Andrea June

Development and initial validation of a self-report assessment tool for anxiety among older adults: The Geriatric Anxiety Scale

Anxiety is a common experience among older adults and can be a cause for major clinical concern. Brief and psychometrically sound screening instruments are needed to detect anxiety in later life. The purposes of this study were to develop a brief, self-report measure of anxiety for use with older adults (called the Geriatric Anxiety Scale [GAS]) and to report on its preliminary psychometrics. The GAS includes 30 self-report items of which 25 items represent three common domains of anxiety symptoms among older adults (cognitive, somatic, and affective) and 5 items represent common content areas of worry. The GAS total score and subscale scores demonstrated good internal reliability in community dwelling and in clinical samples. In addition, correlation analyses provided solid evidence of convergent and construct validity for the GAS in both samples. Present results support the preliminary validity of the GAS for clinical and research purposes. We conclude with a discussion of limitations and future research topics.

Religiousness, social support and reasons for living in African American and European American older adults: an exploratory study.

Objectives: This study examined the relationship between religiousness, perceived social support, and reasons for living among European American (n = 37; M age = 67.7 years) and African American (n = 35; M age = 71.1 years) older adults, where ethnicity was predicted to behave as a moderator. Method: Community-dwelling participants completed the Brief Multidimensional Measure of Religiousness/Spirituality, the Multidimensional Measure of Perceived Social Support, and the Reasons for Living Inventory. Results: As expected, high religiousness was associated with more reasons for living. Ethnicity alone did not meaningfully account for variance differences in reasons for living, but significant interactions indicated that the relationship between religiousness and reasons for living was stronger for African Americans, whereas the relationship between social support and reasons for living was stronger for European Americans. Conclusion: The present findings may be valuable for understanding potentially modifiable pathways to suicide resilience in diverse populations of older adults.

Psychometric Properties of the Geriatric Anxiety Scale: Comparison to the Beck Anxiety Inventory and Geriatric Anxiety Inventory

This study explored the convergent and discriminant validity of the Geriatric Anxiety Scale (GAS), a new measure of anxiety symptoms for older adults. The GAS, Beck Anxiety Inventory (BAI), Geriatric Anxiety Inventory (GAI), Beck Depression Inventory, Second Edition (BDI-II), and Geriatric Depression Scale (GDS) were administered to 117 community-dwelling, predominantly White, older adults (62% female; M age = 74.75 years, range = 60 − 89 years; M years of education = 14.97). Scores on the GAS were strongly associated with scores on measures of anxiety and depression, but not associated with scores on measures of reading ability or processing speed. The GAS possesses strong convergent and discriminant validity and shows promise as a measure of anxiety in older adults.

Pain is prevalent and persisting in cancer survivors: differential factors across age groups.

OBJECTIVE The Institute of Medicine documents a significant gap in care for long term side effects of cancer treatment, including pain. This paper characterizes age differences in the prevalence and predictive characteristics of pain to guide clinicians in identification and treatment. MATERIALS AND METHODS A sample of 170 adults with head and neck, esophageal, gastric, or colorectal cancers were recruited from two regional Veterans Administration Medical Centers. Face to face interviews were conducted 6, 12, and 18 months after diagnosis with the PROMIS scale to assess pain and PHQ-9 scale to assess depression. Descriptive statistics characterized incidence and prevalence of pain impact and intensity ratings. Multivariate linear hierarchical regression identified clinical characteristics associated with pain in older versus younger age groups. RESULTS Clinically significant pain was endorsed in one third (32%) of the sample, with younger adults reporting higher levels of the impact of pain on daily activities and work, and also higher pain intensity ratings than older adults. In younger adults, pain ratings were most associated with lower social support and higher depression, as well as advanced cancer stage. In older adults, pain was multifactorial, associated with baseline comorbidities, adjuvant treatment, and both combat post-traumatic stress disorder (PTSD) and depression. CONCLUSIONS Pain is a significant persisting problem for one in three cancer survivors, requiring ongoing assessment, even months later. Important differences in pains determinants and impact are present by age group. Identification and treatment of pain, as well as associated conditions such as depression, may improve the quality of life in cancer survivors.

