Prevalence and correlates of anxiety among nursing home patients

Department of Nursing Home Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
Journal of Affective Disorders (Impact Factor: 3.38). 10/2005; 88(2):145-53. DOI: 10.1016/j.jad.2005.06.006
Source: PubMed


Very little is known about the prevalence and correlates of anxiety among nursing home patients. The current knowledge is predominantly based on information from population-based studies among elderly.
Prevalence of anxiety was measured with the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) in a sample of 333 nursing home patients of somatic wards of 14 nursing homes in the Netherlands. Participants were over 55 years, had a MMSE-score >14 and were able to communicate sufficiently. Information about demographic, health-related, psychosocial and care-related characteristics was collected in interviews with participants and from attending physicians and nursing home staff.
The prevalence of anxiety disorders was 5.7%, of subthreshold anxiety disorders 4.2% and of anxiety symptoms 29.7%. Only health-related characteristics (MMSE-score >23, depression, stroke) were significantly associated with anxiety disorders and subthreshold anxiety disorders. Demographic (>6 years education), health-related (depression, impaired vision, pain) and psychosocial characteristics (a recent negative life event) were significantly associated with anxiety symptoms. No care-related characteristics were associated with anxiety.
The study population is a selective one (>55 years, MMSE >15, able to communicate sufficiently). The data were collected cross-sectionally.
Anxiety disorders and anxiety symptoms occur frequently among nursing home patients and are mainly associated with health-related characteristics. Physicians should focus special attention on patients with depression or stroke.

