Philippe Landreville

The Beck Anxiety Inventory: Psychometric Properties with Older Adults

The assessment of anxiety disorders in late life is often hindered by the lack of measures specifically validated with older adults. Because anxiety manifestations may vary across age groups, it is important to design new instruments or validate existing measures with older adults. This study examined the psychometric properties of the Beck Anxiety Inventory (BAI) in a sample of 281 older adults who were community-dwelling (82.6%) or living in residential care facilities (17.4%). The mean total BAI score was 6.5 (SD = 7.2), indicating minimal anxiety symptomatology in this older sample. There was a trend for older subjects to score higher. Females scored higher than males, and subjects living in a residential facility scored higher than did community dwellers. Item-total correlations were in the moderate range and the internal consistency of the BAI was adequate (alpha = 0.89). A factor analysis yielded a six-factor structure accounting for 64.6% of the variance, with a somatic factor accounting for the largest portion of the variance (32.2%). Because somatic symptoms are more prevalent with aging, such symptoms should not be weighed as heavily in the total BAI score as cognitive or behavioral symptoms. The findings indicate that the BAI is a useful self-report scale for assessing anxiety symptomatology among older adults.

Burden of Caregivers of People with Stroke: Evolution and Predictors

Background: Caregiver burden differs according to the amount of care, but no study has really focused on that point. This study compares the evolution of burden of two groups of caregivers of people with a recent stroke who returned home after discharge from two different types of health care facilities. Methods: Burden was assessed at 3 weeks and 3 and 6 months after discharge. The two groups of people with stroke and their caregivers were recruited from acute care (n = 69) and rehabilitation facilities (n = 89). Caregivers completed a questionnaire with three dimensions. In addition to sociodemographic characteristics, we assessed variables pertaining to the clinical, physical and cognitive functioning of the people with stroke. Results: Differences in burden were noted. The best predictors of burden were the caregivers’ characteristics, i.e. gender (female), occupation (retired), schooling (low), age (older) and hours of care given, and the stroke survivors’ characteristics, i.e. depressive symptoms, poor motor function (leg), verbal comprehension deficits, difficulty walking and neurological deficits. Conclusion: These results reinforce the view that services (information, training and support) should be tailored to the needs of caregivers, depending on whether or not the recipient of care has received rehabilitation services.

Negative outcomes: what is the evidence on self-administered treatments?

D.C. Mohr (1995) suggested that high deterioration rates may occur in self-directed treatments. The investigators examined data from 5 studies of self-administered treatment for depression and found in contrast much lower rates (9% vs. 19%) than those cited in Mohrs review. The negative response rates for the self-administered treatments compared favorably with the negative response rates in the therapist-administered treatments provided in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. The findings indicate that it may be the manner in which participants are prepared for self-administered treatment that is critical.

Non-pharmacological interventions for aggressive behavior in older adults living in long-term care facilities

BACKGROUND Aggressive behavior (AB) is common in institutional settings. It is an important issue because of its consequences on both the person manifesting such behaviors and their caregivers. Although there are numerous studies assessing non-pharmacologic strategies to manage AB in older adults, no extensive review of the literature is available. This review synthesizes the current knowledge on the effectiveness of non-pharmacological interventions in institutional settings. METHOD Papers describing the assessment of a non-pharmacological intervention to manage AB in which participants were at least 60 years old and living in a long-term care facility were selected mainly by searching various databases. RESULTS A total of 41 studies were identified and included in the review. These studies mainly use quasi-experimental designs and include less than 30 participants. Sixty-six percent (27/41) of the studies report either a statistically or behaviorally significant reduction of AB as a result of a non-pharmacological intervention. Staff training programs and environmental modifications appear to be the most effective strategies. CONCLUSION Non-pharmacological interventions seem effective for managing AB. Future studies on the effectiveness of these interventions need to be more rigorous. Development in this field needs to be based on knowledge regarding the determinants of AB in older adults.

Reducing verbal agitation in people with dementia: evaluation of an intervention based on the satisfaction of basic needs.

Objectives: Positive results have been reported with psychosocial interventions used to reduce verbal agitation (VA) in people with dementia, but there is no clear information regarding the proportion of persons who demonstrate significant behavioural improvement with such treatments. The main objectives of this pilot study are (a) to identify the proportion of persons with dementia who demonstrate significant behavioural improvement with a need-based intervention to reduce VA and (b) to further evaluate the effectiveness of this type of intervention. Method: A single-group repeated measures design was used (N = 26). An individualized multicomponent intervention addressing needs for comfort, social interaction and sensory stimulation was applied by a therapist during 30 min sessions during the time of day when VA was most severe. The frequency and duration of VA were measured through computer-assisted direct observation several times before, during and after the intervention. Results: A statistically significant reduction of the duration of VA during the intervention phase relative to other phases of the protocol was found. This effect was limited to the period during which the treatment is being applied. Half of the participants (54%) demonstrated considerable behavioural improvement during the intervention (50% reduction of symptoms) and those whose functioning is best preserved showed the best response to the intervention. Conclusion: This need-based intervention appears promising for improving the behaviour of a considerable proportion of patients.

