Anxiety Symptoms In Older Adults Research Articles

ASSOCIATION BETWEEN SOCIAL SUPPORT AND ANXIETY IN OLDER ADULTS NEW TO LONG-TERM SERVICES AND SUPPORTS

Anxiety symptoms are common among older adults and are often associated with adverse outcomes. Thus, it is important to examine modifiable factors and manage anxiety symptoms in this population. While many biological and psychological factors related to anxiety symptoms in older adults have been found, little is known about social factors which are essential in one’s mental health. The purpose of this study was to examine the prevalence of anxiety symptoms among older adults new to long-term services and supports (LTSS) and to investigate the relationship between social support and presence of anxiety. This was a secondary data analysis from a study funded to examine health related quality of life in older adults new to LTSS. Anxiety was assessed using a single item, “Recently, how often have you felt anxious?” and the answers were dichotomized into “anxiety” (ratings: ‘very often’, ‘often’, ‘sometimes’, and ‘seldom’) and “no anxiety” (rating: ‘never’). Social support was measured by Medical Outcomes Study Social Support Scale. Prevalence of anxiety symptoms in this sample was 82.7% (n=225). In multivariate logistic regression, adjusting for age, gender, LTSS type, cognitive status, physical and emotional health, and depressive symptoms, older adults with more tangible social supports had lower odds of having anxiety symptoms (Odds ratio=0.515; 95% CI: 0.289-0.919, p=0.025). Improving access to tangible social supports for older adults at the start of LTSS may impact anxiety in older adults. Implications for future research and intervention development to provide tangible social support to older adults in LTSS will be discussed.

Emotional State in Relation to Physical Activity Among Older People

Old age is a stage in human life associated with alteration of physical, mental and social functioning. The aim of this study was to investigate the associations between regular physical activity (PA) and purpose of life, intensity of depressive moods, sense of coherence (SoC) and the level of anxiety in older adults. Forty six individuals physically active (A) and 49 physically inactive (NA) without mental or physical disability were included in the study. The purpose of life was assessed by Purpose of Life Scale (PIL), intensity of depressive moods by Beck Depression Inventory (BDI), SoC by Antonovsky’s questionnaire and level of anxiety by State-Trait Anxiety Inventory (STAI). An AN individuals had lover BDI-feelings level compared with A group (p < 0.05). The AN group also showed a significantly lower scores in anxiety-feature domain of the STAI (p < 0.05). Our results suggest that improved self-perceived quality of life is significantly associated to PA among older adults and regular PA may be effective for improving depression and anxiety symptoms in older adults. A better understanding of the relationship between the PA and depressive moods and level of anxiety is important to develop recommendations regarding modifications in life-style.

Depressive and Anxiety Symptoms in Older Adults With Auditory, Vision, and Dual Sensory Impairment.

Objective: The objective of the study is to examine the association of auditory, vision, and dual sensory impairment with late-life depressive and anxiety symptoms. Method: Our study included 7,507 older adults from the National Health & Aging Trends Study, a nationally representative sample of U.S. Medicare beneficiaries. Auditory and vision impairment were determined by self-report, and depressive and anxiety symptoms were evaluated by the two-item Patient Health Questionnaire (PHQ-2) and two-item Generalized Anxiety Disorder Scale (GAD-2), respectively. Results: Auditory, vision, and dual impairment were associated with an increased risk of depressive and anxiety symptoms in multivariable analyses accounting for sociodemographics, medical comorbidity, and functional impairment. Auditory, vision, and dual impairment were also associated with an increased risk for depressive and anxiety symptoms that persist or were of new onset after 1 year. Discussion: Screening older adults with sensory impairments for depression and anxiety, and screening those with late-life depression and anxiety for sensory impairments, may identify treatment opportunities to optimize health and well-being.

Anxiety Symptoms in Older Adults with Depression Are Associated with Suicidality

Objective: Anxiety symptoms are common in older adults with depression, but whether severe anxiety is associated with poorer outcomes of depression is unknown. The objective of the present study was to examine the association between severity of anxiety and severity of depression and physical illness, suicidality, and physical and cognitive functioning in older adults with depression. Methods: We included 218 older adults with diagnoses of a depressive disorder according to the ICD-10 criteria; their mean age (SD) was 75.6 (7.2), and 67.0% were women. The Geriatric Anxiety Inventory (GAI) was used to measure the severity of anxiety symptoms. The Montgomery-Aasberg Depression Rating Scale (MADRS) was used to assess the severity of depression. We obtained information on the level of functioning with the Physical Self-Maintenance Scale (PSMS) by Lawton and Brody and on cognition with the Mini-Mental State Examination (MMSE) and the Clock-Drawing Test (CDT). Physical health was determined based on information regarding falls and weight loss and an assessment of each patient’s general medical condition. The treating physician evaluated current suicidality in a comprehensive and standardized way. Results: Higher GAI scores were significantly associated with scores on the MADRS (β = 0.233, p = 0.002) and suicidality (β = 0.206, p = 0.006). Levels of physical or cognitive functioning were not associated with the GAI score. Conclusion: The severity of anxiety symptoms was associated with the severity of depression and suicidality in older adults with depressive disorders. The results could indicate a need to focus greater attention on the treatment of anxiety and suicidality in older patients with depression.

