Assessment of anxiety in older adults: a community-based survey and comparison with younger adults

The reliability and validity of existing anxiety self-report scales in elderly adults has not been adequately established, and the phenomenology of anxiety in older adults is largely unknown. In the present study, three anxiety scales and measures of depression and somatization were used to compare symptoms between older (n = 84, mean age = 75.3) and younger (n = 48, mean age = 40.3) community-dwelling adults. Results showed that the anxiety scales demonstrated good internal consistency in both age groups, although the reliabilities of the Fear Questionnaire subscales ranged from poor to good. Convergent and divergent validity were found to be variable in the older group, but this may reflect differences in anxiety as it occurs in older persons rather than psychometric problems. Anxiety symptoms did not vary with age, and levels of anxiety also remained constant. However, gender differences were found only within the older age group, with women reporting more anxiety than men. Findings are discussed with respect to current conceptualizations of anxiety in older people, as well as implications for future research.     

Anxiety disorders in late life: an evolving picture

Although anxiety disorders are the most prevalent group of disorders in the United States, little is known about the efficacy of treatments for these disorders in elderly patients. Anxiety disorders, especially generalized anxiety disorder and phobias, are highly prevalent in older people. Anxiety symptoms and disorders are associated with increased mortality and disability in older people. Risk factors for anxiety disorders include chronic medical illness, disability, low education, low social network, and poor social support. The newer antidepressant medications, in particular the selective serotonin reuptake inhibitors and venlafaxine-extended relief, are recommended as first-line pharmacotherapy of these disorders in elderly. Cognitive-behavioral therapy is recommended as first-line psychotherapy for these disorders. However, these recommendations are based on extrapolation of data from younger adults or retrospective analysis of datasets, the results need to be confirmed with controlled studies in an elderly age group.     

Saving the best for last: how adults treat social partners of different ages

Older adults report more positive feelings and fewer problems in their relationships than do younger adults. These positive experiences may partially reflect how people treat older adults. Social partners may treat older adults more kindly due to their sense that time remaining to interact with these older adults is limited. Younger (n = 87, age 22 to 35) and older (n = 89, age 65 to 77) participants indicated how positively they would behave (i.e., express affection, proffer respect, send sentimental cards) and what types of conflict strategies they would use in response to hypothetical negative interactions with two close social partners, a younger adult and an older adult. Multilevel models revealed that participants were more avoidant and less confrontational when interacting with older adults than when interacting with younger adults. Time perspective of the relationship partially mediated these age differences. Younger and older participants were also more likely to select sentimental cards for older partners than for younger partners. Findings build on socioemotional selectivity theory and the social input model to suggest that social partners facilitate better relationships in late life.     

Personality Dysfunction, Coping Styles, and Clinical Symptoms in Younger and Older Adults

This study examined age-related differences in personality disorders, dispositional coping strategies, and clinical symptoms between younger (n = 79; age range = 18–29; M age = 21.2 years) and older (n = 79; age range = 55–89; M age = 65.5 years) persons (matched on gender and ethnicity). Participants completed the Coolidge Axis II Inventory (CATI), Coping Orientations to Problems Experienced Scale (COPE), and Brief Symptom Inventory (BSI). Personality results (t tests) based on the CATI revealed that older persons were significantly more obsessive–compulsive and schizoid than younger adults but significantly lower on 7 scales, including antisocial, borderline, histrionic, and sadistic. As assessed by the COPE, older adults reported lower levels of dysfunctional coping strategies than younger adults. Specifically, older persons were less likely to use mental disengagement, venting of emotions, and alcohol/drugs to cope with problems. BSI results for clinical symptoms revealed that younger adults were significantly higher on 5 of 9 scales, including anxiety, depression, and hostility. Results suggest that younger adults experience higher levels of personality and clinical symptoms and use more dysfunctional coping strategies than older adults, dispelling the myth that old age is associated with inevitable psychological impairment. Theoretical considerations, clinical implications, and future research ideas are discussed.     

Memories of social interactions: age differences in emotional intensity

The current study examined age differences in the intensity of emotions experienced during social interactions. Because emotions are felt most intensely in situations central to motivational goals, age differences in emotional intensity may exist in social situations that meet the goals for one age group more than the other. Guided by theories of emotional intensity and socioemotional selectivity, it was hypothesized that social partner type would elicit different affective responses by age. Younger (n = 71) and older (n = 71) adults recalled experiences of positive and negative emotions with new friends, established friends, and family members from the prior week. Compared with younger adults, older adults reported lower intensity positive emotions with new friends, similarly intense positive emotions with established friends, and higher intensity positive emotions with family members. Older adults reported lower intensity negative emotions for all social partners than did younger adults, but this difference was most pronounced for interactions with new friends.     

