Christina Bryant

The relationship between attitudes to aging and physical and mental health in older adults

BACKGROUND Attitudes are known to exert a powerful influence on a range of behaviors. The objective of this study was to investigate the contribution of attitudes toward ones own aging to satisfaction with life and physical and mental health measured in a sample of community-dwelling older adults. METHODS Adults who were part of a larger study of health and well-being in rural and regional Australia aged ≥60 years (N = 421) completed a cross-sectional postal survey comprising the Attitudes to Aging Questionnaire, the 12-Item Short Form Health Survey (SF-12), the Satisfaction with Life Scale, the Geriatric Anxiety Inventory, and the Center for Epidemiological Studies Depression Scale. RESULTS Overall, attitudes to aging were positive in this sample. More positive attitudes to aging were associated with higher levels of satisfaction with life, better self-report physical and mental health on the SF-12, and lower levels of anxiety and depression, after controlling for confounding variables. Better financial status and being employed were both associated with more positive attitudes to aging and better self-reported physical health. Relationship status was also significantly associated with mental health and satisfaction with life, but not physical health. CONCLUSION The promotion of successful aging is increasingly becoming important in aging societies. Having positive attitudes to aging may contribute to healthier mental and physical outcomes in older adults. Overcoming negative stereotypes of aging through change at the societal and individual level may help to promote more successful aging.

A physiotherapist-delivered, combined exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a pilot study.

BACKGROUND Osteoarthritis (OA) of the knee is associated with a number of physical and psychological impairments. Unfortunately, very few treatment strategies are capable of addressing both types of impairments concurrently. We performed a pilot, randomized controlled, proof of principle trial investigating the feasibility and effects of an intervention combining physical exercise and pain coping skills training (PCST). METHODS Twenty patients with a clinical and radiographical diagnosis of tibiofemoral OA were randomized to receive either 10 weeks of physiotherapist supervised exercises (lower limb strengthening and walking) combined with non-directive counseling (NDC) or the same exercise program delivered concurrently with PCST. Primary outcomes included self-reported pain and pain coping, while secondary outcomes included self efficacy and self-reported physical function. RESULTS Ten participants were randomized to each group and both groups exhibited significant improvements in isometric knee strength, self-reported knee pain and physical function, self efficacy for control of pain management and other arthritis symptoms. Only those in the exercise + PCST group reported statistically significant improvements in pain control coping and rational thinking. No between-group differences existed in any outcome (0.07 < p < 0.98). Based on our findings, 63 participants per group would be needed for future large-scale studies using similar outcome measures and design. CONCLUSIONS Our study showed that an intervention that combines exercise and PCST within the same treatment session and delivered by specially-trained physiotherapists is feasible and can improve both physical and psychological outcomes in individuals with knee OA. LEVEL OF EVIDENCE Level II Clinical Trials Registry number: ACTRN12609000623291.

Depression and anxiety in medically unwell older adults: prevalence and short-term course

BACKGROUND The objective of this study was to examine the prevalence and short-term course of depression and anxiety in a sample of hospitalized, medically unwell older adults, using both a symptom measure and a diagnostic instrument. METHODS One hundred participants were recruited from in-patients in a geriatric hospital in Melbourne, Australia. Anxiety and depression were assessed shortly after admission, and again two months later, using the Hospital Anxiety and Depression Scale (HADS) and the Geriatric Mental Status Schedule/ AGECAT diagnostic system. RESULTS At Time 1, 60% of the sample exhibited anxiety symptoms at a sub-case level, while 16% had anxiety symptoms at a syndrome case level, whereas 48% of the participants had depression at syndrome level. The HADS and AGECAT were concordant with respect to anxiety for 78% of participants, but agreement was lower for depression; AGECAT identified a further 36 syndrome cases of depression not deemed depressed by the HADS. There was a significant decrease in overall rates of both depression and anxiety symptoms and syndromes from Time 1 to Time 2. CONCLUSION This study confirms the findings of previous research with respect to the high prevalence of depression in physically unwell older adults, and extends knowledge about anxiety in this group. Symptoms of anxiety are even more common than symptoms of depression in this group, especially around the time of admission to hospital. Over a relatively short time period, there is a marked reduction in symptoms, but levels of anxiety and depression remain high.

Improving recognition of late life anxiety disorders in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: observations and recommendations of the Advisory Committee to the Lifespan Disorders Work Group

Recognition of the significance of anxiety disorders in older adults is growing. The revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) provides a timely opportunity to consider potential improvements to diagnostic criteria for psychiatric disorders for use with older people. The authors of this paper comprise the Advisory Committee to the DSM5 Lifespan Disorders Work Group, the purpose of which was to generate informative responses from individuals with clinical and research expertise in the field of late‐life anxiety disorders.

Physical Therapist-Delivered Pain Coping Skills Training and Exercise for Knee Osteoarthritis: Randomized Controlled Trial.

To investigate whether a 12‐week physical therapist–delivered combined pain coping skills training (PCST) and exercise (PCST/exercise) is more efficacious and cost effective than either treatment alone for knee osteoarthritis (OA).

A prospective study of the impact of floods on the mental and physical health of older adults.

