-report measure. The RAID, HADS, STAI, and GAI were the most commonly used measures. While overall there is a lack of research and consensus into the psychometric properties of these measures within RACFs, strongest evidence of reliability and validity was found for the GAI.

CONCLUSION

Commonly used measures of anxiety within aged care populations are not well validated for this complex subsample of older adults. Strengths and weaknesses of each measure with regards to their usefulness in aged care settings are discussed, with future research areas highlighted.

Subjective but Not Objective Sleep is Associated with Subsyndromal Anxiety and Depression in Community-Dwelling Older Adults

OBJECTIVE

To examine the relationship between subclinical anxiety and depressive symptoms and objective sleep architecture measures and subjective sleep reports in older adults.

METHODS

Community-dwelling older adults (N = 167) self-rated their current severity of anxiety symptoms, depressive symptoms, daytime sleepiness, and global sleep quality. Participants received overnight ambulatory polysomnography to assess sleep architecture. Multivariate linear regression models examined associations between anxiety and depressive symptoms and objective and subjective sleep measures.

RESULTS

Significant findings emerged for subjective sleep, with higher depression and anxiety scores associated with worse global sleep quality and greater anxiety scores associated with greater daytime sleepiness. No significant associations were observed between subclinical levels of anxiety or depressive symptoms with sleep architecture.

CONCLUSION

Subclinical levels of late-life anxiety and depression have distinct associations with subjective sleep disturbance. Findings implicate subjective measures of sleep quality and daytime sleepiness as stronger trait markers for subthreshold psychiatric symptoms than objective sleep biomarkers.

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.

Detecting anxiety in individuals with Parkinson disease

Objective

To examine diagnostic accuracy of anxiety detection tools compared with a gold standard in outpatient settings among adults with Parkinson disease (PD).

Methods

A systematic review was conducted. MEDLINE, EMABASE, PsycINFO, and Cochrane Database of Systematic Reviews were searched to April 7, 2017. Prevalence of anxiety and diagnostic accuracy measures including sensitivity, specificity, and likelihood ratios were gathered. Pooled prevalence of anxiety was calculated using Mantel-Haenszel-weighted DerSimonian and Laird models.

Results

A total of 6,300 citations were reviewed with 6 full-text articles included for synthesis. Tools included within this study were the Beck Anxiety Inventory, Geriatric Anxiety Inventory (GAI), Hamilton Anxiety Rating Scale, Hospital Anxiety and Depression Scale–Anxiety, Parkinson's Anxiety Scale (PAS), and Mini–Social Phobia Inventory. Anxiety diagnoses made included generalized anxiety disorder, social phobia, and any anxiety type. Pooled prevalence of anxiety was 30.1% (95% confidence interval 26.1%–34.0%). The GAI had the best-reported sensitivity of 0.86 and specificity of 0.88. The observer-rated PAS had a sensitivity of 0.71 and the highest specificity of 0.91.

Conclusions

While there are 6 tools validated for anxiety screening in PD populations, most tools are only validated in single studies. The GAI is brief and easy to use, with a good balance of sensitivity and specificity. The PAS was specifically developed for PD, is brief, and has self-/observer-rated scales, but with lower sensitivity. Health care practitioners involved in PD care need to be aware of available validated tools and choose one that fits their practice.

Telephone-Delivered Cognitive-Behavioral Therapy for Older, Rural Veterans with Depression and Anxiety in Home-Based Primary Care

OBJECTIVES

Rural, homebound older adults are at increased risk for anxiety and depression and have limited access to mental health services. These individuals face many barriers to receiving evidence-based mental health treatment and would benefit from interventions that increase access to and efficiency of care. The aim of this study was to evaluate use of a telephone-delivered, modular, cognitive behavioral therapy (CBT) intervention for both late-life depression and anxiety delivered to rural, homebound Veterans.

METHODS

Three cases are presented to illustrate the flexible adaptation of the intervention for use among older Veterans enrolled in home-based primary care, with varying symptom presentations and functional limitations. The Veterans received 7 to 9 sessions of the CBT intervention, with ordering of skill modules based on symptom presentation and determined collaboratively between patient and therapist.

RESULTS

The three Veterans showed improvement in depression and/or anxiety symptoms following treatment and provided positive feedback regarding their experiences in this program.

CONCLUSIONS

These results suggest that telephone-delivered CBT is acceptable to older adults and can be tailored to individual patient needs.

