Barry A. Edelstein

Assessment of Anxiety in Older Adults: Current Status

In 1994 there were 33.2 million older adults (65 years of age and older) in the United States, and approximately one quarter of these older adults meet diagnostic criteria for some mental disorder. Anxiety is among the most prevalent psychiatric disorder in older adults. However, insufficient research has been conducted on the assessment of anxiety in older adults. The purpose of this article was to provide an overview of issues to consider in assessing anxiety in older adults. First, a discussion of factors that may influence current prevalence and incidence figures is provided. Second, age-related differences in factors that can influence the experience and presentation of anxiety symptoms are considered. Third, age-related factors that can influence the assessment process or outcome are presented. Fourth, a discussion on the important role of multimethod assessment and the psychometric adequacy of available anxiety assessment instruments is presented. Finally, recommendations for clinical assessment and future research are provided.

Effects of modeling and modeling with instructions and feedback on the behavioral components of social skills

Modeling and modeling plus instructions and feedback were compared for social skills training of a male schizophrenic patient in a modified multiple-baseline desggn. Generalization to different individuals and social situations was assessed by probe scenes within sessions and between experimental conditions. For each scence, the subject responsed to male and female stimulus persons. The dependent measures were duration of eye contact, number of head and hand gestures, and ratings of affect and assertiveness. Modeling alone increased affect, but not gestures or duration of eye contact. Modeling combined with instructions and feedback increased eye contact, gestures, and overall affect.

Framing effect debiasing in medical decision making

OBJECTIVE Numerous studies have demonstrated the robustness of the framing effect in a variety of contexts. The present study investigated the effects of a debiasing procedure designed to prevent the framing effect for young adults who made decisions based on hypothetical medical decision-making vignettes. METHODS The debiasing technique involved participants listing advantages and disadvantages of each treatment prior to making a choice. One hundred and two undergraduate students read a set of three medical treatment vignettes that presented information in terms of different outcome probabilities under either debiasing or control conditions. RESULTS The framing effect was demonstrated by the control group in two of the three vignettes. The debiasing group successfully avoided the framing effect for both of these vignettes. CONCLUSION These results further support previous findings of the framing effect as well as an effective debiasing technique. This study improved upon previous framing debiasing studies by including a control group and personal medical scenarios, as well as demonstrating debiasing in a framing condition in which the framing effect was demonstrated without a debiasing procedure. PRACTICE IMPLICATIONS The findings suggest a relatively simple manipulation may circumvent the use of decision-making heuristics in patients.

Behavioral interventions for agitation in older adults with dementia: an evaluative review

BACKGROUND Older adults with dementia commonly exhibit agitated behavior that puts them at risk of injury and institutionalization and is associated with caregiver stress. A range of theoretical approaches has produced numerous interventions to manage these behavior problems. This paper critically reviews the empirical literature on behavioral interventions to reduce agitation in older adults with dementia. METHOD A literature search yielded 23 articles that met inclusion criteria. These articles described interventions that targeted wandering, disruptive vocalization, physical aggression, other agitated behaviors and a combination of these behaviors. Studies are summarized individually and then evaluated. RESULTS Behavioral interventions targeting agitated behavior exhibited by older adults with dementia show considerable promise. A number of methodological issues must be addressed to advance this research area. Problem areas include inconsistent use of functional assessment techniques, failure to report quantitative findings and inadequate demonstrations of experimental control. CONCLUSIONS The reviewed studies collectively provide evidence that warrants optimism regarding the application of behavioral principles to the management of agitation among older adults with dementia. Although the results of some studies were mixed and several studies revealed methodological shortcomings, many of them offered innovations that can be used in future, more rigorously designed, intervention studies.

Adolescent Psychiatric Patients Modifying Aggressive Behavior with Social Skills Training

Socially appropriate means of interrupting, requesting behavior change, and responding to negative communication were trained within a multiple baseline design to modify the aggressive behavior of four adolescent psychiatric patients. Dependent measures included qualitative ratings of responses in these three behavior classes. Such training resulted in increased social appropriateness of responses to role played treated scenes and generalization scenes. Generalization of treatment effects to behavior in extra-treatment settings was demonstrated. Finally, reductions in the number of token economy fines and times in seclusion, and more than six months of successful community tenure were noted for the majority of subjects. The expedience of replacing aggressive behavior with socially appropriate alternative operants rather than merely punishing aggressive responses is discussed.

