On the Measurement of Aging Anxiety: Comparative Validity of Two Popular Measures Among Older Adults.

Aging anxiety is a distinct form of fear characterized by negative feelings associated with growing older. This study directly compared two common measures of aging anxiety within an older adult sample. Participants completed the Anxiety about Aging Scale, the Personal Anxiety Toward Aging Scale and several related constructs including ageism, expectations regarding aging, dementia worry, and death anxiety. The two measures significantly and strongly associated with one another. The Anxiety about Aging Scale (AAS) showed evidence of convergent validity through significant and strong correlations with ageism, expectations regarding aging, and death anxiety, and a moderate correlation with dementia worry. The Personal Anxiety Toward Aging Scale (PAAS) also showed evidence of convergent validity through strong correlations with expectations regarding aging and death anxiety, and moderate correlations with ageism and dementia worry. Factor analysis showed a better model fit for the AAS. Key findings lend support for the AAS as a psychometrically stronger measure than the PAAS for older adult assessment.

Personality disorders in older adults: Differences in self-informant ratings.

Previous research on self-informant reports in assessing personality disorders (PDs) has been mainly focused on adults, leaving older adults under-studied. We examined self-informant agreement in PD screening among older adults (≥60 years) using the Gerontological Personality disorders Scale (GPS). Potential differences such as who reports more personality pathology on a PD screener (i.e., GPS), item accessibility and the effect of relational aspects were studied as well. Data of 326 older adult-informant dyads, of which the older adults were sampled from five general practices in the Netherlands, were used. Results indicate that self-informant agreement ranged from r = 0.26-0.73, with lower concordance on the GPS-subscale measuring intrapersonal aspects of personality pathology. Informants were more sensitive to habitual pathological personality features than older adults. Two GPS items showed differential item functioning across self- and informant-report. Of relational aspects, only congeniality affected the GPS-iv scores; lower ratings on congeniality were associated with higher GPS-iv scores (i.e., higher reporting of personality problems).

Relationships Between Diverse Forms of Anxiety With Intrapersonal Functioning Among Older Adults.

This study assessed how clinical anxiety, anxiety about aging, and death anxiety related to one another and to intrapersonal functioning. Older adults completed the Geriatric Anxiety Scale, Anxiety About Aging Scale, Death Anxiety Scale-Extended, and Intrapersonal Problems Rating Scale. Clinical anxiety was strongly correlated with anxiety about aging (r = .50) and death anxiety (r = .59), and anxiety about aging and death anxiety were strongly positively correlated with each other (r = .51). Intrapersonal problems were significantly and strongly positively correlated with clinical anxiety (r = .79), anxiety about aging (r = .50), and death anxiety (r = .56). Multiple regression results showed that the three types of anxiety accounted for a large amount of variance in intrapersonal problems. Findings suggest strong comorbidities between diverse forms of anxiety with some unique features. Intrapersonal deficits may be prominent in the presence of diverse forms of anxiety. Screening should consider these relationships.

Relationship between anxiety and quality of life among older adults with self-reported polypharmacy in long-term care: A cross-sectional study.

AIMS: To investigate the relationship between anxiety and quality of life among older adults with self-reported polypharmacy living in the long-term care setting. DESIGN: A cross-sectional design was used. METHODS: Between July 2021 and August 2022, 92 older adults living in long-term care completed an anonymous one-time questionnaire packet. Polypharmacy was measured as self-reported five or more medications daily. Anxiety was measured using the Geriatric Anxiety Scale-Long Term Care tool. Quality of life was measured as health-related quality of life using two global questions from the RAND-36 and as medication-related quality of life using the Medication-Related Quality of Life Scale. RESULTS: The prevalence of polypharmacy was 89%. Among participants with polypharmacy, average age was 80.1 ± 7.9 years. The majority were female (70%) and white (85%). There was a moderate-to-strong correlation between anxiety and quality of life. Specifically, anxiety was negatively related to current health-related quality of life, perceived change in health-related quality of life and medication-related quality of life. Overall, anxiety explained 27-31% of the variance in both health-related and medication-related quality of life. CONCLUSION: The results of this study indicate that as anxiety increases, health-related and medication-related quality of life decreases in older adults living in long-term care who report consuming five or more medications daily. Advanced practice nurses can use these findings to guide practice, tailor interventions and improve care for these long-term care residents. IMPLICATIONS: Multiple medications are increasingly prescribed to treat multiple comorbidities in older adults. As a result, the prevalence of polypharmacy (≥5 medications per day) is rising and problematic. The main findings of this study highlight the negative relationship between anxiety and quality of life in this population and the need for adequate assessment of anxiety by advanced practice nurses in order to personalize care. REPORTING METHOD: In preparing the manuscript, the authors have adhered to relevant EQUATOR guidelines and the STROBE checklist for cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution outside of participation in the actual study for purposes of data collection.