CLINICAL IMPLICATIONS

Clinicians should consider telephone-delivered CBT as an alternate mode of therapy to increase access to mental health care for rural, homebound individuals with depression and anxiety.

Validation of the geriatric anxiety inventory in a duloxetine clinical trial for elderly adults with generalized anxiety disorder

BACKGROUND

The Generalized Anxiety Inventory (GAI) has been developed for use in the assessment of anxiety symptoms in older adults (≥ 65 years), but previous validation work has not examined the psychometric qualities of the instrument in relation to treatment. The objective of this study was to examine the performance of the GAI for its internal reliability, convergent and divergent validity, and its sensitivity to treatment.

METHODS

Elderly patients with generalized anxiety disorder (GAD) participated in a 10-week double-blind study of duloxetine treatment for patients with GAD. Anxiety symptoms were assessed with the Hamilton Anxiety Rating Scale (HAMA), the Hospital Anxiety and Depression Scale (HADS) anxiety and depression subscales, and the GAI. Internal reliability of the GAI was assessed with Cronbach's α. Correlations among the HAMA, HADS, and GAI scores were analyzed to determine convergent and divergent validity. Patients were also compared on remission status using recommended cut-off scores for the GAI.

RESULTS

Patients with GAD, who were at least 65 years of age, were randomly assigned to double-blind treatment with either duloxetine (N = 151) or placebo (N = 140) for 10 weeks acute therapy. The mean change on the GAI was significantly greater with duloxetine compared with placebo treatment (-8.36 vs. -4.96, respectively, p ≤ 0.001). The GAI demonstrated good internal consistency, good convergent and divergent validity, but suggested cut-off values for caseness with the GAI did not correspond to remission status as measured by the HAMA.

CONCLUSIONS

Within an elderly patient population with GAD, the GAI demonstrated sound psychometric qualities and sensitivity to change with treatment.

Psychometric properties of the Geriatric Anxiety Inventory (GAI) and its short-form (GAI-SF) in a clinical and non-clinical sample of older adults

BACKGROUND

The Geriatric Anxiety Inventory is a 20-item geriatric-specific measure of anxiety severity. While studies suggest good internal consistency and convergent validity, divergent validity from measures of depression are weak. Clinical cutoffs have been developed that vary across studies due to the small clinical samples used. A six-item short form (GAI-SF) has been developed, and while this scale is promising, the research assessing the psychometrics of this scale is limited.

METHODS

This study examined the psychometric properties of GAI and GAI-SF in a large sample of 197 clinical geriatric participants with a comorbid anxiety and unipolar mood disorder, and a non-clinical control sample (N = 59).

RESULTS

The internal consistency and convergent validity with other measures of anxiety was adequate for GAI and GAI-SF. Divergent validity from depressive symptoms was good in the clinical sample but weak in the total and non-clinical samples. Divergent validity from cognitive functioning was good in all samples. The one-factor structure was replicated for both measures. Receiver Operating Characteristic analyses indicated that the GAI is more accurate at identifying clinical status than the GAI-SF, although the sensitivity and specificity for the recommended cutoffs was adequate for both measures.

CONCLUSIONS

Both GAI and GAI-SF show good psychometric properties for identifying geriatric anxiety. The GAI-SF may be a useful alternative screening measure for identifying anxiety in older adults.

Measuring anxiety in the elderly: psychometric properties of the state trait inventory of cognitive and somatic anxiety (STICSA) in an elderly Italian sample

BACKGROUND

Despite its increasing personal and societal impact, assessment of late-life anxiety has received relatively little attention in psychiatric research. Differential symptom presentation and physical comorbidities among the elderly, relative to younger cohorts creates a need for anxiety measures that are psychometrically validated in the elderly.

METHODS

The present study examined the factor structure and discriminant validity of the state-trait inventory for cognitive and somatic anxiety (STICSA) in a sample of Italian middle-aged and older adults. Participants were 396 community-dwelling middle-aged (50-64 years) and older (≥65 years) adults. In addition to the STICSA, participants completed two depression measures and a general well-being survey with physical and mental health subscales.

RESULTS

Factor analysis supported the validity of both state-trait and cognitive-somatic distinctions underlying the STICSA, all dimensions exhibited excellent internal consistency (Cronbach's α coefficients ≥ 0.86), and correlations with depression measures provided limited evidence for differentiation of anxious and depressive symptoms. The STICSA also showed evidence of discriminating anxious symptoms from physical health symptoms, a particularly relevant feature of a valid anxiety measure in elderly samples.

