Development and validation of a short form of the Geriatric Anxiety Inventory--the GAI-SF. A randomized clinical trial to assess the impact on an emergency response system on anxiety and health care use among older emergency patients after a fall. "Partnering with Seniors for Better Health": computer use and Internet health information retrieval among older adults in a low socioeconomic community. A randomized trial of the effectiveness of cognitive-behavioral therapy and supportive counseling for anxiety symptoms in older adults. The impact on anxiety and perceived control of a short one-on-one nursing intervention designed to decrease treatment seeking delay in people with coronary heart disease Effect of a structured course involving goal management training in older adults: A randomised controlled trial. A pilot randomised controlled trial to reduce suffering and emotional distress in patients with advanced cancer. Cognitive-behavioural therapy-based intervention to reduce fear of falling in older people: therapy development and randomised controlled trial - the Strategies for Increasing Independence, Confidence and Energy (STRIDE) study. Improving depressive symptoms in community-dwelling older adults: a psychosocial intervention using life review and writing. A group music intervention using percussion instruments with familiar music to reduce anxiety and agitation of institutionalized older adults with dementia. Evaluation of a Primary Prevention Program for Anxiety Disorders Using Story Books with Children Aged 9–12 Years Use of benzodiazepines and selective serotonin reuptake inhibitors in middle-aged and older adults with anxiety disorders: a longitudinal and prospective study. A randomized controlled trial to reduce delay in older adults seeking help for symptoms of acute myocardial infarction. A randomised controlled trial of the outcome of health assessment of people aged 75 years and over. Randomised controlled trial of group cognitive behavioural therapy for comorbid anxiety and depression in older adults. Evaluation of a preventive intervention for child anxiety in two randomized attention-control school trials. Treating anxiety and depression in older adults: randomised controlled trial comparing guided v. self-guided internet-delivered cognitive–behavioural therapy
BACKGROUND Anxiety symptoms and anxiety disorders are highly prevalent among older people and are associated with considerable disability burden . While several instruments now exist to measure anxiety in older people , there is a need for a very brief self-report scale to measure anxiety symptoms in epidemiological surveys , in primary care and in acute geriatric medical setting s. Accordingly , we undertook the development of such a scale , based on the Geriatric Anxiety Inventory . METHODS This is a cross-sectional study of r and omly selected , community-residing , older women ( N = 284 ; mean age 72.2 years ) using receiver operating characteristic ( ROC ) analyses . DSM-IV diagnostic interviews were undertaken using the Mini International Diagnostic Interview , fifth edition ( MINI-V ) . RESULTS We developed a 5-item version of the Geriatric Anxiety Inventory , which we have termed the  Geriatric Anxiety Inventory -  Short Form ( GAI-SF ) . We found that a score of three or greater was optimal for the detection of DSM-IV Generalized Anxiety Disorder ( GAD ) in this community sample . At this cut-point , sensitivity was 75 % , specificity was 87 % , and 86 % of participants were correctly classified . GAI-SF score was not related to age , MMSE score , level of education or perceived income adequacy . Internal consistency was high ( Cronbach 's α = 0.81 ) and concurrent validity against the State-Trait Anxiety Inventory was good ( rs = 0.48 , p < 0.001 ) . CONCLUSIONS The GAI-SF is a short form of the Geriatric Anxiety Inventory , which we recommend for use in epidemiological studies . It may also be useful in primary care and acute geriatric medical setting OBJECTIVES Personal emergency response systems ( PERSs ) are reported to reduce anxiety and health care use and may assist in planning the disposition of older patients discharged from the emergency department ( ED ) to home . This study measured the impact of a PERS on anxiety , fear of falling , and subsequent health care use among older ED patients . METHODS This study was a r and omized controlled trial comparing PERS use with st and ard ED discharge planning in subjects 70 years of age or older discharged home after a fall . Outcome assessors were blinded to the study objectives . Anxiety and fear of falling were measured at baseline and 30 days using the Hospital Anxiety and Depression Scale anxiety subscale ( HADS-A ) and modified Falls Efficacy Scale ( mFES ) . Return to the ED , hospitalization , and length of stay were recorded after 30 and 60 days . RESULTS Eighty-six subjects were r and omized and completed follow up ( 43 per group ) . There was no important difference in mean reduction in