Background: Anxiety symptoms and anxiety disorders are highly prevalent among elderly people, alt... more Background: Anxiety symptoms and anxiety disorders are highly prevalent among elderly people, although infrequently the subject of systematic research in this age group. One important limitation is the lack of a widely accepted instrument to measure dimensional anxiety in both normal old people and old people with mental health problems seen in various settings. Accordingly, we developed and tested of a short scale to measure anxiety in older people. Methods: We generated a large number of potential items de novo and by reference to existing anxiety scales, and then reduced the number of items to 60 through consultation with a reference group consisting of psychologists, psychiatrists and normal elderly people. We then tested the psychometric properties of these 60 items in 452 normal old people and 46 patients attending a psychogeriatric service. We were able to reduce the number of items to 20. We chose a 1-week perspective and a dichotomous response scale. Results: Cronbach’s α for the 20-item Geriatric Anxiety Inventory (GAI) was 0.91 among normal elderly people and 0.93 in the psychogeriatric sample. Concurrent validity with a variety of other measures was demonstrated in both the normal sample and the psychogeriatric sample. Inter-rater and test–retest reliability were found to be excellent. Receiver operating characteristic analysis indicated a cut-point of 10/11 for the detection of DSM-IV Generalized Anxiety Disorder (GAD) in the psychogeriatric sample, with 83% of patients correctly classified with a specificity of 84% and a sensitivity of 75%. Conclusions: The GAI is a new 20-item self-report or nurse-administered scale that measures dimensional anxiety in elderly people. It has sound psychometric properties. Initial clinical testing indicates that it is able to discriminate between those with and without any anxiety disorder and between those with and without DSM-IV GAD.
Background: Anxiety symptoms and anxiety disorders are highly prevalent among older people and ar... more Background: Anxiety symptoms and anxiety disorders are highly prevalent among older people and are associated with considerable disability burden. While several instruments now exist to measure anxiety in older people, there is a need for a very brief self-report scale to measure anxiety symptoms in epidemiological surveys, in primary care and in acute geriatric medical settings. Accordingly, we undertook the development of such a scale, based on the Geriatric Anxiety Inventory. Methods: This is a cross-sectional study of randomly selected, community-residing, older women (N = 284; mean age 72.2 years) using receiver operating characteristic (ROC) analyses. DSM-IV diagnostic interviews were undertaken using the Mini International Diagnostic Interview, fifth edition (MINI-V). Results: We developed a 5-item version of the Geriatric Anxiety Inventory, which we have termed the Geriatric Anxiety Inventory – Short Form (GAI-SF). We found that a score of three or greater was optimal for the detection of DSM-IV Generalized Anxiety Disorder (GAD) in this community sample. At this cut-point, sensitivity was 75%, specificity was 87%, and 86% of participants were correctly classified. GAI-SF score was not related to age, MMSE score, level of education or perceived income adequacy. Internal consistency was high (Cronbach’s α = 0.81) and concurrent validity against the State-Trait Anxiety Inventory was good (rs = 0.48, p < 0.001). Conclusions: The GAI-SF is a short form of the Geriatric Anxiety Inventory, which we recommend for use in epidemiological studies. It may also be useful in primary care and acute geriatric medical settings.
Objective: To assess the psychometric properties and health correlates of the Geriatric Anxiety I... more Objective: To assess the psychometric properties and health correlates of the Geriatric Anxiety Inventory (GAI) in a cohort of Australian community-residing older women. Method: Cross-sectional study of a population-based cohort of women aged 60 years and over (N ¼ 286). Results: The GAI exhibited sound internal consistency and demonstrated good concurrent validity against the state half of the Spielberger State Trait Anxiety Inventory and the neuroticism domain of the NEO five-factor inventory. GAI score was significantly associated with self-reported sleep difficulties and perceived memory impairment, but not with age or cognitive function. Women with current DSM-IV Generalized Anxiety Disorder (GAD) had significantly higher GAI scores than women without such a history. In this cohort, the optimal cut-point to detect current GAD was 8/9. Although the GAI was designed to have few somatic items, women with a greater number of general medical problems or who rated their general health as worse had higher GAI scores. Conclusion: The GAI is a new scale designed specifically to measure anxiety in older people. In this Australian cohort of older women, the instrument had sound psychometric properties.
Purpose of review
The advent of global population ageing raises understandable concerns about the... more Purpose of review The advent of global population ageing raises understandable concerns about the high-prevalence mental disorders in older people. Accordingly, this review covers recently published scientific articles concerning anxiety and depression. Recent findings There is a paucity of findings on anxiety in older people, although the availability of several new scales suggests increased interest in this topic. The low prevalence of late- life depression in many population surveys does not appear to be due to misattribution of depressive symptoms to physical disorders. Although it is well established that dementia leads to depression, there is now increasing evidence for the proposition that depression leads to cognitive decline and dementia. There is now good evidence also for a bidirectional relationship between obesity and depression. The prognosis of treated late-life depression varies with baseline neuropsychological function and the severity of white matter hyperintensities. Summary An excellent body of research on depression in older people is now available, although more work on both pharmacological and nonpharmacological treatments is needed. More research is urgently required into anxiety disorders in older people. These are highly prevalent and associated with considerable disease burden. As the literature on depression in older people reaches maturity, there should be greater research and clinical interest in anxiety.
Introduction: There has been a growing interest in the cross-cultural adaptation of instruments f... more Introduction: There has been a growing interest in the cross-cultural adaptation of instruments for assessment of anxiety, but studies involving anxiety specifically in the geriatric population is still unusual. Thus, there is a lack of instruments designed to comply with this population. Translation and cultural adaptation is the first step to providing comparisons between different cultural contexts. Objective: Elaborate the semantic equivalence of the Geriatric Anxiety Inventory to Brazilian Portuguese. Method: The cross-cultural adaptation process consisted in four steps: two translations, two back- translations, both made by independent translators, the development of a synthetic version, and a pretest applied in a population sample. Results: For each item of the instrument, we present the results of four steps. Throughout the process, any problems found could be solved by ensuring the quality of the instrument and its appropriateness to the population to which it is intended. Discussion: The use of four-step method proved effective and safe in the process of semantic equivalence.
The assessment of anxiety can be difficult in older populations. In particular, the assessment of... more The assessment of anxiety can be difficult in older populations. In particular, the assessment of anxiety in long-term care settings can be problematic, because patients may be experiencing some level of cognitive impairment as well as co-existing medical conditions. The Geriatric Anxiety Inventory (GAI) is a brief, 20-item anxiety screening tool validated previously in community and outpatient samples of older adults. In this series of studies the predictive validity of the instrument in residential care settings is examined. Results indicated that classification of presence or absence of anxiety symptoms by the GAI was not significantly associated with an individual’s cognitive status, in either community dwelling or residential care samples. In addition, data supported the predictive validity of the GAI in residential care settings with respect to diagnosis of anxiety disorders. Thus the GAI may be a useful measure to assess anxiety symptoms in residential care.