0089 Does Good Sleep Efficiency Protect Against the Cognitive Consequences of Anxiety Symptoms in Older Adults?

0089 Does Good Sleep Efficiency Protect Against the Cognitive Consequences of Anxiety Symptoms in Older Adults?

Association of Neighborhood Green Space with Depressive and Anxiety Symptoms in Older Adults

Background/Aim: Mental health disorders are the third leading cause of global disease burden worldwide. Despite that a role of neighborhood green space in the pathogenesis of mental disorders has b...

Trajectories of depressive and anxiety symptoms in older adults: a 6-year prospective cohort study.

Depressive and anxiety symptoms are common in older adults, significantly affect quality of life, and are risk factors for Alzheimer's disease. We sought to identify the determinants of predominant trajectories of depressive and anxiety symptoms in cognitively normal older adults. Four hundred twenty-three older adults recruited from the general community underwent Aβ positron emission tomography imaging, apolipoprotein and brain-derived neurotrophic factor genotyping, and cognitive testing at baseline and had follow-up assessments. All participants were cognitively normal and free of clinical depression at baseline. Latent growth mixture modeling was used to identify predominant trajectories of subthreshold depressive and anxiety symptoms over 6years. Binary logistic regression analysis was used to identify baseline predictors of symptomatic depressive and anxiety trajectories. Latent growth mixture modeling revealed two predominant trajectories of depressive and anxiety symptoms: a chronically elevated trajectory and a low, stable symptom trajectory, with almost one in five participants falling into the elevated trajectory groups. Male sex (relative risk ratio (RRR)=3.23), lower attentional function (RRR=1.90), and carriage of the brain-derived neurotrophic factor Val66Met allele in women (RRR=2.70) were associated with increased risk for chronically elevated depressive symptom trajectory. Carriage of the apolipoprotein epsilon 4 allele (RRR=1.92) and lower executive function in women (RRR=1.74) were associated with chronically elevated anxiety symptom trajectory. Our results indicate distinct and sex-specific risk factors linked to depressive and anxiety trajectories, which may help inform risk stratification and management of these symptoms in older adults at risk for Alzheimer's disease. Copyright © 2017 John Wiley & Sons, Ltd.

The incidence and predictors of depressive and anxiety symptoms in older adults with vision impairment: a longitudinal prospective cohort study.

Depression and anxiety are highly prevalent in older adults with vision impairment. Because symptoms of depression and anxiety appear to fluctuate, it is important to identify patients who are at risk of developing these symptoms for early diagnosis and treatment. Therefore, the aim of this study was to determine the incidence of subthreshold depression and anxiety, and to investigate predictors of developing symptoms of depression and anxiety in older adults with vision impairment who had no subthreshold depression or anxiety at baseline. A longitudinal prospective cohort study with a follow-up of 24months in 540 older adults with vision impairment (mean age 75years, 56% female, 48% macular degeneration, 15% glaucoma) from outpatient low-vision rehabilitation organisations was performed. The cumulative incidences of subthreshold depression and anxiety were calculated and linear mixed models with maximum likelihood estimation were used to determine two prediction models. Main outcome measures were: fluctuations in (i) depressive symptoms (Center for Epidemiologic Studies Depression Scale, CES-D) and (ii) anxiety symptoms (Hospital Anxiety and Depression Scale-Anxiety subscale, HADS-A). The annual cumulative incidences of subthreshold depression and anxiety were 21.3% (95% Confidence Interval (CI) 18.7-23.9%) and 9.5% (95% CI 7.4-11.6%), respectively. Risk factors for developing depressive symptoms were: living alone, having just enough money to cover expenses, having macular degeneration, having problems with adaptation to vision loss, reduced health related quality of life, and experiencing symptoms of anxiety. For developing anxiety symptoms, a relatively younger age, experiencing symptoms of depression, not living alone and experiencing hindrance at work proved to be risk factors. This study shows that the incidence of subthreshold depression and anxiety in older adults with vision impairment is twice as high compared with older adults in general and confirms that depression and anxiety symptoms fluctuate over time. It is of great importance that low vision rehabilitation staff monitor older adults with vision impairment who are most vulnerable for developing these symptoms, based on the risk factors that were found in this study, to be able to offer early interventions to prevent and treat mental health problems in this population.

