Late-life Anxiety Research Articles

Anxiety symptoms in Korean elderly individuals: a two-year longitudinal community study.

Although late-life anxiety occurs frequently and is associated with higher morbidity, few longitudinal studies have been concerned with the evaluation thereof. We investigated the prevalence, incidence, and persistence of anxiety and related factors over a two-year period in community-dwelling Korean elderly individuals. A total of 1,204 Korean elderly individuals were evaluated at baseline, and 909 were followed up two years later. The community version of the Geriatric Mental State Schedule was used to estimate anxiety at both baseline and follow-up interviews. We defined "prevalence" as the rate of anxiety symptoms (for both anxiety cases and sub-threshold anxiety) at baseline; "incidence" as the rate of anxiety symptoms at follow-up in those without baseline anxiety symptoms; and "persistence" as the rate of anxiety symptoms at follow-up in those with baseline anxiety symptoms. Associations between various covariates and anxiety status were examined using multivariate logistic regression models. The prevalence, incidence, and persistence of anxiety symptoms were 38.1%, 29.3%, and 41.1%, respectively. Prevalent anxiety symptoms were associated independently with female, rented housing, more stressful life event and medical illness, physical inactivity, depression, insomnia, and lower cognitive function. Incident anxiety symptoms were predicted by older age, female gender, depression, and insomnia; persistent anxiety symptoms were predicted by older age, more medical illness, and baseline depression. Since depression was associated with prevalent, incident, and persistent anxiety symptoms, effective detection and management thereof is important in older adults to reduce anxiety. Furthermore, preventive collaborative care should be considered, particularly for older, female, insomniac patients.

How conditioned muscles can mediate resilience to stress-induced depression

The Western Australian Pregnancy Cohort (Raine) Study, a prospective study of 2868 live births, underwent longitudinal review at ages 1, 2, 3, 5, 8, 10, 14, 17 and 20. The primary care giver reported the family’s exposure to life stress events in the past year. At age 20, offspring completed the Depression Anxiety Stress Scale (DASS). Trajectories of stress events from age 1 to 17 were analysed using SAS PROC TRAJ and treated as predictors of DASS scores in linear regression analyses. Five stress trajectories were identified. In females, the high, medium and ascending trajectories predicted depression and anxiety symptoms at age 20 whilst the low and descending trajectories did not, after adjustment for relevant confounders. In males, there was only an association with the medium trajectory and DASS scores. Developmental trajectories of life stress events appear more important than any single time-point in predicting associations with depression and anxiety. Girls appear more vulnerable to the negative effects of stress-events than boys do. Interventions aimed at reducing numbers of life stress events in early childhood and adolescence are likely to have beneficial outcomes on rates of depression and anxiety in later life.

THE IMPACT OF LATE-LIFE ANXIETY AND DEPRESSION ON COGNITIVE FLEXIBILITY AND COGNITIVE RESTRUCTURING SKILL ACQUISITION.

Studies examining treatment moderators and mediators in late-life anxiety and depression are sparse. Executive functioning skills decrease with age, and are poorer in the context of anxiety and depression. One of the key cognitive behavioral therapy techniques for anxiety and depression is cognitive restructuring (CR), which teaches people to identify and dispute maladaptive thoughts. There is evidence that cognitive flexibility (CF), one aspect of executive functioning, has a negative impact on CR skill acquisition in nonclinical older adults, and this warrants extension in a clinical sample. This study assessed CR skill acquisition in a clinical sample of 47 older adults with anxiety and depression and 53 nonclinical controls during an experimental paradigm, and investigated the influence of CF on this relationship. A battery of neuropsychological tests assessing CF were administered and CR was learned during a brief intervention. The clinical sample showed poorer CF on some measures, as well as poorer CR quality and efficacy (reduction in subjective distress). CF partially mediated the relationship between clinical status and CR quality, and between clinical status and CR efficacy. These results provide preliminary evidence that older adults with anxiety and depression are worse at learning and benefiting from CR with a brief intervention and this is partially due to having poorer CF skills. These findings warrant further examination in a treatment context to assess whether CR skill acquisition improves over treatment.