Background: Differential diagnosis implies identifying shared and divergent characteristics betwe... more Background: Differential diagnosis implies identifying shared and divergent characteristics between clinical states. Clinical work with older adults demands not only the knowledge of nosological features associated with differential diagnosis, but also recognition of idiosyncratic factors associated with this population. Several factors can interfere with an accurate diagnosis of specific phobia in older cohorts. The goal of this paper is to review criteria for specific phobia and its differential diagnosis with panic disorder, agoraphobia, post- traumatic stress disorder and obsessive compulsive disorder, while stressing the specific factors associated with aging. Methods: A literature search regarding specific phobia in older adults was carried out using PubMed. Relevant articles were selected and scanned for further pertinent references. In addition, relevant references related to differential diagnosis and assessment were used. Results: Etiologic factors, specificity of feared stimulus or situation, fear predictability and the nature of phobic situations are key points to be assessed when implementing a differential diagnosis of specific phobia. Conclusions: First, age-related sensory impairments are common and interfere both with information processing and communication. Second, medical illnesses create symptoms that might cause, interfere with, or mimic anxiety. Third, cohort effects might result in underreporting, through the inability to communicate or recognize anxiety symptoms, misattributing them to physical conditions. Finally, diagnostic criteria and screening instruments were usually developed using younger samples and are therefore not adapted to the functional and behavioral characteristics of older samples.
Phobias are common in later life, yet treatment research in this population remains scant. The ef... more Phobias are common in later life, yet treatment research in this population remains scant. The efficacy of exposure therapy, in combination with other Cognitive-Behavioral Therapy (CBT) components, in the treatment of specific phobia with a middle and older aged sample was examined. Sixteen adults aged 45–68 with DSM-IV diagnosis of a specific phobia received a manualized intervention over ten weeks, and were compared with a control group. Results indicated significant time effects in the treatment group for the primary outcome variables of phobic severity and avoidance as well as secondary outcome variables including depression and anxiety. Symptom presence and severity also significantly declined in the treatment group. No significant changes in state anxiety were noted across the treatment period. Such results provide support for the efficacy of exposure combined with CBT treatment for specific phobia in middle to older aged adults.
Popular assertions portray depression as an inevitable outcome of aging, a widespread image embra... more Popular assertions portray depression as an inevitable outcome of aging, a widespread image embraced by many health professionals. Although epidemiological data contradict the prevalent image that depressive syndromes increase with age, the prognosis becomes more negative as one grows older. An early thorough assessment is vital to identify depressive symptoms in older adults, thus promoting the development of tailored interventions and improved recovery rates. The main problems associated with the assessment of depressive symptoms in older adults include a lack of knowledge about changes in the pattern of symptoms, the inadequacy of techniques developed for other age cohorts, the misuse of psychometric instruments, and deficits in additional areas of assessment. The underlying goal of this article is to analyze the obstacles to a successful assessment of depression symptoms in older adults, suggesting strategies to overcome them.
The practice of psychology covers the range of ages from conception through to the end of life an... more The practice of psychology covers the range of ages from conception through to the end of life and palliative care. Psychologists practice in a variety of roles, but the majority of these roles involve interactions with nonprofessionals of varying ages. These interactions are governed by codes of ethical practice, whether these are developed by the funding bodies for research activities, professional associations, or regulatory bodies. Ethical codes vary in their format and emphasis, but all have the protection of the public as a major purpose. Often there are special provisions in these codes for particular populations or circumstances. Here we describe the development of ethical guidelines for the practice of psychology with older adults in Australia and report on those guidelines and their supporting literature.
One reason that older drivers may have elevated crash risk is because they anticipate hazardous s... more One reason that older drivers may have elevated crash risk is because they anticipate hazardous situations less well than middle-aged drivers. Hazard perception ability has been found to be amenable to training in young drivers. This article reports an experiment in which video-based hazard perception training was given to drivers who were between the ages of 65 and 94 years. Trained participants were significantly faster at anticipating traffic hazards compared with an untrained control group, and this benefit was present even after the authors controlled for pretraining ability. If future research shows these effects to be robust, the implications for driver training and safety are significant.
Hazard perception in driving involves a number of different processes. This paper reports the dev... more Hazard perception in driving involves a number of different processes. This paper reports the develop- ment of two measures designed to separate these processes. A Hazard Perception Test was developed to measure how quickly drivers could anticipate hazards overall, incorporating detection, trajectory predic- tion, and hazard classification judgements. A Hazard Change Detection Task was developed to measure how quickly drivers can detect a hazard in a static image regardless of whether they consider it hazardous or not. For the Hazard Perception Test, young novices were slower than mid-age experienced drivers, con- sistent with differences in crash risk, and test performance correlated with scores in pre-existing Hazard Perception Tests. For drivers aged 65 and over, scores on the Hazard Perception Test declined with age and correlated with both contrast sensitivity and a Useful Field of View measure. For the Hazard Change Detection Task, novices responded quicker than the experienced drivers, contrary to crash risk trends, and test performance did not correlate with measures of overall hazard perception. However for drivers aged 65 and over, test performance declined with age and correlated with both hazard perception and Useful Field of View. Overall we concluded that there was support for the validity of the Hazard Percep- tion Test for all ages but the Hazard Change Detection Task might only be appropriate for use with older drivers.
The number of life events reported by study participants is sensitive to the method of data colle... more The number of life events reported by study participants is sensitive to the method of data collection and time intervals under consideration. Individual characteristics also influence reporting; respondents with poor mental health report more life events. Much current research on life events is cross-sectional. Data from a longitudinal study of women’s health from 4 waves over a decade suggest that over time additional systematic biases in reporting life events occur. Inconsistency over time is due to both fall-off of reporting and telescoping. Intracategory variability and ambiguity of items, as well as respondent characteristics, also potentially contribute to response biases. Although some factors (e.g., item wording) are controllable, others (e.g., respondents’ mental health) are not and must be factored into data analysis and interpretation.
Background: There are well-established risk factors, such as lower education, for attrition of st... more Background: There are well-established risk factors, such as lower education, for attrition of study participants. Consequently, the representativeness of the cohort in a longitudinal study may deteriorate over time. Death is a common form of attrition in cohort studies of older people. The aim of this paper is to examine the effects of death and other forms of attrition on risk factor prevalence in the study cohort and the target population over time. Methods: Differential associations between a risk factor and death and non-death attrition are considered under various hypothetical conditions. Empirical data from the Australian Longitudinal Study on Women’s Health (ALSWH) for participants born in 1921-26 are used to identify associations which occur in practice, and national cross- sectional data from Australian Censuses and National Health Surveys are used to illustrate the evolution of bias over approximately ten years. Results: The hypothetical situations illustrate how death and other attrition can theoretically affect changes in bias over time. Between 1996 and 2008, 28.4% of ALSWH participants died, 16.5% withdrew and 10.4% were lost to follow up. There were differential associations with various risk factors, for example, non-English speaking country of birth was associated with non-death attrition but not death whereas being underweight (body mass index < 18.5) was associated with death but not other forms of attrition. Compared to national data, underrepresentation of women with non-English speaking country of birth increased from 3.9% to 7.2% and over-representation of current and ex-smoking increased from 2.6% to 5.8%. Conclusions: Deaths occur in both the target population and study cohort, while other forms of attrition occur only in the study cohort. Therefore non-death attrition may cause greater bias than death in longitudinal studies. However although more than a quarter of the oldest participants in the ALSWH died in the 12 years following recruitment, differences from the national population changed only slightly.