Behavioral Approaches for Reducing Agitation in Residents of Long-Term-Care Facilities: Critical Review and Suggestions for Future Research

Many residents in long-term-care facilities demonstrate agitated behaviors. Research on behavioral approaches for reducing agitation in nursing home residents has been conducted during the past 25 years. This research is critically reviewed in this article and suggestions for future research are offered. Empirical evidence suggests that behavioral approaches are effective. Antecedent control strategies have been shown to reduce physically nonaggressive behaviors. Both aggressive and verbally agitated behaviors have been successfully treated by manipulating reinforcing consequences of these behaviors. Future research in this area needs to test behavioral treatments using randomized group designs, compare behavioral interventions to other treatments used alone or in combination, specify criteria for clinically significant improvement, diversify and ascertain the validity of assessment methods, and verify the maintenance of treatment effects over relatively long follow-up periods.

Relationship between delirium and behavioral symptoms of dementia.

BACKGROUND Persons with dementia frequently present behavioral and psychological symptoms as well as delirium. However, the association between these has received little attention from researchers and current knowledge in this area is limited. The purpose of this study was to examine the relation between delirium and behavioral symptoms of dementia (BSD). METHODS Participants were 155 persons with a diagnosis of dementia, 109 (70.3%) of whom were found delirious according to the Confusion Assessment Method. BSD were assessed using the Nursing Home Behavior Problem Scale. RESULTS Participants with delirium presented significantly more BSD than participants without delirium. More specifically, they presented more wandering/trying to leave, sleep problems, and irrational behavior after controlling for cognitive problems and use of antipsychotics and benzodiazepines. Most relationships between participant characteristics and BSD did not differ according to the presence or absence of delirium, but some variables, notably sleep problems, were more strongly associated to BSD in persons with delirium. CONCLUSIONS Although correlates of BSD in persons with delirium superimposed on dementia are generally similar to those in persons with dementia alone, delirium is associated with a higher level of BSD. Results of this study have practical implications for the detection of delirium superimposed on dementia, the management of behavioral disturbances in patients with delirium, and caregiver burden.

The role of activity restriction in poststroke depressive symptoms.

OBJECTIVE Little is known about the determinants of poststroke depression. The Activity Restriction Model of Depressed Affect (ARMDA) may be helpful in understanding poststroke depression but has never been tested in that context. The goal of this study was to examine the relation between activity restriction and depressive symptoms in stroke survivors during the period following discharge from the hospital. METHOD Participants (N = 197) were assessed on three occasions: (1) time 1 (T1), 3 weeks following discharge; (2) time 2 (T2), 3 months after discharge; and (3) time 3 (T3), 6 months after discharge. RESULTS Although both stroke severity and activity restriction were significantly related to depressive symptoms, the relation between stroke severity and depression was no longer significant after controlling for activity restriction. Moreover, restrictions in daily activities and social roles were both related to depressive symptoms, but these relations were found to vary during the course of the period following discharge. CONCLUSIONS These findings support the ARMDA and have practical implications for the prevention of poststroke depression.

Disruptive vocalizations: A means to communicate in dementia?

Disruptive vocalizations (DVs) constitute a serious problem in geriatric nursing homes. The current literature suggests that DV can be interpreted as a way for demented persons with language limitations to communicate with others. In an attempt to test this hypothesis, 59 participants were recruited from six nursing homes to form two groups: one group of individuals with preserved language skills (PLS) and another group with altered language skills (ALS). They were compared on the frequency and types of DV. The results indicate that individuals with ALS manifest DV at a greater frequency than those with PLS. These persons also present a greater number of distinct DV forms. The results are interpreted in terms of language deterioration associated with dementia.

Questionnaire de Dépression de Beck: Etude psychométrique auprès d'une population âgée francophone

Psychometric properties of the Beck Depression Inventory are questionable for elderly francophones. Consequently, the aim of this study is to assess the reliability and the validity of the French version of the BDI (Questionnaire de Depression de Beck: Bourque & Beaudette, 1982) for this group. Six hundred and forty-three French-speaking elders from Quebec and New-Brunswick answered the BDI. The reliability coefficients showed satisfactory internal consistency (.85), split-half reliability (.76) and test-retest correlation (.74). A principal-components analysis yielded three factors (somatic complaints, negative view of the self, and helplessness) accounting for 46.9 per cent of the total variance. The choice of an optimal cut-off score and the use of the BDI with the elderly are also discussed in this study.