Assessment of Personality Disorders in Older Adults. A Practice Guide.

Assessment of personality disorders (PDs) in older adults is a nuanced trade of its own. The aim of this practice guide is to illustrate gerontological assessment challenges using 3 case vignettes. We argue that it is important to pay extra attention to the influence of cognitive and medical (somatic) disorders on personality functioning in older adults during personality assessment. We also note that information provided by informants contributes added value to personality assessment. Personality assessment should be sufficiently age-specific to prevent overdiagnosis or underdiagnosis in older adults. Furthermore, given the reduced psychological or somatic capacity of some older adults, phased or sequential personality assessment is recommended. This should be focused on the assessment questions to be answered, for example starting with short general screening of personality functioning, followed by more in-depth exploration. Personality assessment should be kept as brief and simple as possible in terms of formulation of the items.

Assessing late-life anxiety in Japanese older adults: psychometric evaluation of the Japanese version of the Geriatric Anxiety Scale.

BACKGROUND: This study developed a Japanese version of the Geriatric Anxiety Scale (GAS-J) and its short form (GAS-10-J) to evaluate anxiety in Japanese older adults and assess its psychometric properties using a cross-sectional design. METHODS: A total of 331 community-dwelling older adult participants (208 men, 116 women, seven unknowns; mean age = 73.47 ± 5.17 years, range = 60-88 years) recruited from two Silver Human Resources Centres in the Kanto region, Japan, answered a set of self-report questionnaires. Of these respondents, 120 participated in a follow-up survey to evaluate test-retest reliability. RESULTS: Confirmatory factor analysis suggested that, as with the original GAS, the GAS-J had a three-factor structure and the GAS-10-J had a unifactor structure with high standardised factor loadings. Test-retest correlations and internal consistency analyses indicated that these scales were reliable. Correlations between the GAS-J/GAS-10-J with the Geriatric Anxiety Inventory, Generalised Anxiety Disorder-7, Geriatric Depression Scale-15, World Health Organization-Five Well-Being Index, and Kihon Checklist were mostly consistent with our hypotheses, thereby supporting the construct validity of the GAS-J/GAS-10-J. CONCLUSIONS: The findings indicate that the GAS-J and GAS-10-J have robust psychometric properties for assessing late-life anxiety in Japanese older adults. Further GAS-J studies are required for clinical groups.

Associations between physical health and the alternative model of personality disorders: A cross-sectional age study.

The Alternative Model of Personality Disorders (AMPD) is a relatively new dimensional model of personality disorders (PDs) that assesses two diagnostic constructs: personality functioning and pathological personality traits. Thus far, research on the AMPD among older adults has been limited, but the research that does exist suggests limited generalizability to the unique biopsychosocial context of later life. To further examine the applicability of the AMPD to older adults, the purpose of this study was to examine relationships between the AMPD's two constructs with perceived physical health status among younger and older adult samples. Older adults (n = 222) and younger adults (n = 215) completed the Short Form-36 (SF-36), Levels of Personality Functioning Scale-Self-Report (LPFS-SR), and Personality Inventory for DSM-5-Brief Form (PID-5-BF). Correlations and Fisher's z-tests revealed significantly stronger relationships between the SF-36 with the LPFS-SR and PID-5-BF domains for older adults than younger adults. Additionally, age group significantly moderated the relationships between personality functioning and pathological personality traits and health. The stronger relationships between health and the AMPD's constructs for older adults suggest meaningful overlap between negative health outcomes and PD pathology. Future research should further investigate specific mechanisms in which personality pathology negatively impacts health in older adults.