Introduction: The International Psychogeriatric Association Task Force on Mental Health Services ... more Introduction: The International Psychogeriatric Association Task Force on Mental Health Services in Long- Term Care Facilities seeks to improve care of persons in residential aged care facilities (RACFs). As part of that effort the current authors have contributed an overview and discussion of the uses of brief screening instruments in RACFs. Methods: While no current guidelines on the use of screening instruments in nursing homes were found, relevant extant guidelines were consulted. The literature on measurement development, testing standards, psychometric considerations and the nursing home environment were consulted. Results: Cognitive, psychiatric, behavioral, functional and omnibus screening instruments are described at a category level, along with specifics about their use in a RACF environment. Issues surrounding the selection, administration, interpretation and uses of screening instruments in RACFs are discussed. Issues of international interest (such as translation of measures) or clinical concern (e.g. impact of severe cognitive decline on assessment) are addressed. Practical points surrounding who can administer, score and interpret such screens, as well as their psychometric and clinical strengths more broadly, are articulated. Conclusions: Guidelines for use of screening instruments in the RACF environment are offered, together with broad recommendations concerning the appropriate use of brief screening instruments in RACFs. Directions for future research and policy directions are outlined, with particular reference to the international context.
Reasons behind older adults’ under-utilisation of mental health services are complex. Barriers to... more Reasons behind older adults’ under-utilisation of mental health services are complex. Barriers to access to mental health services for this group include service access and availability, attitudes of medical and mental health professionals, and attitudes of older people themselves. This questionnaire-based study sought to investigate variables that may influence attitudes towards psychological help seeking among a late mid-age–young-old Australian sample of 159 community- dwelling adults. The results suggest that attitudes towards seeking psychological help in this population were relatively positive. In addition,450% of participants in the sample indicated that they had sought treatment for emotional or psychological difficulties in the past, with the greatest proportion of those who sought help noting that it was for ‘‘family problems’’ (56%). The findings suggest that negative attitudes to help seeking in this age group may not be as pervasive as previously assumed, and that help-seeking behaviours may be high among those with positive attitudes towards help seeking.
Background: There is a worldwide shortage of mental health professionals trained in the provision... more Background: There is a worldwide shortage of mental health professionals trained in the provision of mental health services to older adults. This shortage in many countries is most acutely felt in the discipline of psychology. Examining training programs in clinical psychology with respect to training content may shed light on ways to increase interest among students and improve practical experiences in working with older adults. Methods: A large multinational survey of geropsychology content in university-based clinical and counselling psychology training programs was conducted in 2007 in the U.S.A., Australia, and Canada. Both clinical/counseling programs and internship/practicum placements were surveyed as to staffing, didactic content and training opportunities with respect to geropsychology. Results: Survey response rates varied from 15% in the U.S.A. (n = 46), 70% in Australia (n = 25) to 91.5% in Canada (n = 22). The U.S.A. and Australia reported specialist concentrations in geropsychology within graduate clinical psychology training programs. More assessment and psychopathology courses in the three countries were cited as having ageing content than psychotherapy courses. Many non-specialist programs in all three countries offered course work in geropsychology, and many had staff who specialized in working clinically with an older population. Interest in expanding aging courses and placements was cited by several training sites. Recruiting staff and finding appropriate placement opportunities with older adult populations were cited as barriers to expanding geropsychology offerings. Conclusions: In light of our results, we conclude with a discussion of innovative means of engaging students with ageing content/populations, and suggestions for overcoming staffing and placement shortcomings.
Background: The underlying goals of the present study were (i) to assess knowledge of and attitud... more Background: The underlying goals of the present study were (i) to assess knowledge of and attitudes towards aging in a sample of Portuguese undergraduate students undertaking various degrees in health and welfare subjects, and (ii) to analyze the extent to which knowledge, attitudes and other factors were associated with interest in working with older adults. Methods: The study was cross-sectional in design. The sample comprised 460 Portuguese undergraduate students enrolled in degrees in nursing, social work, and psychology. They were asked to complete questionnaires and quizzes, which were analyzed using contingency tables and one way analysis of variance for inter-group comparison, and then subjected to multivariate logistic regression analysis. Results: Significant differences emerged between groups on knowledge, attitudes towards aging and interest in working with older adults, with both nursing and social work students displaying more positive attitudes, knowledge, and interest in working with older adults, when compared with psychology students. A regression analysis indicated that attitudes, knowledge, and previous formal contact were significant predictors of interest. Conclusion: Interest in working with older adults was significantly related to positive attitudes, more knowledge and formal previous contact. Positive attitudes towards older adults can be promoted through interaction with faculty members and experts, knowledge acquisition about normative changes with age, and contact with healthy and impaired older adults.
The level of training required for the practice of professional psychology varies across countrie... more The level of training required for the practice of professional psychology varies across countries, and usually evolves from a combination of input from local and national regulatory bodies, legislative requirements, academic institutions and relevant professional bodies. Here we explore the North American and Australian historical developments and future directions in levels of training required and aspired to for professional psychologists, along with a brief comparison to training for psychologists in Central and South America, Europe and Asia. The recent proliferation of professional doctorate degrees in Australian universities has added another layer to the suite of available qualifications for professional psychologists and to some degree reflects international trends in the profession. The important role of professional organisations in establishing the educational requirements for entry into professional practice is highlighted.
The interview has a long history of being used to select individuals for positions in industry, p... more The interview has a long history of being used to select individuals for positions in industry, professional occupations, and for a variety of specialised educational programs. Despite its widespread popularity, the selection interview is often criticised for its potential bias and unreliability, which in turn has led to its decreasing use in some settings. The purpose of the present study was to explore the views of the directors of 21 Australian clinical training programs as to the value of interviews as part of the admission process for their clinical psychology postgraduate training candidates. Three programs reported not conducting interviews at all, expressing reservations concerning their validity. Most other directors saw interviews as having at least some value, with the opportunity to evaluate interpersonal skills being one of the most commonly mentioned advantages. A variety of methods was used for the final admission decisions, with substantial variation in acceptance rates by candidates who survived the interview process. Implications for selection processes in the future are discussed.
Background: Anxiety symptoms and anxiety disorders are highly prevalent among elderly people, alt... more Background: Anxiety symptoms and anxiety disorders are highly prevalent among elderly people, although infrequently the subject of systematic research in this age group. One important limitation is the lack of a widely accepted instrument to measure dimensional anxiety in both normal old people and old people with mental health problems seen in various settings. Accordingly, we developed and tested of a short scale to measure anxiety in older people. Methods: We generated a large number of potential items de novo and by reference to existing anxiety scales, and then reduced the number of items to 60 through consultation with a reference group consisting of psychologists, psychiatrists and normal elderly people. We then tested the psychometric properties of these 60 items in 452 normal old people and 46 patients attending a psychogeriatric service. We were able to reduce the number of items to 20. We chose a 1-week perspective and a dichotomous response scale. Results: Cronbach’s α for the 20-item Geriatric Anxiety Inventory (GAI) was 0.91 among normal elderly people and 0.93 in the psychogeriatric sample. Concurrent validity with a variety of other measures was demonstrated in both the normal sample and the psychogeriatric sample. Inter-rater and test–retest reliability were found to be excellent. Receiver operating characteristic analysis indicated a cut-point of 10/11 for the detection of DSM-IV Generalized Anxiety Disorder (GAD) in the psychogeriatric sample, with 83% of patients correctly classified with a specificity of 84% and a sensitivity of 75%. Conclusions: The GAI is a new 20-item self-report or nurse-administered scale that measures dimensional anxiety in elderly people. It has sound psychometric properties. Initial clinical testing indicates that it is able to discriminate between those with and without any anxiety disorder and between those with and without DSM-IV GAD.