Cognitive–behavioral therapy for late-life anxiety: Similarities and differences between Veteran and community participants

Cognitive–behavioral therapy (CBT) is an evidence-based treatment for anxiety; however, a growing body of research suggests that CBT effect sizes are smaller in Veteran samples. The aim of this study was to perform secondary data analyses of a randomized controlled trial of CBT for late-life generalized anxiety disorder compared with treatment as usual (TAU) in a Veteran (n=101) and community-based (n=122) sample. Veterans had lower income and less education than community participants, greater severity on baseline measures of anxiety and depression, poorer physical health, and higher rates of psychiatric comorbidity. Treatment effects were statistically significant in the community sample (all ps<0.01), but not in Veterans (all ps>0.05). Further analyses in Veterans revealed that poorer perceived social support significantly predicted poorer outcomes (all ps<0.05). Our results underscore the complexity of treating Veterans with anxiety, and suggest that additional work is needed to improve the efficacy of CBT for Veterans, with particular attention to social support.

Social Difficulties Attributed to Health Problems Are Associated with Late-Life Anxiety and Depression

Many studies have examined the relationship that social and medical factors have with anxiety and depression in older adults. Poor social support, stressful life events, chronic medical illness, and functional impairment can place older adults at increased risk for anxiety and affective disorders. Less is known, however, regarding how social impairment caused by medical problems is associated with late-life anxiety and depression. We hypothesize that older adults with social difficulties attributed to health problems have an increased risk of anxiety and depression, even after accounting for other indicators of physical health.

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

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

Using virtual reality to improve the efficacy of cognitive-behavioral therapy (CBT) in the treatment of late-life anxiety: preliminary recommendations for future research.

Cognitive-behavioral therapy (CBT) using traditional exposure techniques (i.e. imaginal and in vivo) seems less effective to treat anxiety in older adults than in younger ones. This is particularly true when imaginal exposure is used to confront the older patient to inaccessible (e.g. fear of flying) or less tangible/controllable anxiety triggers (e.g. fear of illness). Indeed, imaginal exposure may become less effective as the person gets older since normal aging is characterized by the decline in cognitive functions involved in the creation of vivid/detailed mental images. One way to circumvent this difficulty is to expose the older patient to a virtual environment that does not require the ability to imagine the frightening situation. In virtuo exposure has proven to be efficient to treat anxiety in working-age people. In virtuo exposure could be employed to improve the efficacy of CBT with exposure sessions in the treatment of late-life anxiety? The current paper explores this question and suggests new research avenues.

Key Points in Managing Late-Life Anxiety

Key Points in Managing Late-Life Anxiety

Anxiety Disorders in Older Adults

Late life anxiety disorders are the most prevalent psychiatric conditions among older adults and they often present at a sub-threshold level. Specific phobias (SP) are particularly frequent and fear of falling is increasingly being recognized as a class of phobias typically seen in older adults. Generalized anxiety disorder (GAD), although recognized as a chronic disorder with early onset, has been found to have an onset late in life as well. Social phobia (SoP) has been found to not necessarily have a chronic course in this population. Post-traumatic stress disorder (PTSD) manifests in older adults often as an exacerbation of symptoms from a trauma earlier in life. Cognitive behavior therapy (CBT) augmented with learning and memory aids, and a combination of CBT and medication, has had good outcomes in the management of anxiety disorders in older adults.

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.

Threshold and subthreshold generalized anxiety disorder in later life.

Symptoms and disorders of anxiety are highly prevalent among older adults; however, late-life anxiety disorders remain underdiagnosed. The objective of this study was to (1) estimate the prevalence of late-life threshold and subthreshold generalized anxiety disorder (GAD), (2) examine sociodemographic and health correlates associated with membership in these groups, (3) assess 3-year conversion rates of these groups, and (4) explore characteristics associated with 3-year conversion to GAD. Using Waves 1 and 2 of the National Epidemiological Survey of Alcohol and Related Conditions, 13,420 participants aged 55-98 years were included in this study. Subthreshold GAD was more highly prevalent than threshold GAD and was interposed between asymptomatic and GAD groups in terms of severity of health characteristics. Although most participants with subthreshold and threshold GAD were asymptomatic by Wave 2, differences in disability persisted. Subthreshold GAD at baseline was not a predictor of threshold GAD at follow-up. These findings suggest that late-life GAD should be conceptualized as a dimensional rather than categorical construct. The temporal stability of anxiety-associated disability further suggests that subthreshold GAD bears clinical significance. However, the suitability and efficacy of interventions for minimizing negative sequelae in this group remain to be determined.

