Interdisciplinary development and implementation of a dementia skills training program in a VA community living center: a pilot study.

This pilot study investigates the usefulness of a dementia care training program developed by an interdisciplinary team to address problem behaviors associated with dementia. Staff members of a VA Community Living Center completed an 8-hour workshop covering fundamental knowledge about dementia and instruction in skills to use with patients through video, lecture, and role-plays. Measures on dementia knowledge and perceived self-efficacy were completed by staff members before and after the workshop. Results revealed increases in self-efficacy and knowledge, with particular gains in general knowledge of dementia and communicating with patients. Younger staff members scored higher on tests of knowledge at pre- and post-test, whereas staff members with more years of work experience rated their self-efficacy higher at post-test only. There was an associated decrease in assaultive behaviors by patients with dementia in the year this workshop was implemented. Results highlight the benefit of interdisciplinary collaboration in developing educational content and the value of providing staff training on managing dementia-related behaviors. Adjustments to this training program are discussed.

Older adults report more sadness and less jealousy than young adults in response to worry induction.

OBJECTIVES: The present study examined age differences in descriptions of the experience of worry and worry content. METHOD: Twenty-eight older and 25 younger adults participated in an experimental manipulation of worry (i.e. 5-minute worry induction). Participants identified their three main worries and completed an emotion checklist before and after the induction. RESULTS: After the induction, younger adults endorsed feeling fearful, impatient, and irritated, whereas older adults endorsed feeling tense or worrying. Older adults were more likely than younger adults to report feeling sad (χ2(53) = 7.52, p = .01), whereas younger adults were marginally more likely to report feeling jealous (χ2(53) = 4.34, p = .05). With regards to worry content, older adults worried more about community/world affairs (χ2 = 6.59, p = .01), whereas younger adults worried more about school (χ2 = 17.61, p < .001). Only age differences in worry about school remained significant after applying the Holm-Bonferroni correction. CONCLUSION: Following a worry induction, older and younger adults endorsed a wide variety of negative affect beyond the typical emotions associated with worry. Greater sadness experienced by older compared with younger adults highlights the importance of considering negative affect states, particularly depression, when working with older adult worriers.

Development and preliminary evaluation of the anxiety in cognitive impairment and dementia (ACID) scales.

BACKGROUND: Although rates of anxiety tend to decrease across late life, rates of anxiety increase among a subset of older adults, those with mild cognitive impairment (MCI) or dementia. Our understanding of anxiety in dementia is limited, in part, by a lack of anxiety measures designed for use with this population. This study sought to address limitations of the literature by developing a new measure of anxiety for cognitively impaired individuals, the anxiety in cognitive impairment and dementia (ACID) Scales, which includes both proxy (ACID-PR) and self-report (ACID-SR) versions. METHODS: The ACID-SR and ACID-PR were administered to 45 residents, aged 60 years and older, of three long-term care (LTC) facilities, and 38 professional caregivers at these facilities. Other measures of anxiety, and measures of depression, functional ability, cognition, and general physical and mental health were also administered. RESULTS: Initial evaluation of its psychometric properties revealed adequate to good internal consistency for the ACID-PR and ACID-SR. Evidence for convergent validity of measures obtained with the ACID-SR and ACID-PR was demonstrated by moderate-to-strong associations with measures of worry, depressive symptoms, and general mental health. Discriminant validity of measures obtained with the ACID-SR and ACID-PR was demonstrated by weak correlations with measures of cognition, functional ability, and general physical well-being. CONCLUSIONS: The preliminary results suggest that the ACID-SR and ACID-PR can obtain reliable and valid measures of anxiety among individuals with cognitive impairment. Given the subjective nature of anxiety, it may be prudent to collect self-report of anxiety symptoms even among those with moderate cognitive impairment.

Experimental examination of worry among older and young adults.

