Abstract
BackgroundAnxious symptoms have a negative impact on different aspects of the elderly’s quality of life, ranging from the adoption of unhealthy lifestyle behaviours to an increased functional impairment and a greater physical disability. Different brief assessment instruments have been developed as efficacy measures of geriatric anxiety in order to overcome psychometric weaknesses of its long form. Among these, the 10-item Geriatric Anxiety Scale (GAS-10) showed strong psychometric properties in community-dwelling samples. However, its diagnostic accuracy is still unexplored, as well as its discriminative power in clinical samples.MethodsIn the present study, we explored the psychometric performance of the GAS-10 in the elderly through Item Response Theory in a sample of 1200 Italian community-dwelling middle-aged and elderly adults (53.8% males, mean age = 65.21 ± 9.19 years). Concurrent validity, as well as diagnostic accuracy, was examined in a non-clinical sample (N = 229; 46.72% males) and clinical sample composed of 35 elderly outpatients (74.28% females) with Generalized Anxiety Disorder (GAD).ResultsThe GAS-10 displayed good internal construct validity, with unidimensional structure and no local dependency, good accuracy, and no signs of Differential Item Functioning (DIF) or measurement bias due to gender, but negligible due to the age. Differences in concurrent validity and diagnostic accuracy among the long form version of the GAS and the GAS-10 were not found significant. The GAS-10 may be more useful than the longer versions in many clinical and research applications, when time constraints or fatigue are issues.ConclusionUsing the ROC curve, the GAS-10 showed good discriminant validity in categorizing outpatients with GAD disorder, and high anxiety symptoms as measured by the GAS-SF cut-off. The stable cut-off point provided could enhance the clinical usefulness of the GAS-10, which seems to be a promising valid and reliable tool for maximize diagnostic accuracy of geriatric anxiety symptoms.
Highlights
In Europe, anxiety disorders are one of the most common mental health problems among elderly, with lifetime prevalence estimates ranging from 20.1% in Italy to 32.6% in England [1, 2]
Structural analyses As a preliminary step, unidimensionality of the geriatric anxiety construct was assessed on sample 1 with a confirmatory factor analysis (CFA) using the WLSMV
Results showed that the 10 Geriatric Anxiety Scale (GAS) items measured one dimension, WLSMV χ2 (35; p < .001) = 329.683, comparative fit index (CFI) = .95, Tucker Lewis Index (TLI) = .95, and root mean square error of approximation (RMSEA) =
Summary
In Europe, anxiety disorders are one of the most common mental health problems among elderly, with lifetime prevalence estimates ranging from 20.1% in Italy to 32.6% in England [1, 2] This prevalence is probably underestimated, considering that subsyndromal manifestations of anxious symptoms probably range from 15 to 52.3% in community-living older adults [3, 4]. Anxiety has a substantial socio-economic burden, due to an increased use of health services among those who report greater symptoms [12] Both clinicians and mental health practitioners need valid, reliable measures of anxious symptoms tailored for this population and carefully developed to consider the clinical manifestations of late-life anxiety. Its diagnostic accuracy is still unexplored, as well as its discriminative power in clinical samples
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