CONCLUSIONS

The STICSA appears to be a valid measure of cognitive and somatic anxiety in the elderly.

Update on managing generalized anxiety disorder in older adults

With the recent updates to the Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM-5), there are many questions on how to care for older adults with generalized anxiety disorder (GAD) and other psychiatric conditions. The current article reviews the new changes to the DSM-5 for diagnosis of GAD, discusses new anxiety assessment scales that are validated in older adults, evaluates pharmacological agents that have been studied in older adults for GAD treatment, and provides monitoring recommendations to help those who provide care to older adults experiencing GAD.

Measuring anxiety in late life: a psychometric examination of the geriatric anxiety inventory and geriatric anxiety scale

We examined the psychometric properties, internal scale reliability and validity, of two geriatric anxiety measures: the Geriatric Anxiety Inventory (GAI) and Geriatric Anxiety Scale (GAS). We also determined the extent to which memory ability influenced the psychometric properties of these measures. Older adult participants (N=110; M age=75 years) completed self-report, clinician-rated and diagnostic psychiatric measures and a neuropsychiatric battery. GAI and GAS scores had good internal consistency, adequate reliability, and strong convergent validity. GAI scores had better discriminant validity than GAS scores relative to a health rating. Both measures had strong associations with depression scores. Psychometric properties were decreased in participants with average delayed memory recall compared with those with superior recall. Both measures had good psychometric support, particularly in those with strong memory abilities. Psychometric performance characteristics indicate that the GAI and GAS may be good alternatives to anxiety measures not designed specifically for older adults.

Geriatric anxiety inventory: factor structure and associations with cognitive status

OBJECTIVES

The factor structure and clinical correlates of the Geriatric Anxiety Inventory were determined within a sample of patients with cognitive impairment.

METHODS

Using a cross-sectional design, data were collected within an outpatient Memory Disorders Center. Clinical participants were diagnosed with either mild dementia (N = 45) or cognitive impairment, no dementia (N = 55). A comparison group of participants without subjective memory complaints (N = 50) was also included. The Geriatric Anxiety Inventory was administered and scored as both the 20-item version and 5-item short form. Measures of cognitive status, depressive symptoms, and functioning were also completed.

RESULTS

Clinical participants reported more severe anxiety than did participants in the comparison group; however, the two patient groups did not differ. Principal components analysis revealed a four-factor structure of the Geriatric Anxiety Inventory. Item endorsement on factors characterized by excessive worry and difficulty making decisions were associated with a nearly twofold (odds ratio [OR]: 1.86) and nearly sixfold (OR: 5.70) odds of having cognitive impairment, respectively. The short-form version was composed of a single factor, and item endorsement was associated with a twofold increased odds of having cognitive impairment (OR: 2.02).

CONCLUSION

Psychometric properties of the Geriatric Anxiety Inventory are acceptable among patients with cognitive impairment. Anxiety symptoms were common, and symptoms characterized by excessive worry and difficulty making decisions demonstrated the strongest associations with cognitive status.

Anxiety symptoms in older home health care recipients: prevalence and associates

This study examined the prevalence and associates of anxiety symptoms in older home health care recipients (N = 249) who completed structured interviews assessing sociodemographic, cognitive, medical and disability, and psychosocial variables--including anxiety (assessed by the Clinical Anxiety Scale). Mild or moderate anxiety was reported by 3.6% of the sample. No anxiety symptoms whatsoever were reported by 63.9%, while the remaining endorsed at least one symptom. Binary logistic regression analysis revealed that the odds of having any anxiety were elevated among participants who had had a recent fall, OR = 2.81, 95% CI [1.46, 5.43]; and those with major depression, OR = 4.78, 95% CI [1.46, 15.68]. These findings point to the importance of conducting studies to clarify whether the mild severity of anxiety found in this sample is best accounted for by protective factors inherent to the home health care setting or assessment factors that diminish the reporting of anxiety symptoms.

Recognition and treatment of depression and anxiety symptoms in heart failure

OBJECTIVE

The aim of this prospective study was to examine the prevalence, recognition, and treatment of depression and anxiety in ambulatory patients with heart failure.

METHOD

A total of 158 heart failure participants were enrolled between November 2006 and April 2007. Each patient completed a telephone screening interview that included an assessment of heart-failure severity (New York Heart Assciation criteria) as well as measures for depression (Geriatric Depression Scale [GDS]) and anxiety (Geriatric Anxiety Inventory [GAI]). Following study recruitment, each patient's electronic medical record was comprehensively reviewed for the 12 months prestudy and 6 months poststudy assessments to determine whether patients had been recognized as having and/or treated for depression or anxiety.