anxiety ( mean change treatment - control , + 0.35 ; 95 % confidence interval [ CI ] = -1.5 to 0.76 ; p = 0.55 ) or fear of falling ( mean change , + 4.5 ; 95 % CI = -6.7 to 15.7 ; p = 0.70 ) . Return visits to the ED occurred in eight of 43 patients in both the control and treatment groups ( risk difference , 0.0 % ; 95 % CI = -16 % to 16 % ) . Hospitalization occurred in six of 43 in the control group versus three of 43 in the treatment group ( risk difference treatment - control = -7.0 % ; 95 % CI = -19.8 % to 5.9 % ) . CONCLUSIONS In contrast to previous studies , there was no evidence that a PERS reduced anxiety , fear of falling , or return to the ED among older persons discharged from the ED PURPOSE This health communication project measured the psychosocial influences of computer anxiety , computer confidence , and computer self-efficacy in older adults at six meal congregate sites . The adults completed a five-week education intervention , based on B and ura 's self-efficacy model , design ed to assist older adults in retrieving and evaluating health information re sources on the Internet . METHODS One hundred thirty-seven participants , ages sixty-five and older , were r and omized in a controlled , two-group , pre-post , repeated measures design . Participants in the intervention group received a two-hour training session , once a week for five weeks . The  Computer Confidence Subscale and Computer Anxiety Subscale of the Computer Attitude Scale and the Computer Self-Efficacy Measure were administered to both groups at three time intervals : at baseline , completion of the five-week intervention , and six weeks after completion of the intervention . Data were analyzed using repeated measures analysis of variance . RESULTS Findings showed a reduction in computer anxiety and increases in computer confidence and computer self-efficacy in retrieving and evaluating online health information ( P<0.001 ) . DISCUSSION The study suggests an array of possibilities to engage older adults in the use of Internet health information re sources to better contribute to their health , independence , safety , and wellness The authors used a r and omized trial to compare cognitive-behavioral therapy ( CBT ) and supportive counseling ( SC ) in the treatment of  anxiety symptoms in older adults who met Diagnostic and Statistical Manual of Mental Disorders ( 4th ed . : American Psychiatric Association , 1994 ) criteria for anxiety disorders . Both conditions had a 6-week baseline no-treatment phase . Treatment was delivered primarily in patients ' own homes and in an individual format . Outcomes were assessed at posttreatment and at 3- , 6- , and 12-month follow-ups . There was no spontaneous improvement during the baseline phase . Both groups showed improvement on anxiety measures following treatment , with a better outcome for the CBT group on self-rating of anxiety and depression . Over the follow-up period , the CBT group maintained improvement and had significantly greater improvement than the SC group on anxiety and 1 depression measure . Treatment response for anxiety was also superior for the CBT group , although there was no difference between groups in endstate functioning Background : Patient delay in seeking treatment for acute coronary syndrome symptoms remains a problem . Thus , it is vital to test interventions to improve this behavior , but at the same time it is essential that interventions not increase anxiety . Purpose : To determine the impact on anxiety and perceived control of an individual face-to-face education and counseling intervention design ed to decrease patient delay in seeking treatment for acute coronary syndrome symptoms . Methods : This was a multicenter r and omized controlled trial of the intervention in which anxiety data were collected at baseline , 3-months and 12-months . A total of 3522 patients with confirmed coronary artery disease were enrolled ; data from 2597 patients with anxiety data at all time points are included . The intervention was a 45 min education and counseling session , in which the social , cognitive and emotional responses to acute coronary syndrome symptoms were discussed as were barriers to early treatment seeking . Repeated measures analysis of covariance was used to compare anxiety and perceived control levels across time between the groups controlling for age , gender , ethnicity , education level , and comorbidities . Results : There were significant differences in anxiety by group ( p = 0.03 ) . Anxiety level was stable in patients in the control group , but decreased across time in the intervention group . Perceived control increased across time in the intervention group and remained unchanged in the control group ( p = 0.01 ) . Conclusion : Interventions in which cardiac patients directly confront the possibility of an acute cardiac event do not cause anxiety if they provide patients with appropriate strategies for managing symptoms OBJECTIVE The objective of this study was to