Geriatric Depression Scale

Abstract The Long Form and the Short Form of the Geriatric Depression Scale (GDS) were compared in a VA nursing home population. The study had two phases. In the first phase, 86 geriatric male veterans were administered the Long Form of the GDS at intake. The Long Form was rescored on the Short Form and a scatterplot was constructed. The Short Form of the GDS consistently identified 94% of the participants using the Long Form as the standard. In the second phase of the study, 31 veterans were administered both the Long Form and the Short Form of the GDS in alternating order during their intake or annual screening assessment. A scatterplot showed the Short Form to consistently identify 100% of the participants using the Long Form as the standard.

Geriatric Anxiety Scale: item response theory analysis, differential item functioning, and creation of a ten-item short form (GAS-10)

BACKGROUND The Geriatric Anxiety Scale (GAS; Segal et al. (Segal, D. L., June, A., Payne, M., Coolidge, F. L. and Yochim, B. (2010). Journal of Anxiety Disorders, 24, 709-714. doi:10.1016/j.janxdis.2010.05.002) is a self-report measure of anxiety that was designed to address unique issues associated with anxiety assessment in older adults. This study is the first to use item response theory (IRT) to examine the psychometric properties of a measure of anxiety in older adults. METHOD A large sample of older adults (n = 581; mean age = 72.32 years, SD = 7.64 years, range = 60 to 96 years; 64% women; 88% European American) completed the GAS. IRT properties were examined. The presence of differential item functioning (DIF) or measurement bias by age and sex was assessed, and a ten-item short form of the GAS (called the GAS-10) was created. RESULTS All GAS items had discrimination parameters of 1.07 or greater. Items from the somatic subscale tended to have lower discrimination parameters than items on the cognitive or affective subscales. Two items were flagged for DIF, but the impact of the DIF was negligible. Women scored significantly higher than men on the GAS and its subscales. Participants in the young-old group (60 to 79 years old) scored significantly higher on the cognitive subscale than participants in the old-old group (80 years old and older). CONCLUSIONS Results from the IRT analyses indicated that the GAS and GAS-10 have strong psychometric properties among older adults. We conclude by discussing implications and future research directions.

Views of Hospice and Palliative Care Among Younger and Older Sexually Diverse Women

The aim of the present study was to explore end-of-life health care attitudes among younger and older sexually diverse women. Self-identified lesbian and heterosexual older women as well as lesbian and heterosexual middle-aged women were recruited. Results indicated that lesbian women held significantly more positive beliefs about hospice services and the role of alternative medicines in health care. No differences among sexual orientation were found for comfort discussing pain management but heterosexual women reported a significantly greater desire for life-sustaining treatments in the event of an incurable disease and severe life-limiting conditions (eg, feeding tube, life support, no brain response). Additionally, as expected, older women in this study held more positive beliefs about hospice and more comfort discussing pain management than middle-aged women.

Participation in intergenerational service-learning benefits older adults: A brief report

ABSTRACT Most research on intergenerational service-learning has focused on the benefits for college students, with fewer studies examining the benefits to older adults. The present study was designed to assess the impact on older adults of participating in Working Together: Intergenerational Student/Senior Exchange, a brief intergenerational service-learning program that brings together college students and older adults as equal partners to promote intergenerational understanding and communication. Older adults from an assisted living community met up to six times with students enrolled in aging-related courses to discuss a variety of topics and get to know one another. Results showed brief intergenerational service-learning benefits older adults with significant increases in generativity from pre-to post-program assessment. Additionally, a large percentage of the participants expressed interest in participating again and a willingness to refer others to the program. Limitations and future directions are discussed.

Basic Issues in Interviewing and the Interview Process

The ability to conduct an efficient and effective clinical and diagnostic interview is arguably one of the most valued skills among mental health professionals. It is during the interview that the clinician learns about the difficulties and challenges experienced by the client and begins to form the foundations of a healing professional relationship. Although the metaphor is not a novel one, the job of the interviewer may be likened to that of a detective trying to collect enough data and organize the clues to “solve the mystery,” in this example, the presenting problem of the client. The most important aspect of this detective metaphor is that effective interviewers (detectives) are served well by their natural curiosity (truly wanting to understand all aspects of the client’s experiences, no mater how painful or uncomfortable) and the thoughtfulness of their approach (being guided by strategies and principles for gathering data while also forming an emotional connection with the client).