Assessment of anxiety in older adults: a review of self-report measures

Associations between self-reported ADHD symptoms and depression and anxiety in mothers and fathers during the postpartum period: A Canadian nationwide longitudinal study

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) may be a risk factor for intra- and inter-parental affective disorders in the perinatal period, placing families at risk for negative outcomes.

METHODS

A large prospective cohort of Canadian women and their male partners (N = 2544 couples) were recruited in the postpartum period. Repeated measures data were collected at baseline and six timepoints over 24-months postpartum. Self-reported ADHD symptoms were measured at baseline, and depression/anxiety were measured at all timepoints. Generalized estimating equations examined associations between possible ADHD and ADHD symptoms with new depression, anxiety, and comorbidity. Cross-parental associations were explored.

RESULTS

Compared to mothers without, those with possible ADHD had higher odds of depression (adjusted odds ratio [aOR] = 1.70, 95 % CI [1.13-2.56]), anxiety (aOR = 1.74 [1.30-2.34]), and comorbidity (aOR = 1.66, [1.06-2.60]), at 3-24 months postpartum. Maternal ADHD symptoms were associated with anxiety in fathers (aOR = 1.03 [1.01-1.06] for 1-unit increase in symptoms) at 3-24-months. When compared to fathers without, those with possible ADHD had higher odds of depression (aOR = 2.33 [1.78-3.05]), anxiety (aOR = 2.02, [1.60-2.55]), and comorbidity (aOR = 2.05, [1.51-2.79]), as well as paternal ADHD symptoms associated with depression (aOR = 1.05, [1.01-1.08] for 1-unit increase in symptoms) and comorbidity (aOR = 1.04 [1.00-1.08] for 1-unit increase in symptoms) in mothers at 3-24-months.

LIMITATIONS

Self-reported measures.

CONCLUSIONS

Parental ADHD in the postpartum period is associated with depression and anxiety among mothers and fathers. Paternal ADHD was a risk for maternal mental health problems in the early postpartum period, and maternal ADHD was a risk for paternal mental health problems in the late postpartum period.

Cognitive Deficits in Late-Life Depression: From Symptoms and Assessment to Therapeutics

Cognitive symptoms and deficits are core features of late-life depression (LLD), with an estimated 20%-50% of affected individuals meeting diagnostic criteria for mild cognitive impairment (MCI). Cognitive deficits, especially executive dysfunction, have consistently been associated with poorer treatment outcomes among people with LLD. Furthermore, distinguishing depression with cognitive complaints or cognitive impairment from the early stages of Alzheimer's disease (AD) can be challenging. Cognitive concerns are often emphasized among those with LLD, although, paradoxically, their description of memory difficulty may include detailed recall of specific memory lapses. Conversely, people with AD often have limited insight into their progressive cognitive decline, minimizing and concealing their cognitive difficulties. Neuropsychological assessment is one of the most useful means of clarifying this differential diagnosis. A subcortical cognitive pattern is commonly observed among people with LLD, including psychomotor slowing, variable attention, and executive dysfunction, which can affect memory encoding and free recall. A broad range of therapeutic approaches have been applied to older adults experiencing LLD along with cognitive symptoms, MCI, or dementia. Most studies focus on treatments to address LLD or MCI, with relatively fewer examining treatments specifically at this intersection. Nonpharmacological strategies, including aerobic exercise, cognitive remediation, and neuromodulation, are highly recommended to improve both depression and cognition. Antidepressants may have benefits for elements of cognition among people with LLD, but they have less evidence for their efficacy for people with cognitive deficits and dementia. This review provides an updated conceptual and practical framework for clinicians evaluating and treating LLD.

Using the 5Ms Framework to Advance Aging-Responsive Care for Heart Failure with Reduced Ejection Fraction

Complexity of care is the inevitable consequence of an aging population and is particularly true in instances where patients are managing chronic conditions such as heart failure with reduced ejection fraction (HFrEF). HFrEF itself is complex, with an undulating course of illness, increased risk of sudden cardiac death, and myriad accompanying treatment considerations. Generalist management of HFrEF among older patients is further complicated by competing comorbidities, potential for financial toxicity, potential for mental health symptoms, and risk of care with does not align with goals and preferences. The 5Ms (multicomplexity, mind, mobility, medications, and matters most) is a holistic conceptualization of care that has been applied to the care of older adults, including in gastroenterology, ICU care, oncology, and dentistry. In this narrative review, we present 5Ms Model of care for older adults with HFrEF.

Prevalence of depressive symptoms in people aged 50 years and older: A retrospective cross-sectional study

BACKGROUND

Depression is a serious health problem worldwide and is often associated with disability and reduced quality of life. In aging societies, early recognition of depression in older adults is highly relevant. Therefore, this study investigated the prevalence of depressive symptoms in individuals aged 50 and older with the aim to identify those at risk for major depression.

METHODS

We performed a retrospective cross-sectional study with data from 1000BRAINS to assess depressive symptoms in a sample of 1017 healthy adults aged 50 and older. The prevalence and dimension of depressive symptoms were measured by the Beck Depression Inventory II, and differences between demographic, clinical, and lifestyle-associated variables and the prevalence of depressive symptoms were analyzed.

RESULTS

Depressive symptoms were present in 21.3 % of the participants and were minimal in 14.2 %, mild in 4.5 %, moderate in 1.8 %, and severe in 0.8 %. The prevalence of depressive symptoms was highest in the age group 50 to 59 years, and the prevalence of severe depressive symptoms decreased with increasing age. A positive family history of depression, cognitive impairment, medication intake, and polyneuropathy were associated with significantly higher levels of depressive symptoms.

LIMITATIONS

The retrospective cross-sectional design and evaluation of depressive symptoms by a self-rating instrument may limit the generalizability of the results.

CONCLUSION

This study supports earlier findings of a higher prevalence of depressive symptoms among older adults. The group aged 50 to 59 appears to be particularly affected. Additionally, poor physical health, greater cognitive impairment, and sex-specific factors appear to contribute to depressive symptomatology.

Weight bias among students and employees in university settings: an exploratory study

BACKGROUND

Weight bias and stigmatization are highly prevalent in modern society, especially in educational settings, such as universities. Despite extensive documentation of the adverse consequences on students' daily functioning and psychological health, there is limited literature regarding factors associated with weight bias and its extent in Quebec universities.

OBJECTIVES

This exploratory study aims to assess the prevalence of weight bias and experiences of weight-related stigmatization, as well as to examine their associations with gender, psychological health problems, and status (students or employees) in a college environment in the province of Quebec.

METHODS

Participants were recruited via their university emails. A total of 292 students and 129 university employees participated in an online survey distributed via the secure REDCap platform. The following data was collected: sociodemographic information, status (students or employees), body weight, experiences of stigma, and prejudice towards people living with a higher weight (Fat Phobia Scale; FPS).

RESULTS

Approximately half of the respondents reported experiencing weight-related stigma (44.7%), and half indicated holding prejudice towards overweight people (51.1%), with a moderate rate of bias according to the FPS (3.25). Experience of weight-related stigma was found to be associated with gender (X2 = 7.88, p = 0.019), and a higher prevalence of psychological health problems (X2 = 9.41, p = 0.002), while having prejudice was associated with gender, with men scoring higher at the FPS (F = 7.64, p = 0.006), but not with the status (student or employee). The regression model identified significant effects of status [F(4, 347) = 2.856, p = 0.005] and the interaction between gender and status [F(4, 347) = -2.326, p = 0.021] on the FPS scores.

CONCLUSIONS

Various factors are associated with the experience of weight bias and stigmatization towards people with higher weight in the college population. Campaigns to prevent and reduce weight-related bias should be aimed specifically at staff members as well as students. Future research should examine weight bias internalization as a mediator between self-perceived weight and prejudice.

Validity and measurement invariance of abbreviated scales of the State-Trait Anxiety Inventory (STAI-Y) in a population of Italian young adults

Introduction

This study evaluates the validity and measurement invariance of the 8-item scales of the State-Trait Anxiety Inventory (STAI) across gender and age. Originally developed by Spielberger (STAI-Y), these scales have been shortened to create more efficient versions without compromising psychometric robustness.

Methods

A sample of Italian young adults, aged between 18 and 36 years, completed the abbreviated scales. The scales were assessed for internal consistency, convergent validity with the Endler Multidimensional Anxiety Scales (EMAS), and measurement invariance across gender and age.

Results

The results demonstrated excellent internal consistency and significant correlations with the EMAS, supporting the convergent validity of the STAI-S-8 and STAI-T-8. Both scales retained balanced factorial structures and robust anxiety measurement capabilities. Measurement invariance was confirmed across gender and age, indicating the scales' reliability for anxiety assessment in young adults regardless of demographic differences.