investigate the effects of a structured 6-week neuropsychological course on the executive functioning of older adults with cognitive complaints . METHODS A r and omised controlled design was used involving 69 community dwelling individuals aged 55 years and older . Both objective and subjective measures were included to assess executive functioning . General linear model with repeated measures analysis of variance was used to examine the intervention effects . RESULTS After the intervention , the participants in the intervention group were significantly less annoyed by their cognitive failures , were better able to manage their executive failures and reported less anxiety symptoms than those in the waiting list control group . CONCLUSION These findings indicate that a combination of psycho-education and training has the potential to change the attitude of older individuals towards their cognitive functioning . PRACTICE IMPLICATION S Because this training focussed on cognitive functions that are among the first to decline in older adults and the subjective evaluation of the people after training was quite favourable , the proposed intervention may be considered a valuable contribution to cognitive interventions for older adults INTRODUCTION A pilot trial was carried out to determine if a focussed narrative interview could alleviate the components of suffering and anxiety and depression in advanced cancer patients . INTERVENTION Patients recruited were invited to participate in a focussed narrative interview and reflect on their perspectives on their sense of " meaning " , regarding suffering and their psychological , physical , social and spiritual well being - the emphasis was on allowing the patient to tell their story . Patients were encouraged to share what re sources they themselves had utilised in addition to what professional care they may have received , to maintain a sense of well being . METHOD Patients with advanced metastatic disease were recruited from hospices in the North West of Engl and - the only exclusion criteria were not being able to underst and written and spoken English and a non cancer diagnosis . At recruitment patients were asked to complete a numerical scale for suffering ; the Brief Edinburgh Depression Scale , Edmonton Symptom Assessment Scale ( ESAS ) , FACIT Spiritual well being question naire , Demographic information was collected and patients were r and omised to either the intervention arm of the trial or the usual care arm of the study . Patients in both groups were invited to complete each measure at 2 , 4 and 8 weeks . RESULTS One hundred people were recruited into the study - 49 were r and omised to intervention group and 51 to control group . The median age of patients was 66 years age range ( 31 - 89 years ) and 68 % of patients were female . At baseline the ECOG performance of 75 % of patients recruited was 1 or 2 . The median survival of all patients in the study was 169.5 days ( range 10 days to still alive at end of study ) . There was no significant difference at any timepoint in scores on suffering measure between intervention group and control group . At each time point the intervention demonstrated mean improvement in scores for depression and anxiety on ESAS - the greatest changes for both depression and anxiety were seen at 4 weeks . CONCLUSION This pilot r and omised controlled trial of a focussed narrative intervention demonstrated an improvement in mean changes in scores for depression and anxiety at 2 , 4 , and 8 weeks . We suggest this intervention may have beneficial effects on depression and anxiety , but a larger powered trial is required to determine the full effects BACKGROUND Falls cause fear , anxiety and loss of confidence , result ing in activity avoidance , social isolation and increasing frailty . The umbrella term for these problems is ' fear of falling ' , seen in up to 85 % of older adults who fall . Evidence of effectiveness of physical and psychological interventions is limited , with no previous studies examining the role of an individually delivered cognitive-behavioural therapy ( CBT ) approach . OBJECTIVES Primary objective To develop and then determine the effectiveness of a new CBT intervention ( CBTi ) delivered by health-care assistants ( HCAs ) plus usual care compared with usual care alone in reducing fear of falling . Secondary objectives To measure the impact of the intervention on falls , injuries , functional abilities , anxiety/depression , quality of life , social participation and loneliness ; investigate the acceptability of the intervention for patients , family members and professionals and factors that promote or inhibit its implementation ; and measure the costs and benefits of the intervention . DESIGN Phase I CBTi development . Phase II Parallel-group patient r and omised controlled trial ( RCT ) of the new CBTi plus usual care compared with usual care alone . SETTING Multidisciplinary falls services . PARTICIPANTS Consecutive community-dwelling