Linking obsessional beliefs to OCD symptoms in older and younger adults

There are many open questions about the phenomenology of obsessive-compulsive disorder (OCD) in the elderly, and theories about the development of OCD have rarely been applied to older populations. The current study uses structural equation models to evaluate the relationship between obsessional beliefs and OCD symptoms across young and older adult age groups in a large community sample (aged 18-93; N=335), and to examine whether subjective concerns about cognitive decline partially mediate this relationship. Results support partial mediation, and follow-up analyses suggest that the pattern of relationships among subjective cognitive concerns, obsessional beliefs and OCD symptoms is invariant for younger and older adults, but older adults report relatively greater levels of subjective cognitive concerns.     

Development of an abbreviated Social Phobia and Anxiety Inventory (SPAI) using item response theory: the SPAI-23

An abbreviated version of the Social Phobia and Anxiety Inventory (SPAI) was developed using methods based in nonparametric item response theory. Participants included a nonclinical sample of 1,482 undergraduates (52% female, mean age = 19.4 years) as well as a clinical sample of 105 individuals (56% female, mean age = 36.4 years) diagnosed with either generalized (73%) or specific social phobia (27%). Twenty-three of the 45 SPAI items demonstrated good discrimination along the social anxiety continuum. In addition, option characteristic curves (OCCs) indicated that the SPAI's 7-point scale may generate errors in ranking individuals. Thus, options were collapsed to improve item performance. No gender differences emerged between any of the items' OCCs, suggesting that items function similarly among men and women. The abbreviated version also correlated highly with the original 45-item SPAI and exhibited similar patterns of correlations with measures of social anxiety. The SPAI-23 has considerable practical benefits, including a screening of both social and agoraphobic anxiety as well as decreased assessment and scoring time.     

Characteristics of problem gamblers 56 years of age or older: a statewide study of casino self-excluders

Gambling among older adults appears to be increasing, though little is known about the characteristics of older adult problem gamblers. The purpose of this study was to compare older adults to younger and middle-aged adults in a cohort of problem gamblers participating in a state-administered casino self-exclusion program. Self-reported problem gamblers (N = 1,601) who voluntary banned themselves from Missouri casinos from 2001 to 2003 were categorized by age as younger adults (ages 21 to 35; n = 490), middle-aged adults (ages 36 to 55; n = 950), and older adults (ages 56 to 79; n = 161), and were compared with respect to demographic variables, gambling participation, and reasons for self-exclusion. Older adult self-excluders typically began gambling in midlife, experienced gambling problems around age 60, reported preferences for nonstrategic forms of gambling, and identified fear of suicide as the primary reason for self-excluding. Implications for intervention, prevention and treatment are discussed. (PsycINFO Database Record (c) 2008 APA, all rights reserved).     

The structure and correlates of anxiety sensitivity in older adults

Anxiety sensitivity (AS) has been defined as the fear of symptoms of anxiety and panic, and is most frequently assessed with the Anxiety Sensitivity Index (Peterson & Reiss, 1987). To investigate the nature and structure of AS in an older sample, data were collected from a sample of 322 adults aged 65 to 97, with mean age 75. Confirmatory factor analysis indicated a hierarchical structure with three group factors (physical concerns, mental incapacitation concerns, and social concerns), as well as a general factor, consistent with previous investigations. Results suggest that the nature and structure of the AS trait in older adults are highly similar to those of younger adults.     

Validating age-related functional imaging changes in verbal working memory with acute stroke

Functional imaging studies consistently find that older adults recruit bilateral brain regions in cognitive tasks that are strongly lateralized in younger adults, a characterization known as the Hemispheric Asymmetry Reduction in Older Adults model. While functional imaging displays what brain areas are active during tasks, it cannot demonstrate what brain regions are necessary for task performance. We used behavioral data from acute stroke patients to test the hypothesis that older adults need both hemispheres for a verbal working memory task that is predominantly left-lateralized in younger adults. Right-handed younger (age ? 50, n = 7) and older adults (age > 50, n =21) with acute unilateral stroke, as well as younger (n =6) and older (n =13) transient ischemic attack (TIA) patients, performed a self-paced verbal item-recognition task. Older patients with stroke to either hemisphere had a higher frequency of deficits in the verbal working memory task compared to older TIA patients. Additionally, the deficits in older stroke patients were mainly in retrieval time while the deficits in younger stroke patients were mainly in accuracy. These data suggest that bihemispheric activity is necessary for older adults to successfully perform a verbal working memory task.     

