Isabel Cabrera

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.

Examining attentional biases underlying trait anxiety in younger and older adults

Previous research has not adequately assessed the independent contributions of component attentional processes to anxiety-linked biases. MacLeod and Sadler developed a novel, lexical decision task using negative and neutral word stimuli, to enable the independent measurement of attentional engagement and disengagement. Their results suggest that anxiety-linked attentional biases are associated with facilitated attentional engagement with negative information. The present study aimed to determine the replicability of these findings, with two important extensions. First, this study included positive word stimuli in the lexical decision task, to determine whether anxiety-linked attentional biases exist only towards negative information, or toward emotionally arousing information in general. Second, this study explored age-related differences in anxiety-linked attentional biases. Younger (N=32) and older adults (N=32) with both high and low trait anxiety completed the lexical decision task. The results suggest that heightened anxiety may be associated with a deficit in engaging with positive words. No age-related differences in anxiety-linked attentional biases were apparent.

Influencia del conocimiento sobre la vejez en la gravedad de la preocupación en personas mayores

Resumen Introduccion este trabajo se dirige a analizar el papel del nivel de conocimientos sobre el envejecimiento en la prediccion del grado de preocupacion-rasgo en una muestra de personas mayores. El conocimiento de los procesos normales de envejecimiento puede facilitar la percepcion de control sobre los sucesos estresantes de la vejez y ser un factor protector para el desarrollo de problemas emocionales generados por los sucesos estresantes asociados al incremento de la edad. Este trabajo analiza si este posible efecto se produce, incluso tras controlar el efecto de la frecuencia de las preocupaciones sobre varios contenidos especificos de la edad avanzada. Material y metodo la muestra estuvo compuesta por 111 personas no institucionalizadas, con edades entre 55 y 88 anos. El conocimiento sobre la vejez se evaluo con una version del cuestionario Facts on Aging Quiz, y el grado de preocupacion con una adaptacion de la version abreviada del Inventario de Preocupacion de Pensilvania. Resultados en un analisis de regresion con pasos forzados, el grado de conocimiento sobre la vejez explico un porcentaje de variancia adicional significativo (incremento en R2 de 5,1%) sobre el grado de preocupacion-rasgo, al explicado por la frecuencia de preocupacion sobre varios contenidos caracteristicos de la vejez, apoyando la hipotesis de partida (R2 final = 0,651). Este efecto se mantuvo cuando distintas variables demograficas fueron controladas. Conclusiones estos resultados recalcan la importancia del grado de conocimientos sobre el envejecimiento y su potencial valor explicativo y preventivo sobre los trastornos emocionales en la edad avanzada.

Effect of anxiety on memory for emotional information in older adults.

Background: Several studies have shown that anxiety is associated with a better memory of negative events. However, this anxiety-related memory bias has not been studied in the elderly, in which there is a preferential processing of positive information. Objectives: To study the effect of anxiety in a recognition task and an autobiographical memory task in 102 older adults with high and low levels of trait anxiety. Method: Negative, positive and neutral pictures were used in the recognition task. In the autobiographical memory task, memories of the participants’ lives were recorded, how they felt when thinking about them, and the personal relevance of these memories. Results: In the recognition task, no anxiety-related bias was found toward negative information. Individuals with high trait anxiety were found to remember less positive pictures than those with low trait anxiety. In the autobiographical memory task, both groups remembered negative and positive events equally. However, people with high trait anxiety remembered life experiences with more negative emotions, especially when remembering negative events. Individuals with low trait anxiety tended to feel more positive emotions when remembering their life experiences and most of these referred to feeling positive emotions when remembering negative events. Conclusions: Older adults with anxiety tend to recognize less positive information and to present more negative emotions when remembering life events; while individuals without anxiety have a more positive experience of negative memories.

Attentional avoidant biases as mediators in the association between experiential avoidance and blood pressure in dementia family caregivers

ABSTRACT Objectives: Experiential avoidance in caregiving (EAC) has been found to be related with dementia family caregivers´ distress and blood pressure (BP). The association between EAC and avoidant attentional biases to emotional stimuli in dementia caregivers, and the potential mediating role of these attentional biases in the association between EAC and increased BP are explored. Method: Seventy nine dementia family caregivers performed a dot-probe task with emotional pictures (distressing and positive) varying in content (general vs. caregiving-related (CR)) and time of exposure (100 vs. 500 ms). They also completed measures of EAC, anxiety, depression, alexithymia and rumination, and their BP was measured. Results: EAC was associated with avoidant attentional biases to CR emotional pictures and negative pictures in general at 100 ms. Experiential Avoidance in Caregiving Questionnaire (EACQ) ‘avoidant behaviors’ and EACQ ‘intolerance of negativity’ factors were associated with diastolic and systolic BP, respectively, with attentional avoidance of CR emotional pictures (distressing and positive, respectively) mediating this association. Conclusion: Attentional avoidance of CR emotional stimuli may be the link between EAC and increased BP, as it prevents emotional processing and facilitates the maintenance of physiological activation. EAC may pose a risk for cardiovascular disease in dementia caregivers.