older adults , both sexes , aged ≥ 60 years , with excessive or undue fear of falling per Falls Efficacy Scale-International ( FES-I ) score of > 23 . INTERVENTIONS Phase I Development of the CBTi . The CBTi was developed following patient interviews and taught to HCAs to maximise the potential for uptake and generalisability to a UK NHS setting . Phase II RCT . The CBTi was delivered by HCAs weekly for 8 weeks , with a 6-month booster session plus usual care . MAIN OUTCOME MEASURES These were assessed at baseline , 8 weeks , 6 months and 12 months . Primary outcome measure Fear of falling measured by change in FES-I scores at 12 months . Secondary outcome measures These comprised falls , injuries , anxiety/depression [ Hospital Anxiety and Depression Scale ( HADS ) ] , quality of life , social participation , loneliness and measures of physical function . There were process and health-economic evaluations alongside the trial . RESULTS Four hundred and fifteen patients were recruited , with 210 patients r and omised to CBTi group and 205 to the control group . There were significant reductions in mean FES-I [ -4.02 ; 95 % confidence interval ( CI ) -5.95 to -2.1 ] , single-item numerical fear of falling scale ( -1.42 ; 95 % CI -1.87 to 1.07 ) and HADS ( -1 ; 95 % CI -1.6 to -0.3 ) scores at 12 months in the CBTi group compared with the usual care group . There were no differences in the other secondary outcome measures . Most patients found the CBTi  acceptable . Factors affecting the delivery of the CBTi as part of routine practice were identified . There was no evidence that the intervention was cost-effective . CONCLUSIONS Our new CBTi delivered by HCAs significantly improved fear of falling and depression scores in older adults who were attending falls services . There was no impact on other measures . FURTHER WORK Further work should focus on a joint CBTi and physical training approach to fear of falling , more rational targeting of CBTi , the possibility of mixed group and individual CBTi , and the cost-effectiveness of provision of CBTi by non-specialists . TRIAL REGISTRATION Current Controlled Trials IS RCT N78396615 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 20 , No. 56 . See the NIHR Journals Library website for further project information The purpose of this r and omized , controlled trial was to test the efficacy of a community-based intervention , the Life Story Workshop , on depressive symptoms , operationalized as depression subscale scores on the Brief Symptom Inventory 18 , in adults age 60 and older . Thirty-three men and women were r and omly assigned to one of two groups : an intervention group that attended 2-hour workshops once a week for 10 weeks or a wait-list control group . The intervention provided an opportunity for older participants to reflect on , write , and share stories about their lived and current lives . The depression subscale of the Brief Symptom Inventory 18 was administered before and after the workshops . Mean depression scores were compared using Welch 's t test . A significant improvement was measured for the intervention group compared with the control group ( p = .03 ) . This research supports the Life Story Workshop as an effective intervention for improving depressive symptoms in older adults OBJECTIVE This experimental study aim ed to evaluate the effects of a group music intervention on anxiety and agitation of institutionalized older adults with dementia . METHODS A total of 60 participants were r and omly assigned to an experimental or a control group . The experimental group received a 30-min music intervention using percussion instruments with familiar music in a group setting in mid afternoon twice weekly for 6 weeks , whereas the control group received usual care with no music intervention . The Rating of Anxiety in Dementia scale was used to assess anxiety , and Cohen-Mansfield Agitation Inventory was used to assess agitation at baseline , week 4 and week 6 . RESULTS Repeated measures analysis of covariance indicated that older adults who received a group music intervention had a significantly lower anxiety score than those in the control group while controlling for pre-test score and cognitive level ( F = 8.98 , p = 0.004 ) . However , the reduction of agitation between two groups was not significantly different . CONCLUSIONS Anxiety and agitation are common in older adults with dementia and have been reported by caregivers as challenging care problems . An innovative group music intervention using percussion instruments with familiar music as a cost-effective approach has the potential to reduce anxiety and improve psychological well-being of those with dementia This article reports the results of a study evaluating a book-supported primary prevention program “ Dominique ’s H and y Tricks ” for anxiety disorders in children aged 9–12 years . This cognitive-behavioural program is delivered using a combination of storybooks and workshop sessions . The originality of the