Perceived anxiety control is associated with sleep disturbance in young and older adults

Objective: This study examined the extent to which perceived anxiety control was related to subjective sleep disturbance in young and older adults.

Method: Fifty-one young adults (18 to 30 years old) and 48 older adults (aged 65 years and older) completed questionnaires including the Pittsburgh Sleep Quality Index (PSQI) to assess sleep disturbance, Anxiety Control Questionnaire to assess perceived control over anxiety, a perceived health rating, and demographic questionnaire. Correlation and multivariable adjusted hierarchical regression analyses examined the extent to which anxiety control was associated with sleep disturbance.

Results: Anxiety control and health status were associated with global sleep quality on the PSQI, but no age differences in PSQI scores were found. In post hoc analyses, greater anxiety control was related to shorter sleep latency. Both older age and greater anxiety control were associated with less daytime dysfunction, whereas only older age was associated with better sleep quality.

Discussion: Although some variations in sleep quality by age were found, overall findings suggest that perceived anxiety control contributes to sleep disturbance in young and older adults. Greater anxiety control could lead to shorter sleep latency through reduced anxiety and worry symptoms at bedtime. Future studies should examine whether improved anxiety control with psychological treatments is one mechanism through which beneficial and lasting effects on sleep disturbance can be achieved.     

Reexamining the domain of hypochondriasis: Comparing the Illness Attitudes Scale to other approaches

The present study examined utility of the Illness Attitudes Scale (IAS; [Kellner, R. (1986). Somatization and hypochondriasis. New York: Praeger Publishers]) in a non-clinical college sample (N = 235). Relationships among five recently identified IAS dimensions (fear of illness and pain, symptom effects, treatment experience, disease conviction, and health habits) and self-report measures of several anxiety-related constructs (health anxiety, body vigilance, intolerance of uncertainty, anxiety sensitivity, and non-specific anxiety symptoms) were examined. In addition, this study investigated the incremental validity of the IAS dimensions in predicting medical utilization. The fear of illness and pain dimension and the symptom effects dimension consistently shared stronger relations with the anxiety-related constructs compared to the other three IAS dimensions. The symptom effects dimension, the disease conviction dimension, and the health habits dimension showed incremental validity over the anxiety-related constructs in predicting medical utilization. Implications for the IAS and future conceptualizations of HC are discussed.     

Knowledge about aging and worry in older adults: Testing the mediating role of intolerance of uncertainty

Objectives: This study aims to explore the relationship between knowledge about aging and severity of worry in older adults, and to test the potential mediational role of intolerance of uncertainty.

Method: The sample was composed of 120 community-dwelling older adults, with a mean of age of 71.0 years (SD = 6.3). Mediational analyses and structural equation modeling were used to analyze and compare different models.

Results: Greater knowledge about aging was negatively related to both intolerance of uncertainty and worry, and its effect on worry was partially mediated by intolerance of uncertainty. The mediational model obtained an excellent fit to the data (i.e. Goodness of fit index (GFI) = 0.995) and clearly had a better fit than alternative models.

Conclusion: These results suggest that a good knowledge of the aging process could help decrease aversive uncertainty and thus reduce the level of worry among older adults. Thus, educational programs to increase knowledge about aging could serve as one preventive strategy for anxiety in old age.     

Clinical characteristics of generalized anxiety disorder: older vs. young adults

Background: Generalized anxiety disorder (GAD) is one of the most common anxiety disorders in older people. Although GAD in older adults seems to differ in many aspects like clinical presentation, severity and treatment response, there is a paucity of comparative research.

Aims: The aim of the study is to compare the clinical presentation of GAD between older and young adults.

Methods: One hundred and two non-demented older patients (age ≥65) and 64 young patients (age <45) who were diagnosed with GAD according to the DSM-IV-TR criteria were included to the study. Socio-demographic Data Form, the Structured Clinical Interview for DSM Disorders-1 (SCID-1), the Questionnaire for the Suggested Behavioral Criteria of GAD for DSM-5, the Hamilton Depression Scale (HAM-D), the Generalized Anxiety Disorder Severity Scale (GADSS) and the Sheehan Disability Scale (SDS) were applied to both groups.