Personality, Interpersonal Problems, and Anxiety Among Older Adults.

INTRODUCTION: This study examined relationships between personality disorder (PD) features, Big Five personality traits, and interpersonal problems with anxiety. METHOD: Older adults (N = 130) completed the Geriatric Anxiety Scale, Coolidge Axis Two Inventory, Big Five Inventory-2, and Circumplex Scales of Interpersonal Problems. Pearson correlation analyses were used to assess simple relationships between anxiety with PD features (CATI scales), Big Five personality domains (BFI-2 scales), and interpersonal problems (CSIP scales). Multiple linear regression analyses were performed to determine the extent to which the PD scales of the CATI, the personality scales of the BFI-2, and the scales of the CSIP explained variance in anxiety. RESULTS: Anxiety was positively correlated with 13 of 14 PD scales, ranging from .23 (Narcissistic) to .61 (Depressive). Regarding Big Five personality traits, anxiety was negatively associated with Agreeableness (-.23), Conscientiousness (-.30), and Extraversion (-.31) but was positively associated with Negative Emotionality (.56). Regarding interpersonal problems, anxiety was positively related to all eight CSIP scales, ranging from Self-sacrificing (.30) to Distant/Cold (.62). Regression analyses indicated that PD features accounted for the most variance in anxiety symptoms (53%), followed by interpersonal problems (46%), and Big Five personality traits (33%). DISCUSSION: Anxiety appears to be meaningfully associated with PD features, several aspects of Big Five personality traits, and interpersonal problems, suggesting that these variables may play important roles in the development and maintenance of anxiety, or vice versa. Our findings especially speak to the growing awareness of the deleterious impact of PD features on clinical syndromes in later life, as evidenced by strong comorbidities with anxiety.

Impact of self-reported cognitive dysfunction on the alternative model of personality disorders among older adults.

METHOD: Older adults (N = 202) completed the Levels of Personality Functioning Scale-Self-Report, Personality Inventory for DSM-5, and Coolidge Axis II Inventory with its six self-report cognitive dysfunction scales. RESULTS: Results suggested high correlational overlap between subjective cognitive problems with personality functioning and pathological personality, as measured by the AMPD. Hierarchical regressions revealed that subjective measures of executive functions, perceptual motor, and language difficulties were most strongly related to the AMPD's constructs. Results are discussed in the context of prior research on objective cognitive impairment among individuals with PDs. CONCLUSION: The degree of overlap found within the current older adult sample suggested an age-related problem or potential age-bias, with older adults being at-risk of (a) having their subjective cognitive problems being incorrectly interpreted as personality pathology under the AMPD or (b) having personality pathology being overlooked under the AMPD, with symptoms instead attributed to subjective cognitive issues. This study suggested that subjective cognitive dysfunction may be one mechanism that contributes to differential performance of the AMPD among older adults.

Development and Validation of a Short Form of the Geriatric Anxiety Scale (GAS-12) among Italian Older Adults.

OBJECTIVES: We developed a new Italian short version of the Geriatric Anxiety Scale (GAS-12) and evaluated its psychometric properties. The GAS-12 specifically screens for anxiety symptoms in the Italian older adult population by identifying items that best discriminate anxiety in this population. METHODS: In Study 1, we administered the full-length Italian translation of the GAS to 517 older adults and used item response theory to identify the most discriminating items and to develop the short form used in Study 2. In Study 2, we evaluated the functioning of the new short form of the questionnaire in a new sample of 427 older adults using Confirmatory factor analysis. RESULTS: Analyses indicated 12 items that discriminated well between anxious and non-anxious participants and distributed along the latent continuum of each trait. The GAS-12 fits a three-factor structure. There was also evidence for convergent and divergent validity. CONCLUSIONS: The Italian GAS-12 appears to be a useful instrument for the quantitative screening of anxiety in Italian older adults. CLINICAL IMPLICATIONS: Anxiety imposes significant impairment thus making imperative the screening and assessment of anxiety symptoms. The GAS-12 is particularly indicated with limited time and many scales in a clinical assessment or research protocols.

