Ignacio Montorio

The Geriatric Depression Scale: A Review of Its Development and Utility

This article reviews the significance of the Geriatric Depression Scale (GDS) to practitioners and researchers in clinical gerontology, more than 10 years after the scale was introduced to the scientific community. This report summarizes findings from the most relevant validation studies in which this self-report for assessing depression in elderly people has been tested. Included is discussion of the use of the GDS with specific populations (elderly medical inpatients, nursing home residents, and dementia populations), with description of the scales psychometric properties and its utility when used with them. This article also provides data on the use of the GDS from more recent studies, including additional information on psychometric properties, influence of source bias, and the international dissemination of the GDS. We conclude that the GDS is a relevant self-report for the assessment of depression in the elderly, given its advantage over other self-reports that are not as easily administered to this age group, its utility in the detection of depression, and its adequate psychometric properties. However, the GDS does not maintain its validity in demented populations because it fails to identify depression in persons with mild to moderate dementia. Finally, some suggestions for future research are made.

Cross-cultural study comparing the association of familism with burden and depressive symptoms in two samples of Hispanic dementia caregivers

Familism has been pointed out as a key value in Hispanic culture that may or may not be associated with caregiver distress. Although groups included in the Hispanic identity have many common features, differences between Hispanic sub-groups in the relationship of familism with burden and depressive symptoms remain unexplored. The association of familism with burden and depressive symptomatology was examined in 48 Hispanic dementia caregivers from Los Angeles (CA, USA) and 60 from Madrid (Spain) through path analyses. Burden and depressive symptomatology were positively and significantly related in both samples. Familism was significantly correlated with lesser burden in the USA Hispanic caregiver sample, but with higher levels of depressive symptoms in the Spanish sample. Significant differences between Hispanic samples were found in the relationship between familism, burden, and depression, denoting the importance of specific cultural contexts influencing dementia caregiving in Hispanics.

Modification of dysfunctional thoughts about caregiving in dementia family caregivers: Description and outcomes of an intervention programme

Among the diverse group of interventions developed to help dementia family caregivers cognitive-behavioural approaches show especially promising results. Objectives: This study describes a cognitive-behavioural group intervention aimed principally at the modification of dysfunctional thoughts associated with caregiving (MDTC). The efficacy of the MDTC intervention in reducing caregivers’ depressive symptomatology, together with the frequency and appraisal of problem behaviours, is compared to that of a waiting-list control group (WL). Furthermore, the potential mediating role of the dysfunctional thoughts in the relationship between this intervention and caregivers’ depressive symptomatology is analyzed. Of the 74 dementia caregivers who were randomized to one of two conditions (MDTC and WL), 39 completed the post-intervention assessment. Statistical analyses were performed on an intention-to-treat basis, using last observation carried forward. The results reveal that the MDTC intervention is successful in reducing caregivers’ level of depressive symptomatology and dysfunctional thoughts about caregiving, as well as in modifying their appraisal of their relatives problem behaviours. Furthermore, a mediating role for dysfunctional thoughts was found in the relationship between the MDTC intervention and levels of depressive symptomatology. The relevance of addressing dysfunctional thoughts and cognitive distortions in group interventions with caregivers is highlighted.

Characterization of worry according to severity of anxiety in elderly living in the community.

The goals of this study were to analyse the characteristics of the phenomenon of worry in old age, to analyse differential characteristics of worry in the elderly according to severity of anxiety, and to explore the discriminative ability of different DSM-IV criteria for generalized anxiety disorder (GAD) to reveal the presence of this disorder. Starting from a randomized sample of 97 individuals, those 85 representing three levels of severity of the anxiety were retained: 74 non-clinical, four with sub-threshold anxiety and seven with GAD. They were assessed with different variables typically considered to be relevant for the analysis and characterization of worry. Results indicate that the most remarkable differences in contents of worry as a function of severity of anxiety occurred in the domains of worries about health and personal worries. Furthermore, elderly people with high levels of anxiety worry more frequently, and about more issues, and perceive less control over their worrying. Significant differences between groups in past and present orientation of worry were found. Worries were more frequent in GAD and they were oriented mainly towards the present and minor everyday problems in both GAD and non-clinical people. Moreover, worry about minor things together with the extent to which worry interferes in daily life were the best discriminant variables for GAD, being better than the core DSM-IV GAD criteria. We conclude that this pattern of results suggests that the potential of a specific worry to affect daily well-being and quality of life is strongly related to the presence of a disorder.

The role of psychological variables in explaining depression in older people with chronic pain

Objectives: Depression is commonly associated with chronic pain, and is also a common condition in the elderly. However research in the area of depression and pain is scarce. The aim of the present work was to analyse how cognitive–behavioural and perceptual variables help to explain the presence or absence of depression in older people with chronic pain caused by osteoarthritis. Method: A total of 104 older adults were evaluated using a protocol that measured depression, perceptual characteristics of pain (intensity, frequency and duration), beliefs about pain, self-efficacy beliefs, coping style, coping strategies and pain behaviours. Results: Using Students t-tests and discriminant analysis, we found that psychological variables such as catastrophizing, passive coping, complaint behaviour, avoidance, coping self-statements, ignoring pain sensations and stability and mystery beliefs help to explain depressive symptomatology. Conclusion: The present study confirms the important role of cognitive–behavioural variables in the discrimination between older adults who suffer pain with and without symptoms of depression. Moreover, certain variables that in young adults had been seen to play a non-adaptive role, such as ignoring pain sensations, were seen to have an adaptive function in the elderly. Also, our results are in support of depression models – such as Abramsons Hopelessness Model – proposing that depression in chronic pain patients, unlike in other groups of depressed people, is characterized by absence of self-blame feelings.