Results and conclusions: Older GAD patients had more disturbances of sleep, less reassurance seeking behaviors, higher rates of depression and higher depression severity when compared to the young patients. Although older people seemed to have a lower severity of GAD, they had higher disability due to worries. Older patients worried more about their own health and family well-being, whereas young patients worried more about future and other’s health.     

Group cognitive behavioral therapy targeting intolerance of uncertainty: a randomized trial for older Chinese adults with generalized anxiety disorder

Objectives: China has entered the aging society, but the social support systems for the elderly are underdeveloped, which may make the elderly feel anxiety about their health and life quality. Given the prevalence of generalized anxiety disorder (GAD) in the elderly, it is very important to pay more attention to the treatment for old adults. Although cognitive behavioral therapy targeting intolerance of uncertainty (CBT-IU) has been applied to different groups of patients with GAD, few studies have been performed to date. In addition, the effects of CBT-IU are not well understood, especially when applied to older adults with GAD.

Method: Sixty-three Chinese older adults with a principal diagnosis of GAD were enrolled. Of these, 32 were randomized to receive group CBT-IU (intervention group) and 31 were untreated (control group). GAD and related symptoms were assessed using the Penn State Worry Questionnaire, Intolerance of Uncertainty Scale–Chinese Version, Beck Anxiety Inventory, Beck Depression Inventory, Why Worry-II scale, Cognitive Avoidance Questionnaire, Generalized Anxiety Disorder Questionnaire-IV, and Generalized Anxiety Disorder Severity Scale across the intervention. The changes between pre and after the intervention were collected, as well as the six-month follow-up. F test and repeated-measures ANOVA were conducted to analyze the data.

Results: Compared to control group, the measures’ scores of experimental group decreased significantly after the intervention and six-month follow-up. Besides the main effects for time and group were significant, the interaction effect for group × time was also significant. These results indicated the improvement of the CBT-IU group and the persistence of effect after six months.

Conclusion: Group CBT-IU is effective in Chinese older adults with GAD. The effects of CBT-IU on GAD symptoms persist for at least six months after treatment.     

Mental health service use among Canadian older adults with anxiety disorders and clinically significant anxiety symptoms

Objectives: Despite evidence of disproportionate underutilization of mental health services by older adults and by individuals with anxiety disorders, little is known specifically about service use by older adults with anxiety. This study examines the prevalence of mental health service use among older adults with anxiety disorders and clinically significant anxiety symptoms, as well as factors associated with service use.

Method: The authors used data from the Canadian Community Health Survey–Mental Health and Well-Being, a nationally representative survey of community-dwelling Canadians. This study examined past-year use of mental health services in both the specialty mental health and general medical sectors by adults aged 55+ (N = 12,792). Logistic regression analyses examined predictors of service use among those with anxiety disorders (N = 279) and clinically significant anxiety symptoms (N = 880).

Results: Only 20.8% of older adults with an anxiety disorder and no mood disorder used services in the past year, compared to 43.1% of those with a mood disorder and 72.7% of those with comorbid disorders. In the final logistic regression models, only need variables were significant predictors of service use among older adults with anxiety disorders and among those with significant anxiety symptoms.

Conclusion: Findings indicate that anxious older adults are less likely to use mental health services than those who are depressed. While predisposing and enabling factors do not appear to impede service use, the need for help does. Anxious older adults and those they interact with may not be interpreting their anxiety symptoms as warranting services.     

Understanding health anxiety among community dwelling seniors with varying degrees of frailty

Objective: In this study, we attempted to disentangle the extent to which older age vs physical health problems contribute to health anxiety. Thus, we compared the levels of health anxiety among younger adults and seniors, with either low or high levels of frailty. Predictors of health anxiety in seniors were explored.