Social impairment and personality disorder features among older adults: An application of the circumplex model.

The interpersonal circumplex is a model that places interpersonal problems along two axes (communion and agency), resulting in eight theoretically derived patterns. Application of the circumplex to older adults is poorly understood. Subsequently, this study examined relationships between the interpersonal circumplex and personality disorder (PD) features among older adults, since social impairments are core components of PDs. Two models of PDs were examined: the traditional model of 10 PDs and the Alternative Model of PDs (AMPD) with its personality functioning and pathological personality trait features. Older adults (N = 202) completed the Inventory of Interpersonal Problems-Short Circumplex, Coolidge Axis II Inventory, Levels of Personality Functioning Scale-Self-Report, and Personality Inventory for DSM-5. Overlap between the interpersonal circumplex and PD features were detected, but patterns were distinct from prior studies with younger samples. Cluster B and C PD features showed meaningful relationships, whereas Cluster A did not. The circumplex was limited in its relation to the AMPD's personality functioning. The communion component of the circumplex significantly related to the AMPD's pathological trait model, whereas the agency component was limited in its association with pathological traits. Overall, the circumplex meaningfully related to PD features across two different PD models, providing some evidence of validity.

Distinctions between depression and anxiety with fear of being a burden in late life.

Objectives: The perception of being a burden is a well-known risk factor for dying by suicide. Research on factors that precede the state of perceived burdensomeness, such as fearing being a burden, is necessary. We investigated the extent to which health status, elevated depressive symptoms, and elevated anxiety symptoms are associated with fear of being a burden in late life.Method: Older adult participants (N = 155) completed the Geriatric Anxiety Scale (GAS), Patient Health Questionnaire (PHQ-8), and demographic and health questions. Fear of being a burden, assessed with a supplemental item on the GAS, was categorically grouped as 'no fear' or 'some fear'. Using logistic regression, we examined predictors of fear of being a burden.Results: In the first step, elevated depression was associated with fear of being a burden (OR = 2.30, 95% CI: 1.09, 4.89, p = .03), but health status was not significant. In the second step, elevated anxiety was significant (OR = 2.63, 95% CI: 1.15, 5.99, p = .02); depression was no longer significant.Conclusion: Contrary to expectations, anxiety more strongly predicted fear of being a burden than depression. Future research should further investigate the role of anxiety in fear of being a burden and ways of intervening.

An Empirical Evaluation of the DSM-5 Alternative Model of Personality Disorders in Later Life.

Personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are conceptualized as distinct clinical syndromes. However, debate persists about the clinical utility of this categorical model, with many researchers supporting a dimensional model that focuses on pathological personality traits and personality dysfunction. This model was published in Section III of DSM-5 and named the Alternative Model of Personality Disorders (AMPD). This study evaluated the AMPD by examining relationships between traits and dysfunction with traditional categorical PD constructs among older adults. Older adults (N = 202) completed the Personality Inventory for DSM-5, Levels of Personality Functioning Scale-Self-Report, and Coolidge Axis II Inventory. Results indicated that pathological personality traits do not relate to categorical PDs in directions predicted by the AMPD. Personality functioning related to categorical PDs in expected theoretical patterns according to the AMPD but lacked incremental validity above pathological personality traits. An implication of these findings is that the AMPD does not fully resolve the age-related issues with the traditional categorical PD model.

Relationships Among Executive Dysfunction, Constructive Worrying, and Worry Responses in Older Adults.