Discussion

While the findings underscore the practical utility of the 8-item STAI scales for rapid anxiety assessment in clinical and research settings, limitations include the absence of a clinical sample and reliance on self-report measures, which may introduce biases. Future research should include clinical populations and explore cultural differences in anxiety manifestation. Despite these limitations, the 8-item STAI scales offer valid, reliable, and efficient tools for measuring anxiety, with significant implications for timely interventions and enhanced psychological assessment.

Comparison of the Beck Anxiety Inventory and the Geriatric Anxiety Scale in an Older Adult Neurology Clinic Sample

OBJECTIVE

The Beck Anxiety Inventory (BAI) is a commonly used anxiety measure, but it was not specifically designed for use among older adults. Previous research has raised concern that it may inflate anxiety ratings among older adults because of its emphasis on physical symptoms. The Geriatric Anxiety Scale (GAS) is designed for older adults but has not been examined in a neurology clinic setting. This study sought to compare the psychometric properties of the BAI and the GAS in an older adult neurology clinic sample. An exploratory aim was to determine the influence of motor symptoms on anxiety scores.

METHOD

Participants included 68 adults age 60+ referred for a neuropsychological evaluation in an outpatient neurology clinic. Measures included the BAI, GAS, and the Montreal Cognitive Assessment (MoCA). Psychometric properties were determined. A McNemar test compared the proportion of anxiety classifications between the BAI and GAS. Referral source (cognitive disorder versus movement-oriented teams) was used as a proxy for grouping patients who were likely to have prominent motor symptoms versus those who were not. An independent t-test compared scale performance between these groups to examine the influence of motor symptoms on anxiety ratings.

RESULTS

Both scales had good internal consistency (GAS α = 0.93; BAI α = 0.88). Convergent validity (GAS and BAI: r = 0.81, p < .001) and discriminant validity (GAS and MoCA, r = 0.18, p = .20) were supported. The BAI detected anxiety among 40% of participants, while the GAS detected anxiety among 56%, which was a statistically significant difference (p = .002). Anxiety ratings did not differ based on referral source (t(66) = -1.59, p = .12).

CONCLUSION

Both scales had good psychometric properties, though the GAS detected a higher rate of anxiety compared to the BAI despite having less focus on motor symptoms that could be attributed to age-related physical changes or movement disorders. The GAS may capture aspects of anxiety not assessed by the BAI among older adults.

Study on the relationship between indoor ventilation frequency and anxiety and depression symptoms in older persons: based on the data of 2018 CLHLS

BACKGROUND

To investigate the association between indoor ventilation frequency and symptoms of depression and anxiety in older persons.

METHODS

A binary logistic regression model was used to analyze the effects of indoor ventilation frequency on depression and anxiety by using data from the 2018 Chinese longitudinal healthy longevity survey (CLHLS).

RESULTS

A total of 9,690 older persons with an average age of (83.20 ± 11.27) years were included, including 4,458 males (46.0%) and 5,232 females (54.0%). The average score of indoor ventilation frequency was (6.06 ± 1.98) points, including 770 people (7.9%) with low frequency, 3,066 people (31.6%) with medium frequency, and 5,854 people (60.4%) with high frequency. 842 (8.7%) had symptoms of depression and 204 (2.1%) had symptoms of anxiety. Compared with the older persons with low indoor ventilation frequency, the older persons with higher ventilation frequency had a lower incidence of depression (OR(95%CI) = 1.92 (1.50 ∼ 2.46), 1.51 (1.27 ∼ 1.79); P < 0.001). However indoor ventilation frequency was not associated with anxiety symptoms.

CONCLUSION

Indoor ventilation frequency is related to depressive symptoms in older persons. Communities and families should pay more attention to indoor ventilation and intervene in time to promote and improve the mental health of older persons.

Factors associated with anxiety and fear of falling in older adults: A rapid systematic review of reviews

BACKGROUND

Anxiety disorders are prevalent amongst older adults and negatively impact their quality-of-life and health. Anxiety disorders often go undetected or are misattributed to age-related changes. The aim of this systematic review of reviews, was to synthesize existing evidence on risk factors associated with anxiety in older adults to improve opportunities for early detection and intervention.

METHODS

A rapid systematic review of reviews was performed. Studies were included if they were systematic reviews, specific to older adults, reported modifiable or non-modifiable factors associated with increased or decreased frequency of anxiety, and reported on anxiety disorders or symptoms of anxiety (including fear of falling).

RESULTS

27 papers met criteria for inclusion. A total of 77 unique risk and protective factors across demographic, health, environmental, and psychosocial domains were identified. Recurrently identified risk factors for anxiety included female sex, health (e.g., multimorbidity, sensory impairments), physical functions (e.g., impaired balance, history of falls), psychological factors (e.g., fear of falling, depression), social isolation, and sleep disturbances, whereas good physical health and balance confidence were protective.

CONCLUSIONS

This review reinforces the multifaceted and complex nature of anxiety in older adults. The results synthesized, highlight risk factors that should prompt detection of older adults for anxiety disorders and provide valuable insight for the development of tailored detection tools that better identify older adults at risk. Future research should address methodological limitations and include more diverse populations to improve opportunities for early detection and intervention in this vulnerable population.

Leptin, ghrelin and high-molecular-weight adiponectin in relation to anxiety in older adults

BACKGROUND

Leptin and ghrelin have been linked to depressive symptoms in older adults. There is a large overlap between depression and anxiety in this group. It is unclear whether the same associations exist with anxiety. Adiponectin has an inverse association with anxiety in older adults. However, the association between the most biologically active isoform - high-molecular-weight (HMW) adiponectin - and anxiety has not been previously reported.

METHODS

We analyzed the association between leptin, ghrelin and HMW adiponectin and general symptoms of anxiety (HADS-A score ≥ 7) at baseline and after three years of follow-up in a population based cohort of older adults in the Netherlands (n = 898) using multivariable logistic regression analyses.

RESULTS

For leptin there was significant effect modification by sex. We found a positive association between leptin and general symptoms of anxiety in men at baseline and after three years of follow-up after adjusting for depressive symptoms, when comparing the third to the first leptin tertile (T3 vs T1 OR 3.40, 95 % CI 1.08 - 10.78). We found no significant associations for ghrelin. HMW adiponectin was associated with general symptoms of anxiety at follow up. We found a positive association both before and after adjustment for depressive symptoms (T3 vs T1 OR 3.26, 95 % CI 1.36 - 7.83).

CONCLUSIONS

Our results showed significant associations in men only between leptin and HMW adiponectin and general symptoms of anxiety after three years of follow up. Our findings contribute to further insight into the pathophysiology of anxiety in older adults. However, further research is necessary as we show associations.

A latent profile analysis and network analysis of anxiety and depression symptoms in Chinese widowed elderly

BACKGROUND

Widowhood, as a traumatic event in the aging process, may lead to adverse psychological consequences such as anxiety and depression. However, the heterogeneity of anxiety and depression comorbidity patterns in widowed elderly and the interrelationships between symptoms have not been adequately studied.

METHOD

10,239 elderly aged 65 years and older were screened from the Chinese Longitudinal Healthy Longevity Survey (CLHLS 2017-2018), to assess depression and anxiety using the Center for Epidemiologic Studies Depression Scale (CESD) and the 7-item Generalized Anxiety Disorder Questionnaire (GAD). The subgroups of widowed elderly with similar patterns of symptoms were identified by latent profile analysis (LPA). The structure of anxiety-depressive comorbidity network was characterized using "bridge expected influence" as centrality indices. Network stability was tested using a case drop bootstrap program. A network comparison test (NCT) was performed to examine the differences in network characteristics across LPA subgroups.

RESULT

LPA identified dichotomous profiles: low comorbid (n = 4457) and high comorbid (n = 692). NCT revealed a significant difference in the global strength between networks (S = 0.631, p < 0.001). GAD1 (Nervousness or anxiety) is the common bridging symptom for both networks, while the bridging symptom for the high comorbidity network also includes GAD3 (Generalized worry).

LIMITATIONS

Cross-sectional methods are unable to verify causal relationships, and further randomized controlled trials are warranted.

CONCLUSION

Anxiety-depressive pattern in Chinese widowed elderly can be categorized into a low comorbid or a high comorbid group. GAD3 (Generalized worry) can be used as the core intervention target during intervention.

