Percent Of Older Adults Research Articles

Relationship between Lifestyle and Frailty among Iranian Community-Dwelling Older Adults: Pilot Study.

Aging affects physical, mental, and social functions, which can lead to an increase in frailty. Old adults with frailty syndrome are prone to disabilities and hospitalization. Lifestyle is a context-based factor that has the potential to prevent frailty. This study aimed to assess the relationship between lifestyle and frailty among Iranian community-dwelling older adults. This is a descriptive-analytical cross-sectional study. The participants were 513 older adults over 60 years by the convenience sampling method from the retirement center. Data were collected using Tilberg's frailty index, the Iranian elderly lifestyle questionnaire, and the Mini-Cog test. Data were analyzed with SPSS v.26 software by chi-square and logistic regression tests. The age of the participants was 66.43 ± 4.69 years. The male-to-female sex ratio was 1.5 (39.2% women). The lifestyle of 96 (19.3%) old adults was unfavorable. 18.7 percent of older adults had Frailty syndrome. The logistic regression test showed that moderate and favorable lifestyle (OR= 0.06; 95% CI: 0.02-0.16), age over 75 years (OR= 5.25; 95% CI: 2.35-11.69), retired employment status (OR= 0.13; 95% CI: 0.29-0.05) are factors that have a significant relationship with frailty (P< 0.05). The findings showed that lifestyle can predict frailty. Therefore, it seems that an optimal lifestyle can prevent the frailty of older adults.

Changing Age Segregation in the US: 1990 to 2010.

Age segregation adversely impacts health and wellbeing. Prior studies, although limited, report increasing age segregation of the US. However, these studies are dated, do not comprehensively examine the spatiotemporal patterns and the correlates of intergenerational segregation, or suffer from methodological limitations. To address these gaps, we assess the spatiotemporal patterns of age segregation between 1990 and 2010 using census-tract data to compute the dissimilarity index (D) at the national, state, and county levels. Results contradict previous findings, providing robust evidence of decreasing age segregation for most parts of the country and across geographical levels. We also examine factors explaining adult-older adult segregation across counties between 1990 and 2010. Higher levels of rurality indicated lower levels of adult-older adult segregation, but this association diminished over time. Percent of older adults and percent of population in group quarters were inversely related to adult-older adult segregation, contrary to results from previous decades.

Pain Persistence Is Associated With Increased Odds of MCI in Late Midlife and Early Older Adulthood

Twenty percent of older adults will experience persistent pain, the sensation of bodily harm lasting three or more months. Persistent pain doubles the risk of dementia, but we know less about the impact on earlier stages, such as mild cognitive impairment (MCI). As a step for clarification, this study leveraged data from the Vietnam Era Twin Study of Aging (VETSA) to understand how pain persistence relates to MCI in late midlife to early older adulthood. Participants (n=1,465, 100% male) were recruited across three waves at average ages 56, 62, and 68. At each wave, participants completed the SF-36 and were asked to rate their pain intensity from none (1) to very severe (6). Clinical pain was coded as pain intensity rated more than mild (>3/6). As a time-varying predictor, pain persistence was then calculated as a running frequency of the total waves reporting clinical pain. MCI diagnosis was based on Jak-Bondi criteria. Age, depressive symptoms, comorbidities, and opioid use were included as time-varying covariates. Age and education were included as time-invariant covariates. General estimating equations showed that pain persistence over two waves, reported in 35% of the sample, increased MCI odds by 57% (OR=1.57, 95%CI: 1.28 to 1.94). Pain persistence over three waves, reported in 17% of the sample, increased MCI odds by 98% (OR=1.98, 95%CI: 1.44 to 2.70). The findings emphasize the role of pain in earlier stages of dementia and the potential importance of pain management in offsetting cognitive decline.