program comes from the use of storybooks that were not developed specifically for anxiety management . Every session is based on a story describing characters facing common stressors and how they manage to cope with their daily problems . In our r and omized control trial with 46 children , participation in the program led to a significant improvement in coping skills , perceived self-efficacy , anxiety sensitivity , as well as in symptoms of anxiety and fear . The theoretical and practical elements underlying the delivery of this primary prevention program are described . Conclusion : It is suggested that such an approach , without any labelling specific to anxiety disorders , can be useful in primary prevention programs OBJECTIVE The purpose of this study was to examine the use of benzodiazepines ( BZs ) and selective serotonin reuptake inhibitors/selective norepinephrine reuptake inhibitors ( SSRIs/SNRIs ) over nine years of follow-up in middle-aged and older adults with diagnoses of panic disorder with or without agoraphobia , social phobia , or generalized anxiety disorder . SETTING AND PARTICIPANTS Participants in this study were enrolled in the Harvard/Brown Anxiety Research Project ( HARP ) . HARP is a naturalistic , longitudinal , multisite study of adults with anxiety disorders who are recruited from psychiatric setting s. The analytic sample consisted of 51 participants with anxiety disorders who were 55 to 70 years old at baseline and a younger cohort of 211 participants added for comparative analysis . DESIGN The authors examined patterns of medication use ( BZs and SSRIs/SNRIs ) in participants with anxiety disorders as they aged , by assessing the proportion of participants taking these medications using generalized estimating equation modeling . MEASUREMENTS The present data were derived from the structured diagnostic interview administered at enrollment using a combination of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders , Third Edition-R Non-Affective Disorder , Patient Version , Research Diagnostic Criteria Schedule for Affective Disorders-Lifetime , and subsequent follow-up interviews over a nine-year period using the Longitudinal Interval Follow-up Evaluation-Pharmacia & Upjohn to assess the weekly course of disorders to indicate syndrome severity and document medication use by specific type and dose on a weekly basis . RESULTS Findings showed that rates of BZ use were high among both the older ( 53 % at baseline ) and the younger ( 57.4 % ) age groups and did not significantly decrease over time , after controlling for time in episode of their anxiety disorders . There was a statistically significant increase in  SSRI/SNRI use over time in both groups . At the beginning of the study , 18 % of the older group and 21 % of the younger group were using SSRIs/SNRIs ; however , at the end of the study , the rates increased to 35 % and 43 % , respectively . CONCLUSIONS Although there was an increase in  SSRI/SNRI use in older participants with anxiety disorders over the course of study , at nine years of follow-up , only 35 % of participants were utilizing SSRI/SNRI medication , while more than one-half of the same participants were continuing to use BZs . To the authors ' knowledge , there are no r and omized clinical trials that have addressed comparative efficacy and safety of BZs and SSRIs/SNRIs in this population . However , there is documented evidence of adverse effects of chronic BZ use and the risk of developing dependency in older population Older adults with symptoms of acute myocardial infa rct ion ( AMI ) have longer pre-treatment delay times than their younger counterparts . A 2-group , r and omized controlled sample consisted of 115 adults , 65 years of age or older with a self-reported history of coronary artery disease . A pre-test was given to all participants followed by a structured education and counseling intervention to those in the experimental group . Data were re-collected at 3 months . There was a statistically significant increase in knowledge , beliefs , and perceived control without an increase in anxiety in the intervention group . There was no significant difference in attitudes .  Older adults at risk for AMI should be targeted for individualized education and counseling in clinics , physician offices , and community centers OBJECTIVES To measure the outcomes of a health assessment , conducted by a nurse , of people aged 75 years and older ( 75+HA ) living independently in their own homes . DESIGN R and omised controlled trial ( RCT ) . SETTING A convenience sample of six general practice s within the Adelaide Western Division of General Practice ( AWDGP ) . A r and om sample of 100 participants was drawn from practice age-sex registers . Data were collected in initial visits between 1 August 1998 and February 1999 , then in follow-up visits one year later . PARTICIPANTS Participants were aged 75 years and over on 1 August 1998 and living independently in the community . 