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Available from: Martin Smalbrugge, Oct 01, 2015
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    • "HADS-A 12 a 0.85 Kang et al. (2010) 46 Secondary analysis of cross-sectional data from 5 RACFs (USA) 60+ HARS 6.5 b 0.75 Neville and Teri (2011) 148 Retrospective, secondary analysis of cross-sectional data from 19 RACFs (USA) 69–101 RAID CAS 11 c (RAID) 18 d (CAS) 0.85 Sandberg et al. (1998) 202 Cross-sectional 3 RACFs (Sweden) 75+ OBS Scale 58.4 e 0.72 Selbaek et al. (2007) 1163 Cross-sectional sample, 26 RACFs (Norway) Mean age = 84.4 NPI 20.5 f 0.75 Smalbrugge et al. (2005) 333 Cross-sectional, representative sample of 14 RACFs (Netherlands) 55+ SCAN 29.7 g 0.95 Smith et al. (2008) 198 Cross-sectional, stratified random sample of 22 RACFs (USA) Not stated NPI CSDD 22.2 h 0.85 Zuidema et al. (2007) 1322 Cross-sectional, 59 RACFs (Netherlands) Mean age = 80 NPI-NH 21 i 0.80 "
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    ABSTRACT: Objectives To synthesize and summarize the studies examining the prevalence rate of anxiety disorders and symptoms in older adults living in residential aged care. Methods Using the PRISMA guidelines, five electronic databases were searched using key terms and subject headings, as well as reference lists of relevant papers. The search was limited to literature published in English. Eligible studies examined the prevalence of anxiety disorders or symptoms in aged care residents aged 50+ years. Results A total of 2249 articles were identified, of which 18 studies (with a total of 5927 participants) were included in this review. The rate of overall anxiety disorders ranged from 3.2% to 20%, with the highest quality studies estimating a prevalence rate of 5% to 5.7%. Generalized anxiety disorder and specific phobias were found to be the most common anxiety disorders among aged care residents, while clinically significant anxiety symptoms were found to be more frequent (6.5% to 58.4%) than threshold disorders. Conclusions Anxiety disorders and anxiety symptoms are common in older aged care residents. Given the paucity and overall quality of research examining anxiety within this population and the heterogeneity found in studies, further research is needed to help clarify this issue.
    Full-text · Article · Nov 2015 · International Journal of Geriatric Psychiatry
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    • "Accordingly, since NH patients are characterized by high age, frailty, mortality, disability, powerlessness, dependency, and vulnerability, anxiety and depression symptoms are more likely to appear. Prevalence of anxiety in NH patients has been reported to 14–31% (Smalbrugge et al., 2005; Selbaek et al., 2007). Still, a paucity of findings on anxiety in older people is reported, emphasizing an requirement for more research into anxiety disorders in older populations (Byrne and Pachana, 2010). "
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    ABSTRACT: Background: Depression and anxiety are particularly common among individuals living in long-term care facilities. Therefore, access to a valid and reliable measure of anxiety and depression among nursing home patients is highly warranted. Aim: To investigate the dimensionality, reliability and construct validity of the Hospital Anxiety and Depression scale (HADS) in a cognitively intact nursing home population. Methods: Cross-sectional data were collected from two samples; 429 cognitively intact nursing home patients participated, representing 74 different Norwegian nursing homes. Confirmative factor analyses and correlations with selected construct were used. Results: The two-factor model provided a good fit in Sample1, revealing a poorer fit in Sample2. Good-acceptable measurement reliability was demonstrated, and construct validity was supported. Limitations: Using listwise deletion the sample sizes were 227 and 187, for Sample1 and Sample2, respectively. Greater sample sizes would have strengthen the statistical power in the tests. The researchers visited the participants to help fill in the questionnaires; this might have introduced some bias into the respondents’ reporting. The 14 HADS items were part of greater questionnaires. Thus, frail, older NH patients might have tired during the interview causing a possible bias. Conclusion: Low reliability for depression was disclosed, mainly resulting from three items appearing to be inappropriate indicators for depression in this population. Further research is needed exploring which items might perform as more reliably indicators for depression among nursing home patients. Keywords: confirmatory factor analysis; construct validity; dimensionality; depression; HADS; nursing home; reliability
    Full-text · Article · Aug 2014 · Journal of Affective Disorders
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    • "In general, the literature regarding the impact and prevalence of anxiety and worry in these settings is far less developed compared to that of depression. However, initial research has indicated that increased anxiety symptoms are associated with greater functional impairment , pain, and loneliness, as well as decreased wellbeing in nursing home residents (Smalbrugge et al., 2005; 2006). The prevalence of anxiety disorders in long-term care settings is largely unknown, with some estimates ranging from 0% to 20% (Smalbrugge et al., 2005). "
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    ABSTRACT: Background: Accurate assessment of anxiety in later life is critical, as anxiety among older adults is associated with social and functional impairment and poorer quality of life. The Geriatric Anxiety Inventory (GAI) and the GAI-Short Form (GAI-SF) were designed to detect anxiety symptoms among community-dwelling older adults, but the usefulness of the GAI and GAI-SF in long-term care is unknown. The present study examined the psychometric properties of the GAI and GAI-SF among residents at a long-term care facility. Methods: Seventy-five nursing home residents completed the GAI and measures of depression, executive functioning, and adaptive functioning. The mean age of residents was 69.60 years (SD = 10.76). Psychiatric diagnoses included dementia, psychotic disorders, mood disorders, anxiety disorders, substance abuse, sleep disorders, and mental retardation. Results: Internal consistency of the GAI was good (α = 0.92) and the GAI-SF was adequate (α = 0.73). GAI and GAI-SF scores were moderately correlated with depression scores, and weakly correlated with adaptive functioning scores and executive functioning scores, suggesting discriminant validity. Logistic regression analyses were conducted with GAI and GAI-SF scores predicting an anxiety disorders diagnosis. Results provided support for the predictive validity of the GAI and GAI-SF. Sensitivity, specificity, and the percentage of individuals correctly classified at various cut-off scores were also calculated. Conclusions: Both the GAI and GAI-SF appear to be useful tools for assessing anxiety among nursing home residents with psychological disorders. The GAI-SF may be a viable replacement for the GAI as a screener for anxiety in long-term care.
    Full-text · Article · Jun 2013 · International Psychogeriatrics
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