Photobiomodulation in the aging brain: a systematic review from animal models to humans

Aging is a multifactorial biological process that may be associated with cognitive decline. Photobiomodulation (PBM) is a non-pharmacological therapy that shows promising results in the treatment or prevention of age-related cognitive impairments. The aim of this review is to compile the preclinical and clinical evidence of the effect of PBM during aging in healthy and pathological conditions, including behavioral analysis and neuropsychological assessment, as well as brain-related modifications. 37 studies were identified by searching in PubMed, Scopus, and PsycInfo databases. Most studies use wavelengths of 800, 810, or 1064 nm but intensity and days of application were highly variable. In animal studies, it has been shown improvements in spatial memory, episodic-like memory, social memory, while different results have been found in recognition memory. Locomotor activity improved in Parkinson disease models. In healthy aged humans, it has been outlined improvements in working memory, cognitive inhibition, and lexical/semantic access, while general cognition was mainly enhanced on Alzheimer disease or mild cognitive impairment. Anxiety assessment is scarce and shows mixed results. As for brain activity, results outline promising effects of PBM in reversing metabolic alterations and enhancing mitochondrial function, as evidenced by restored CCO activity and ATP levels. Additionally, PBM demonstrated neuroprotective, anti-inflammatory, immunomodulatory and hemodynamic effects. The findings suggest that PBM holds promise as a non-invasive intervention for enhancing cognitive function, and in the modulation of brain functional reorganization. It is necessary to develop standardized protocols for the correct, beneficial, and homogeneous use of PBM.

Anxiety Disorders in Later Life

Contrary to ageist stereotypes, anxiety disorders are less common in older compared with younger adults. However, anxiety is often under-recognized and undertreated in this population. Anxiety disorders affect around 1 in 10 older adults, are unremitting, and are associated with a range of negative outcomes, including increased risk of depression, cognitive and functional decline, physical health problems, increased healthcare use, and suicide. This article summarizes the epidemiology and risk factors of anxiety in later life, explores variations in symptom presentation compared with younger adults, and outlines recommendations for assessment and treatment.

Prevalence of subthreshold depression in older adults: A systematic review and meta-analysis

BACKGROUND

The prevalence of subthreshold depression (StD) in older adults shows considerable variation across studies. This study aimed to determine the prevalence of subthreshold depression in elderly people.

METHODS

We conducted a thorough literature search across multiple databases, including PubMed, Web of Science, Medline, Cochrane Library, SinoMed, Wan Fang Data, CNKI, and VIP. Statistical analyses were carried out using STATA version 16.0. Our study was prospectively registered with PROSPERO (CRD42023494210).

RESULTS

Seventy-seven studies involving 225,232 individuals were included in this meta-analysis. The overall prevalence of subthreshold depression was 18.6 % (95 % CI: 16.0 %-21.2 %, I2 =99.8 %, p<0.001. Subgroup analyses showed the prevalence of StD in older adults varied depending on the screening tools used and the continent of the study. Funnel plots and Egger's test did not reveal any significant publication bias (Egger's test: p = 0.057).

CONCLUSION

The prevalence of subthreshold depression in older adults is high, suggesting attention needs to be paid to the mental health of the elderly. To prevent a larger public health issue, it is imperative to implement timely and effective preventive measures and interventions, focusing on early detection and intervention.

Optimizing Care Across the Continuum for Older Adults with Lung Cancer: A Review

Older adults with lung cancer experience inferior clinical outcomes compared to their younger counterparts. This review provides the scaffolding to address these disparities by delineating (1) the distinct and varied care needs of older adults with lung malignancies, (2) evidence-based measures for identifying subgroups within this population meriting tailored approaches to care, (3) age-specific considerations for the selection of cancer-directed therapy, and (4) opportunities for future work to enhance clinical outcomes and care delivery.

Rumination in dementia and its relationship with depression, anxiety, and attentional biases

Rumination (self-referential and repetitive thinking), attentional biases (AB), and impaired cognitive control are theorized as being integral factors in depression and anxiety. Yet, research examining the relationship between rumination, mood, and AB for populations with reduced cognitive control, e.g., people living with dementia (PwD), is lacking. To explore whether literature-based relationships are demonstrated in dementia, PwD (n = 64) and healthy controls (HC) (n = 75) completed an online self-report survey measuring rumination and mood (twice), and a telephone cognitive status interview (once). Rumination was measured as an emotion-regulation style, thinking style, and response to depression. We examined the test-retest reliability of PwD's (n = 50) ruminative-scale responses, ruminative-scale internal consistency, and correlations between rumination, age, cognitive ability, and mood scores. Also, nine participants (PwD = 6, HC = 3) completed an AB measure via eye-tracking. Participants fixated on a cross, naturally viewed pairs of facial images conveying sad, angry, happy, and neutral emotions, and then fixated on a dot. Exploratory analyses of emotional-face dwell-times versus rumination and mood scores were conducted. Except for the HC group's reflective response to depression measure, rumination measures were reliable, and correlation strengths between rumination and mood scores (.29 to .79) were in line with literature for both groups. For the AB measure subgroup, ruminative thinking style scores and angry-face metrics were negatively correlated. The results of this study show that literature-based relationships between rumination, depression, and anxiety are demonstrated in dementia, but the relationship between rumination and AB requires further investigation.

Social connection and self-neglect: A case for broader exploration

OBJECTIVE

Self-neglect (SN) is the most common report to Adult Protective Services (APS) and is associated with significant morbidity and mortality risks for older adults. Lack of instrumental support is a well-evidenced etiologic factor in the development and continuation of SN, but little is known about other modifiable social connection characteristics. The social connection framework provides evidence-based characteristics across structure, function, and quality missing from SN studies that could be identified if explored. These factors could provide prevention and intervention targets related to poor health.

METHODS

A narrative case study is presented using quantitative and qualitative data to explore social connection across structure, function, and quality in the context of SN.

RESULTS

The findings highlight the complexity of social connection that may be observed in SN cases reported to APS. Strategic utilization of direct and indirect social interventions to support social connection in this case are presented.

CONCLUSION

The results from this case give rise to considerations that may be generalizable to other SN cases. Recommendations for future research on social connection in this population are provided.

Turkish adaptation of the state-trait anxiety inventory short version (STAIS-5, STAIT-5)

AIM

This study examines the validity and reliability of a Turkish version of the State-Trait Anxiety Inventory Short Version.

METHODS

The sample consisted of 306 people between the ages of 18-59 who agreed to participate in the study and met the inclusion criteria. Data were collected with the demographic questionnaire, State-Trait Anxiety Inventory Short Version, State-Trait Anxiety Inventory and Brief Fear of Negative Evaluation Scale.

RESULTS

All factor loadings of the State Anxiety Inventory Short Version were between 0.706 and 0.835, and those of the Trait Anxiety Inventory Short Version were between 0.694 and 0.810. The Cronbach alpha coefficients of the State and Trait Anxiety Inventory Short Version were calculated as 0.838 and 0.837, respectively. There was a significant difference between the first-test and retest values of the State Anxiety Inventory Short Version (p = 0.033) and no difference in the Trait Anxiety Inventory Short Version (p = 0.145).

CONCLUSIONS

The Turkish-adapted State-Trait Anxiety Inventory Short Version is a valid and reliable measurement tool to determine the anxiety levels of individuals aged 18-59.

Anger and anxiety in older adults: a cross-lagged examination

OBJECTIVES

Both anger and anxiety are common in older adulthood, with aversive consequences for individuals' physical and mental health. Theory suggests that anger can be an emotional response to the experience of anxiety. Similarly, anger can induce anxiety symptoms. Despite studies documenting the co-occurrence of anger and anxiety and their strong theoretical links, little is known about their temporal relationship. The primary aim of this study was to investigate the longitudinal cross-lagged relationship between anger expression, anger suppression, and anxiety.

METHODS

A large and representative sample of older adults (N=6,852) was utilized, with data collected in two waves at an interval of four years. All variables were measured using validated self-report scales.Data were analyzed using Structural Equation Modeling.

RESULTS

Results indicate that both anger suppression and anger expression are significant predictors of anxiety symptoms. Similarly, anxiety is a significant predictor of both anger suppression and anger expression.

CONCLUSIONS

The effects did not differ in magnitude, suggesting a balanced reciprocity between anger and anxiety. An understanding of this reciprocal association can inform interventions and strategies aimed at promoting emotional well-being in older individuals. By addressing both anger and anxiety concurrently, interventions may have a more comprehensive impact on improving mental health outcomes in this population.

Preoperative anxiety management for elderly patients undergoing cataract surgery: An integrative review

BACKGROUND

Preoperative anxiety in elderly cataract surgery patients presents challenges, demanding effective non-pharmacological interventions to ensure patient safety.

METHOD

A comprehensive review was conducted on PubMed, CINAHL, and Embase from 2013 to 2023. Twelve experimental studies were analyzed. Interventions such as music therapy, education videos, hand massages, and non-fasting protocols were evaluated, with anxiety measured using various scales and physiological indicators.

RESULT

Overall, the findings highlight the efficacy of these interventions in managing preoperative anxiety among elderly cataract surgery patients. Seven studies measured physiological indicators such as blood pressure or heart rate alongside anxiety scales, with four studies showing significant reductions of those indicators alongside anxiety reduction.

