To examine long-term outcome of late-life anxiety disorders and utilization of mental health care services.
A cohort of subjects (aged > or = 55 years) with an anxiety disorder (n = 112) was identified in the Longitudinal Aging Study Amsterdam (n = 3107). At 6 year follow-up, the rate of persistence and prognostic factors for persistence of anxiety were established.
Six years after baseline 23% of our sample met the criteria for an anxiety disorder. Another 47% suffered from subclinical anxiety symptoms. Persistence of anxiety was associated with a high score on neuroticism at baseline. Use of benzodiazepines was high (43%), while use of mental health care facilities (14%) and anti-depressants (7%) remained low in those with persistent anxiety.
Results indicate that those high in neuroticism are at greater risk for persistence of anxiety. Efforts to enhance appropriate referral of anxious older adults do not seem to have had the desired effect.
"Physical health, social support, socio-demographic, and recent stressful life events are additional domains relevant to the anxiety state of older adults. Chronic physical illness (Smit et al., 2007) and disability (de Beurs et al., 1999) have been linked to late-life anxiety, although a longitudinal study did not find that chronic disease or functional limitation contributed to anxiety outcome (Schuurmans et al., 2005). Higher ratings of perceived social support have been associated with a modestly decreased risk (Cairney et al., 2008b), and recent life events may contribute to an elevated risk, of late-life anxiety disorders (Beekman et al., 2000). "
[Show abstract][Hide abstract] ABSTRACT: To assess the characteristics of anxiety in aging services network (ASN) clients.
Interviews were conducted as part of an academic-community partnership for studying the mental health needs of community-dwelling older adults. Participants consisted of ASN clients in Monroe County, NY, that were aged 60 years and older and received an in-home assessment for care management services. The Goldberg Anxiety Scale screened for anxiety symptoms, and instruments covering the domains of associated mental health, physical health and disability, social support, negative life events, and other areas relevant to delivery of aging services were administered.
Of 378 subjects enrolled, 27% had clinically significant levels of anxiety. In bivariate analyses anxiety was associated with having a current major depressive episode (MDE), five or more medical conditions, pain, younger age, less income, and negative life events. After controlling for MDE in multivariate analyses, medical conditions, pain, negative life events, and younger age were significant correlates of anxiety in ASN clients.
Anxiety was common among ASN clients who received in-home care management services. These anxious clients suffered from a combination of mental, medical, and social issues that suggests the need for multidisciplinary care. Because aging services providers work with their clients to ameliorate conditions that are highly correlated with anxiety, the ASN represents a promising venue for detecting, managing, and preventing anxiety among older adults.
International Journal of Geriatric Psychiatry 01/2011; 26(1):31-8. DOI:10.1002/gps.2474 · 2.87 Impact Factor
"Prospective studies have shown that the majority of community-dwelling older adults with depression or an anxiety disorder at baseline continued to suffer from depression or anxiety symptoms up to six years later (Beekman et al., 2002; Schuurmans et al., 2005), the consequences of which can be severe. Late-life depression is also associated with increased healthcare utilization and expenditures (Luppa et al., 2008), and anxiety and depression result in large financial burdens to the individual as well as society (Greenberg et al., 2003; Greenberg et al., 1999). "
[Show abstract][Hide abstract] ABSTRACT: This study aimed to characterize healthcare and human services utilization among mentally distressed and non-distressed clients receiving in-home care management assessment by aging services provider network (ASPN) agencies in the U.S.A.
A two-hour research interview was administered to 378 English-speaking ASPN clients aged 60+ years in Monroe County, NY. A modified Cornell Services Index measured service utilization for the 90 days prior to the ASPN assessment. Clients with clinically significant anxiety or depressive symptoms were considered distressed.
ASPN clients utilized a mean of 2.93 healthcare and 1.54 human services. The 42% of subjects who were distressed accessed more healthcare services (e.g. mental health, intensive medical services) and had more outpatient visits and days hospitalized than the non-distressed group. Contrary to expectations, distressed clients did not receive more human services. Among those who were distressed, over half had discussed their mental health with a medical professional in the past year, and half were currently taking a medication for their emotional state. A far smaller proportion had seen a mental health professional.
In the U.S.A., aging services providers serve a population with high medical illness burden and medical service utilization. Many clients also suffer from anxiety and depression, which they often have discussed with a medical professional and for which they are receiving medications. Few, however, have seen a mental health specialist preceding intake by the ASPN agency. Optimal care for this vulnerable, service intensive group would integrate primary medical and mental healthcare with delivery of community-based social services for older adults.
International Psychogeriatrics 08/2010; 22(5):739-49. DOI:10.1017/S104161021000058X · 1.93 Impact Factor
"However, this hypothesis awaits scientific testing. Neuroticism was found to be predictive of a detrimental naturalistic long-term outcome of anxiety disorders in older adults by our research group (Schuurmans et al., 2005). For the present study, we hypothesized that neuroticism might also affect treatment outcome for late-life anxiety disorders. "
[Show abstract][Hide abstract] ABSTRACT: Although anxiety disorders are prevalent in older adults, randomized controlled trials of treatment effectiveness for late-life anxiety are scarce and have focused primarily on the effectiveness of psychotherapeutic interventions. However, recent findings suggest that in some cases, pharmacological treatment may be more beneficial for late-life anxiety disorders. As yet, there have been no systematic studies investigating prognostic factors for the outcome of cognitive behavioral therapy (CBT) and pharmacotherapy for late-life anxiety. The objective of the present study was to study long-term treatment outcomes and to explore differential predictors for both short-term and long-term treatment outcomes of sertraline and CBT for late-life anxiety disorders.
Participants of a randomized controlled trial (RCT) comparing sertraline and CBT for the treatment of late-life anxiety were contacted one year after completing their treatment, so that predictors for both short-term and long-term treatment outcome could be established.
Sertraline showed a greater reduction of symptoms than CBT on anxiety (Hamilton Anxiety Rating Scale; HARS) and worry (Worry Domain Questionnaire) ratings at one-year follow-up. The strongest predictor for short-term CBT outcome was poor perceived health, explaining 40% of the variance in post-treatment residual gain scores on the HARS. The strongest predictor for long-term CBT outcome was neuroticism, explaining 20% of the variance in residual gain scores at one-year follow-up. Analyses revealed no significant predictors for treatment outcome in sertraline participants.
Our study suggests that long-term use of sertraline might be more beneficial for late-life anxiety than a 15-week CBT program. Poor perceived health and neuroticism are predictive of less improvement after CBT in anxious older adults. Implications of these findings are discussed.
International Psychogeriatrics 12/2009; 21(6):1148-59. DOI:10.1017/S1041610209990536 · 1.93 Impact Factor
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