Methods: Forty-nine seniors with high levels of frailty were compared with 63 seniors with low levels of frailty and 130 younger adults. Comparisons were made on the Illness Attitudes Scale (IAS) and on a Medically Adjusted Illness Attitudes Scale, an adapted version ensuring scores reflect health anxiety, and not greater illness. Seniors also completed measures of frailty, pain, depression, trait anxiety and coping.

Results: Results varied depending on the health anxiety measure. Using the traditional IAS, seniors with high frailty experienced greater levels of health anxiety than seniors with low-frailty and younger adults. Using the medically adjusted version, seniors with high frailty experienced similar levels of heath anxiety compared with younger adults; seniors with low frailty had the lowest levels of health anxiety. Using multiple regression analysis, emotional preoccupation and trait anxiety uniquely predicted health anxiety among seniors.

Conclusions: Researchers and clinicians should ensure that health anxiety measures actually assess health anxiety and not physical illness. Using an appropriate health anxiety measure, the results suggest seniors with relatively fewer health problems may experience reduced health anxiety compared with other older adults and younger adults. The results are considered in the context of research on aging and anxiety. Implications for clinical practice and future research are discussed.     

Assessment of anxiety in older adults: a systematic review of commonly used measures

Objectives: The authors set out to systematically review the research literature in order to identify the anxiety measures most commonly used in the assessment of older adults. Once identified, the literature was reviewed to determine the extent to which these instruments had age-relevant norms and psychometric data supporting their use with older adults.

Method: Literature searches were conducted in PsycINFO and PubMed to identify research articles in which anxiety measures were completed by older adults. After screening for suitability, a total of 213 articles were reviewed to determine the most commonly used anxiety measures with older adults to examine the psychometric properties of these instruments and to evaluate whether the instruments are appropriate for use with older adults.

Results: A total of 91 different anxiety measures were used in the 213 included articles. Twelve anxiety measures were most commonly used in the literature and of those three were specifically developed for older adults.

Conclusions: Of the most commonly used measures, the majority lacked sufficient evidence to warrant their use with older adults. Based on psychometric evidence, three measures (Beck Anxiety Inventory, Penn State Worry Questionnaire, and Geriatric Mental Status Examination) showed psychometric properties sufficient to justify the use of these instruments when assessing anxiety in older adults. In addition, two measures developed specifically for older adults (Worry Scale and Geriatric Anxiety Inventory) were also found to be appropriate for use with older adults.     

Age-related changes in slow wave activity rise time and NREM sleep EEG with and without zolpidem in healthy young and older adults

ObjectiveWhether there are age-related changes in slow wave activity (SWA) rise time, a marker of homeostatic sleep drive, is unknown. Additionally, although sleep medication use is highest among older adults, the quantitative electroencephalographic (EEG) profile of the most commonly prescribed sleep medication, zolpidem, in older adults is also unknown. We therefore quantified age-related and regional brain differences in sleep EEG with and without zolpidem.MethodsThirteen healthy young adults aged 21.9 ± 2.2 years and 12 healthy older adults aged 67.4 ± 4.2 years participated in a randomized, double-blind, within-subject study that compared placebo to 5 mg zolpidem.ResultsOlder adults showed a smaller rise in SWA and zolpidem increased age-related differences in SWA rise time such that age differences were observed earlier after latency to persistent sleep. Age-related differences in EEG power differed by brain region. Older, but not young, adults showed zolpidem-dependent reductions in theta and alpha frequencies. Zolpidem decreased stage 1 in older adults and did not alter other age-related sleep architecture parameters.ConclusionsSWA findings provide additional support for reduced homeostatic sleep drive or reduced ability to respond to sleep drive with age. Consequences of reduced power in theta and alpha frequencies in older adults remain to be elucidated.     

Psychometric properties and health correlates of the Geriatric Anxiety Inventory in Australian community-residing older women

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 = 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.