RESULTS

Prevalence of depression (GDS score ≥ 6) was 41.8%, and prevalence of anxiety (GAI score ≥ 9) was 25.3%. Of patients with a positive GDS or GAI result, 57.5% had a diagnosis or medical-record notation for depression and/or anxiety, and 60.3% received mental health treatment during the 18-month period of the EMR review. Of patients with a documented diagnosis of depression or anxiety, 92.3% received mental health treatment. Results showed that higher GDS scores were associated with recognition of depression/anxiety in the medical record, and a positive primary care depression screening predicted documented mental health treatment.

CONCLUSION

These data suggest that symptomatic depression and anxiety are underrecognized in heart failure patients and that mental health screening may be important for receipt of care. Notably, once depression and/or anxiety was documented in the medical record, patients were highly likely to receive mental health treatment.

Impairments in life quality among clients in geriatric home care: associations with depressive and anxiety symptoms

OBJECTIVE

The aim of this study was to determine the independent contributions of depressive and anxiety symptoms to quality of life among older adults who were receiving services through a home care program.

METHODS

The study sample consisted of 66 community-dwelling older adults (ages 65 years and older), who were experiencing chronic medical illness and concomitant functional disability necessitating home care. Participants completed self-report measures of depression, anxiety, and health-related quality of life. Additional data on cognitive, health, and functional status were collected to be used as covariates.

RESULTS

The associations of depressive symptoms with quality of life impairments in home care were substantial and pervasive. Depressive symptoms were significantly associated with quality of life impairments in nearly all domains. After controlling for depressive symptoms, anxiety symptoms accounted for additional and statistically significant variance in impaired life quality in the domains of mental health, role emotional functioning, and bodily pain.

CONCLUSIONS

These results indicate that depressive and anxiety symptoms demonstrate negative associations with life quality among older adults in home care and highlight the importance of developing community-based programs to assess and treat depressive and anxiety symptoms among home care clients.

The role of anxiety sensitivity, behavioral inhibition, and cognitive biases in anxiety symptoms: structural equation modeling of direct and indirect pathways

OBJECTIVE(S)

Limited research has examined how temperamental (i.e., behavioral inhibition, anxiety sensitivity) and cognitive (i.e., interpretive and judgment biases) risks for the development anxiety covary to influence anxiety symptoms. Thus, the present study aimed to advance understanding of the direct and indirect links between anxiety sensitivity, behavioral inhibition, and interpretive biases, and judgment biases (in the form of perceived control) to anxiety outcomes (i.e., worry and trait anxiety symptoms).

METHOD

842 emerging adults (mean = 18.75 years, standard deviation = 1.05; age range = 18-24; 70% women) recruited from a university in the northeast participated in this study. Participants completed a battery of self-report measures assessing risk factors and anxiety outcomes of interest.

RESULTS

Structural equation modeling revealed anxiety sensitivity and behavioral inhibition were directly linked with anxiety outcomes. Anxiety sensitivity and behavioral inhibition were also indirectly linked with anxiety outcomes through interpretive and judgment biases. The hypothesized model was partially invariant across high-risk and low-risk groups for anxiety disorders.

CONCLUSIONS

Results of this study provide preliminary support for theoretical models hypothesizing a developmental progression from temperamental to cognitive risks and culminating in the expression of anxiety symptoms. Limitations and clinical implications of this research are discussed.

Assessment of anxiety in older adults: a systematic review of commonly used measures

OBJECTIVES

The authors set out to systematically review the research literature in order to identify the anxiety measures most commonly used in the assessment of older adults. Once identified, the literature was reviewed to determine the extent to which these instruments had age-relevant norms and psychometric data supporting their use with older adults.

METHOD

Literature searches were conducted in PsycINFO and PubMed to identify research articles in which anxiety measures were completed by older adults. After screening for suitability, a total of 213 articles were reviewed to determine the most commonly used anxiety measures with older adults to examine the psychometric properties of these instruments and to evaluate whether the instruments are appropriate for use with older adults.

RESULTS

A total of 91 different anxiety measures were used in the 213 included articles. Twelve anxiety measures were most commonly used in the literature and of those three were specifically developed for older adults.