The silent geriatric giant- anxiety disorders in late life

Late-life anxiety can often be silent, missed or difficult to diagnose as older adults tend to somatize psychiatric problems. Yet late-life anxiety disorders are a "geriatric giant," being twice as prevalent as dementia among older adults and four to eight times more prevalent than major depressive disorders, causing significant impact on the quality of life, morbidity, and mortality of older adults. Bangladesh is one of the twenty countries in the world with the largest elderly population and by 2025, along with four other Asian countries, will account for 44% of world's total elderly population. Demographic and epidemiological transitions reveal geriatric problems as burning public health issue. So more emphasis should be given on geriatric health problems in order to ensure physical, mental and socially sound health. http://dx.doi.org/10.3329/bjpp.v29i1-2.20065 Bangladesh J Physiol Pharmacol 2013; 29(1&amp;2) : 29-31

Validation of the Brazilian Portuguese Version of Geriatric Anxiety Inventory--GAI-BR.

The Geriatric Anxiety Inventory (GAI) is a recently developed scale aiming to evaluate symptoms of anxiety in later life. This 20-item scale uses dichotomous answers highlighting non-somatic anxiety complaints of elderly people. The present study aimed to evaluate the psychometric properties of the Brazilian Portuguese version GAI (GAI-BR) in a sample from community and outpatient psychogeriatric clinic. A mixed convenience sample of 72 subjects was recruited for answering the research protocol. The interview procedures were structured with questionnaires about sociodemographic data, clinical health status, anxiety, and depression previously validated instruments, Mini-Mental State Examination, Mini International Neuropsychiatric Interview, and GAI-BR. Twenty-two percent of the sample were interviewed twice for test-retest reliability. For internal consistency analyses, the Cronbach's α test was applied. The Spearman correlation test was applied to evaluate the test-retest GAI-BR reliability. A ROC (receiver operating characteristic) curve study was made to estimate the GAI-BR area under curve, cut-off points, sensitivity, and specificity for the Generalized Anxiety Disorder diagnosis. The GAI-BR version showed high internal consistency (Cronbach's α = 0.91) and strong and significant test-retest reliability (ρ = 0.85, p < 0.001). It also showed moderate and significant correlation with the Beck Anxiety Inventory (ρ = 0.68, p < 0.001) and the State-Trait Anxiety Inventory (ρ = 0.61, p < 0.001) showing evidence of concurrent validation. The cut-off point of 13 estimated by ROC curve analyses showed sensitivity of 83.3% and specificity of 84.6% to detect Generalized Anxiety Disorder (DSM-IV). GAI-BR has demonstrated very good psychometric properties and can be a reliable instrument to measure anxiety in Brazilian elderly people.

Coping Styles for Anxiety and Depressive Symptoms in Community-Dwelling Older Adults

The aim of the present study was to examine whether specific coping styles are associated with self-reported anxiety in a sample of older adults. A total of 210 community-dwelling older adults completed self-report measures of anxiety and depression and the Coping Orientations to Problems Experienced scale. Results indicated that a tendency to utilize dysfunctional coping strategies predicted anxiety symptomatology in late life, with older adults who reported high levels of anxiety more likely to report using dysfunctional coping. After controlling for depressive symptoms, use of venting and self-blame made an independent contribution in predicting anxiety symptoms. Overall, 65% of the variance in anxiety symptoms was explained by education, depressive affect, and use of self-blame and venting as coping strategies. Our findings indicate that specific coping styles such as venting and self-blame are associated with experiencing high levels of anxiety symptoms in late life. These results suggest that targeting specific dysfunctional copying styles may be useful for prevention strategies and interventions treating anxiety in late life.