CONCLUSION

These non-pharmacological interventions offer an effective alternative to pharmacological approaches, enhancing patient safety and potentially reducing healthcare costs related to polypharmacy. The international scope of the studies suggests broad applicability across diverse cultural contexts, advocating for their inclusion in hospital protocols.

Understanding Anxiety in Cervical Dystonia: An Imaging Study

BACKGROUND

Anxiety may precede motor symptoms in cervical dystonia (CD) and is associated with an earlier onset of dystonia. Our understanding of anxiety in CD is inadequate.

OBJECTIVE

To investigate brain networks associated with anxiety in CD.

METHODS

Twenty-six subjects with idiopathic CD underwent MRI Brain without contrast. Correlational tractography was derived using Diffusion MRI connectometry. Quantitative Anisotropy (QA) was used in deterministic diffusion fiber tracking. Correlational tractography was then used to correlate QA with State-Trait Anxiety Inventory (STAI) state (STAI-S) and trait (STAI-T) subscales.

RESULTS

Connectometry analysis showed direct correlation between state anxiety and QA in tracts from amygdala to thalamus/ pulvinar bilaterally, and trait anxiety and QA in tracts from amygdala to motor cortex, sensorimotor cortex and parietal association area bilaterally (FDR ≤0.05).

CONCLUSION

Our efforts to map anxiety to brain networks in CD highlight the role of the amygdala in the pathophysiology of anxiety in CD.

The feasibility and impact of a brief behavioural intervention for anxiety in later life: perceptions of general practice nurses

BACKGROUND

Anxiety is prevalent in older people and is associated with adverse health outcomes. Early detection and intervention are imperative, yet clinically significant anxiety in older people is often under-diagnosed. When diagnosed, pharmacotherapy is often the initial treatment, but resistance due to stigma, polypharmacy concerns, and side effects are common among the elderly. Non-pharmacological interventions such as deep breathing and progressive muscle relaxation may offer more acceptable and cost-effective options to managing anxiety. While primary care is ideal for addressing anxiety in older adults, it is important to assess the feasibility and acceptability of nurse-led interventions in general practice.

OBJECTIVE

To explore the perspectives of General Practice Nurses (GPNs) on the feasibility and acceptability of implementing a guided relaxation intervention for older people living with symptoms of anxiety, in Australian metropolitan and regional settings.

METHODS

GPNs were trained and then administered a guided relaxation intervention to older people at three metropolitan general practices and one large rural practice encompassing four sites. Subsequently, five GPNs participated in semi-structured interviews exploring the acceptability and feasibility of implementing the intervention. Interviews were recorded, transcribed and findings were mapped to four key domains of interest: "Screening", "Training and Delivery", "Perceived impact of the Intervention" and "Barriers to the intervention".

RESULTS

Overall, GPNs reported that the intervention was easy to implement, was well received, helped build relationships and enabled conversations about mental health and well-being. They noted broader applicability of acquired knowledge and skills with other clients.

CONCLUSION

The intervention shows promise in promoting and supporting healthcare capabilities in primary care. GPNs are ideally placed to detect clinical symptoms of anxiety among older people and deliver brief well-being initiatives. However, to sustain and scale well-being interventions structured skill development, commitment from general practices, and policy shifts such as government rebates for GPNs are required.

Anxiety in adolescents and subsequent risk of suicidal behavior: A systematic review and meta-analysis

BACKGROUND

Suicide is a major public health concern, and anxiety is a prevalent developmental challenge in adolescents closely linked to suicidal behavior. This study aimed to assess the association between anxiety in adolescents and subsequent risk of suicidal behavior through a meta-analysis, offering crucial insights for suicide prevention.

METHODS

Six bibliographic databases were comprehensively searched to clarify the association between adolescents anxiety and subsequent risk of suicidal behavior. We used a fixed-effects model to determine the total pooled effect size estimate and reported odds ratios and the corresponding 95 % confidence intervals. Subgroup analysis, sensitivity analysis and publication bias analysis were conducted with Stata version 15.1.

RESULTS

The findings revealed a significant association between anxiety in adolescents and subsequent suicidal behavior (OR = 2.33, 95 % CI [2.00, 2.71]). Subgroup analyses indicated differences in mean effect size estimates based on clinical diagnoses and self-reported measures used to assess anxiety. The correlation strength between adolescent anxiety and subsequent suicidal behavior increased with a longer follow-up period. Furthermore, adolescents anxiety was associated with increased risk of subsequent suicidal ideation (OR = 1.97, 95 % CI [1.72, 2.25]) and attempts (OR = 3.56, 95 % CI [2.49, 5.07]). Finally, boys (OR = 2.41, 95 % CI [1.67, 3.47]) with anxiety had a greater risk of subsequent suicidal behavior than girls (OR = 2.02, 95 % CI [1.47, 2.78]).

CONCLUSION

This study revealed that adolescents anxiety increases the risk of suicidal behavior, including suicidal ideation and attempts. Consequently, there is a critical need for timely interventions tailored to adolescents with anxiety to prevent future instances of suicide.

Effect of physical activity for reducing anxiety symptoms in older adults: a meta-analysis of randomized controlled trials

BACKGROUND

Anxiety symptoms in older adults can significantly impact their well-being. Physical activity is increasingly recognized as a potential intervention to alleviate anxiety in this population. We conducted a systematic review and meta-analysis to explore the impact of physical activity on anxiety symptoms in geriatric individuals.

METHODS

A systematic search was conducted in MEDLINE (via PubMed), Scopus, and Embase databases until November 29, 2023. Two independent reviewers screened articles based on predefined inclusion criteria.

RESULTS

Eleven randomized controlled trials were included. These trials, involving 770 geriatric participants, demonstrated a significant overall effect of physical activity on reducing anxiety symptoms (SMD =-0.60, 95% CI: -0.88 to -0.32). Subgroup analysis based on type of intervention and duration of follow-up was performed. The results showed all types of exercises reduced anxiety symptoms compared to the control group. Furthermore, those studies with shorter follow-up (less than 10 weeks) did not show a statistically significant reduction in anxiety symptoms. Moderate heterogeneity was observed (I2 = 67%). Sensitivity analyses confirmed the robustness of the overall effect size. Funnel plot inspection and Egger's test (p = 0.36) suggested no signs of publication bias or small study effects.

CONCLUSION

This meta-analysis provides strong evidence that physical activity significantly reduces anxiety symptoms in older adults. The study highlights the differential effects of cardio and strength exercises and underscores the high quality of evidence supporting the anxiolytic benefits of physical activity in geriatric populations.

Detection of anxiety symptoms and disorders in older adults: a diagnostic accuracy systematic review

BACKGROUND

Anxiety symptoms and disorders are common in older adults and often go undetected. A systematic review was completed to identify tools that can be used to detect anxiety symptoms and disorders in community-dwelling older adults.

METHODS

MEDLINE, Embase and PsycINFO were searched using the search concepts anxiety, older adults and diagnostic accuracy in March 2023. Included articles assessed anxiety in community-dwelling older adults using an index anxiety tool and a gold standard form of anxiety assessment and reported resulting diagnostic accuracy outcomes. Estimates of pooled diagnostic accuracy outcomes were completed.

RESULTS

Twenty-three anxiety tools were identified from the 32 included articles. Pooled diagnostic accuracy outcomes were estimated for the Geriatric Anxiety Inventory (GAI)-20 [n = 3, sensitivity = 0.89, 95% confidence interval (CI) = 0.70-0.97, specificity = 0.80, 95% CI = 0.67-0.89] to detect generalized anxiety disorder (GAD) and for the GAI-20 (n = 3, cut off ≥ 9, sensitivity = 0.74, 95% CI = 0.62-0.83, specificity = 0.96, 95% CI = 0.74-1.00), Beck Anxiety Inventory (n = 3, sensitivity = 0.70, 95% CI = 0.58-0.79, specificity = 0.60, 95% CI = 0.51-0.68) and Hospital Anxiety and Depression Scale (HADS-A) (n = 3, sensitivity = 0.78, 95% CI = 0.60-0.89, specificity = 0.76, 95% CI = 0.60-0.87) to detect anxiety disorders in clinical samples.

CONCLUSION

The GAI-20 was the most studied tool and had adequate sensitivity while maintaining acceptable specificity when identifying GAD and anxiety disorders. The GAI-20, GAI-Short Form and HADS-A tools are supported for use in detecting anxiety in community-dwelling older adults. Brief, self-rated and easy-to-use tools may be the best options for anxiety detection in community-dwelling older adults given resource limitations. Clinicians may consider factors including patient comorbidities and anxiety prevalence when selecting a tool and cut off.