BACKGROUND: Worry is experienced by many older adults, yet our understanding of the emotional experience of late-life worry is poor as findings regarding older adults are inferred from findings of studies conducted with young adults. In the present study, we aimed to characterize age differences in affect, self-reported arousal, and physiological arousal experienced during worry. METHODS: Fifty-three young (M = 21.4, SD = 2.6 years) and 55 older community-dwelling adults (M = 69.1, SD = 8.1 years) participated in an experimental induction of worry or pleasant/neutral recall. Measures collected included: Penn State Worry Questionnaire (PSWQ), worry intensity item, Multiple Affect Adjective Checklist-Revised (MAACL-R), Self-Assessment Maniken arousal item, and heart rate. Standardized residual scores were calculated to represent change from baseline for self-report and psychophysiological measures. RESULTS: Older adults had lower trait worry and worry intensity at baseline. A significant age by induction type interaction was found for the MAACL-R subscales of anxiety, depression, hostility, and positive affect. Compared with young adults, older adults experienced smaller changes in emotions in response to the worry induction than in the recall induction. For both worry and recall inductions, older adults exhibited less change in self-reported arousal and interbeat intervals from baseline compared with young adults. CONCLUSIONS: Findings from the present study illuminate both similarities and differences in the experience of worry for older and young adults. This study provides preliminary evidence for the characterization of late-life worry as generating less anxiety than worry during young adulthood.

Assessment of anxiety in long-term care: examination of the Geriatric Anxiety Inventory (GAI) and its short form.

BACKGROUND: Accurate assessment of anxiety in later life is critical, as anxiety among older adults is associated with social and functional impairment and poorer quality of life. The Geriatric Anxiety Inventory (GAI) and the GAI-Short Form (GAI-SF) were designed to detect anxiety symptoms among community-dwelling older adults, but the usefulness of the GAI and GAI-SF in long-term care is unknown. The present study examined the psychometric properties of the GAI and GAI-SF among residents at a long-term care facility. METHODS: Seventy-five nursing home residents completed the GAI and measures of depression, executive functioning, and adaptive functioning. The mean age of residents was 69.60 years (SD = 10.76). Psychiatric diagnoses included dementia, psychotic disorders, mood disorders, anxiety disorders, substance abuse, sleep disorders, and mental retardation. RESULTS: Internal consistency of the GAI was good (α = 0.92) and the GAI-SF was adequate (α = 0.73). GAI and GAI-SF scores were moderately correlated with depression scores, and weakly correlated with adaptive functioning scores and executive functioning scores, suggesting discriminant validity. Logistic regression analyses were conducted with GAI and GAI-SF scores predicting an anxiety disorders diagnosis. Results provided support for the predictive validity of the GAI and GAI-SF. Sensitivity, specificity, and the percentage of individuals correctly classified at various cut-off scores were also calculated. CONCLUSIONS: Both the GAI and GAI-SF appear to be useful tools for assessing anxiety among nursing home residents with psychological disorders. The GAI-SF may be a viable replacement for the GAI as a screener for anxiety in long-term care.

Initial evaluation of the Older Adult Social-Evaluative Situations Questionnaire: a measure of social anxiety in older adults.

BACKGROUND: The assessment of social anxiety in late life has been examined in few studies (e.g. Gretarsdottir et al., 2004; Ciliberti et al., 2011). The present study describes the creation and initial psychometric evaluation of a new, content valid measure of social anxiety for older adults, the Older Adult Social-Evaluative Situations Questionnaire (OASES). METHODS: Psychometric properties of the OASES were evaluated in a community dwelling sample of older adults (N = 137; 70.8% female). Convergent validity was established by examining the relation between the OASES and the Liebowitz Social Anxiety Scale (LSAS), Social Phobia and Anxiety Inventory (SPAI), and Beck Anxiety Inventory (BAI). Discriminant validity was established by examining the relation between the OASES and measures of depression (Geriatric Depression Scale, GDS), perceived health status (Short Form Health Survey, SF-12), and demographic variables. The validity analyses of the OASES were based on a smaller sample with n values ranging from 98 to 137 depending on missing data on each questionnaire. RESULTS: Internal consistency, measured by Cronbach's α, for the OASES total score was 0.96. All items on the OASES were endorsed by participants. Convergent validity was demonstrated by medium to large correlations with the SPAI, LSAS, and BAI. Support for discriminant validity was evidenced by small to medium correlations between the OASES and GDS, SF-12, and demographic variables. CONCLUSIONS: Evidence in support of convergent and discriminant validity of the OASES is discussed. Although the results from the present study suggest that this measure may assess anxiety in and avoidance of social situations salient to older adults, future studies are needed to further examine the psychometric properties of the OASES and replicate these results in both clinical and more diverse samples of older adults.