Social Isolation of Older Adults in Long Term Care as a Result of COVID-19 Mitigation Measures During the COVID-19 Pandemic

Social Isolation of Older Adults in Long Term Care as a Result of COVID-19 Mitigation Measures During the COVID-19 Pandemic

Relationship between chewing tobacco, smoking, consuming alcohol and cognitive impairment among older adults in India: a cross\u2010sectional study

BackgroundPhysical aging increases the sensitivity to the effects of substance use, elevating the risk for cognitive impairment among older adults. Since studies on the association of substance use with cognitive ability in later years are scant in India, we aimed to explore the factors associated with cognitive impairment especially, alcohol consumption, smoking, and chewing tobacco later in life.MethodsThe present research used nationally representative data from Building a Knowledge Base on Population Aging in India (BKPAI) that was conducted in 2011, across seven states of India (N=9,453). Sample distribution along with percentage distribution was calculated for cognitive impairment over explanatory variables. For finding the association between cognitive impairment over explanatory variables, binary logistic regression models were estimated.ResultsAbout 16.5 percent of older adults in rural areas consumed smoked tobacco compared to 11.7 percent in urban areas. Nearly, 23.7 percent of rural older adults consumed smokeless tobacco in comparison to 16 percent in urban areas. Alcohol consumption was high among rural residents (7.9%) than urban counterparts (6.7%). The prevalence of cognitive impairment was 62.8% and 58% among older adults from rural and urban areas respectively. Older adults who smoked tobacco had a 24 percent significantly higher likelihood to have cognitive impairment with reference to older adults who did not smoke [OR: 1.24, CI: 1.02-1.49]. Moreover, older adults who consumed alcohol had a 30 percent significantly higher likelihood to have cognitive impairment [OR: 1.02, 1.65]. It was also found that older adults who had smoked along with consuming alcohol were at risk of worse cognitive outcomes than those who neither smoke nor drink alcohol [OR: 1.56, CI: 1.21-2.00] or consumed either of them unlike consuming smokeless tobacco only.ConclusionThe encouragement of older people to stop smoking and smokeless tobacco use could be considered as part of a strategy to reduce the incidence of cognitive impairment. Further, appropriate measures should be taken for the detection of early stages of cognitive decline in older individuals and efforts should be made to improve the availability and quality of care for dementing older adults.

Prevalence of Treatment Burden in the Last Three Years of Life.

Background: Little is known about the experience of treatment burden, or the difficulties that arise when the treatment workload overwhelms one's ability to take on treatment activities, at the end of life. Objective: We first assessed rates of treatment burden experienced by all older adults in the last three years of life. Among the subset of our sample who had multiple chronic conditions (MCCs), we determined correlates of treatment burden with sociodemographic, health, and caregiving factors. Design: We conducted a cross-sectional study using nationally representative data from the National Health and Aging Trends Study (NHATS). Setting/Subjects: Our sample included 356 adults, aged 65 years and older, who died within three years of completing the 2012 NHATS Treatment Burden Questionnaire. Our MCC cohort included only those in our sample with two or more chronic conditions. Measurements: Our measure of treatment burden included reports of difficulty in managing treatment activities, delays in treatments, or feeling that physicians asked for too much. We built a composite measure to identify burden if participants reported that at least one item occurred sometimes or often. Results: Forty-three percent of older adults in their last three years of life experienced treatment burden. Among individuals with MCCs, bivariate analysis found that treatment burden was associated with being a racial minority and having depression, anxiety, and a cancer diagnosis. These associations were not statistically significant in a multivariable model. Conclusion: Treatment burden is a common experience among older adults regardless of sociodemographic, clinical, and caregiving factors.

Patterns of Psychoactive Medication Use in Community-Dwelling Older Adults in the US in 2016: A Descriptive Cross-Sectional Study.