The traditional Chinese version of the Geriatric Anxiety Inventory: Psychometric properties and cutoff point for detecting anxiety

The study aimed to translate the Geriatric Anxiety Inventory into traditional Chinese (GAI-TC), examine its psychometric properties, and identify the optimal cutoff point. This research recruited 337 older adults from two community activity centers. Structured questionnaires were used, including demographic information and characteristics, the GAI-TC, and the State-Trait Anxiety Inventory (STAI). Cronbach's α of the GAI-TC was 0.93. The intraclass correlation coefficient was 0.90. The content validity index was 1.0. An exploratory factor analysis revealed that three factors in the GAI-TC, including cognition anxiety, impact of anxiety, and somatic anxiety, explained 59.46 % of the variance. The criterion-related validity showed a significant positive correlation between the GAI-TC and STAI, with an optimal cutoff of 9/10 for detecting anxiety in older persons living in the community. The GAI-TC had good reliability and validity and can provide professionals with a tool for the early identification of anxiety among older adults.

Prospective exploration of the role of combined internalizing symptoms in self-reported memory among older adults during the COVID-19 pandemic

OBJECTIVES

A growing literature suggests depression and anxiety increase risk of cognitive decline. However, few studies have examined their combined effects on cognition, among older adults, especially during periods of high stress.

METHOD

Based on a sample of community dwelling older adults (N = 576), we evaluated the effects of pre-pandemic anxiety and depressive symptoms, obtained in September 2018, to changes in self-reported memory (SRM) assessed 3 months into the COVID-19 pandemic.

RESULTS

In separate models, we found participants with depression scores at least 1-SD above the mean and participants with anxiety scores at least 2-SD above the mean to report a significant decline in SRM. Moderation analyses revealed those with high depressive symptoms (at or above the mean) showed a decrease in SRM regardless of anxiety. The extent to which high pre-pandemic anxiety symptoms influenced SRM is dependent on whether pre-pandemic depression was at or above the mean.

CONCLUSIONS

Pre-pandemic depression predicted a decline in SRM regardless of anxiety. Moderation analyses revealed that the extent to which anxiety symptoms influenced SRM was dependent on depression being at or above the mean. Those with high anxiety and depression are at highest risk of experiencing cognitive consequences related to stressful exposures like COVID-19.

Asian Cohort for Alzheimer Disease (ACAD) Pilot Study: Vietnamese Americans

INTRODUCTION

The objective of this pilot study was to establish the feasibility of recruiting older Vietnamese Americans for research addressing genetic and nongenetic risk factors for Alzheimer disease (AD).

METHODS

Twenty-six Vietnamese Americans were recruited from communities in San Diego. A Community Advisory Board provided cultural and linguistic advice. Bilingual/bicultural staff measured neuropsychological, neuropsychiatric, lifestyle, and medical/neurological functioning remotely. Saliva samples allowed DNA extraction. A consensus team reviewed clinical data to determine a diagnosis of normal control (NC), mild cognitive impairment (MCI), or dementia. Exploratory analyses addressed AD risk by measuring subjective cognitive complaints (SCC), depression, and vascular risk factors (VRFs).

RESULTS

Twenty-five participants completed the study (mean age=73.8 y). Eighty percent chose to communicate in Vietnamese. Referrals came primarily from word of mouth within Vietnamese communities. Diagnoses included 18 NC, 3 MCI, and 4 dementia. Participants reporting SCC acknowledged more depressive symptoms and had greater objective cognitive difficulty than those without SCC. Eighty-eight percent of participants reported at least 1 VRF.

DISCUSSION

This pilot study supports the feasibility of conducting community-based research in older Vietnamese Americans. Challenges included developing linguistically and culturally appropriate cognitive and neuropsychiatric assessment tools. Exploratory analyses addressing nongenetic AD risk factors suggest topics for future study.

A scoping review of functional near-infrared spectroscopy biomarkers in late-life depression: Depressive symptoms, cognitive functioning, and social functioning

Late-life depression is one of the most damaging mental illnesses, disrupting the normal lives of older people by causing chronic illness and cognitive impairment. Patients with late-life depression, accompanied by changes in appetite, insomnia, fatigue and guilt, are more likely to experience irritability, anxiety and somatic symptoms. It increases the risk of suicide and dementia and is a major challenge for the public health systems. The current clinical assessment, identification and effectiveness assessment of late-life depression are primarily based on history taking, mental status examination and scale scoring, which lack subjectivity and precision. Functional near-infrared spectroscopy is a rapidly developing optical imaging technology that objectively reflects the oxygenation of hemoglobin in different cerebral regions during different tasks and assesses the functional status of the cerebral cortex. This article presents a comprehensive review of the assessment of functional near-infrared spectroscopy technology in assessing depressive symptoms, social functioning, and cognitive functioning in patients with late-life depression. The use of functional near-infrared spectroscopy provides greater insight into the neurobiological mechanisms underlying depression and helps to assess these three aspects of functionality in depressed patients. In addition, the study discusses the limitations of previous research and explores potential advances in the field.

Mental health among centenarians living in Switzerland

BACKGROUND

Given the increasing number of people achieving exceptionally long lifespans, there is an urgent need for a better understanding of mental health in centenarians. This study aimed to understand the prevalence of mental health conditions-depressive symptoms, anxiety, sleep disturbances, disinhibition, and aberrant motor behaviour-among centenarians in Switzerland.

METHODS

Data were collected from N = 169 participants via telephone interviews or paper questionnaires, either directly from centenarians or through proxy informants. Half the data were collected during a period when protective measures were imposed due to the COVID-19 pandemic, and half were collected after the measures were lifted.

RESULTS

Mental health conditions were prevalent in our sample, particularly depressive symptoms (44.51%) and anxiety (42.17%). Significant positive associations were found between depressive symptoms and anxiety, and between disinhibition and aberrant motor behaviour. Furthermore, we identified statistical predictors for the occurrence of mental health conditions. Notably, institutionalised living increased the odds of depressive symptomatology, while those with higher education levels or an absence of cognitive impairment experienced more sleep disturbances. Finally, cognitive impairment was linked to increased disinhibition and aberrant motor behaviour.

CONCLUSIONS

The high prevalence of mental health conditions underscores the need for proactive mental health care strategies in advanced old age. Moreover, it is vital to consider the interconnected nature of mental health conditions and to prioritise vulnerable groups, such as centenarians in institutional settings.

Comparison of networks of loneliness, depressive symptoms, and anxiety symptoms in at-risk community-dwelling older adults before and during COVID-19

Network analysis provides an innovative approach to examining symptom-to-symptom interactions in mental health, and adverse external conditions may change the network structures. This study compared the networks of common risk factors and mental health problems (loneliness, depressive symptoms, and anxiety symptoms) in community-dwelling older people before and during COVID-19. Older adults (aged ≥ 60) at risk for depression were recruited through non-governmental organizations. Loneliness, depressive symptoms and anxiety symptoms were measured using the three-item Loneliness Scale (UCLA-3), nine-item Patient Health Questionnaire (PHQ-9), and seven-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Data from 2549 (before) and 3506 (during COVID-19) respondents were included using propensity score matching. Being restless (GAD-7-item5) was most central, indicated by Expected Influence, in both pre and during COVID-19 networks despite low severity (mean score). The network during COVID-19 had higher global strength and edge variability than the pre-pandemic network, suggesting easier symptom spread and potentially more complex symptom presentation. In addition, feeling isolated from others (UCLA-3-item3) had stronger connections with feeling worthless/guilty (PHQ-9-item6) and anticipatory anxiety (GAD-7-item7) during COVID-19 than before. These findings may enhance our knowledge of the symptom structure of common mental health problems and the impacts of the pandemic. Targeting central symptoms may offer novel preventive strategies for older people.

Sense of coherence, mental health, and hair cortisol concentrations among older people during the COVID -19 pandemic: a cross-sectional study

BACKGROUND

A person's sense of coherence (SoC) is likely to affect coping when exposed to a life changing event like the COVID -19 pandemic, which impacted the older population especially hard, an age group that already suffers from a lot of mental illness. Thus, the aim of this study was to investigate the associations between SoC and mental health in older adults using both screening scales and hair cortisol concentrations (HCC).

METHOD

A cross-sectional design studying a cohort of 70-80 years old, N = 260, set in Swedish primary care during the pandemic years 2021-2022. Instruments used are sense of coherence 13 (SoC-13), EQ-5D-3L, Geriatric depression scale 20 (GDS-20), Hospital anxiety and depression scale (HADS), and Perceived stress scale 10 (PSS-10). Sociodemography and factors concerning SoC, and mental health are explored. HCC are measured using radioimmunoassay. Outcome measures are factors independently associated with SoC. Linear regression models were performed with SoC as dependent variable, and priory path analyses explored whether associations with SoC were direct, or indirect via anxiety.