145 eligible patients were invited to join the study , and 100 of these consented to enrol ( 69 % ) . INTERVENTION A 75+HA conducted in the participant 's home by a nurse and reported to their usual general practitioner . MAIN OUTCOME MEASURES Primary : number of problems in each group ; number of participants with problems ; and mortality . Secondary : physical function ; psychological ( including cognitive ) function ; falls ; and admission to institution . RESULTS There were no significant differences between the control and intervention groups at follow-up in the number of problems , the number of participants with problems , or mortality . In the intervention group , there was significant improvement in self-rated health , geriatric depression score ( GDS 15 ) , and number of falls . CONCLUSIONS This RCT has not demonstrated improvement in health status of the intervention group which received a 75+HA compared with a control group left to usual care Anxiety and depression are commonly comorbid in older adults and are associated with worse physical and mental health outcomes and poorer response to psychological and pharmacological treatments . However , little research has examined the effectiveness of psychological programs to treat comorbid anxiety and depression in older adults . Sixty-two community dwelling adults aged over 60 years with comorbid anxiety and depression were r and omly allocated to group cognitive behavioural therapy or a waitlist condition and were assessed immediately following and three months after treatment . After controlling for cognitive ability at pre-treatment , cognitive behaviour therapy result ed in significantly greater reductions , than waitlist , on symptoms of anxiety and depression based on a semi-structured diagnostic interview rated by clinicians unaware of treatment condition . Significant time by treatment interactions were also found for self-report measures of anxiety and depression and these gains were maintained at the three month follow up period . In contrast no significant differences were found between groups on measures of worry and well-being . In conclusion , group cognitive behavioural therapy is efficacious in reducing comorbid anxiety and depression in geriatric population s and gains maintain for at least three months The present research examined the effectiveness of a cognitive-behavioral therapy ( CBT ) based intervention program , FRIENDS , for children from grade s 4 to 6 , using r and om assignment at the school-level and an attention-control design in two longitudinal studies . The first study targeted children with anxiety symptoms ( N=191 , mean age=10.1 ) as screened with self , parent , and teacher-reports ; the second study took a universal approach with full classrooms of children participating ( N=253 , mean age=9.8 ) . The results showed no intervention effect in both studies , with children 's anxiety symptoms decreasing over time regardless of whether they were in the story-reading ( attention control ) or FRIENDS condition . The findings also indicated that girls reported a higher level of anxiety than boys and children in higher grade s reported lower anxiety relative to younger children in both studies . In addition , similar patterns were found using a subgroup of children with high-anxiety symptoms  from both studies Background Symptoms of anxiety and depression are prevalent in older adults . Aims To compare clinician-guided and self-guided versions of a transdiagnostic internet-delivered cognitive – behavioural therapy ( iCBT ) intervention for adults aged 60 years and above . Method Adults ( n=433 ) with symptoms of anxiety and depression were r and omly allocated to : ( 1 ) clinician-guided treatment ( n=153 ) ; ( 2 ) initial clinician interview followed by self-guided treatment ( n=140 ) ; or ( 3 ) self-guided treatment without interview ( n=140 ) . Results Large reductions ( d ≥1.00 ) in symptoms of depression and anxiety were observed across groups , and sustained at follow-up . No differences were observed in clinical outcomes or satisfaction ratings . Age did not affect outcomes . Conclusions Carefully developed iCBT interventions may significantly reduce symptoms of anxiety and depression  in older adults when delivered in either clinician-guided or self-guided formats . Declaration of interest N.T. and B.F.D. developed the Wellbeing Plus Course but derive no financial benefit from it . Copyright and usage © 2016 The Royal College of Psychiatrists . This is an open access article distributed under the terms of the Creative Commons Non-Commercial , No Derivatives ( CC BY-NC-ND ) licence
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 Question naire , 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
Objectives : The authors set out to systematic ally 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 review ed to determine the extent to which these instruments had age-relevant norms and psychometric data supporting their use with older adults .