Background: Anxiety symptoms and anxiety disorders are highly prevalent among older people and ar... more Background: Anxiety symptoms and anxiety disorders are highly prevalent among older people and are associated with considerable disability burden. While several instruments now exist to measure anxiety in older people, there is a need for a very brief self-report scale to measure anxiety symptoms in epidemiological surveys, in primary care and in acute geriatric medical settings. Accordingly, we undertook the development of such a scale, based on the Geriatric Anxiety Inventory. Methods: This is a cross-sectional study of randomly selected, community-residing, older women (N = 284; mean age 72.2 years) using receiver operating characteristic (ROC) analyses. DSM-IV diagnostic interviews were undertaken using the Mini International Diagnostic Interview, fifth edition (MINI-V). Results: We developed a 5-item version of the Geriatric Anxiety Inventory, which we have termed the Geriatric Anxiety Inventory – Short Form (GAI-SF). We found that a score of three or greater was optimal for the detection of DSM-IV Generalized Anxiety Disorder (GAD) in this community sample. At this cut-point, sensitivity was 75%, specificity was 87%, and 86% of participants were correctly classified. GAI-SF score was not related to age, MMSE score, level of education or perceived income adequacy. Internal consistency was high (Cronbach’s α = 0.81) and concurrent validity against the State-Trait Anxiety Inventory was good (rs = 0.48, p < 0.001). Conclusions: The GAI-SF is a short form of the Geriatric Anxiety Inventory, which we recommend for use in epidemiological studies. It may also be useful in primary care and acute geriatric medical settings.
Objective: To assess the psychometric properties and health correlates of the Geriatric Anxiety I... more Objective: To assess the psychometric properties and health correlates of the Geriatric Anxiety Inventory (GAI) in a cohort of Australian community-residing older women. Method: Cross-sectional study of a population-based cohort of women aged 60 years and over (N ¼ 286). Results: The GAI exhibited sound internal consistency and demonstrated good concurrent validity against the state half of the Spielberger State Trait Anxiety Inventory and the neuroticism domain of the NEO five-factor inventory. GAI score was significantly associated with self-reported sleep difficulties and perceived memory impairment, but not with age or cognitive function. Women with current DSM-IV Generalized Anxiety Disorder (GAD) had significantly higher GAI scores than women without such a history. In this cohort, the optimal cut-point to detect current GAD was 8/9. Although the GAI was designed to have few somatic items, women with a greater number of general medical problems or who rated their general health as worse had higher GAI scores. Conclusion: The GAI is a new scale designed specifically to measure anxiety in older people. In this Australian cohort of older women, the instrument had sound psychometric properties.
Purpose of review
The advent of global population ageing raises understandable concerns about the... more Purpose of review The advent of global population ageing raises understandable concerns about the high-prevalence mental disorders in older people. Accordingly, this review covers recently published scientific articles concerning anxiety and depression. Recent findings There is a paucity of findings on anxiety in older people, although the availability of several new scales suggests increased interest in this topic. The low prevalence of late- life depression in many population surveys does not appear to be due to misattribution of depressive symptoms to physical disorders. Although it is well established that dementia leads to depression, there is now increasing evidence for the proposition that depression leads to cognitive decline and dementia. There is now good evidence also for a bidirectional relationship between obesity and depression. The prognosis of treated late-life depression varies with baseline neuropsychological function and the severity of white matter hyperintensities. Summary An excellent body of research on depression in older people is now available, although more work on both pharmacological and nonpharmacological treatments is needed. More research is urgently required into anxiety disorders in older people. These are highly prevalent and associated with considerable disease burden. As the literature on depression in older people reaches maturity, there should be greater research and clinical interest in anxiety.
Introduction: There has been a growing interest in the cross-cultural adaptation of instruments f... more Introduction: There has been a growing interest in the cross-cultural adaptation of instruments for assessment of anxiety, but studies involving anxiety specifically in the geriatric population is still unusual. Thus, there is a lack of instruments designed to comply with this population. Translation and cultural adaptation is the first step to providing comparisons between different cultural contexts. Objective: Elaborate the semantic equivalence of the Geriatric Anxiety Inventory to Brazilian Portuguese. Method: The cross-cultural adaptation process consisted in four steps: two translations, two back- translations, both made by independent translators, the development of a synthetic version, and a pretest applied in a population sample. Results: For each item of the instrument, we present the results of four steps. Throughout the process, any problems found could be solved by ensuring the quality of the instrument and its appropriateness to the population to which it is intended. Discussion: The use of four-step method proved effective and safe in the process of semantic equivalence.
The assessment of anxiety can be difficult in older populations. In particular, the assessment of... more The assessment of anxiety can be difficult in older populations. In particular, the assessment of anxiety in long-term care settings can be problematic, because patients may be experiencing some level of cognitive impairment as well as co-existing medical conditions. The Geriatric Anxiety Inventory (GAI) is a brief, 20-item anxiety screening tool validated previously in community and outpatient samples of older adults. In this series of studies the predictive validity of the instrument in residential care settings is examined. Results indicated that classification of presence or absence of anxiety symptoms by the GAI was not significantly associated with an individual’s cognitive status, in either community dwelling or residential care samples. In addition, data supported the predictive validity of the GAI in residential care settings with respect to diagnosis of anxiety disorders. Thus the GAI may be a useful measure to assess anxiety symptoms in residential care.
Background: Differential diagnosis implies identifying shared and divergent characteristics betwe... more Background: Differential diagnosis implies identifying shared and divergent characteristics between clinical states. Clinical work with older adults demands not only the knowledge of nosological features associated with differential diagnosis, but also recognition of idiosyncratic factors associated with this population. Several factors can interfere with an accurate diagnosis of specific phobia in older cohorts. The goal of this paper is to review criteria for specific phobia and its differential diagnosis with panic disorder, agoraphobia, post- traumatic stress disorder and obsessive compulsive disorder, while stressing the specific factors associated with aging. Methods: A literature search regarding specific phobia in older adults was carried out using PubMed. Relevant articles were selected and scanned for further pertinent references. In addition, relevant references related to differential diagnosis and assessment were used. Results: Etiologic factors, specificity of feared stimulus or situation, fear predictability and the nature of phobic situations are key points to be assessed when implementing a differential diagnosis of specific phobia. Conclusions: First, age-related sensory impairments are common and interfere both with information processing and communication. Second, medical illnesses create symptoms that might cause, interfere with, or mimic anxiety. Third, cohort effects might result in underreporting, through the inability to communicate or recognize anxiety symptoms, misattributing them to physical conditions. Finally, diagnostic criteria and screening instruments were usually developed using younger samples and are therefore not adapted to the functional and behavioral characteristics of older samples.
Phobias are common in later life, yet treatment research in this population remains scant. The ef... more Phobias are common in later life, yet treatment research in this population remains scant. The efficacy of exposure therapy, in combination with other Cognitive-Behavioral Therapy (CBT) components, in the treatment of specific phobia with a middle and older aged sample was examined. Sixteen adults aged 45–68 with DSM-IV diagnosis of a specific phobia received a manualized intervention over ten weeks, and were compared with a control group. Results indicated significant time effects in the treatment group for the primary outcome variables of phobic severity and avoidance as well as secondary outcome variables including depression and anxiety. Symptom presence and severity also significantly declined in the treatment group. No significant changes in state anxiety were noted across the treatment period. Such results provide support for the efficacy of exposure combined with CBT treatment for specific phobia in middle to older aged adults.