RESULTS

SoC was significantly associated with anxiety (p < 0.001), perceived economic status (p = 0.003), belief in the future (p = 0.001), and perceived negative mental effect from the COVID -19 pandemic (p = 0.002). The latter was 96% indirectly associated with SoC (p < 0.001), whereas perceived economic status together with belief in the future was 82% directly associated with SoC (p = 0.17). HCC and sex were not significantly associated with SoC, but, noticeably, high HCC was equally distributed between women and men. Women reported significantly lower quality of life (p = 0.03), and more symptoms of anxiety (p = 0.001) and depression (p < 0.001).

CONCLUSION

Anxiety, belief in the future, perceived negative effect on mental health due to the pandemic, and perceived economic status were significantly associated with SoC. Anxiety is suggested to be important in explaining the association between perceived negative mental effect from the COVID-19 pandemic and SoC. Women reported significantly poorer mental health and life quality than men.

[Interpretation of a concept for functional movement disorders from the perspective of older patients]

A recently published concept considers a significant proportion of the occurrence and persistence of functional movement disorders (FMD) to be explained by increased/incorrect weighting of the expected movement (feedforward signal) in the presence of decreased/altered actual feedback of the movement. In the context of aging and age-associated diseases, there is an increased likelihood that these prerequisites will occur, also in combination. For example, the feedforward signal can be enhanced by accumulation of a wealth of experience but can for example become prone to error due to changes in attention and (fear of) falling. Conversely, the actual feedback is subject to age-related changes, such as reduction of sensory functions. This could explain why FMDs also occur in old age and offer treatment approaches for this so far poorly studied disorder. It follows that a specific focus on (the correction of) feedforward signals and strengthening as well as training of the actual feedback are potentially promising therapeutic approaches for older people with FMD.

Hybrid representation learning for cognitive diagnosis in late-life depression over 5 years with structural MRI

Late-life depression (LLD) is a highly prevalent mood disorder occurring in older adults and is frequently accompanied by cognitive impairment (CI). Studies have shown that LLD may increase the risk of Alzheimer's disease (AD). However, the heterogeneity of presentation of geriatric depression suggests that multiple biological mechanisms may underlie it. Current biological research on LLD progression incorporates machine learning that combines neuroimaging data with clinical observations. There are few studies on incident cognitive diagnostic outcomes in LLD based on structural MRI (sMRI). In this paper, we describe the development of a hybrid representation learning (HRL) framework for predicting cognitive diagnosis over 5 years based on T1-weighted sMRI data. Specifically, we first extract prediction-oriented MRI features via a deep neural network, and then integrate them with handcrafted MRI features via a Transformer encoder for cognitive diagnosis prediction. Two tasks are investigated in this work, including (1) identifying cognitively normal subjects with LLD and never-depressed older healthy subjects, and (2) identifying LLD subjects who developed CI (or even AD) and those who stayed cognitively normal over five years. We validate the proposed HRL on 294 subjects with T1-weighted MRIs from two clinically harmonized studies. Experimental results suggest that the HRL outperforms several classical machine learning and state-of-the-art deep learning methods in LLD identification and prediction tasks.

Psychometric Evaluation of a Tablet-Based Tool to Detect Mild Cognitive Impairment in Older Adults: Mixed Methods Study

BACKGROUND

With the rapid aging of the global population, the prevalence of mild cognitive impairment (MCI) and dementia is anticipated to surge worldwide. MCI serves as an intermediary stage between normal aging and dementia, necessitating more sensitive and effective screening tools for early identification and intervention. The BrainFx SCREEN is a novel digital tool designed to assess cognitive impairment. This study evaluated its efficacy as a screening tool for MCI in primary care settings, particularly in the context of an aging population and the growing integration of digital health solutions.

OBJECTIVE

The primary objective was to assess the validity, reliability, and applicability of the BrainFx SCREEN (hereafter, the SCREEN) for MCI screening in a primary care context. We conducted an exploratory study comparing the SCREEN with an established screening tool, the Quick Mild Cognitive Impairment (Qmci) screen.

METHODS

A concurrent mixed methods, prospective study using a quasi-experimental design was conducted with 147 participants from 5 primary care Family Health Teams (FHTs; characterized by multidisciplinary practice and capitated funding) across southwestern Ontario, Canada. Participants included health care practitioners, patients, and FHT administrative executives. Individuals aged ≥55 years with no history of MCI or diagnosis of dementia rostered in a participating FHT were eligible to participate. Participants were screened using both the SCREEN and Qmci. The study also incorporated the Geriatric Anxiety Scale-10 to assess general anxiety levels at each cognitive screening. The SCREEN's scoring was compared against that of the Qmci and the clinical judgment of health care professionals. Statistical analyses included sensitivity, specificity, internal consistency, and test-retest reliability assessments.

RESULTS

The study found that the SCREEN's longer administration time and complex scoring algorithm, which is proprietary and unavailable for independent analysis, presented challenges. Its internal consistency, indicated by a Cronbach α of 0.63, was below the acceptable threshold. The test-retest reliability also showed limitations, with moderate intraclass correlation coefficient (0.54) and inadequate κ (0.15) values. Sensitivity and specificity were consistent (63.25% and 74.07%, respectively) between cross-tabulation and discrepant analysis. In addition, the study faced limitations due to its demographic skew (96/147, 65.3% female, well-educated participants), the absence of a comprehensive gold standard for MCI diagnosis, and financial constraints limiting the inclusion of confirmatory neuropsychological testing.

CONCLUSIONS

The SCREEN, in its current form, does not meet the necessary criteria for an optimal MCI screening tool in primary care settings, primarily due to its longer administration time and lower reliability. As the number of digital health technologies increases and evolves, further testing and refinement of tools such as the SCREEN are essential to ensure their efficacy and reliability in real-world clinical settings. This study advocates for continued research in this rapidly advancing field to better serve the aging population.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/25520.

There is no association between anxiety and lifestyle in older adults during the COVID-19 pandemic: A cross-sectional study

Introduction and objective

The COVID-19 pandemic has caused mental health problems worldwide. Older people have been particularly affected by the lockdown as their health conditions have changed, although they have been kept in isolation to avoid exposure to contagion. We sought to determine the association between lifestyles and anxiety in older adults during the COVID-19 pandemic.

Materials and methods

This study was cross-sectional. We enrolled 150 older adults of both sexes and with a history of chronic diseases from the municipality of El Agustino (Lima, Peru). The 20-item Geriatric Anxiety Scale and the 25-item Lifestyle Questionnaire on eating, physical activity, rest, and sleep were administered in Spanish during July-August 2021.

Results

The mean age was 70.8 ± 8.1 years, 54.7% were male, and 75.3% practiced exercise. During the COVID-19 pandemic, 99.3% of the elderly had healthy lifestyles and 40% presented anxiety (mild, moderate, and severe anxiety in 26.7%, 8.7%, and 4.7%, respectively). We found no association between anxiety and lifestyle (p = 0.189), physical exercise was a predictor of lifestyle (p < 0.001) and we did not find predictors of anxiety symptoms (p > 0.05).

Conclusions

Our results suggest that there was no link between anxiety symptoms and lifestyle in older adults during the lockdown. It is important to conduct in-depth research on factors associated with anxiety symptoms among older residents in other regions, focusing on population groups with the highest rates of infection and death from COVID-19.

Psychometric properties of the GAD-7 (General Anxiety Disorder-7): a cross-sectional study of the Peruvian general population

BACKGROUND

Anxiety disorders are among the main mental health problems worldwide and are considered one of the most disabling conditions. Therefore, it is essential to have measurement tools that can be used to screen for anxiety symptoms in the general population and thus identify potential cases of people with anxiety symptoms and provide them with timely care. Our aim was to evaluate the psychometric properties of the General Anxiety Disorder-7 scale (GAD-7) in the Peruvian population.

METHOD

Our study was a cross-sectional study. The sample included people aged 12 to 65 years in Peru. Confirmatory factor analysis, analysis of measurement invariance, convergent validity with the Patient Health Questionnaire-9 (PHQ-9) and internal consistency analysis were performed.

RESULTS

In total, 4431 participants were included. The one-factor model showed the best fit (CFI = 0.994; TLI = 0.991; RMSEA = 0.068; WRMR = 1.567). The GAD-7 score showed measurement invariance between men and women and between age groups (adults vs. adolescents) (ΔCFI < 0.01). The internal consistency of the one-factor model was satisfactory (ω = 0.90, α = 0.93). The relationship between depressive symptoms (PHQ-9) and anxiety symptoms (GAD-7) presented a moderate correlation (r = 0.77).