Objectives: We aim to quantify any use and long-term use patterns of psychoactive medications and explore differences in use by sociodemographic factors in older adults (60-85years) using the 2016 Medical Expenditure Panel Survey. Methods: Prevalence estimates of any use and long-term use were calculated. Chi-square and crude odds ratios were calculated to estimate differences in any use and long-term use of psychoactive medication by sociodemographic characteristics of respondents. Results: Thirty percent of older adults in the US reported any use of psychoactive medications. Long-term use was significantly higher in women (28.3% [95% confidence interval: 26.5, 30.2]), white (27.8 [26.1, 29.7]), presently unmarried (27.5 [25.4, 29.7]), and low-income (30.3 [27.7, 32.9]) subgroups than in men (20.5 [18.4, 22.5]), Black (14.7 [12.3, 17.1]), presently married (22.8 [20.7, 24.9]), and high-income (21.1 [19.1, 23.1]) subgroups, respectively. Discussion: Despite continued risks associated with use, long-term use of psychoactive medications is prevalent in the older adult population in the US. Given the increased complexity of pharmacotherapy regimens in this population, enhanced efforts at improving use of psychoactive medications should be intensified.

Older Adults and Exergames Olympics: Feasibility and Fun

ABSTRACT Seventy-five percent of older adults do not participate in regular physical activity. Exergames is a new subject of research with older adults. The aim of the study was to determine the impact of older adults’ participation in Xbox Kinect and Nintendo Wii games. Tweleve senior center members played a variety of exergames for 6 weeks. There were improvements in the Berg Balance, non-significant improvements in Chair Stands and the Timed-Up and Go, and no changes in psychosocial measures. Older adults’ participation Xbox Kinect exergames may promote physical activity in a fun, social supportive, and positive community environment and improved physical activity.

SERVICE NEEDS AMONG OLDER ADULTS AT RISK FOR FINANCIAL ELDER ABUSE

It is estimated that 5 percent of older adults within the United States experience some form of financial exploitation (Acierno, et al., 2010; Conrad et al., 2011). Examples of financial exploitation include scams, thefts, and abuse of trust to misappropriate money or property. Using the Anderson Model for Health Service Use, we tested whether the experience of financial exploitation increased likelihood of using mental health or financial services. Methods: For this descriptive, cross-sectional study, ninety-nine older adults at risk for elder abuse were recruited and interviewed from community-based agencies. Standardized measures were used for elder mistreatment, depression, trauma, and service use. Bivariate analysis tested whether financial exploitation is directly associated with depression and current trauma symptoms. Logistic regression tested likelihood of using mental health and other services. Results: Participants were above age 60, mostly widowed or divorced, females, with about half living alone. Eleven percent reported experiencing some form of financial exploitation. Financial exploitation was associated with worse trauma symptoms and depression. While the service most frequently used linked to physical health, aging services, and religious supports, few used mental health services. Experience of financial exploitation and current mental health symptoms were not significantly predictive of use of mental health services. Implications: Given the potential mental health impacts of financial exploitation, it is alarming few reported current service use and neither the experience of mental health symptoms or financial exploitation was a driving need for service use. Thus, interventions need to consider how to enhance response to mental health symptoms

Acceptance of a Protein Fortified Biscuit Recipe for Use among Geriatric, Nutritionally Compromised Patients

Malnutrition is prevalent in the geriatric population, as is age-related decline in skeletal muscle mass. Research indicates that nearly forty percent of older adults in skilled nursing facilities across the nation are undernourished, with over half experiencing protein-energy malnutrition (PEM). Effects include a gradual loss of mass, strength and function. Concurrently, studies indicate optimal protein-energy intake increases the quality and length of life, and mortality may be reduced by supplementation in this group. However, as protein needs increase, skilled nursing facilities struggle to meet patient protein needs as appetite, amino acid metabolism, chewing, and swallowing capacity decline. Nutrient-dense foods are essential in promoting geriatric health with an emphasis on protein. Fortification of foods is a common, cost-effective approach to enhance nutritional health in this setting, as increasing the volume of food intake is not always a viable solution. The aim of this research was to create a functional food, fortifying a food item that is eaten as a part of a typical diet. Researchers modified a biscuit recipe to increase the protein and calorie content of this popular southern food and compared the acceptance among a sample of adults (n=97) during a blind trial, and the effects of adding two different protein powders, a whey protein modular or instant dry milk powder, on nutrient composition. Analysis of Variance and post hoc testing indicated a statistically significant effect when adding protein sources on acceptability, texture, and flavor (P<0.05). Participants rated the flavor and overall acceptance of the milk fortified protein biscuit highest among variations, with the texture of the control and milk variations most similar; the whey variation was poorly accepted. Results suggest the addition of instant dry milk powder to a popular biscuit recipe may be a cost-effective method of improving its nutrient composition, while maintaining acceptability.