Popular assertions portray depression as an inevitable outcome of aging, a widespread image embra... more Popular assertions portray depression as an inevitable outcome of aging, a widespread image embraced by many health professionals. Although epidemiological data contradict the prevalent image that depressive syndromes increase with age, the prognosis becomes more negative as one grows older. An early thorough assessment is vital to identify depressive symptoms in older adults, thus promoting the development of tailored interventions and improved recovery rates. The main problems associated with the assessment of depressive symptoms in older adults include a lack of knowledge about changes in the pattern of symptoms, the inadequacy of techniques developed for other age cohorts, the misuse of psychometric instruments, and deficits in additional areas of assessment. The underlying goal of this article is to analyze the obstacles to a successful assessment of depression symptoms in older adults, suggesting strategies to overcome them.
The practice of psychology covers the range of ages from conception through to the end of life an... more The practice of psychology covers the range of ages from conception through to the end of life and palliative care. Psychologists practice in a variety of roles, but the majority of these roles involve interactions with nonprofessionals of varying ages. These interactions are governed by codes of ethical practice, whether these are developed by the funding bodies for research activities, professional associations, or regulatory bodies. Ethical codes vary in their format and emphasis, but all have the protection of the public as a major purpose. Often there are special provisions in these codes for particular populations or circumstances. Here we describe the development of ethical guidelines for the practice of psychology with older adults in Australia and report on those guidelines and their supporting literature.
One reason that older drivers may have elevated crash risk is because they anticipate hazardous s... more One reason that older drivers may have elevated crash risk is because they anticipate hazardous situations less well than middle-aged drivers. Hazard perception ability has been found to be amenable to training in young drivers. This article reports an experiment in which video-based hazard perception training was given to drivers who were between the ages of 65 and 94 years. Trained participants were significantly faster at anticipating traffic hazards compared with an untrained control group, and this benefit was present even after the authors controlled for pretraining ability. If future research shows these effects to be robust, the implications for driver training and safety are significant.
Hazard perception in driving involves a number of different processes. This paper reports the dev... more Hazard perception in driving involves a number of different processes. This paper reports the develop- ment of two measures designed to separate these processes. A Hazard Perception Test was developed to measure how quickly drivers could anticipate hazards overall, incorporating detection, trajectory predic- tion, and hazard classification judgements. A Hazard Change Detection Task was developed to measure how quickly drivers can detect a hazard in a static image regardless of whether they consider it hazardous or not. For the Hazard Perception Test, young novices were slower than mid-age experienced drivers, con- sistent with differences in crash risk, and test performance correlated with scores in pre-existing Hazard Perception Tests. For drivers aged 65 and over, scores on the Hazard Perception Test declined with age and correlated with both contrast sensitivity and a Useful Field of View measure. For the Hazard Change Detection Task, novices responded quicker than the experienced drivers, contrary to crash risk trends, and test performance did not correlate with measures of overall hazard perception. However for drivers aged 65 and over, test performance declined with age and correlated with both hazard perception and Useful Field of View. Overall we concluded that there was support for the validity of the Hazard Percep- tion Test for all ages but the Hazard Change Detection Task might only be appropriate for use with older drivers.
The number of life events reported by study participants is sensitive to the method of data colle... more The number of life events reported by study participants is sensitive to the method of data collection and time intervals under consideration. Individual characteristics also influence reporting; respondents with poor mental health report more life events. Much current research on life events is cross-sectional. Data from a longitudinal study of women’s health from 4 waves over a decade suggest that over time additional systematic biases in reporting life events occur. Inconsistency over time is due to both fall-off of reporting and telescoping. Intracategory variability and ambiguity of items, as well as respondent characteristics, also potentially contribute to response biases. Although some factors (e.g., item wording) are controllable, others (e.g., respondents’ mental health) are not and must be factored into data analysis and interpretation.
Background: There are well-established risk factors, such as lower education, for attrition of st... more Background: There are well-established risk factors, such as lower education, for attrition of study participants. Consequently, the representativeness of the cohort in a longitudinal study may deteriorate over time. Death is a common form of attrition in cohort studies of older people. The aim of this paper is to examine the effects of death and other forms of attrition on risk factor prevalence in the study cohort and the target population over time. Methods: Differential associations between a risk factor and death and non-death attrition are considered under various hypothetical conditions. Empirical data from the Australian Longitudinal Study on Women’s Health (ALSWH) for participants born in 1921-26 are used to identify associations which occur in practice, and national cross- sectional data from Australian Censuses and National Health Surveys are used to illustrate the evolution of bias over approximately ten years. Results: The hypothetical situations illustrate how death and other attrition can theoretically affect changes in bias over time. Between 1996 and 2008, 28.4% of ALSWH participants died, 16.5% withdrew and 10.4% were lost to follow up. There were differential associations with various risk factors, for example, non-English speaking country of birth was associated with non-death attrition but not death whereas being underweight (body mass index < 18.5) was associated with death but not other forms of attrition. Compared to national data, underrepresentation of women with non-English speaking country of birth increased from 3.9% to 7.2% and over-representation of current and ex-smoking increased from 2.6% to 5.8%. Conclusions: Deaths occur in both the target population and study cohort, while other forms of attrition occur only in the study cohort. Therefore non-death attrition may cause greater bias than death in longitudinal studies. However although more than a quarter of the oldest participants in the ALSWH died in the 12 years following recruitment, differences from the national population changed only slightly.
Introduction: The International Psychogeriatric Association Task Force on Mental Health Services ... more Introduction: The International Psychogeriatric Association Task Force on Mental Health Services in Long- Term Care Facilities seeks to improve care of persons in residential aged care facilities (RACFs). As part of that effort the current authors have contributed an overview and discussion of the uses of brief screening instruments in RACFs. Methods: While no current guidelines on the use of screening instruments in nursing homes were found, relevant extant guidelines were consulted. The literature on measurement development, testing standards, psychometric considerations and the nursing home environment were consulted. Results: Cognitive, psychiatric, behavioral, functional and omnibus screening instruments are described at a category level, along with specifics about their use in a RACF environment. Issues surrounding the selection, administration, interpretation and uses of screening instruments in RACFs are discussed. Issues of international interest (such as translation of measures) or clinical concern (e.g. impact of severe cognitive decline on assessment) are addressed. Practical points surrounding who can administer, score and interpret such screens, as well as their psychometric and clinical strengths more broadly, are articulated. Conclusions: Guidelines for use of screening instruments in the RACF environment are offered, together with broad recommendations concerning the appropriate use of brief screening instruments in RACFs. Directions for future research and policy directions are outlined, with particular reference to the international context.
Reasons behind older adults’ under-utilisation of mental health services are complex. Barriers to... more Reasons behind older adults’ under-utilisation of mental health services are complex. Barriers to access to mental health services for this group include service access and availability, attitudes of medical and mental health professionals, and attitudes of older people themselves. This questionnaire-based study sought to investigate variables that may influence attitudes towards psychological help seeking among a late mid-age–young-old Australian sample of 159 community- dwelling adults. The results suggest that attitudes towards seeking psychological help in this population were relatively positive. In addition,450% of participants in the sample indicated that they had sought treatment for emotional or psychological difficulties in the past, with the greatest proportion of those who sought help noting that it was for ‘‘family problems’’ (56%). The findings suggest that negative attitudes to help seeking in this age group may not be as pervasive as previously assumed, and that help-seeking behaviours may be high among those with positive attitudes towards help seeking.