CONCLUSIONS

Our study concluded that the GAD-7 score shows evidence of validity and reliability for the one-factor model. Furthermore, because the GAD-7 score is invariant, comparisons can be made between groups (i.e., by sex and age group). Finally, we recommend the use of the GAD-7 for the general population in the Peruvian context.

Primary outcome reporting in clinical trials for older adults with depression

BACKGROUND

Findings from randomised controlled trials (RCTs) are synthesised through meta-analyses, which inform evidence-based decision-making. When key details regarding trial outcomes are not fully reported, knowledge synthesis and uptake of findings into clinical practice are impeded.

AIMS

Our study assessed reporting of primary outcomes in RCTs for older adults with major depressive disorder (MDD).

METHOD

Trials published between 2011 and 2021, which assessed any intervention for adults aged ≥65 years with a MDD diagnosis, and that specified a single primary outcome were considered for inclusion in our study. Outcome reporting assessment was conducted independently and in duplicate with a 58-item checklist, used in developing the CONSORT-Outcomes statement, and information in each RCT was scored as 'fully reported', 'partially reported' or 'not reported', as applicable.

RESULTS

Thirty-one of 49 RCTs reported one primary outcome and were included in our study. Most trials (71%) did not fully report over half of the 58 checklist items. Items pertaining to outcome analyses and interpretation were fully reported by 65% or more of trials. Items reported less frequently included: outcome measurement instrument properties (varied from 3 to 30%) and justification of the criteria used to define clinically meaningful change (23%).

CONCLUSIONS

There is variability in how geriatric depression RCTs report primary outcomes, with omission of details regarding measurement, selection, justification and definition of clinically meaningful change. Outcome reporting deficiencies may hinder replicability and synthesis efforts that inform clinical guidelines and decision-making. The CONSORT-Outcomes guideline should be used when reporting geriatric depression RCTs.

Above and Beyond Number of Illnesses: A Two-Sample Replication of Current Approaches to Depressive Symptoms in Multimorbidity

OBJECTIVES

To expand current models of depressive symptoms in older adults with multimorbidity (MM) beyond the number of illnesses as a predictor of worsened mental health.

METHODS

Two-sample replication study of adults ≥62 years old with ≥ two chronic illnesses, who completed validated questionnaires assessing depressive symptoms, and disease- and treatment-related stressors. Data were analyzed using hierarchical linear regression.

RESULTS

The model of cumulative number of illnesses was worse at explaining variance in depressive symptoms (Sample 1 R2 = .035; Sample 2 R2 = .029), compared to models including disease- and treatment-related stressors (Sample 1 R2 = .37; Sample 2 R2 = .47). Disease-related stressors were the strongest factor associated with depressive symptoms, specifically, poor subjective cognitive function (Sample 1: b = -.202, p = .013; Sample 2: b = -.288, p < .001) and greater somatic symptoms (b = .455, p < .001; Sample 2: b = .355, p < .001).

CONCLUSIONS

Using the number of illnesses to understand depressive symptoms in MM is a limited approach. Models that move beyond descriptive relationships between MM and depressive symptoms are needed.

CLINICAL IMPLICATIONS

Providers should consider the role of somatic symptom management in patients with MM and depressive symptoms.

tDCS reduces depression and state anxiety symptoms in older adults from the augmenting cognitive training in older adults study (ACT)

BACKGROUND

Pharmacological interventions for depression and anxiety in older adults often have significant side effects, presenting the need for more tolerable alternatives. Transcranial direct current stimulation (tDCS) is a promising non-pharmacological intervention for depression in clinical populations. However, its effects on depression and anxiety symptoms, particularly in older adults from the general public, are understudied.

OBJECTIVE

We conducted a secondary analysis of the Augmenting Cognitive Training in Older Adults (ACT) trial to assess tDCS efficacy in reducing psychological symptoms in older adults. We hypothesized that active stimulation would yield greater reductions in depression and state anxiety compared to sham post-intervention and at the one-year follow-up. We also explored tDCS effects in subgroups characterized by baseline symptom severity.

METHODS

A sample of 378 older adults recruited from the community completed a 12-week tDCS intervention with cognitive or education training. Electrodes were placed at F3/F4, and participants received active or sham tDCS during training sessions. We assessed the association between tDCS group and changes in depression, state anxiety, and trait anxiety from baseline to post-intervention and one-year controlling for covariates.

RESULTS

The active tDCS group demonstrated greater reductions in depression and state anxiety compared to sham post-intervention, particularly in individuals with mild depression and moderate/severe state anxiety at baseline. Furthermore, the active tDCS group with moderate/severe state anxiety maintained greater symptom reductions at one-year.

CONCLUSIONS

tDCS effectively reduced depression and state anxiety symptoms in a large sample of older adults. These findings highlight the importance of considering symptom severity when identifying those who may benefit most from this intervention.

Efficacy and moderators of metacognitive training for depression in older adults (MCT-Silver): A randomized controlled trial

BACKGROUND

Up to 79 % of older adults with depression do not receive treatments commensurate with guideline recommendations. Metacognitive Training-Silver (MCT-Silver) is a low-intensity group training, which aims to reduce depressive symptoms by targeting (meta)cognitive beliefs.

METHODS

A randomized controlled trial comparing MCT-Silver (n = 41) to cognitive remediation (n = 39) was conducted with older adults with major depressive disorder and/or dysthymia. Clinician-rated depression (Hamilton Depression Rating Scale [HDRS, primary outcome]), self-reported depression (Beck Depression Inventory-II [BDI-II]), negative cognitive beliefs, positive metacognitive beliefs, rumination, health status, quality of life, and neurocognitive functioning were assessed at baseline, eight weeks (post) and three months (follow-up).

RESULTS

Both groups demonstrated moderate to large reductions in depression. No superior effects of MCT-Silver on clinician-rated depression (HDRS) were detected. MCT-Silver led to greater reductions in self-reported depression and rumination at post- and follow-up. Despite this, scores at post- and follow-up assessments were similar for both groups. MCT-Silver's effect on depressive symptoms was moderated by baseline rumination, positive metacognitive beliefs and previous treatment experience. MCT-Silver was evaluated as superior according to patient appraisals.

LIMITATIONS

Conclusions are limited by divergent findings on measures of depression and that the study was conducted during the COVID-19 pandemic.

CONCLUSIONS

Whereas no superior effect of MCT-Silver was found for the primary outcome, there was a significant effect of MCT-Silver for self-reported depression and rumination. Patients endorsing rumination and positive metacognitive beliefs as well as those without previous psychological treatment may benefit more from MCT-Silver.

Assessment of Depression in Adults and Youth

This article selectively reviews the key issues and measures for the assessment of depressive disorders and symptoms in youth and adults. The first portion of the article addresses the nature and conceptualization of depression and some key issues that must be considered in its assessment. Next, the diagnostic interview and clinician- and self-administered rating scales that are most widely used to diagnose, screen for, and assess the severity of depression in adults and youth are selectively reviewed. In addition, the assessment of three transdiagnostic clinical features (anhedonia, irritability, and suicidality) that are frequently associated with both depression and other forms of psychopathology is discussed. The article concludes with some broad recommendations for assessing depression in research and clinical practice and suggestions for future research.

Webcam-Based Eye-Tracking of Attentional Biases in Alzheimer's Disease: A Proof-Of-Concept Study

OBJECTIVES

To measure home-based older adults' attentional biases (AB) using webcam-based eye-tracking (WBET) and examine internal consistency.

METHODS

Twelve participants with and without cognitive impairment completed online self-report anxiety and depression screens, and a 96-trial dot-probe task with eye-gaze tracking. For each trial, participants fixated on a cross, free-viewed sad-neutral, sad-angry, sad-happy, angry-neutral, angry-happy, and happy-neutral facial expression pairings, and then fixated on a dot. In emotional-neutral pairings, the time spent looking (dwell-time) at neutral was averaged and subtracted from the emotional average to indicate biases "away from" (negative score) and "toward" (positive score) each emotional face. Internal consistency was estimated for dwell-times and bias scores using Cronbach's alpha and Spearman - Brown corrected split-half coefficients.

RESULTS

The full-cohort and a comorbid anxious and depressed sub-group (n = 6) displayed AB away from sad faces, and toward angry and happy faces, with happy-face AB being more pronounced. AB indices demonstrated low reliability except sub-group happy-face indices. Happy-face AB demonstrated the highest reliability.

CONCLUSIONS

AB measures were in-line with lab-based eye-tracking literature, providing some support for WBET-based measurement.

CLINICAL IMPLICATIONS

Establishing the feasibility of WBET-based measures is a step toward an objective home-based clinical tool. Literature-based suggestions are provided to improve reliability.