Percentage of Americans Taking Antidepressants Climbs

Back to table of contents Previous article Next article PsychopharmacologyFull AccessPercentage of Americans Taking Antidepressants ClimbsJun Yan,Pharm.D.Jun Yan,Search for more papers by this authorPharm.D.Published Online:15 Sep 2017https://doi.org/10.1176/appi.pn.2017.pp9b2AbstractOne contributing factor to the growth of patients taking antidepressants may be that they are being prescribed the medications for non-depression diagnoses, such as anxiety, sleep, and neuropathic pain. Between 2011 and 2014, approximately one in nine Americans of all ages reported taking at least one antidepressant medication in the past month, according to national survey data released by the Centers for Disease Control and Prevention (CDC). Three decades ago, less than one in 50 people did. The use of antidepressants increased with age and reached nearly 19 percent in adults 65 years and older (see bar chart). From 1988 to 1994, only 3 percent of older adults were taking antidepressants. The data were collected in the National Health and Nutrition Examination Survey (NHANES) by the CDC. The sharp rise of antidepressants in all age groups, except children and adolescents, followed the introduction of the first selective serotonin reuptake inhibitor (SSRI), fluoxetine (Prozac). Prozac was first approved in the United States in 1987 and entered the market in 1988. Since then, many more SSRIs and other types of antidepressants have become available. The rise of direct-to-consumer marketing since the 1990s further pushed antidepressants into the public consciousness. Because SSRIs do not carry the potentially life-threatening cardiac risks associated with tricyclic antidepressants, they are considered safer and easy to manage, particularly for elderly patients who often have coexisting cardiovascular diseases. While the current prevalence of antidepressant use in older people is more than twice of that in adults under 45, this does not mean older people are more likely to have depressive disorders. Epidemiological research has shown that depression is not more common in older adults than in younger adults and antidepressants tend to be less efficacious for older patients. One reason contributing to the popularity of antidepressants is the expansion of their indications. “Many patients are given antidepressants for non-depression diagnoses, such as anxiety, sleep, and neuropathic pain,” Donovan Maust, M.D., M.S., a geriatric psychiatrist and assistant professor of psychiatry at the University of Michigan, told Psychiatric News. Since older adults tend to have more contact with the health care system than younger adults, they may be more likely to be given an antidepressant prescription by their family physician, internist, or other specialist. iStock/smartstock“There has been more recognition and awareness of major depression, along with more willingness to prescribe drug therapy,” Maust added. The increase in antidepressants is, therefore, partially justified, he stated.Overtreatment with antidepressants remains a concern, as geriatric patients are far more likely to suffer side effects and drug interactions from the many more medications they take than younger adults. “[SSRIs] may be safer than tricyclics, but they still have side effects, particularly in older patients, such as hyponatremia and risk of falling. Meanwhile, there is limited evidence to support their effectiveness for [treating] subsyndromal depression,” said Maust. For example, antidepressants are frequently prescribed to older patients with dementia to treat mood symptoms, but there is no solid evidence that they are effective for this purpose. Rather than immediately reaching for the prescription pad, physicians should first clearly establish the diagnosis that may require an antidepressant and plan to measure and monitor the effectiveness, Maust recommended. “Such prescriptions are often motivated by the [physician’s] desire to help patients, especially when resources for psychosocial intervention are not available.” Even without psychosocial resources, however, watchful waiting by scheduling an early return visit may be enough for some patients and help reduce unnecessary prescribing, he suggested. ■Back to Psychopharmacology Newsletter Table of Contents ISSUES NewArchived