Background: There is a worldwide shortage of mental health professionals trained in the provision... more Background: There is a worldwide shortage of mental health professionals trained in the provision of mental health services to older adults. This shortage in many countries is most acutely felt in the discipline of psychology. Examining training programs in clinical psychology with respect to training content may shed light on ways to increase interest among students and improve practical experiences in working with older adults. Methods: A large multinational survey of geropsychology content in university-based clinical and counselling psychology training programs was conducted in 2007 in the U.S.A., Australia, and Canada. Both clinical/counseling programs and internship/practicum placements were surveyed as to staffing, didactic content and training opportunities with respect to geropsychology. Results: Survey response rates varied from 15% in the U.S.A. (n = 46), 70% in Australia (n = 25) to 91.5% in Canada (n = 22). The U.S.A. and Australia reported specialist concentrations in geropsychology within graduate clinical psychology training programs. More assessment and psychopathology courses in the three countries were cited as having ageing content than psychotherapy courses. Many non-specialist programs in all three countries offered course work in geropsychology, and many had staff who specialized in working clinically with an older population. Interest in expanding aging courses and placements was cited by several training sites. Recruiting staff and finding appropriate placement opportunities with older adult populations were cited as barriers to expanding geropsychology offerings. Conclusions: In light of our results, we conclude with a discussion of innovative means of engaging students with ageing content/populations, and suggestions for overcoming staffing and placement shortcomings.
Background: The underlying goals of the present study were (i) to assess knowledge of and attitud... more Background: The underlying goals of the present study were (i) to assess knowledge of and attitudes towards aging in a sample of Portuguese undergraduate students undertaking various degrees in health and welfare subjects, and (ii) to analyze the extent to which knowledge, attitudes and other factors were associated with interest in working with older adults. Methods: The study was cross-sectional in design. The sample comprised 460 Portuguese undergraduate students enrolled in degrees in nursing, social work, and psychology. They were asked to complete questionnaires and quizzes, which were analyzed using contingency tables and one way analysis of variance for inter-group comparison, and then subjected to multivariate logistic regression analysis. Results: Significant differences emerged between groups on knowledge, attitudes towards aging and interest in working with older adults, with both nursing and social work students displaying more positive attitudes, knowledge, and interest in working with older adults, when compared with psychology students. A regression analysis indicated that attitudes, knowledge, and previous formal contact were significant predictors of interest. Conclusion: Interest in working with older adults was significantly related to positive attitudes, more knowledge and formal previous contact. Positive attitudes towards older adults can be promoted through interaction with faculty members and experts, knowledge acquisition about normative changes with age, and contact with healthy and impaired older adults.
The level of training required for the practice of professional psychology varies across countrie... more The level of training required for the practice of professional psychology varies across countries, and usually evolves from a combination of input from local and national regulatory bodies, legislative requirements, academic institutions and relevant professional bodies. Here we explore the North American and Australian historical developments and future directions in levels of training required and aspired to for professional psychologists, along with a brief comparison to training for psychologists in Central and South America, Europe and Asia. The recent proliferation of professional doctorate degrees in Australian universities has added another layer to the suite of available qualifications for professional psychologists and to some degree reflects international trends in the profession. The important role of professional organisations in establishing the educational requirements for entry into professional practice is highlighted.
The interview has a long history of being used to select individuals for positions in industry, p... more The interview has a long history of being used to select individuals for positions in industry, professional occupations, and for a variety of specialised educational programs. Despite its widespread popularity, the selection interview is often criticised for its potential bias and unreliability, which in turn has led to its decreasing use in some settings. The purpose of the present study was to explore the views of the directors of 21 Australian clinical training programs as to the value of interviews as part of the admission process for their clinical psychology postgraduate training candidates. Three programs reported not conducting interviews at all, expressing reservations concerning their validity. Most other directors saw interviews as having at least some value, with the opportunity to evaluate interpersonal skills being one of the most commonly mentioned advantages. A variety of methods was used for the final admission decisions, with substantial variation in acceptance rates by candidates who survived the interview process. Implications for selection processes in the future are discussed.
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Methods: We generated a large number of potential items de novo and by reference to existing anxiety scales, and then reduced the number of items to 60 through consultation with a reference group consisting of psychologists, psychiatrists
and normal elderly people. We then tested the psychometric properties of these 60 items in 452 normal old people and 46 patients attending a psychogeriatric service. We were able to reduce the number of items to 20. We chose a 1-week
perspective and a dichotomous response scale.
Results: Cronbach’s α for the 20-item Geriatric Anxiety Inventory (GAI) was 0.91 among normal elderly people and 0.93 in the psychogeriatric sample. Concurrent validity with a variety of other measures was demonstrated in both the normal sample and the psychogeriatric sample. Inter-rater and test–retest
reliability were found to be excellent. Receiver operating characteristic analysis indicated a cut-point of 10/11 for the detection of DSM-IV Generalized Anxiety Disorder (GAD) in the psychogeriatric sample, with 83% of patients correctly
classified with a specificity of 84% and a sensitivity of 75%.
Conclusions: The GAI is a new 20-item self-report or nurse-administered scale that measures dimensional anxiety in elderly people. It has sound psychometric properties. Initial clinical testing indicates that it is able to discriminate between those with and without any anxiety disorder and between those with and without DSM-IV GAD.
Methods: This is a cross-sectional study of randomly selected, community-residing, older women (N = 284; mean age 72.2 years) using receiver operating characteristic (ROC) analyses. DSM-IV diagnostic interviews were undertaken using the Mini International Diagnostic Interview, fifth edition (MINI-V).
Results: We developed a 5-item version of the Geriatric Anxiety Inventory, which we have termed the Geriatric Anxiety Inventory – Short Form (GAI-SF). We found that a score of three or greater was optimal for the detection of DSM-IV Generalized Anxiety Disorder (GAD) in this community sample. At this cut-point, sensitivity was 75%, specificity was 87%, and 86% of participants were correctly classified. GAI-SF score was not related to age, MMSE score, level of education or perceived income adequacy. Internal consistency was high (Cronbach’s α = 0.81) and concurrent validity against the State-Trait Anxiety Inventory was good (rs = 0.48, p < 0.001).
Conclusions: The GAI-SF is a short form of the Geriatric Anxiety Inventory, which we recommend for use in epidemiological studies. It may also be useful in primary care and acute geriatric medical settings.
Method: Cross-sectional study of a population-based cohort of women aged 60 years and over (N ¼ 286).
Results: The GAI exhibited sound internal consistency and demonstrated good concurrent validity against the state half of the Spielberger State Trait Anxiety Inventory and the neuroticism domain of the NEO five-factor inventory. GAI score was significantly associated with self-reported sleep difficulties and perceived memory impairment, but not with age or cognitive function. Women with current DSM-IV Generalized Anxiety Disorder (GAD) had significantly higher GAI scores than women without such a history. In this cohort, the optimal cut-point to detect current GAD was 8/9. Although the GAI was designed to have few somatic items, women with a greater number of general medical problems or who rated their general health as worse had higher GAI scores.
Conclusion: The GAI is a new scale designed specifically to measure anxiety in older people. In this Australian cohort of older women, the instrument had sound psychometric properties.
The advent of global population ageing raises understandable concerns about the high-prevalence mental disorders in older people. Accordingly, this review covers recently published scientific articles concerning anxiety and depression. Recent findings
There is a paucity of findings on anxiety in older people, although the availability of several new scales suggests increased interest in this topic. The low prevalence of late- life depression in many population surveys does not appear to be due to misattribution of depressive symptoms to physical disorders. Although it is well established that dementia leads to depression, there is now increasing evidence for the proposition that depression leads to cognitive decline and dementia. There is now good evidence also for a bidirectional relationship between obesity and depression. The prognosis of treated late-life depression varies with baseline neuropsychological function and the severity of white matter hyperintensities.