Predictors of health anxiety among older and young adults.

BACKGROUND: Many older adults have at least one chronic disease and experience greater health problems than young adults. However, little is known about factors other than health that account for health anxiety (HA) among older adults. The overall objective of the present study was to develop a better understanding of HA among older and young adults. METHODS: We examined how anxiety-related constructs (anxiety sensitivity, intolerance of uncertainty, anxiety control, and emotion regulation) predict two core components of HA described in the cognitive-behavioral model of HA (illness likelihood and negative consequences) in older and young adults. We also examined the extent to which the predictor variables differentially account for HA in both age groups. Older and young adult participants completed several self-report surveys. RESULTS: Young adults reported higher levels of HA than older adults. Anxiety sensitivity and reappraisal predicted illness likelihood for older and young adults. Intolerance of uncertainty predicted negative consequences in both age groups. Anxiety sensitivity predicted negative consequences for older adults only. Anxiety control did not predict illness likelihood or negative consequences for either age group. CONCLUSIONS: Results suggest that anxiety sensitivity and intolerance of uncertainty may predispose older and young adults to HA, which is influenced by reappraisal. Implications for the cognitive-behavioral model of HA in both age groups are discussed.

Anxiety-related constructs mediate the relation between age and health anxiety.

OBJECTIVE: Few studies have examined health anxiety in older adults, and it is unknown which factors account for age-related differences in health anxiety. Given similarities between health anxiety and the anxiety disorders, anxiety-related constructs, including anxiety sensitivity, intolerance of uncertainty, emotion regulation, and anxiety control, were examined as mediators of the relation between age (older vs. young adults) and health anxiety. METHODS: Eighty-six older adults aged 60 and older and 117 young adults aged 18 to 30 completed several self-report measures of health anxiety and anxiety-related constructs. RESULTS: Young adults reported higher levels of health anxiety than older adults. Anxiety sensitivity and intolerance of uncertainty partially mediated the relation between age and health anxiety. Perceived anxiety control, reappraisal, and suppression did not mediate the relation between age and health anxiety. CONCLUSIONS: Anxiety sensitivity and intolerance of uncertainty are predisposing characteristics that appear to partially explain age-related differences in health anxiety. These constructs may be necessary targets for assessment and interventions among older and young adults.

Exploratory factor analysis of the Anxiety Control Questionnaire among older adults.

Among young adults and clinical populations, perceived inability to control internal and external events is associated with anxiety. At present, it is unclear what role perceived anxiety control plays in anxiety among older adults. The Anxiety Control Questionnaire (ACQ) was developed to assess one's perceived ability to cope with anxiety-related symptoms, reactions, and external threats but has limited psychometric support for use with older adults. Psychometric evaluations of other measures often reveal that factor structures differ among older adults compared with other age groups. The present study examined the factor structure of the ACQ in a sample of community-dwelling older adults in an attempt to understand the construct of perceived anxiety control in this population. A total of 135 adults aged 60 to 94 completed the ACQ and a demographics questionnaire. An exploratory factor analysis was accomplished using maximum likelihood extraction with equamax rotation. Parallel analysis indicated that a four-factor structure be retained. The four-factor solution explained 40.80% of variance and provided a good fit to the data. The four factors were Internal Control, External Lack of Control, Internal Lack of Control, and Effective Coping. Each factor contained an adequate number of items and had good internal consistency. The four-factor solution suggests that a previous recommendation to shorten the ACQ, based on factor analysis with young adults, may be imprudent for older adults. The authors also discuss implications for the understanding of perceived anxiety control among older adults and assessment of anxiety in older adults.