Effect of Jacobson's Progressive Muscle Relaxation on Anxiety and Happiness of Older Adults in the Nursing Home

Background

Older adults encounter serious psychological challenges in addition to physical problems. Reducing stress and anxiety, along with promoting happiness, is critical to maintaining the mental health of the elderly. Jacobson's Progressive Muscle Relaxation (JPMR) will lead to peace of mind by relieving physical stress. The present study aimed to investigate the effect of JPMR on the anxiety and happiness of older adults.

Materials and Methods

A single-group pretest-posttest design as a type of quasi-experimental study was conducted on 34 older adults living in a nursing home in Rasht, the north of Iran, in 2021. The intervention was performed one session per week, for 8 weeks. The research instruments included the Geriatric Anxiety Inventory (GAI) and the Oxford Happiness Inventory (OHI). Descriptive statistics and the Wilcoxon test were used for data analysis.

Results

After the intervention, the Mean (Standard Deviation [SD](of anxiety was 4.91 (1.96), and the Mean (SD) (of happiness was 37.18 (7.92). The mean score of anxiety among older adults after the intervention was significantly lower compared to the before intervention (Z = -4.73, p < 0.001). In addition, the mean score of happiness of the samples after the intervention was significantly higher compared to the before intervention (Z = -5.09, p < 0.001).

Conclusions

JPMR has a positive effect on reducing anxiety and promoting happiness in the elderly. Developing training programs and allocating time to non-pharmacological treatments such as JPMR for the elderly living in nursing homes will help make them happier and healthier.

Risk Factors for Long COVID in Older Adults

As time has passed following the COVID-19 pandemic, individuals infected with SARS-CoV-2 have gradually exhibited a variety of symptoms associated with long COVID in the postacute phase of infection. Simultaneously, in many countries worldwide, the process of population aging has been accelerating. Within this context, the elderly population has not only become susceptible and high-risk during the acute phase of COVID-19 but also has considerable risks when confronting long COVID. Elderly individuals possess specific immunological backgrounds, and during the process of aging, their immune systems can enter a state known as "immunosenescence". This further exacerbates "inflammaging" and the development of various comorbidities in elderly individuals, rendering them more susceptible to long COVID. Additionally, long COVID can inflict both physical and mental harm upon elderly people, thereby reducing their overall quality of life. Consequently, the impact of long COVID on elderly people should not be underestimated. This review seeks to summarize the infection characteristics and intrinsic factors of older adults during the COVID-19 pandemic, with a focus on the physical and mental impact of long COVID. Additionally, it aims to explore potential strategies to mitigate the risk of long COVID or other emerging infectious diseases among older adults in the future.

Optimizing a Technology-Based Body and Mind Intervention to Prevent Falls and Reduce Health Disparities in Low-Income Populations: Protocol for a Clustered Randomized Controlled Trial

BACKGROUND

The lack of health care coverage, low education, low motivation, and inconvenience remain barriers to participating in fall prevention programs, especially among low-income older adults. Low-income status also contributes to negative aging self-perceptions and is associated with a high perceived barrier to care. Existing fall prevention intervention technologies do not enable participants and practitioners to interact and collaborate, even with technologies that bring viable strategies to maintain independence, prevent disability, and increase access to quality care. Research is also limited on the use of technology to enhance motivation and help individuals align their perception with physiological fall risk. We developed a novel, 8-week Physio-Feedback Exercise Program (PEER), which includes (1) technology-based physio-feedback using a real-time portable innovative technology-the BTrackS Balance Tracking System, which is reliable and affordable, allows for home testing, and provides feedback and tracks balance progression; (2) cognitive reframing using the fall risk appraisal matrix; and (3) peer-led exercises focusing on balance, strength training, and incorporating exercises into daily activities.

OBJECTIVE

This study consists of 3 aims. Aim 1 is to examine the effects of the technology-based PEER intervention on fall risk, dynamic balance, and accelerometer-based physical activity (PA). Aim 2 is to examine the effects of the PEER intervention on fall risk appraisal shifting and negative self-perceptions of aging. Aim 3 is to explore participants' experiences with the PEER intervention and potential barriers to accessing and adopting the technology-based PEER intervention to inform future research.

METHODS

This is an intention-to-treat, single-blinded, parallel, 2-arm clustered randomized controlled trial study. We will collect data from 340 low-income older adults at baseline (T1) and measure outcomes after program completion (T2) and follow-up at 3 months (T3) and 6 months (T4). Participants will be enrolled if they meet all the following inclusion criteria: aged ≥60 years, cognitively intact, and able to stand without assistance. Exclusion criteria were as follows: a medical condition precluding exercise or PA, currently receiving treatment from a rehabilitation facility, plan to move within 1 year, hospitalized >3 times in the past 12 months, and does not speak English or Spanish.

RESULTS

As of August 2023, the enrollment of participants is ongoing.

CONCLUSIONS

This study addresses the public health problem by optimizing a customized, technology-driven approach that can operate in low-resource environments with unlimited users to prevent falls and reduce health disparities in low-income older adults. The PEER is a novel intervention that combines concepts of physio-feedback, cognitive reframing, and peer-led exercise by motivating a shift in self-estimation of fall risk to align with physiological fall risk to improve balance, PA, and negative aging self-perception.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05778604; https://www.clinicaltrials.gov/ct2/show/study/NCT05778604.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51899.

The Eight-Item Center for Epidemiological Studies Depression Scale in the English Longitudinal Study of Aging: Longitudinal and Gender Invariance, Sum Score Models, and External Associations

The disease burden of depression among older populations is high. Detecting changes in late-life depression is predicated on the seldom-examined assumption of longitudinal measurement invariance (MI). Therefore, we investigated longitudinal MI of the 8-item Center for Epidemiological Studies Depression Scale in core members repeatedly assessed in the English Longitudinal Study of Aging, a nine-wave representative study of the English population above 50 years of age (initial N = 11,391). Based on prior literature, we tested MI of a one-factor solution, a one-factor solution with correlated errors of reversely coded items, and a two-factor solution (depressed affect/somatic complaints). For all factor solutions, residual MI was confirmed across nine waves and gender. Sum score models (i.e., all factor loadings constrained to equity) had a good fit. Depression scores correlated with psychiatric diagnoses, ill health, lower life quality, and female gender. Associations slightly differed depending on the factor solutions, signifying their applicability across contexts.

Drawbacks and Unexpected Advantages of the Response to Modeling Posttraumatic Stress Disorder in Old Wistar Rats

In modeling post-traumatic stress disorder (PTSD), old Wistar rats exhibit the same general signs of a PTSD-like condition as young rats do. The ratio of testosterone to corticosterone levels was assessed as a new index and proved to provide a guideline for dividing the rat population into low- and high-anxiety groups when modeling PTSD. Several features were observed in behavior, psycho-emotional manifestations, hormone levels, and myocardial state in old rats. A sharp rise in circulating testosterone was for the first time shown to occur in old, but not young, rats in stress, contributing to a more rapid decision as to where to move in the labyrinth space. Priority data were obtained on dysfunctional accumulation of mitochondria in the myocardium in intact and stressed old rats. The information obtained may be useful in developing drugs against harmful consequences of PTSD and senile changes in the myocardium.

Prevalence of Anxiety and Associated Factors Among Inpatients with Type 2 Diabetes Mellitus in China: A Cross-Sectional Study

This study aimed to investigate the prevalence of anxiety and its associated factors among inpatients with type 2 diabetes mellitus (T2DM) in China. This study was a cross-sectional study. Inpatients with T2DM admitted to the Endocrinology Department of Xiangya Hospital, Central South University in Hunan Province of China from March 2021 to December 2021 were consecutively included in this study. Participants were interviewed to obtain the data on socio-demographic characteristics, lifestyle characteristics, T2DM-related information, and social support. Anxiety was measured using the Hospital Anxiety and Depression Scale-anxiety subscale by experienced physicians. Multivariable logistic regression analysis was used to estimate the independent contribution of each independent variable to anxiety. A total of 496 inpatients with T2DM were included in this study. The prevalence of anxiety was 21.8% (95% confidence interval [CI]: 18.1%-25.4%). The results of multivariable logistic regression analysis indicated that age of at least 60 (adjusted odd ratio [aOR] = 1.79, 95% CI: 1.04-3.08), and having diabetes specific complications (aOR = 4.78, 95% CI: 1.02-22.44) were risk factors for anxiety, and an educational level of high school or above (aOR = 0.55, 95% CI: 0.31-0.99), regular physical activity (aOR = 0.36, 95% CI: 0.22-0.58), and high social support (aOR = 0.30, 95% CI: 0.17-0.53) were protective factors for anxiety. A predictive model based on these five variables showed good performance (area under the curve = 0.80). Almost one in five inpatients with T2DM suffered from anxiety in China. Age, educational level, regular physical activity, diabetes specific complications, and social support were independently associated with anxiety.