Risk factors of elder abuse in a community dwelling Spanish sample

We analyzed the discriminative capacity of several risk factors for elder abuse and neglect, in order to identify what characteristics distinguish between caregivers with a high or low risk of abuse and neglect. Forty-five caregivers of relatives with dementia participated. The combination of caregiving impact, frequency of aggressive behaviors by care-recipients, stress related to provocative and aggressive behaviors, the frequency of provocative behaviors, interpersonal burden, autoefficiency expectations, quantity of help received and depression classify correctly as risk factors in 90.9% of the cases. This study permits us to identify what characteristics distinguish between caregivers with a high or low risk of abuse and neglect and caregivers.

Optimising the diagnostic performance of the Geriatric Depression Scale

The aim of this work is to empirically generate a shortened version of the Geriatric Depression Scale (GDS), with the intention of maximising the diagnostic performance in the detection of depression compared with previously GDS validated versions, while optimizing the size of the instrument. A total of 233 individuals (128 from a Day Hospital, 105 randomly selected from the community) aged 60 or over completed the GDS and other measures. The 30 GDS items were entered in the Day Hospital sample as independent variables in a stepwise logistic regression analysis predicting diagnosis of Major Depression. A final solution of 10 items was retained, which correctly classified 97.4% of cases. The diagnostic performance of these 10 GDS items was analysed in the random sample with a receiver operating characteristic (ROC) curve. Sensitivity (100%), specificity (97.2%), positive (81.8%) and negative (100%) predictive power, and the area under the curve (0.994) were comparable with values for GDS-30 and higher compared with GDS-15, GDS-10 and GDS-5. In addition, the new scale proposed had excellent fit when testing its unidimensionality with CFA for categorical outcomes (e.g., CFI=0.99). The 10-item version of the GDS proposed here, the GDS-R, seems to retain the diagnostic performance for detecting depression in older adults of the GDS-30 items, while increasing the sensitivity and predictive values relative to other shortened versions.

Knowledge about aging and worry in older adults: Testing the mediating role of intolerance of uncertainty

Objectives: This study aims to explore the relationship between knowledge about aging and severity of worry in older adults, and to test the potential mediational role of intolerance of uncertainty. Method: The sample was composed of 120 community-dwelling older adults, with a mean of age of 71.0 years (SD = 6.3). Mediational analyses and structural equation modeling were used to analyze and compare different models. Results: Greater knowledge about aging was negatively related to both intolerance of uncertainty and worry, and its effect on worry was partially mediated by intolerance of uncertainty. The mediational model obtained an excellent fit to the data (i.e. Goodness of fit index (GFI) = 0.995) and clearly had a better fit than alternative models. Conclusion: These results suggest that a good knowledge of the aging process could help decrease aversive uncertainty and thus reduce the level of worry among older adults. Thus, educational programs to increase knowledge about aging could serve as one preventive strategy for anxiety in old age.

A test of the measurement invariance of a brief version of the Penn State Worry Questionnaire between American and Spanish older adults

BACKGROUND Both anxiety disorders and subclinical anxiety symptoms are related to poorer health and functioning in later life. Because worry is an important component of anxiety, the accurate measurement of worry is crucial to studying the etiology, prevention and treatment of anxiety disorders. Assessment of the trait worry has emerged as the most widely used strategy to establish the presence and extent of pathological worry. However, the Penn State Worry Questionnaire (PSWQ), the most widely used measure of the trait worry, has not been validated cross-culturally in groups outside of the U.S.A. METHODS We tested the psychometric properties and measurement invariance of an 8 item abbreviated version of the PSWQ (PSWQ-A) in American (N = 206) and Spanish (N = 137) older adult samples. RESULTS Internal consistency was high and analyses supported a unidimensional solution in both samples. Measurement invariance was tested using confirmatory factor analysis (CFA) and Rasch models. Results of the CFA suggest that measurement invariance between the samples can be assumed for women but not for men. Rasch modeling results by gender suggested that three items have different endorsability levels in the two samples, suggesting that certain items may more closely represent the construct of the trait worry in American and Spanish older adults. CONCLUSIONS Overall, the PSWQ-A appears appropriate for cross-cultural use, although deletion of one item (item 6) may improve the psychometric properties of the scale across different populations.

Prevalencia de malos tratos hacia personas mayores que viven en la comunidad en España

BACKGROUND AND OBJECTIVE Although elder abuse is not a new phenomenon, it remains hidden. There have been carried out various preliminary studies about the prevalence of elder abuse in different countries. The aim of this study is to estimate the prevalence of suspicion of elder abuse in old persons without cognitive impairment, dwelling in community, who were attended in Primary Health Care or Social Services Centres. PATIENTS AND METHOD We carried out a transverse study in which 340 elders participated. RESULTS We found a 12.1% prevalence of suspicion of elder abuse. Psychological abuse suspicion was the most frequent type and it was very common the simultaneous presence of different types of abuse (psychological and physical and sexual). The suspicion of elder abuse was more frequent in women and spouses were responsible in a high great frequency. CONCLUSIONS The information obtained allows advancing in the knowledge of elder abuse in Spain, where the research about this issue is poor. However, the prevalence found neither has to be considered as a social alarm nor as a social slackness.