Worry is a ubiquitous human experience and core symptom of anxiety. The present study examined the extent to which specific aspects of worry are related to perceived executive dysfunction in older adults. A total of 100 older adult participants (M age = 68.82 years; range = 65-79 years) completed the Worry Behaviors Inventory, the Coolidge Axis II Inventory Executive Dysfunctions Scale, and the Constructive and Unconstructive Worry Questionnaire. Multiple regression analyses found that worry constructiveness and response behaviors were predictive of executive dysfunction. Specifically, greater avoidance behaviors and unconstructive worry were uniquely predictive of greater executive dysfunctions. Thus, findings indicate that worry constructiveness and approaches to worry management are significantly related to cognitive functioning in older adults. These findings imply a need to assess both worry and executive dysfunction to more accurately determine causal factors regarding anxiety and cognitive decline in older adults.

Relationships between pathological narcissism and maladaptive personality traits among older adults.

Objectives: The Pathological Narcissism Inventory (PNI) is a measure of narcissism, with two domains of Vulnerability and Grandiosity, that has limited evidence of validity among older adults. Subsequently, the objective of the present study was to examine relationships between the PNI and measures of diverse pathological personality features.Method: Participants consisted of 125 community-dwelling older adults (M age = 71.8 years) who completed the PNI, the Personality Inventory for DSM-5 (PID-5), and the Coolidge Axis II Inventory (CATI).Results: Total Narcissism, Vulnerability, and Grandiosity were significantly correlated with every PD scale, with the exception of Grandiosity with Schizotypal PD. Regression analyses revealed that Narcissistic and Avoidant PDs had the strongest relationships with the PNI. Total Narcissism was also significantly correlated with all five PID-5 domains, with regression indicating Negative Affect and Antagonism as the strongest predictors.Conclusions: Findings generally support the convergent validity of the PNI for use among older adults and suggest that pathological narcissism may be related to general personality pathology in later life.

Severity Indices of Personality Problems-Short Form in Old-Age Psychiatry: Reliability and Validity.

The Severity Indices of Personality Problems (SIPP; Verheul et al., 2008) is a popular self-report questionnaire that measures severity of maladaptive personality functioning. Two studies demonstrated the utility of the short form (SIPP-SF) among older adults but validation in clinical settings is lacking. Therefore, we examined the psychometric properties of the SIPP-SF in a large sample of older adult Dutch outpatients (N = 124; age range = 60-85 years, M = 69.8, SD = 5.3). The SIPP-SF domains showed good to excellent internal reliability (Cronbach's α = .75-.91) and effectively discriminated between participants with and without a personality disorder, as assessed with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Convergent validity of the SIPP-SF was examined with instruments for measuring personality pathology among older adults (Informant Personality questionnaire [HAP]; Gerontological Personality Disorders Scale [GPS]). The GPS generally correlated with the SIPP-SF domains in expected directions, with small to large effect sizes. For the HAP, only 1 scale correlated with all SIPP-SF domains. No associations were found between the SIPP-SF and psychiatric symptomatology as measured by the Brief Symptom Inventory (BSI). The SIPP-SF appears to be a promising instrument for assessing maladaptive personality functioning among older adult outpatients.

Psychometric evaluation of the Levels of Personality Functioning Scale-Brief Form 2.0 among older adults.

The Levels of Personality Functioning Scale-Brief Form 2.0 (LPFS-BF 2.0) is a new measure of personality functioning according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition's, alternative model of personality disorders, containing a total personality functioning score and two subscales (Self and Interpersonal). The LPFS-BF 2.0 has limited evidence of validity among older adults. Subsequently, this study examined relationships between the LPFS-BF 2.0 and anxiety, interpersonal functioning, and normative personality traits to establish convergent validity. In all, 130 community-dwelling older adults (Mage = 64.61) completed the LPFS-BF 2.0, Geriatric Anxiety Scale, Circumplex Scales of Interpersonal Problems (CSIP), and Big Five Inventory-2 (BFI-2). Internal consistency (Cronbach's α) was acceptable to good for each of the LPFS-BF 2.0 scale scores (Self, α = .74; Interpersonal, α = .85; Total Personality Functioning, α = .79). Correlations were computed between the LPFS-BF 2.0 scales and the Geriatric Anxiety Scale, CSIP, and BFI-2. Overall, significant correlations were detected in expected directions. Additionally, to further establish convergent validity, regression analyses were conducted with the CSIP and BFI-2 scales predicting each of the LPFS-BF 2.0 scales. The models accounted for significant variance, and significant predictors were found in anticipated and theoretically consistent directions. Results provide strong but initial psychometric support for the use of the LPFS-BF 2.0 as an assessment tool for measuring personality functioning among older adults. An implication is that this measure may be used to identify important personality features that are part of a full assessment of personality pathology. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Assessment of Anxiety in Long-Term Care Residents: Issues and Strategies.