Gender differences in functional disability and self-care among seniors in Bangladesh

BackgroundDisability among older adults is a public health concern. To date there are no in-depth and comprehensive analyses on older adults’ disabilities in Bangladesh. This study investigated gender differences in the prevalence of disability and the socio-demographic factors associated with disability among older adults in Bangladesh.MethodsThis research used a sample of 4176 elderly males and females aged 60 years and over from a nationally representative data set- Bangladesh’s 2010 Household Income and Expenditure Survey. The study used both household level and individual level data and applied a wealth index, which was constructed based on household assets using principal component analysis. The Washington Group’s short set of questions on disability were used to measure disability. Chi-square tests and ordinal logistic regression models were fit.ResultsForty-two percent of older had some form of functional disability, including 5% of elderly with severe/extreme functional disability. Seven percent of older adults had a self-care disability, including 3% of elderly with a severe/extreme form of self-care disability. Elderly females suffered from all the studied disabilities, including functional and self-care disabilities in higher percentages, and had higher odds ratios of having both functional disability and self-care disability compared to elderly males. The study also identified some significant factors affecting functional disability and self-care disability, namely age, having a chronic condition, wealth status and place of residence, including divisional differences.ConclusionsPrograms aimed at reducing functional disability among seniors, particularly elderly females, should be granted the highest priority in Bangladesh.

Trends in osteoporosis and low bone mass in older US adults, 2005-2006 through 2013-2014.

Recent preliminary data from Medicare suggest that the decline in hip fracture incidence among older US adults may have plateaued in 2013-2014, but comparable data on BMD trends for this time period are currently lacking. This study examined trends in the prevalence of osteoporosis and low bone mass since 2005 using BMD data from NHANES. The present study also updated prevalence estimates to 2013-2014 and included estimates for non-Hispanic Asians. Femur neck and lumbar spine BMD by DXA were available for 7954 adults aged 50years and older from four NHANES survey cycles between 2005-2006 and 2013-2014. Significant trends (quadratic or linear) were observed for the femur neck (mean T-score and osteoporosis in both sexes; low bone mass in women) but not for the lumbar spine. The trend in femur neck status was somewhat U-shaped, with prevalences being most consistently significantly higher (by 1.1-6.6 percentage points) in 2013-2014 than 2007-2008. Adjusting for changes in body mass index, smoking, milk intake, and physician's diagnosis of osteoporosis between surveys did not change femur neck trends. In 2013-2014, the percent of older adults with osteoporosis was 6% at the femur neck, 8% at the lumbar spine, and 11% at either site. There was some evidence of a decline in femur neck BMD between 2005-2006 and 2013-2014, but not in lumbar spine BMD. Changes in the risk factors that could be examined did not explain the femur neck BMD trends.

Elder abuse and dementia: a review of the research and health policy.

Older adults with dementia may be at high risk for abuse, but the topic has not been well studied. We conducted a literature review to examine the relationships between elder abuse and dementia. We found that psychological abuse was the most common form of abuse among older adults, with estimates of its prevalence ranging from 27.9 percent to 62.3 percent. Physical abuse was estimated to affect 3.5-23.1 percent of older adults with dementia. We also found that many older adults experienced multiple forms of abuse simultaneously, and the risk of mortality from abuse and self-neglect may be higher in older adults with greater levels of cognitive impairment. We summarize programs and policies related to the abuse of older adults with dementia, including adult protective services, mandatory elder abuse reporting, and the Long-Term Care Ombudsman Program. We also summarize aspects of the National Alzheimer's Project Act, the Older Americans Act, and the Elder Justice Act. In spite of a recent increase in research and policy developments on elder abuse, challenges such as insufficient funding, limited knowledge about elder abuse, a lack of funding for the implementation of federal and state programs relevant to elder abuse and dementia, and a lack of dementia-specific training for front-line health care staff persist. Stronger programs targeting the well-being of older adults with dementia are needed.