Poster Number: EI 12 - Depressive and Anxiety Symptoms in Older Adults with Auditory, Vision, and Dual Impairment

Poster Number: EI 12 - Depressive and Anxiety Symptoms in Older Adults with Auditory, Vision, and Dual Impairment

Psychometric properties of the French Canadian version of the Geriatric Anxiety Inventory

ABSTRACTBackground: The Geriatric Anxiety Inventory (GAI) and a short form of this instrument (GAI-SF) were developed to assess the severity of anxiety symptoms in older adults in order to compensate for the lack of validated screening tools adapted to the elderly population. This study examined the psychometric properties of the French Canadian version of the GAI, in its complete (GAI-FC) and short form (GAI-FC-SF).Method: A total of 331 community-dwelling seniors between 65 and 92 years old participated in this study.Results: Both the GAI-FC and the GAI-FC-SF have sound psychometric properties with, respectively, a high internal consistency (α = .94 and .83), an adequate convergent validity (r = .50 to .86 with instruments known to evaluate constructs similar to the GAI or related to anxiety), a good test–retest reliability (r = .89 and .85), in addition to a single-factor structure.Conclusions: The results support the use of both the GAI-FC and the GAI-FC-SF. The GAI-FC-SF seems to be an interesting alternative to the GAI-FC as a screening tool when time available for assessment is limited.

Exposure to traffic pollution and increased risk of depressive and anxiety symptoms in older adults

Background: Mental health disorders are the third most costly non-fatal condition in America, and account for &gt;140 million disability-adjusted life years worldwide. While the genetic profile is been major risk factor of mental disorders, recent evidence has suggested a role of traffic-related air pollution in the pathogenesis of mental disorders. Methods: We examined the association of distance to road, a marker of traffic pollution exposure, with depression and anxiety in 4,854 community-dwelling adults (aged ≥57) of the National Social Life, Health and Aging Project, a nationally representative, longitudinal sample of older adults in the US. Depression and anxiety were evaluated using standardized questionnaires, with cases identified by dichotomizing questionnaire scores using well-established cutoffs. As a proxy for traffic exposure, we calculated distance from each residential address to the closest A1–A3 road segments. Generalized linear mixed models were used to assess the association with adjustment of confounders (e.g., socioeconomic status), and to explore effect modification (e.g., by season). Results: In models adjusted for age, gender, race, calendar year, season, day of week, region and individual- and neighborhood-level socioeconomic status, we found 1.38 times the odds of adverse depressive symptoms (95%CI: 1.07, 1.78), and 1.51 times the odds of adverse anxiety symptoms (95%CI: 1.16, 1.96) in individuals living within 50m of a road, compared with those living 200m or farther away. We saw no elevations in odds for adults living 50–200 m from the road. The association remains robust upon adjustment of fine particular matter (PM2.5). Association with other neighborhood characteristics (e.g., crime/foreclosure rate, greenness) will be examined. Conclusions: Distance to road was associated with depression and anxiety, suggesting that pollution from traffic may be a newly identified environmental risk factor for mental health.

Association of Ambient Air Pollution with Depressive and Anxiety Symptoms in Older Adults: Results from the NSHAP Study.

Background:Ambient fine particulate matter (PM2.5) is among the most prevalent sources of environmentally induced inflammation and oxidative stress, both of which are implicated in the pathogenesis of most mental disorders. Evidence, however, concerning the impact of PM2.5 on mental health is just emerging.Objective:We examined the association between PM2.5 and current level of depressive and anxiety symptoms using a nationally representative probability sample (n = 4,008) of older, community-dwelling individuals living across the United States (the National Social Life, Health and Aging project).Methods:Mental health was evaluated using validated, standardized questionnaires and clinically relevant cases were identified using well-established cutoffs; daily PM2.5 estimates were obtained using spatiotemporal models. We used generalized linear mixed models, adjusting for potential confounders, and explored effect modification.Results:An increase in PM2.5 was significantly associated with anxiety symptoms, with the largest increase for 180-days moving average (OR = 1.61; 95% CI: 1.35, 1.92) after adjusting for socioeconomic measures (SES); PM2.5 was positively associated with depressive symptoms, and significantly for 30-day moving average (OR = 1.16; 95% CI: 1.05, 1.29) upon SES adjustment. The observed associations were enhanced among individuals who had low SES and history of comorbidity. When considering mental health as chronic conditions, PM2.5 was significantly associated with incident depressive symptoms for all exposure windows examined, but with incident anxiety symptoms only for shorter exposure windows, which may be due to a drop in power resulting from the decreased between-subject variability in chronic PM2.5 exposure.Conclusion:PM2.5 was associated with depressive and anxiety symptoms, with associations the strongest among individuals with lower SES or among those with certain health-related characteristics.Citation:Pun VC, Manjourides J, Suh H. 2017. Association of ambient air pollution with depressive and anxiety symptoms in older adults: results from the NSHAP study. Environ Health Perspect 125:342–348; http://dx.doi.org/10.1289/EHP494