Assessment of Capacity in an Aging Society

Over the past 40 years, the assessment and scientific study of capacity in older adults has emerged as a distinct field of clinical and research activity for psychologists. This new field reflects the convergence of several trends: the aging of American society, the growing incidence and prevalence of dementia, and the patient rights, deinstitutionalization, and disability rights movements. Because of these forces, capacity issues now permeate the fabric of everyday life, whether in the form of guardianship petitions, questions of capacity to consent to treatment, the ability to make a new will, or participation in human research. In seeking to resolve these issues, families, clinicians, and legal professionals increasingly turn to psychologists to assess a capacity and to provide empirically supported judgments that properly balance autonomy and protection for the individual. Psychologists have taken a leading role in the development of functional assessment instruments that measure important aspects of the capacity construct. In addition, psychology has been a major contributor to the scientific study of capacity. In collaboration with colleagues from medicine and law, psychologists have articulated crucial theoretical frameworks that integrate legal, clinical, and ethical dimensions of the capacity problem. This article focuses on the evolution of theory, law, science, and practice in the evaluation of capacity in older adults and its recent culmination in a series of interdisciplinary handbooks sponsored by the American Psychological Association and the American Bar Association.

Development and Psychometric Evaluation of the Reasons for Living—Older Adults Scale: A Suicide Risk Assessment Inventory

PURPOSE The purposes of these studies were to develop and initially evaluate the psychometric properties of the Reasons for Living Scale-Older Adult version (RFL-OA), an older adults version of a measure designed to assess reasons for living among individuals at risk for suicide. DESIGN AND METHODS Two studies are reported. Study 1 involved instrument development with 106 community-dwelling older adults, and initial psychometric evaluation with a second sample of 119 community-dwelling older adults. Study 2 evaluated the psychometric properties of the RFL-OA in a clinical sample. One hundred eighty-one mental health patients 50 years or older completed the RFL-OA and measures of depression, suicide ideation at the current time and at the worst point in ones life, and current mental status and physical functioning. RESULTS Strong psychometric properties were demonstrated for the RFL-OA, with high internal consistency (Cronbachs alpha coefficient). Convergent validity was evidenced by negative associations among RFL-OA scores and measures of depression and suicide ideation. RFL-OA scores predicted current and worst-episode suicide ideation above and beyond current depression. Discriminant validity was evidenced with measures of current mental status and physical functioning. Criterion-related validity was also demonstrated with respect to lifetime history of suicidal behavior. IMPLICATIONS These findings provide preliminary support for the validity and reliability of the RFL-OA. The findings also support the potential value of attending to reasons for living during clinical treatment with depressed older adults and others at risk for suicide.

Older Adult Psychological Assessment : Current Instrument Status and Related Considerations

Abstract The psychological assessment of older adults is often challenging due to the frequent co-morbidity of mental and physical health problems, multiple medications, interactions among medications, age-related sensory and cognitive deficits, and the paucity of assessment instruments with psychometric support for use with older adults. First, psychological assessment instruments for examining five important clinical areas (suicide ideation, sleep disorders, anxiety, depression, and personality) are discussed in light of the most current research regarding their psychometric properties and suitability for use with older adults. Instruments developed specifically for older adults are distinguished from instruments developed for younger adults that have some psychometric support for their use with older adults. Second, the potential sensory deficits that could compromise assessment, factors to consider in light of these deficits, and accommodations that can be made to minimize their effects are discussed.

Effects of phenothiazines and social skills training in a withdrawn schizophrenic

The effects of phenothiazines and social skills training on a severely withdrawn schizophrenic were examined. Regulation of phenothiazine levels had the result that the patient became more receptive to behavioral interventions. Specific application of a token economy program effected a marked improvement in the assertive training was employed to improve the patients repertoire of ininterpersonal responses. Prior to actual hospital discharge the patient was faded back into his natural environment during a job retraining phase at Goodwill Industries. Specific data on the patients improved social functioning are presented in a multiple baseline analysis. Follow-up data document the patients successful adaptation of his natural enviroment.

Stress, Social Support, and Burnout Among Long-Term Care Nursing Staff

Long-term care nursing staff are subject to considerable occupational stress and report high levels of burnout, yet little is known about how stress and social support are associated with burnout in this population. The present study utilized the job demands–resources model of burnout to examine relations between job demands (occupational and personal stress), job resources (sources and functions of social support), and burnout in a sample of nursing staff at a long-term care facility (N = 250). Hierarchical linear regression analyses revealed that job demands (greater occupational stress) were associated with more emotional exhaustion, more depersonalization, and less personal accomplishment. Job resources (support from supervisors and friends or family members, reassurance of worth, opportunity for nurturing) were associated with less emotional exhaustion and higher levels of personal accomplishment. Interventions to reduce burnout that include a focus on stress and social support outside of work may be particularly beneficial for long-term care staff.