Antiglucocorticoid therapy for older adults with anxiety and co-occurring cognitive dysfunction: results from a pilot study with mifepristone

In older adults with anxiety disorders, chronically elevated cortisol may contribute to cognitive impairment and elevated anxiety. We conducted a pilot study with mifepristone, a glucocorticoid receptor antagonist, as a potential treatment for late-life anxiety disorders and co-occurring cognitive dysfunction. Fifteen individuals 60 years and older with an anxiety disorder plus cognitive dysfunction participated in the 12-week study. In the first week, participants were randomly assigned to mifepristone 300 mg daily or placebo. In the subsequent 3 weeks, all participants received mifepristone 300 mg. Mifepristone was then discontinued, and the participants were reassessed 8 weeks later. We examined the following: (1) cognitive changes; (2) worry symptom severity; (3) safety and tolerability; and (4) salivary cortisol before, during, and after mifepristone exposure. Overall safety, tolerability, and high retention supported the feasibility of this research. Participants with higher baseline cortisol levels (peak cortisol >6.0 ng/ml, n = 5) showed improvements in memory, executive function, and worry severity after 3-4 weeks of mifepristone with persistent memory and worry improvements 8 weeks after mifepristone discontinuation. Individuals with low-to-normal baseline cortisol (n = 8) showed little to no improvement. As expected, cortisol levels rose during mifepristone exposure and returned to pretreatment levels 8 weeks after mifepristone discontinuation. In the first week of treatment, there were no differences between placebo-treated and mifepristone-treated participants. The results of this pilot study warrant further testing of antiglucocorticoid agents in late-life anxiety disorders with co-occurring cognitive dysfunction. Mifepristone is hypothesized to have benefits in patients with evidence of glucocorticoid excess. Directions for further study are discussed.

Anxiety Symptoms in 74+ Community-Dwelling Elderly: Associations with Physical Morbidity, Depression and Alcohol Consumption

ObjectiveAnxiety among community-dwelling older adults has not been studied sufficiently. The aims of this cross-sectional population-based study were to estimate the point prevalence of clinically relevant anxiety symptoms and to describe their socio-demographic and clinical features, with particular focus on the association with somatic illnesses.MethodsThree-hundred-sixty-six non-demented older adults (mean age 83.7±6.2, range 74–99 years) from the Faenza Project (Northern Italy) were assessed using the Cambridge Mental Disorders of the Elderly Examination-Revised (CAMDEX-R) and the Geriatric Anxiety Inventory short form (GAI-sf). Multi-adjusted regression analyses were used to estimate Odds Ratio (OR) and 95% Confidence Intervals (95% CI).ResultsClinically relevant anxiety symptoms occurred in one out of five participants (point prevalence 21.0%) and were significantly associated with depression (OR 5.6 per rank; 95% CI: 3.1–10.1), physical morbidity (OR 3.5 per illness; 95% CI: 1.0–11.9) and female gender (OR 2.8; 95% CI: 1.4–5.5). Further, there were significant associations with a consumption of alcohol exceeding 1 alcoholic unit/day.ConclusionsAnxiety symptoms are very common in older subjects, especially when medically ill. Depression and alcohol consumption often co-occur with late-life anxiety symptoms, thus requiring special attention in daily clinical practice.

Telephone-delivered psychotherapy for rural-dwelling older adults with generalized anxiety disorder: study protocol of a randomized controlled trial

BackgroundGeneralized Anxiety Disorder (GAD), characterized by excessive and uncontrollable worry, has a negative impact on the health, well-being, and functioning of older adults. Cognitive behavioral therapy has demonstrated efficacy in reducing anxiety and worry in older adults, but the generalizability of these findings to community-dwelling older adults is unknown. The aim of the current study is to examine the efficacy of a cognitive-behavioral intervention delivered by telephone in reducing anxiety and worry in rural community-dwelling older adults with GAD.Methods/DesignWe propose a randomized controlled trial comparing telephone-delivered cognitive behavioral therapy (CBT-T) with nondirective supportive therapy (NST-T). One hundred seventy six adults 60 years and older diagnosed with GAD will be randomized to one of the two treatment conditions. The primary outcomes are self-report worry and clinician-rated anxiety. Secondary outcomes include depressive symptoms, sleep, quality of life, and functional status.DiscussionIt is hypothesized that CBT-T will be superior to NST-T in reducing anxiety and worry among older adults with GAD. Further, CBT-T is hypothesized to be superior to NST-T in reducing problems with depressive symptoms, sleep, functional status and quality of life. If this program is successful, it could be implemented as a low-cost program to treat late-life anxiety, especially in rural areas or in circumstances where older adults may not have access to qualified mental health providers.Trial registrationclinicaltrials.gov Identifier: NCT01259596