CONCLUSIONS

Of the most commonly used measures, the majority lacked sufficient evidence to warrant their use with older adults. Based on psychometric evidence, three measures (Beck Anxiety Inventory, Penn State Worry Questionnaire, and Geriatric Mental Status Examination) showed psychometric properties sufficient to justify the use of these instruments when assessing anxiety in older adults. In addition, two measures developed specifically for older adults (Worry Scale and Geriatric Anxiety Inventory) were also found to be appropriate for use with older adults.

Psychometric properties of the GAD-Q-IV and DERS in older, community-dwelling GAD patients and controls

Thirty-seven community-dwelling, older generalized anxiety disorder (GAD) patients and 37 nonanxious controls completed the Generalized Anxiety Disorder Questionnaire for DSM-IV (GAD-Q-IV; Newman et al., 2002), the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004), and other measures of anxiety and depression. The GAD-Q-IV and DERS were assessed for internal consistency reliability, construct validity, and test-retest reliability, with results indicating good psychometric performance. Receiver operating characteristic (ROC) analysis conducted on the full sample suggested that the optimal GAD-Q-IV cutoff for classifying GAD cases was 3.71, with .97 sensitivity and .92 specificity. The cutoff score for classifying those participants with GAD and comorbid conditions was higher, however. ROC analysis with the full sample revealed an optimal DERS cutoff score of 62.5, with .76 sensitivity and .86 specificity. Findings support the use of the GAD-Q-IV and DERS as screening instruments for GAD in older, community-dwelling adults in a research setting.

Anxiety disorders in older people

This article reviews the research into anxiety disorders in adults aged 65 years and older that has been published over the past ten years. The topics covered include: the construct of anxiety and its disorders in this age group; epidemiology, including prevalence, incidence, course, outlook, and risk factors; assessment scales; co-morbidity and differential diagnosis (depression, dementia, physical illness); and management, both pharmacological and non-pharmacological. There has been a significant improvement in our understanding of these disorders in older adults over this period, but evidence to support their treatment and prevention is still quite sparse.

Psychometric properties of the Spanish version of the Geriatric Anxiety Inventory

BACKGROUND

The Geriatric Anxiety Inventory (GAI) was developed for assessing anxiety in older adults. The objectives of this work were: (a) to analyze the psychometric properties of the Spanish version of the GAI, and (b) to explore the associations between anxiety and other variables related to emotional distress (depression) and emotion regulation (rumination, experiential avoidance, and emotion suppression).

METHODS

Three-hundred-and-two people (75.5% female) aged 60 years and over living in the community participated in this study. Anxiety, depression, rumination, suppression and experiential avoidance were measured.

RESULTS

Three factors explaining 50.11% of the variance were obtained. The obtained internal consistency for the total scale was 0.91, with alphas ranging between 0.71 and 0.89 for the factors. Significant associations between all the GAI factors, the GAI total score, and depression, rumination, and experiential avoidance were found (all p < 0.01). Women reported higher scores than men for both the GAI total score and for all of the subscales. However, no significant gender differences were found between people with scores higher than the cut-off score for the GAI.

CONCLUSIONS

The results of this study suggest that the Spanish version of the GAI displays good psychometric properties. Further, our data suggest that the scale can be recommended for measuring anxiety in non-clinical older Spanish persons, and may be a useful instrument to be used in research studies aimed at analyzing anxiety and its correlates among older adults.

Portuguese version of the Geriatric Anxiety Inventory: transcultural adaptation and psychometric validation

OBJECTIVES

The Geriatric Anxiety Inventory (GAI) is a recently developed anxiety instrument designed to assess the severity of anxiety symptoms across a range of presentations in older adults. In this study, the authors examined the validity of the Portuguese version of the GAI and assessed its psychometric properties.

METHOD

A cross-sectional study was designed using a sample of 152 community-dwelling older adults, and a geriatric psychiatric sample of outpatients with clinical diagnoses of depression (n = 32), anxiety disorders (n = 23), and early Alzheimer's disease (n = 10).

RESULTS

The Portuguese version of the GAI required linguistic and transcultural adaptations, particularly on the somatic expressions of anxiety. It exhibited sound internal consistency and demonstrated good concurrent validity against the state half of the Spielberg State-Trait Anxiety Inventory, the Geriatric Depression Scale (GDS-30), and the General Health Questionnaire (GHQ-12). The optimal cut-off point to detect severe anxiety symptoms was 8/9, but no optimal cut-off point for Generalized Anxiety Disorder could be estimated.

CONCLUSION

These findings provide initial evidence that the Portuguese version of the GAI is a valid and reliable measure for assessing late-life anxiety and highlights the need for possible modifications of the instrument before being used in other languages and cultural groups.