Why recall our highs and lows: relations between memory functions, age, and well-being

This study examined whether positive and negative memories (life story high and low points) were differentially used for reminiscence functions concerning self and social aspects of reminiscing, and relations between function use and well-being in two age groups. Life story high and low points were collected from a sample of emerging (n =56) and older (n =55) adults, as well as a measure of the use of these memories for the self-functions of death preparation, identity, and problem solving, and the social functions of conversation and teach/inform, and a measure of psychological well-being. Memories were also coded for whether or not they contained a redemptive narrative structure (from emotionally negative to emotionally positive). Results showed that the endorsement of reminiscence functions did differ by memory type, with high points more often endorsed for the functions of identity, teach/inform, and conversation than low points. These main effects were qualified by memory type x age interactions. The use of these functions for each kind of memory was also related to well-being, but differentially for older and younger people, and redemptive sequencing was especially important to the well-being of the younger group. Findings are discussed in terms of the importance of different emotional memories for self and well-being at different points in the lifespan.     

Why recall our highs and lows: Relations between memory functions,age, and well-being

This study examined whether positive and negative memories (life story high and low points) were differentially used for reminiscence functions concerning self and social aspects of reminiscing, and relations between function use and well-being in two age groups. Life story high and low points were collected from a sample of emerging (n =56) and older (n =55) adults, as well as a measure of the use of these memories for the self-functions of death preparation, identity, and problem solving, and the social functions of conversation and teach/inform, and a measure of psychological well-being. Memories were also coded for whether or not they contained a redemptive narrative structure (from emotionally negative to emotionally positive). Results showed that the endorsement of reminiscence functions did differ by memory type, with high points more often endorsed for the functions of identity, teach/inform, and conversation than low points. These main effects were qualified by memory type × age interactions. The use of these functions for each kind of memory was also related to well-being, but differentially for older and younger people, and redemptive sequencing was especially important to the well-being of the younger group. Findings are discussed in terms of the importance of different emotional memories for self and well-being at different points in the lifespan.     

The age prospective memory paradox within the same sample in time-based and event-based tasks

The present research investigated the age prospective memory (PM) paradox by testing the performance of the same participants on laboratory and naturalistic PM tasks. Younger, middle-aged, and older adults performed three tasks (time-based, event-based with focal cue, and event-based with nonfocal cue); first in the laboratory, then in the context of their everyday lives. Additionally, the social importance of PM tasks was manipulated in the laboratory. As expected, age-dependent declines on the laboratory tasks were reversed in the naturalistic tasks. Middle-aged adults performed as well as younger adults in the laboratory and as well as the elderly outside of the laboratory. When the social importance of laboratory tasks was stressed, the performance of younger adults fell. In addition, older adults showed higher self-reported commitment to the naturalistic tasks than both younger and middle-aged adults. Findings are discussed in the context of possible explanations for the age PM paradox.     

Age differences in three facets of empathy: performance-based evidence

This study investigated age differences in cognitive and affective facets of empathy: the ability to perceive another's emotions accurately, the capacity to share another's emotions, and the ability to behaviorally express sympathy in an empathic episode. Participants, 80 younger (M(age) = 32 years) and 73 older (M(age) = 59 years) adults, viewed eight film clips, each portraying a younger or an older adult thinking-aloud about an emotionally engaging topic that was relevant to either younger adults or older adults. In comparison to their younger counterparts, older adults generally reported and expressed greater sympathy while observing the target persons; and they were better able to share the emotions of the target persons who talked about a topic that was relevant to older adults. Age-related deficits in the cognitive ability to accurately perceive another's emotions were only evident when the target person talked about a topic of little relevance to older adults. In sum, the present performance-based evidence speaks for multidirectional age differences in empathy.     

Concurrent validity of the Social Phobia and Anxiety Inventory

The Social Phobia and Anxiety Inventory (SPAI) is a new instrument designed to assess symptoms of social phobia. Although the scale has been shown to have a good test-retest reliability, internal consistency, and construct validity, no studies have examined its concurrent validity with respect to other measures of social anxiety and avoidance. In the present study, the relationship between the SPAI and several self-report measures of social anxiety was examined in a sample of 23 patients meeting DSM-III-R criteria for social phobia. The relationship between the SPAI and other measures of psychopathology, as well as performance during a role play test and an impromptu speech, was also examined. The results strongly support the concurrent validity and the specificity of the SPAI. The Social Phobia subscale may be a better index of social anxiety symptoms than the Difference subscale.This research was supported, in part, by NIMH grants MH 38636 and MH 41577 to the second author.     