The effects of regular physical activity on anxiety symptoms in healthy older adults: a systematic review

Objective:Anxiety symptoms are common in older adults with or without anxiety disorders. Pharmacological options may be limited for these patients. Alternative treatments, such as physical activity (PA), are often indicated, although few trials have evaluated their efficacy. The aim of this review was to evaluate the efficacy of regular PA on improving anxiety symptoms in older adults without anxiety disorders. Potential neuroendocrine, inflammatory, and oxidative mechanisms, as well as cognitive factors to explain these effects are also discussed.Methods:A systematic literature review was performed to identify randomized controlled trials, cross-sectional, cohort, and case-control studies, as well as case series including healthy previously sedentary older adults. We searched the PubMed and Web of Science databases for articles published in English, with no set time limits.Results:Eight studies evaluating the effect of PA on anxiety symptoms in healthy older adults were included in this review. In all studies, regular and supervised PA was directly related to decreased anxiety symptoms in older individuals.Conclusion:Regular PA may be effective for improving anxiety symptoms in older adults. More studies are needed to identify the ideal PA modality, frequency, duration, and intensity for optimizing the positive effects of exercise on anxiety in this population.

Association of Hearing Impairment and Anxiety in Older Adults.

The objective of the study is was investigate the association between hearing impairment and anxiety. We conducted a cross-sectional analysis of 1,732 community-based adults aged 76 to 85 years who participated in the Health Aging and Body Composition (ABC) study. Logistic regression models were adjusted for demographic and cardiovascular risk factors. Hearing impairment was defined by the speech-frequency pure tone average. Anxiety was defined as reporting two symptoms of at least "a little" or one symptom "quite a bit" on the three-item Hopkins Symptom Checklist. Compared with individuals with no hearing impairment, the odds of prevalent anxiety were higher among individuals with mild hearing impairment (odds ratio [OR] = 1.32, 95% confidence interval [CI] = [1.01, 1.73]) and moderate or greater hearing impairment (OR = 1.59, 95% CI = [1.14, 2.22]). Hearing aid use was not significantly associated with lower odds of anxiety. Hearing impairment is independently associated with greater odds of anxiety symptoms in older adults.

Mindfulness-based cognitive therapy for anxiety symptoms in older adults in residential care

ABSTRACTObjectives: Anxiety in older people is under-diagnosed and poorly treated despite significant impairments that arise from anxiety. Mindfulness-based cognitive therapy (MBCT) has been shown to be a promising treatment for anxiety. The aim of this study was to determine the effect of an MBCT program on anxiety symptoms in older people living in residential care.Method: Fifty-two participants (34 females) were randomly allocated into therapy and control groups using a 2 × 3 mixed design. The average age of participants was 83 years. Results: The group effect showed significant improvements on all measures at the end of the seven-week program in the therapy group, while the control group did not show significant changes.Conclusion: This study represents one of the first studies of the effectiveness of an MBCT program on anxiety symptoms for older people using a randomized controlled trial. The study has implications for future research that include the effectiveness of MBCT for the treatment of anxiety symptoms in older people, the utility of group therapy programs in residential care and the benefits of using specialized instruments for older populations.

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

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

Do negative affect characteristics and subjective memory concerns increase risk for late life anxiety?