Summary
An excellent body of research on depression in older people is now available, although more work on both pharmacological and nonpharmacological treatments is needed. More research is urgently required into anxiety disorders in older people. These are highly prevalent and associated with considerable disease burden. As the literature on depression in older people reaches maturity, there should be greater research and clinical interest in anxiety.
Objective: Elaborate the semantic equivalence of the Geriatric Anxiety Inventory to Brazilian Portuguese.
Method: The cross-cultural adaptation process consisted in four steps: two translations, two back- translations, both made by independent translators, the development of a synthetic version, and a pretest applied in a population sample.
Results: For each item of the instrument, we present the results of four steps. Throughout the process, any problems found could be solved by ensuring the quality of the instrument and its appropriateness to the population to which it is intended.
Discussion: The use of four-step method proved effective and safe in the process of semantic equivalence.
Methods: A literature search regarding specific phobia in older adults was carried out using PubMed. Relevant articles were selected and scanned for further pertinent references. In addition, relevant references related to differential diagnosis and assessment were used.
Results: Etiologic factors, specificity of feared stimulus or situation, fear predictability and the nature of phobic situations are key points to be assessed when implementing a differential diagnosis of specific phobia.
Conclusions: First, age-related sensory impairments are common and interfere both with information processing and communication. Second, medical illnesses create symptoms that might cause, interfere with, or mimic anxiety. Third, cohort effects might result in underreporting, through the inability to communicate or recognize anxiety symptoms, misattributing them to physical conditions. Finally, diagnostic criteria and screening instruments were usually developed using younger samples and are therefore not adapted to the functional and behavioral characteristics of older samples.
Methods: Differential associations between a risk factor and death and non-death attrition are considered under various hypothetical conditions. Empirical data from the Australian Longitudinal Study on Women’s Health (ALSWH) for participants born in 1921-26 are used to identify associations which occur in practice, and national cross- sectional data from Australian Censuses and National Health Surveys are used to illustrate the evolution of bias over approximately ten years.
Results: The hypothetical situations illustrate how death and other attrition can theoretically affect changes in bias over time. Between 1996 and 2008, 28.4% of ALSWH participants died, 16.5% withdrew and 10.4% were lost to follow up. There were differential associations with various risk factors, for example, non-English speaking country of birth was associated with non-death attrition but not death whereas being underweight (body mass index < 18.5) was associated with death but not other forms of attrition. Compared to national data, underrepresentation of women with non-English speaking country of birth increased from 3.9% to 7.2% and over-representation of current and ex-smoking increased from 2.6% to 5.8%.
Conclusions: Deaths occur in both the target population and study cohort, while other forms of attrition occur only in the study cohort. Therefore non-death attrition may cause greater bias than death in longitudinal studies. However although more than a quarter of the oldest participants in the ALSWH died in the 12 years following recruitment, differences from the national population changed only slightly.
Methods: While no current guidelines on the use of screening instruments in nursing homes were found, relevant extant guidelines were consulted. The literature on measurement development, testing standards, psychometric considerations and the nursing home environment were consulted.
Results: Cognitive, psychiatric, behavioral, functional and omnibus screening instruments are described at a category level, along with specifics about their use in a RACF environment. Issues surrounding the selection, administration, interpretation and uses of screening instruments in RACFs are discussed. Issues of international interest (such as translation of measures) or clinical concern (e.g. impact of severe cognitive decline on assessment) are addressed. Practical points surrounding who can administer, score and interpret such screens, as well as their psychometric and clinical strengths more broadly, are articulated.
Conclusions: Guidelines for use of screening instruments in the RACF environment are offered, together with broad recommendations concerning the appropriate use of brief screening instruments in RACFs. Directions for future research and policy directions are outlined, with particular reference to the international context.
Methods: A large multinational survey of geropsychology content in university-based clinical and counselling psychology training programs was conducted in 2007 in the U.S.A., Australia, and Canada. Both clinical/counseling programs and internship/practicum placements were surveyed as to staffing, didactic content and training opportunities with respect to geropsychology.
Results: Survey response rates varied from 15% in the U.S.A. (n = 46), 70% in Australia (n = 25) to 91.5% in Canada (n = 22). The U.S.A. and Australia reported specialist concentrations in geropsychology within graduate clinical psychology training programs. More assessment and psychopathology courses in the three countries were cited as having ageing content than psychotherapy courses. Many non-specialist programs in all three countries offered course work in geropsychology, and many had staff who specialized in working clinically with an older population. Interest in expanding aging courses and placements was cited by several training sites. Recruiting staff and finding appropriate placement opportunities with older adult populations were cited as barriers to expanding geropsychology offerings.
Conclusions: In light of our results, we conclude with a discussion of innovative means of engaging students with ageing content/populations, and suggestions for overcoming staffing and placement shortcomings.
Methods: The study was cross-sectional in design. The sample comprised 460 Portuguese undergraduate students enrolled in degrees in nursing, social work, and psychology. They were asked to complete questionnaires and quizzes, which were analyzed using contingency tables and one way analysis of variance for inter-group comparison, and then subjected to multivariate logistic regression analysis.
Results: Significant differences emerged between groups on knowledge, attitudes towards aging and interest in working with older adults, with both nursing and social work students displaying more positive attitudes, knowledge, and interest in working with older adults, when compared with psychology students. A regression analysis indicated that attitudes, knowledge, and previous formal contact were significant predictors of interest.
Conclusion: Interest in working with older adults was significantly related to positive attitudes, more knowledge and formal previous contact. Positive attitudes towards older adults can be promoted through interaction with faculty members and experts, knowledge acquisition about normative changes with age, and contact with healthy and impaired older adults.
Methods: We generated a large number of potential items de novo and by reference to existing anxiety scales, and then reduced the number of items to 60 through consultation with a reference group consisting of psychologists, psychiatrists
and normal elderly people. We then tested the psychometric properties of these 60 items in 452 normal old people and 46 patients attending a psychogeriatric service. We were able to reduce the number of items to 20. We chose a 1-week
perspective and a dichotomous response scale.
Results: Cronbach’s α for the 20-item Geriatric Anxiety Inventory (GAI) was 0.91 among normal elderly people and 0.93 in the psychogeriatric sample. Concurrent validity with a variety of other measures was demonstrated in both the normal sample and the psychogeriatric sample. Inter-rater and test–retest
reliability were found to be excellent. Receiver operating characteristic analysis indicated a cut-point of 10/11 for the detection of DSM-IV Generalized Anxiety Disorder (GAD) in the psychogeriatric sample, with 83% of patients correctly
classified with a specificity of 84% and a sensitivity of 75%.
Conclusions: The GAI is a new 20-item self-report or nurse-administered scale that measures dimensional anxiety in elderly people. It has sound psychometric properties. Initial clinical testing indicates that it is able to discriminate between those with and without any anxiety disorder and between those with and without DSM-IV GAD.
Methods: This is a cross-sectional study of randomly selected, community-residing, older women (N = 284; mean age 72.2 years) using receiver operating characteristic (ROC) analyses. DSM-IV diagnostic interviews were undertaken using the Mini International Diagnostic Interview, fifth edition (MINI-V).
Results: We developed a 5-item version of the Geriatric Anxiety Inventory, which we have termed the Geriatric Anxiety Inventory – Short Form (GAI-SF). We found that a score of three or greater was optimal for the detection of DSM-IV Generalized Anxiety Disorder (GAD) in this community sample. At this cut-point, sensitivity was 75%, specificity was 87%, and 86% of participants were correctly classified. GAI-SF score was not related to age, MMSE score, level of education or perceived income adequacy. Internal consistency was high (Cronbach’s α = 0.81) and concurrent validity against the State-Trait Anxiety Inventory was good (rs = 0.48, p < 0.001).