Age-related changes in generalized anxiety disorder symptoms

Little is known about the effects of age on the symptoms of anxiety disorder. Accordingly, this study sought to investigate age-related differences in the number and kind of symptoms that distinguish between individuals with and without a diagnosis of generalized anxiety disorder (GAD). A sample of 3,486 self-reported worriers was derived from Wave 1 of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC), an epidemiological survey of mental health conducted in the U.S.A. in 2001-2002. Participants were stratified into the following age groups (18-29 years, 30-44 years, 45-64 years, 65-98 years), and then divided into diagnostic groups (GAD and non-GAD worriers). Binary logistic regression analyses revealed that four distinct sets of symptoms were associated with GAD in each age group, and that numerically fewer symptoms were associated with GAD in older adults. Moreover, there were graduated changes in the type and number of symptoms associated with GAD in each successive age group. There are graduated, age-related differences in the phenomenology of GAD that might contribute to challenges in the detection of late-life anxiety.

Therapeutics in Late-Life Anxiety Disorders—An Update

The first choice treatments for all anxiety disorders (ADs) are cognitive behavioral therapy (CBT), pharmacological treatment with antidepressants, or their combination. However, empirical findings for these treatments in elderly suffering from ADs are still scarce. The scarcity of empirical research in this age group may be attributable to the fact that late-life anxiety is generally viewed as a minor health problem, and therefore, that we are dealing with a population that tends to go largely underdiagnosed and hence un(der)treated. From a mental-health perspective, both the material and immaterial costs of this unmet need are substantial. If left untreated, late-life anxiety has a tendency to become chronic and is associated with a substantial risk of major depression, increases in health-care utilization, reduced quality of life, more disability, and increased relative mortality risk. Additionally, most elderly suffering from ADs remain in primary care. This is partly complicated by their worries about stigmatization and reluctance to be referred to specialized mental health care. Therefore, the main issue to solve is how to increase both the detection rate and proper treatment of late-life anxiety in primary care. The following signals in elderly patients may indicate an anxiety disorder: frequent visits to the primary care physician with fluctuating, unexplained somatic symptoms, chronic and non-specific stress-related symptoms (nervousness, irritability, sleep disorder, concentration problems, emotional instability, apathy), hyperventilation, palpitation, dizziness, frequent request for tranquillizers, alcohol abuse, depression, avoidance of (social) activities. Although far from conclusive, the available evidence suggests efficacy, although limited, for CBT in late-life ADs compared with CBT for ADs in younger adults. In the treatment of late-life generalized anxiety disorder there is no difference between CBT or alternative psychological treatments like supportive counseling or a discussion group. The efficacy of antidepressant treatment with selective serotonin re-uptake inhibitors (SSRIs) or tri-cyclic antidepressants (TCAs) seems to be comparable in both younger and older adults. However, one has to keep in mind that direct comparisons of CBT or pharmacological treatment between younger and older adults suffering from ADs have not yet been conducted. Therefore, the main treatment options in late-life ADs are comparable with those in younger adults with ADs.

EPA-1072 – Anxiety and the risk of suicide in elderly

Anxiety is one of the most common disorders in the elderly, twice as prevalent as dementia and four to eight times more prevalent than major depressive disorder. 90% of late-life anxiety are accounted for by either generalized anxiety disorder (GAD) or specific phobia and is often comorbid with depression, therefore older adults being particularly vulnerable to suicide. This study sought to determine the prevalence of suicidal behavior among older patients with GAD hospitalized in the Psychiatry Department of Arad between 2009–2012. To evaluate the suicide risk in late-life anxiety. Our research is based on the study of 65 subjects (52 female and 13 male) diagnosed with GAD; the mean age was 68.3. The diagnostic of GAD was based on the DSM-IV and ICD-10 criteria. The study protocol assessed age, sex, social support, economic status, length of illness, recent traumatic events, medical or another psychiatric illness. The severity of the suicide risk was estimated according to: presence of thoughts of death, severity of suicidal ideation, history of suicide attempt, severity of suicide attempt. The onset of GAD for the majority of patients was in earlier life with late-life exacerbation. 41 patients had associated minor depression. Our study revealed a risk of suicide of 4.6% (three patients). Patients diagnosed with GAD have a higher suicide risk, especially in association with depression, medical illnesses or lack of social support. In the future, specific diagnostic criteria for late-life anxiety will be needed, in order to prevent suicidal behavior.