To better understand the development and exacerbation of late-life anxiety, we tested a risk model positing that trait negative affect (NA) characteristics would interact with cognitive functioning, thereby increasing some older adults’ risk for increased anxiety symptoms. The moderator–mediator model consisted of measures of NA, cognitive functioning, and their interaction, as predictors of later Hamilton Anxiety Rating Scale scores (HARS) via a mediational process, subjective memory concerns (SMCs). Older adults (aged 65-years and over; Mage=76.7 years, SD=6.90 years) completed evaluations four times over approximately 18 months. A latent growth curve model including Anxiety Sensitivity Index total score (ASI), Mattis Dementia Rating Scale-2 (DRS) total raw score, the ASI×DRS interaction, a SMC measure as mediator, HARS intercept (scores at times 3 and 4), and HARS slope provided good fit. The ASI×DRS-2 interaction at Time 1 predicted HARS slope score (β=−.34, p<.05). When ASI score was high, stronger cognitive functioning was associated with fewer anxiety symptoms. The indirect effect of ASI score predicting HARS score 18-months later through the SMC mediator was statistically significant (β=.08, p<.05). Results suggest that the cognitive functioning changes associated with aging might contribute to the development of anxiety symptoms in older adults with specific NA traits. Implications for predicting and preventing late life anxiety disorders are discussed.

Concordance of self- and proxy-rated worry and anxiety symptoms in older adults with dementia

We compared the psychometric performance of two validated self-report anxiety symptom measures when rated by people with dementia versus collaterals (as proxies). Forty-one participants with mild-to-moderate dementia and their respective collaterals completed the Geriatric Anxiety Inventory, the Penn State Worry Questionnaire-Abbreviated, and a structured diagnostic interview. We used descriptive and nonparametric statistics to compare scores according to respondent characteristics. Receiver operating characteristic (ROC) curves were calculated to establish the predictive validity of each instrument by rater type against a clinical diagnosis of an anxiety disorder. Participant and collateral ratings performed comparably for both instruments. However, collaterals tended to give more severe symptom ratings, and the best-performing cut-off scores were higher for collaterals. Our findings suggest that people with mild-to-moderate dementia can give reliable self-reports of anxiety symptoms, with validity comparable to reports obtained from collaterals. Scores obtained from multiple informants should be interpreted in context.

The roles of social support and self-efficacy in physical health's impact on depressive and anxiety symptoms in older adults.

Physical illness may precipitate psychological distress among older adults. This study examines whether social support and self-efficacy moderate the associations between physical health and depression and anxiety. Predictions were tested in 222 individuals age 60 or older presenting for help with worry. Physical health was assessed through self-report (subjective) and physical diagnoses (objective). Objective physical health did not have a significant association with depression or anxiety. Worse subjective physical health was associated with increased somatic anxiety, but not with depression or worry. The relationship between subjective physical health and depressive symptoms was moderated by self-efficacy and social support. As predicted, when self-efficacy was low, physical health had its strongest negative association with depressive symptoms such that as physical health improved, depressive symptoms also improved. However, the moderation effect was not as expected for social support; at high levels of social support, worse physical health was associated with increased depressive affect.

Prevention of depression and anxiety in later life: design of a randomized controlled trial for the clinical and economic evaluation of a life-review intervention.

BackgroundDepressive and anxiety symptoms in older adults could develop into significant health problems with detrimental effects on quality of life and a possibly poor prognosis. Therefore, there is a need for preventive interventions which are at once effective, acceptable and economic affordable.Methods and designThis paper describes the design of a study evaluating "The stories we live by", a preventive life-review group intervention, which was recently developed for adults of 55 years and over with depressive and anxiety symptoms. Both clinical and economic effectiveness will be evaluated in a pragmatic randomized controlled trial. The participants in the intervention condition will receive the 8-session preventive intervention. The participants in the control condition will have access to usual care. Clinical end-terms are depressive and anxiety symptoms, current major depressive episode, quality of life and positive mental health post-treatment (3 months after baseline) and at follow-ups (6 and 12 months after baseline). Additional goals of this study are to identify groups for whom the intervention is particularly effective and to identify the therapeutic pathways that are vital in inducing clinical change. This will be done by analyzing if treatment response is moderated by demographics, personality, past major depressive episodes, important life events and chronically disease, and mediated by reminiscence functions, perceived control, automatic positive thoughts and meaning in life. Finally the cost-effectiveness of the intervention relative to care as usual will be assessed by computing incremental costs per case of depression and anxiety avoided (cost-effectiveness) and per quality adjusted life year (QALY) (cost utility).DiscussionIt is expected that both the life-review intervention and its evaluation will contribute to the existing body of knowledge in several ways. First, the intervention is unique in linking life-review with narrative therapy and in its focus on specific, positive memories. Second, the evaluation is likely to answer questions regarding the acceptability and cost-effectiveness of life-review that have not been addressed thoroughly until now. Positive results of this study will make available a new evidence-based intervention to improve public health among people of 55 years and over.Trial registrationNederlands Trial Register TC = 1860.