Conclusions: The GAI-SF is a short form of the Geriatric Anxiety Inventory, which we recommend for use in epidemiological studies. It may also be useful in primary care and acute geriatric medical settings.
Method: Cross-sectional study of a population-based cohort of women aged 60 years and over (N ¼ 286).
Results: The GAI exhibited sound internal consistency and demonstrated good concurrent validity against the state half of the Spielberger State Trait Anxiety Inventory and the neuroticism domain of the NEO five-factor inventory. GAI score was significantly associated with self-reported sleep difficulties and perceived memory impairment, but not with age or cognitive function. Women with current DSM-IV Generalized Anxiety Disorder (GAD) had significantly higher GAI scores than women without such a history. In this cohort, the optimal cut-point to detect current GAD was 8/9. Although the GAI was designed to have few somatic items, women with a greater number of general medical problems or who rated their general health as worse had higher GAI scores.
Conclusion: The GAI is a new scale designed specifically to measure anxiety in older people. In this Australian cohort of older women, the instrument had sound psychometric properties.
The advent of global population ageing raises understandable concerns about the high-prevalence mental disorders in older people. Accordingly, this review covers recently published scientific articles concerning anxiety and depression. Recent findings
There is a paucity of findings on anxiety in older people, although the availability of several new scales suggests increased interest in this topic. The low prevalence of late- life depression in many population surveys does not appear to be due to misattribution of depressive symptoms to physical disorders. Although it is well established that dementia leads to depression, there is now increasing evidence for the proposition that depression leads to cognitive decline and dementia. There is now good evidence also for a bidirectional relationship between obesity and depression. The prognosis of treated late-life depression varies with baseline neuropsychological function and the severity of white matter hyperintensities.
Summary
An excellent body of research on depression in older people is now available, although more work on both pharmacological and nonpharmacological treatments is needed. More research is urgently required into anxiety disorders in older people. These are highly prevalent and associated with considerable disease burden. As the literature on depression in older people reaches maturity, there should be greater research and clinical interest in anxiety.
Objective: Elaborate the semantic equivalence of the Geriatric Anxiety Inventory to Brazilian Portuguese.
Method: The cross-cultural adaptation process consisted in four steps: two translations, two back- translations, both made by independent translators, the development of a synthetic version, and a pretest applied in a population sample.
Results: For each item of the instrument, we present the results of four steps. Throughout the process, any problems found could be solved by ensuring the quality of the instrument and its appropriateness to the population to which it is intended.
Discussion: The use of four-step method proved effective and safe in the process of semantic equivalence.
Methods: A literature search regarding specific phobia in older adults was carried out using PubMed. Relevant articles were selected and scanned for further pertinent references. In addition, relevant references related to differential diagnosis and assessment were used.
Results: Etiologic factors, specificity of feared stimulus or situation, fear predictability and the nature of phobic situations are key points to be assessed when implementing a differential diagnosis of specific phobia.
Conclusions: First, age-related sensory impairments are common and interfere both with information processing and communication. Second, medical illnesses create symptoms that might cause, interfere with, or mimic anxiety. Third, cohort effects might result in underreporting, through the inability to communicate or recognize anxiety symptoms, misattributing them to physical conditions. Finally, diagnostic criteria and screening instruments were usually developed using younger samples and are therefore not adapted to the functional and behavioral characteristics of older samples.
Methods: Differential associations between a risk factor and death and non-death attrition are considered under various hypothetical conditions. Empirical data from the Australian Longitudinal Study on Women’s Health (ALSWH) for participants born in 1921-26 are used to identify associations which occur in practice, and national cross- sectional data from Australian Censuses and National Health Surveys are used to illustrate the evolution of bias over approximately ten years.
Results: The hypothetical situations illustrate how death and other attrition can theoretically affect changes in bias over time. Between 1996 and 2008, 28.4% of ALSWH participants died, 16.5% withdrew and 10.4% were lost to follow up. There were differential associations with various risk factors, for example, non-English speaking country of birth was associated with non-death attrition but not death whereas being underweight (body mass index < 18.5) was associated with death but not other forms of attrition. Compared to national data, underrepresentation of women with non-English speaking country of birth increased from 3.9% to 7.2% and over-representation of current and ex-smoking increased from 2.6% to 5.8%.
Conclusions: Deaths occur in both the target population and study cohort, while other forms of attrition occur only in the study cohort. Therefore non-death attrition may cause greater bias than death in longitudinal studies. However although more than a quarter of the oldest participants in the ALSWH died in the 12 years following recruitment, differences from the national population changed only slightly.
Methods: While no current guidelines on the use of screening instruments in nursing homes were found, relevant extant guidelines were consulted. The literature on measurement development, testing standards, psychometric considerations and the nursing home environment were consulted.
Results: Cognitive, psychiatric, behavioral, functional and omnibus screening instruments are described at a category level, along with specifics about their use in a RACF environment. Issues surrounding the selection, administration, interpretation and uses of screening instruments in RACFs are discussed. Issues of international interest (such as translation of measures) or clinical concern (e.g. impact of severe cognitive decline on assessment) are addressed. Practical points surrounding who can administer, score and interpret such screens, as well as their psychometric and clinical strengths more broadly, are articulated.
Conclusions: Guidelines for use of screening instruments in the RACF environment are offered, together with broad recommendations concerning the appropriate use of brief screening instruments in RACFs. Directions for future research and policy directions are outlined, with particular reference to the international context.
Methods: A large multinational survey of geropsychology content in university-based clinical and counselling psychology training programs was conducted in 2007 in the U.S.A., Australia, and Canada. Both clinical/counseling programs and internship/practicum placements were surveyed as to staffing, didactic content and training opportunities with respect to geropsychology.
Results: Survey response rates varied from 15% in the U.S.A. (n = 46), 70% in Australia (n = 25) to 91.5% in Canada (n = 22). The U.S.A. and Australia reported specialist concentrations in geropsychology within graduate clinical psychology training programs. More assessment and psychopathology courses in the three countries were cited as having ageing content than psychotherapy courses. Many non-specialist programs in all three countries offered course work in geropsychology, and many had staff who specialized in working clinically with an older population. Interest in expanding aging courses and placements was cited by several training sites. Recruiting staff and finding appropriate placement opportunities with older adult populations were cited as barriers to expanding geropsychology offerings.
Conclusions: In light of our results, we conclude with a discussion of innovative means of engaging students with ageing content/populations, and suggestions for overcoming staffing and placement shortcomings.
Methods: The study was cross-sectional in design. The sample comprised 460 Portuguese undergraduate students enrolled in degrees in nursing, social work, and psychology. They were asked to complete questionnaires and quizzes, which were analyzed using contingency tables and one way analysis of variance for inter-group comparison, and then subjected to multivariate logistic regression analysis.
Results: Significant differences emerged between groups on knowledge, attitudes towards aging and interest in working with older adults, with both nursing and social work students displaying more positive attitudes, knowledge, and interest in working with older adults, when compared with psychology students. A regression analysis indicated that attitudes, knowledge, and previous formal contact were significant predictors of interest.
Conclusion: Interest in working with older adults was significantly related to positive attitudes, more knowledge and formal previous contact. Positive attitudes towards older adults can be promoted through interaction with faculty members and experts, knowledge acquisition about normative changes with age, and contact with healthy and impaired older adults.