Patterns of Technology Use Among Older Adults With and Without Disabilities

The purpose of this study was to describe prevalence of technology use among adults ages 65 and older, particularly for those with disability and activity-limiting symptoms and impairments. Data from the 2011 National Health and Aging Trends Study, a nationally representative sample of community-dwelling Medicare beneficiaries (N = 7,609), were analyzed. Analysis consisted of technology use (use of e-mail/text messages and the internet) by sociodemographic and health characteristics and prevalence ratios for technology usage by disability status. Forty percent of older adults used e-mail or text messaging and 42.7% used the internet. Higher prevalence of technology use was associated with younger age, male sex, white race, higher education level, and being married (all p values <.001). After adjustment for sociodemographic and health characteristics, technology use decreased significantly with greater limitations in physical capacity and greater disability. Vision impairment and memory limitations were also associated with lower likelihood of technology use. Technology usage in U.S. older adults varied significantly by sociodemographic and health status. Prevalence of technology use differed by the type of disability and activity-limiting impairments. The internet, e-mail, and text messaging might be viable mediums for health promotion and communication, particularly for younger cohorts of older adults and those with certain types of impairment and less severe disability.

Alcoholism and Depression

One out of 2 Americans report drinking on a routine basis, making the excessive consumption of alcohol the third leading cause of preventable death in America (). Alcoholism and depression are common comorbidities that home healthcare professionals frequently encounter. To achieve the best patient outcomes, alcoholism should be addressed initially. Although all age groups are at risk, alcoholism and depression occur in more than 8 percent of older adults. Prevention through identifying alcohol use early in adolescence is vital to reduce the likelihood of alcohol dependence. This article provides an overview of the long-term effects of alcohol abuse, including alcoholic cirrhosis and hepatic encephalopathy. The diagnostic criteria for substance dependence and ideas for nonthreatening screening questions to use with patients who are adolescent or older are discussed. While providing patient care, home healthcare nurses share the patient's intimate home environment. This environment is perceived as a safe haven by the patient and home care nurses can take advantage of counseling and treatment opportunities in this nonthreatening environment.

Older adults' self-management of daily symptoms: complementary therapies, self-care, and medical care.

To describe older adults' use of complementary therapies, self-care practices, and medical care to treat daily symptoms and to delineate gender, ethnic, age, and education differences. A total of 200 African American and White participants (age 65+) selected using a site-based procedure complete a baseline interview and up to six sets of three daily follow-up interviews at monthly intervals. The percent of older adults using a therapy and the frequency with which therapies are used are considered. The use of complementary therapies to treat daily symptoms, though important, is substantially less than the use of self-care practices and medical care. Participants differed by age, ethnicity, and education in the use of therapies. In considering the percentage of individuals who use a therapy and the frequency with which therapies are used, this analysis adds a new dimension to understanding how older adults manage daily symptoms. Older adults are selective in their use of health self-management.

Tuberculosis in Older Adults in the United States, 1993-2008

To describe older adults with tuberculosis (TB) and compare demographic, diagnostic, and disease characteristics and treatment outcomes between older and younger adults with TB. Descriptive analysis of all confirmed people with TB aged 21 and older. The National Tuberculosis Surveillance System (NTSS) for the 50 United States and the District of Columbia from 1993 to 2008. A total of 250,784 adult TB cases were reported, including 61,119 people with TB aged 65 and older. TB case count and rates and proportion of TB cases in older adults. Older adults had consistently higher incidence rates of TB than younger adults. In 2008, the rate of TB in older adults was 6.4 per 100,000, compared with 5.0 per 100,000 for younger adults. A lower percentage of older adults had TB diagnostic test results (tuberculin skin test, sputum smear, sputum culture) or human immunodeficiency virus (HIV) infection status reported. TB risk factors (substance use, homelessness, HIV infection) and multidrug-resistant TB were less prevalent in older than younger adults. Seven percent of older adults were dead at diagnosis, and 21% died during therapy, compared with 2% and 7%, respectively, of younger adults. Sputum culture conversion percentages were similar for people who did not die. Older adults also completed therapy in a timely manner, similar to younger adults. Although older adults had higher rates of TB and mortality, for older adults who survived therapy, successful treatment outcomes were similar to those of younger adults.