The social phobia and anxiety inventory: Construct validity

The Social Phobia and Anxiety Inventory (SPAI) is a new instrument composed of social phobia and agoraphobia subscales. The latter scale is used to detect social anxiety that may result from agoraphobia. The SPAI's construct validity was assessed through several procedures. First, confirmatory factor analyses were conducted to validate the existence of the two subscales. Second, exploratory factor analyses examined the underlying structure of the social phobia subscale. Third, a Q factor procedure determined if different anxiety diagnostic groups could be differentiated by their SPAI response pattern. The results confirmed the utility of the two SPAI subscales and identified a number of dimensions contained within the social phobia subscale which differed depending upon the specific subject sample. In addition, the complaints of social phobies appeared more homogeneous than those of an agoraphobic comparison group. The results are discussed in terms of construct validity and the sensitivity of the SPAI to various dimensions of social phobia fears.This study was supported in part by NIMH Grants 41852, 30915, 18269, and 16884.     

Emotion, physiology, and expression in old age

Emotion-specific autonomic nervous system (ANS) activity was studied in 20 elderly people (age 71-83 years, M = 77) who followed muscle-by-muscle instructions for constructing facial prototypes of emotional expressions and relived past emotional experiences. Results indicated that (a) patterns of emotion-specific ANS activity produced by these tasks closely resembled those found in other studies with younger Ss, (b) the magnitude of change in ANS measures was smaller in older than in younger Ss, (c) patterns of emotion-specific ANS activity showed generality across the 2 modes of elicitation, (d) emotion self-reports and spontaneous production of emotional facial expressions that occurred during relived emotional memories were comparable with those found in younger Ss, (e) elderly men and women did not differ in emotional physiology or facial expression, and (f) elderly women reported experiencing more intense emotions when reliving emotional memories than did elderly men.     

Comparison of Privacy Consciousness Between Younger and Older Adults

The degree of being conscious about privacy for the self and others is known as privacy consciousness. This study aimed to compare privacy consciousness between younger and older adults. Japanese younger (n = 166) and older (n = 145) adults were requested to rate all items in the Privacy Consciousness Scale, which assessed their degree of consciousness about privacy for the self and others and behaviors for maintaining privacy based on this consciousness. Results indicated that older adults scored lower on Consciousness Regarding Privacy of Others and higher on Behaviors Regarding Privacy of Others than younger adults. However, no significant difference was found in Consciousness and Behaviors Regarding Privacy of the Self between younger and older adults.     

Aging, body image, and body shape

Participants were 25 older men (M age = 72 years, SD = 10 years) and 27 older women (M age = 71 years, SD = 8 years) who examined multiple line-drawing figures of babies, children, young adults, middle-aged adults, and older adults. Participants picked a number on a Likert-type scale ranging from 1 (very thin) to 9 (very obese) in response to questions including "Which is the most attractive?" and "Which figure would you most like to look like?" They also completed questionnaires about their body image and body shape. In response to the age-specific line drawings (e.g., those depicting older men and older women), older women endorsed thinner figures (e.g., picked smaller numbers) than did men. Likewise, older women reported thinking more about their body shape and appearance than did men and perceived their body image as "a little too big" in comparison with the older men who perceived their body image as "just the right size." However, a breakdown of normal and overweight women in this sample revealed that for some overweight elderly women, obesity could become a satisfactory way of life. Much as with college-aged women, the endorsement of a thinner body image by many of the older adult female participants appeared to persist into late adulthood and suggests that research into body image issues with older adults is relevant and necessary.     

Impairment in risk-sensitive decision-making in older suicide attempters with depression

Suicidal behavior is a potentially lethal complication of late-life depression. In younger adults, suicide has been linked to abnormal decision-making ability. Given that there are substantial age-related decreases in decision-making ability, and that older adults experience environmental stressors that require effective decision-making, we reasoned that impaired decision-making may be particularly relevant to suicidal behavior in the elderly. We thus compared performance on a probabilistic decision-making task that does not involve working memory ("Cambridge Gamble Task") in four groups of older adults: (1) individuals with major depression and a history of suicide attempt (n = 25), (2) individuals with major depression with active suicidal ideation but no suicide attempt (n = 13), (3) individuals with major depression without suicidality (n = 35), and (4) nondepressed control subjects (n = 22). There was a significant effect of group on quality of decision-making, whereby the suicide attempters exhibited poorer ability to choose the likely outcome, compared with the nonsuicidal depressed and nondepressed comparison subjects. There were no group differences in betting behavior. The suicide attempters differed in several aspects of social problem-solving on a self-report scale. Quality of decision-making was negatively correlated with the score on the impulsive/careless problem-solving subscale. These data suggest that older suicide attempters have a deficit in risk-sensitive decision-making, extending observations in younger adults. More specifically, older suicide attempters seem to neglect outcome probability and make poor choices. These impairments may precipitate and perpetuate suicidal crisis in depressed elders. Identification of decision-making impairment in suicidal elders may help with designing effective interventions.