The experience of clinically significant anxiety and anxiety disorders represent significant and often debilitating problems for many residents in long-term care (LTC) settings. However, anxiety problems often go undetected and untreated in this growing population. The purposes of this paper are to examine the prevalence and impact of anxiety problems among residents in LTC facilities, describe the efficacy of the current instruments that are used to detect anxiety in these settings, and provide clinical guidance for the thorough assessment of anxiety. Regarding measurement tools, the GAI, GAI-SF, GAS-LTC, and the BADS are the only self-report measures designed for older adults that have been successfully validated for use with older adults living in LTC settings. Clinicians should focus on ways to educate LTC directors and staff to emphasize the importance of screening and assessing for anxiety, using validated measures, to improve the assessment and treatment of anxiety in their residents.

Development of a tool to detect older adults with severe personality disorders for highly specialized care.

OBJECTIVES: Current guidelines recommend highly specialized care for patients with severe personality disorders (PDs). However, there is little knowledge about how to detect older patients with severe PDs. The aim of the current study was to develop an age-specific tool to detect older adults with severe PDs for highly specialized mental health care. DESIGN: In a Delphi study, a tool to detect adults with severe PDs for highly specialized mental health care was adjusted for older adults based on expert opinion. Subsequently, the psychometric properties of the age-specific tool were evaluated. SETTING: The psychometric part of the study was performed in two Dutch highly specialized centers for PDs in older adults. PARTICIPANTS: Patients (N = 90) from two highly specialized centers on PDs in older adults were enrolled. MEASUREMENTS: The age-specific tool was evaluated using clinical judgment as the gold standard. RESULTS: The Delphi study resulted in an age-specific tool, consisting of seven items to detect older adults with severe PDs for highly specialized mental health care. Psychometric properties of this tool were evaluated. Receiver operating curve analysis showed that the questionnaire was characterized by sufficient diagnostic accuracy. Internal consistency of the tool was sufficient and inter-rater reliability was moderate. CONCLUSIONS: An age-specific tool to detect older adults with severe PDs was developed based on expert opinion. Psychometric properties were evaluated showing sufficient diagnostic accuracy. The tool may preliminarily be used in mental health care to detect older adults with severe PDs to refer them to highly specialized care in an early phase.

Impact of end-of-life planning on surrogate decision-maker anxiety in the US.

At the end of life, hospice patients frequently rely on surrogate decision makers (SDMs) for healthcare decisions, which creates anxiety among SDMs. This project evaluated whether an educational intervention to create a plan of care for hospice patients would reduce anxiety among SDMs. Before the intervention, immediately after the intervention, and 2 weeks following the intervention SDM anxiety was measured with the Geriatric Anxiety Scale, State Trait Anxiety Inventory-State Anxiety Scale, and one question about decision-making anxiety. Twelve patients (80±14.7 years) and 18 SDMs (60±12.9 years) completed the intervention. Immediately after the intervention SDMs showed a significant decrease (P=0.003) in anxiety. When anxiety was measured 2 weeks post-intervention, anxiety had increased again, and was no longer significantly different from pre-intervention levels. This project demonstrated that an educational intervention in the hospice setting can be effective in creating a short-term decrease to SDM anxiety levels.