Foot pain: common, of consequence, and consulted about

Foot pain is highly prevalent in the community. Foot pain and ankle pain occurring on most days are reported by 25% and 15% of older adults, respectively. Both foot and ankle pain are more prevalent in women than men but no consistent relationship with age has been identified. Pain within the foot most commonly occurs at the toes or forefoot, followed by the arch or ball, with the heel and hindfoot least frequently affected. Foot pain is commonly associated with locomotor disability. Almost two-thirds of adults aged 50 years and over with foot pain report problems related to physical function. Eight percent of older adults without disabling foot pain experience its onset over a three-year period whereas resolution appears to be uncommon, with 70% of those with disabling symptoms still having them three years later. Onset of physical impairment associated with foot pain most commonly relates to increased reliance on vehicular transport, and difficulty walking and standing. Furthermore, foot pain is also associated with poor balance and risk of falling. Although musculoskeletal foot problems account for a substantial number of consultations in primary care, it appears that only a minority of people with foot problems consult about them. Eight percent of primary care musculoskeletal consultations (290 primary care consultations per 10,000 registered patients per year) involve musculoskeletal foot problems. However, only 20% of people with musculoskeletal foot problems see their family doctor over a three-year period and a similar proportion of those with foot pain see a podiatrist over twelve months. Primary care consultation with a musculoskeletal foot problem is more likely in those with foot pain, those who consult frequently about other problems, and those who believe effective treatments are available. Most primary care consultations for musculoskeletal foot problems are categorized by family doctors using non-specific terms describing pain location, eg foot pain or ankle pain, with specific diagnostic codes, eg plantar fasciitis, used less frequently. In summary, foot pain is a common problem both in the community and in primary care, and frequently associates with locomotor disability. However, only a small proportion of those with musculoskeletal foot problems consult about them. Further studies are needed to explore why people choose to consult a particular health care professional about their foot problem, how the decision to consult can be influenced, and how foot pain and problems are managed in different healthcare settings.

Insomnia in Older Adults With Generalized Anxiety Disorder

The purposes of this study are to determine the frequency and severity of insomnia symptoms and related complaints experienced by older adults with Generalized Anxiety Disorder (GAD) and compare them with older adults without GAD; compare insomnia symptoms among older adults with GAD with and without comorbid depression; determine if there are age differences in insomnia severity among people with GAD; and determine if there are differences in insomnia severity between older adults with GAD and older adults diagnosed with insomnia. Cross-sectional. Participants were recruited through primary care clinics, advertisements, and mass mailings. One hundred ten older adults; 31 with GAD, 25 with GAD and depression, 33 worried well, and 21 with no psychiatric diagnosis. Psychiatric diagnosis, sleep disturbance, and health. Participants with GAD with and without comorbid depression reported significantly greater sleep disturbance severity than participants with no psychiatric diagnosis and the worried well. There were no differences in sleep disturbances between older adults with GAD only and older adults with comorbid GAD and depression. The severity of sleep disturbance reported by older participants with GAD was greater than reports by young and middle-aged participants with GAD, and comparable with reports by older adults with a diagnosis of insomnia. Ninety percent of older adults with GAD report dissatisfaction with sleep and the majority report moderate to severe insomnia. These findings support the assessment of sleep disturbances within the context of late-life GAD.