Objectives: With a longitudinal prospective design, we examined the impact of floods on the mental and physical health of older adults and explored risk and protective factors. Method: Two hundred and seventy four older adults (age ≥60) completed surveys before and after a flood event. Both the surveys included measures of anxiety, depression, self-reported health, and satisfaction with life; the post-flood survey also included questionnaires on flood experience, symptoms of post-traumatic stress disorder (PTSD), stoicism, and psychological coping with floods. Results: Compared to those not personally affected (78.8%), personally affected individuals (21.2%) reported significantly higher PTSD symptoms, with about one in six reporting PTSD symptoms that might require clinical attention. Personally affected individuals also reported a greater increase in anxiety post-flood, but changes in their depressive symptoms and self-reported health were not significantly different from those not personally affected. Greater flood exposure and the lack of social support were the risk factors for poorer mental and physical health. Higher stoicism was associated with higher post-flood depression and poorer self-reported mental health. The use of maladaptive coping, such as venting and distraction, was associated with greater deterioration in mental health after floods, whilst emotion-focused coping such as acceptance, positive reframing, and humour, was protective against such deterioration. Conclusion: Floods had adverse psychological impacts on some older adults who were personally affected. Despite the evidence of resilience, a small proportion of older adults experienced significant difficulties after the floods. The findings in this study help understand older adults’ psychological responses to disasters and have practical implications for service planning and delivery.

Anxiety and depression in old age: challenges in recognition and diagnosis

© 2010 International Psychogeriatric Association. Online edition of the journal is available at http://journals.cambridge.org/action/displayJournal?jid=IPG

Evaluation and management of depressive and anxiety symptoms in midlife.

Objectives Evaluation and management of anxiety and depression during the menopausal transition are complicated by the overlap between some symptoms of affective disorder with those of menopausal symptoms, and also by inconsistencies in the literature regarding the relationship between the menopausal transition and affective disorders. Methods We have reviewed key studies over the past three decades addressing depression and anxiety during the menopause transition, in order to present a practical, clinical approach to the evaluation and management of anxiety and depressive symptoms at midlife. Results Symptoms of anxiety and depression are common at midlife and may coincide with menopausal symptoms. Some menopausal symptoms are also symptoms of anxiety and/or depression. Management should include treatment of troublesome menopausal symptoms, providing strategies to deal with psychosocial stressors, and exclusion of clinically significant anxiety and depressive disorders. Interventions such as exercise and cognitive behavior therapy may improve mood and general health at menopause, and a multifocal approach is recommended. Depression of greater than moderate severity requires treatment with an antidepressant. Some selective serotonin reuptake inhibitors and serotonin–norepinephrine reuptake inhibitors may also improve vasomotor symptoms and these should be considered in women with both affective disorder and vasomotor symptoms. Conclusions There is no clear evidence that the menopause transition alone increases the risk of clinically significant affective disorders, except in women with risk factors such as psychosocial stressors, severe and prolonged vasomotor symptoms and a previous history of affective disorders. Nevertheless, anxiety and depression are common in women and clinicians should be alert to the symptoms of these conditions at all encounters.

Anxiety Disorders in Older Adults: Looking to DSM5 and Beyond…

Anxiety in late life was for many years the ‘Cinderella’ of psychiatric disorders, often overshadowed by the focus on depression and dementia, and receiving little attention in research and clinical domains. As highlighted by an editorial published in this journal several years ago [1], the scientific study of anxiety in older age has a relatively brief history. Recently, however, there has been increased recognition of the prevalence and clinical consequences of anxiety disorders in older adults and lively debate about their nature and most appropriate diagnostic criteria [2, 3, 4]. The current evidence reveals that anxiety in older adults is more common than depression in community samples [5], often preceding depressive disorders [6]; moreover, co-morbid anxiety and depression has a poorer outcome than either condition alone [7]. Anxiety disorders are even more prevalent in clinical settings [8], and can have serious consequences for recovery from illness [9] and quality of life [10], as well as substantially increasing disability levels [11]. Therefore, anxiety disorders in older adults should be regarded as conditions of great public health importance.

A physiotherapist-delivered integrated exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a randomised controlled trial protocol

BackgroundKnee osteoarthritis (OA) is a prevalent chronic musculoskeletal condition with no cure. Pain is the primary symptom and results from a complex interaction between structural changes, physical impairments and psychological factors. Much evidence supports the use of strengthening exercises to improve pain and physical function in this patient population. There is also a growing body of research examining the effects of psychologist-delivered pain coping skills training (PCST) particularly in other chronic pain conditions. Though typically provided separately, there are symptom, resource and personnel advantages of exercise and PCST being delivered together by a single healthcare professional. Physiotherapists are a logical choice to be trained to deliver a PCST intervention as they already have expertise in administering exercise for knee OA and are cognisant of the need for a biopsychosocial approach to management. No studies to date have examined the effects of an integrated exercise and PCST program delivered solely by physiotherapists in this population. The primary aim of this multisite randomised controlled trial is to investigate whether an integrated 12-week PCST and exercise treatment program delivered by physiotherapists is more efficacious than either program alone in treating pain and physical function in individuals with knee OA.Methods/designThis will be an assessor-blinded, 3-arm randomised controlled trial of a 12-week intervention involving 10 physiotherapy visits together with home practice. Participants with symptomatic and radiographic knee OA will be recruited from the community in two cities in Australia and randomized into one of three groups: exercise alone, PCST alone, or integrated PCST and exercise. Randomisation will be stratified by city (Melbourne or Brisbane) and gender. Primary outcomes are overall average pain in the past week measured by a Visual Analogue Scale and physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index subscale. Secondary outcomes include global rating of change, muscle strength, functional performance, physical activity levels, health related quality of life and psychological factors. Measurements will be taken at baseline and immediately following the intervention (12 weeks) as well as at 32 weeks and 52 weeks to examine maintenance of any intervention effects. Specific assessment of adherence to the treatment program will also be made at weeks 22 and 42. Relative cost-effectiveness will be determined from health service usage and outcome data.DiscussionThe findings from this randomised controlled trial will provide evidence for the efficacy of an integrated PCST and exercise program delivered by physiotherapists in the management of painful and functionally limiting knee OA compared to either program alone.Trial registrationAustralian New Zealand Clinical Trials Registry reference number: ACTRN12610000533099