Alzheimer's, Dementia & Mental Health
New Tools to Quickly, Accurately Measure Anxiety May
Benefit Increasing Elderly Patients
Growing numbers of caregivers and elderly concerned
about anxiety: once thought not to be a problem for older people - more
about seniors and anxiety below news report
March 9, 2010 A new questionnaire and measurement
scale to evaluate anxiety may be welcomed by the growing number of
senior citizens concerned about the disorder because of the simplicity
and rapid results determination using these tools. Anxiety becomes more
common as we get older, according to the American Geriatrics Society
Foundation, because medical, psychological, and social problems tend to
build up.
(Read more about senior
citizens and anxiety below news report.)
This new questionnaire and outcomes measurement
scale is designed to be brief for patients to complete and then quickly
scored by a clinician.
It was developed by the department of psychiatry at
Rhode Island Hospital has proven to be a reliable and valid measure of
anxiety, according to a report that appears online ahead of print in the
Journal of Clinical Psychiatry.
To determine the impact of treatment on any medical
disorder, it is necessary to evaluate outcomes. Standardized scales are
increasingly recommended as an outcome measurement tool in the treatment
of psychiatric disorders.
If scales are to be incorporated into clinical
practices, it is necessary to develop measures that are feasible and
have good psychometric properties. With this in mind, Mark Zimmerman,
MD, director of outpatient psychiatry at Rhode Island Hospital, and his
colleagues developed the Clinically Useful Anxiety Outcome Scale (CUXOS).
Their scale can easily be incorporated into routine
clinical practice when treating psychiatric disorders.
As Zimmerman says, "If the optimal delivery of
mental health treatment ultimately depends on examining outcome, then
precise, reliable, valid, informative, and user-friendly measurement is
critical to evaluating the quality and efficiency of care in clinical
practice."
"Clinicians, he adds, are already overburdened
with paperwork, and adding to this load by requiring repeated detailed
evaluations using instruments that are available is unlikely to meet
success."
The researchers note that only 11 percent of the
psychiatrists are routinely using standardized measures to assess
outcomes when treating depression or anxiety disorders.
In their study, nearly 1,000 psychiatric
outpatients completed the CUXOS, which took less than one and a half
minutes to complete. Clinicians rated the severity of depression,
anxiety, and anger on standardized scales and each CUXOS could be scored
in less than 15 seconds.
The researchers also had a subset of patients
complete other self-report symptom severity scales in order to examine
discriminant and convergent validity. Another subset completed the CUXOS
twice in order to examine test-retest reliability. In addition,
sensitivity to change was examined in patients with panic disorder and
generalized anxiety disorder.
Zimmerman, who is also an associate professor of
psychiatry and human behavior at The Warren Alpert Medical School of
Brown University, says that the scale was found to have high internal
consistency and test-retest reliability.
Further, it was more highly correlated with other
self-report measures of anxiety than with measures of depression,
substance abuse problems, eating disorders and anger.
It was also more closely aligned with clinician
severity ratings of anxiety than depression and anger, and the CUXOS
scores were significantly higher in psychiatric outpatients with anxiety
disorders than other psychiatric disorders. Finally, it was found to be
a valid measure of symptom change.
Zimmerman says, "We believe that the use of
standardized scales should be the standard of care and routinely used to
measure outcome when treating psychiatric disorders. Only in this way
can we ensure that we are having an impact on our patients."
The researchers also note that there is no shortage
of self-report questionnaires, and the development of any new scale
should be questioned. They believe, however, that the CUXOS
distinguishes itself in several respects and is intended as a general
measure of the severity of psychic and somatic anxiety.
"We have developed what we believe to be an
effective tool that can easily be incorporated into clinicians'
routines. However, future research should explore both clinicians' and
patients' perspectives as to whether the use of a general or disorder
specific scales is preferred," Zimmerman concludes.
The study was based on work in the Rhode Island
Methods to Improve Diagnostic Assessment and Services (MIDAS) Project,
for which Zimmerman is the principal investigator. It is a unique
integration of research quality diagnostic methods into a
community-based outpatient practice affiliated with an academic medical
center.
Along with Zimmerman, other researchers in the
study are Iwona Chelminski, PhD, Diane Young, PhD, and Kristy Dalrymple,
PhD, all of Rhode Island Hospital and Alpert Medical School.
About Rhode Island Hospital:
Founded in 1863, Rhode Island Hospital in
Providence, RI, is a private, not-for-profit hospital and is the largest
teaching hospital of The Warren Alpert Medical School of Brown
University. A major trauma center for southeastern New England, the
hospital is dedicated to being on the cutting edge of medicine and
research. Rhode Island Hospital receives nearly $50 million each year in
external research funding. For more information on Rhode Island
Hospital, visit
www.rhodeislandhospital.org.
Senior Citizens and
Anxiety
"We all worry from
time to time for various reasons, such as illness or financial problems.
When we worry about one thing in particular, or if the worry is a
realistic one, this is a normal reaction to an unpredictable situation
and not a clinical anxiety disorder. Clinical anxiety disorders involve
unrealistic or excessive worry about multiple areas of life. This may
include worrying about misfortune to children and grandchildren,
finances, or physical health," according to the American Geriatrics
Association Foundation.
"Anxiety disorders
become more common as we get older because medical, psychological, and
social problems tend to build up. Some community surveys suggest that
perhaps one in five older adults suffer anxiety symptoms severe enough
to warrant treatment.
"Persistent or
extreme anxiety can seriously decrease quality of life and can be a sign
of other problems, such as depression, dementia, physical illness, or
side effects to drug treatment. Anxiety can be a symptom associated with
many medical disorders common in older adults, including heart disease,
lung disease, thyroid and other endocrine problems, neurologic illness,
dietary problems (eg, excess caffeine intake or vitamin B12 deficiency),
psychological illnesses, and side effects to medications."
Symptoms of Anxiety from Health in Aging, AGS
Foundation
The signs of
anxiety fall into four general categories:
● Tense muscles,
which can lead to shaking, trembling, muscle restlessness, and easy
tiring
● Increased
nervous system activity, which can lead to shortness of breath, rapid
heart rate, sweating, dry mouth, dizziness, nausea, diarrhea, flushes or
chills, frequent urination, or difficulty swallowing
● Being overly
watchful or alert, including feeling "keyed up" or "on edge," being
easily startled, having difficulty concentrating, having trouble falling
asleep or staying asleep, or feeling irritable
● Changes in
behavior or normal routines that are used to reduce anxiety, such as
avoiding specific situations, withdrawing, or generally decreasing
activities outside the home. Sometimes, specific behaviors, eg, checking
up on things or handwashing, are repeated over and over.
Health in Aging, AGS Foundation,
American Geriatrics Society - Anxiety
Anxiety Disorders
Don't Decline with Age - As OnceThougth
By Anxiety
Disorders Association of American
Until a few years
ago, anxiety disorders were believed to decline with age. Thats because
older patients are less likely to report psychiatric symptoms and more
likely to emphasize their physical complaints.
But experts now
recognize that aging and anxiety are not mutually exclusive: Anxiety is
as common among the old as among the young. In fact, many older adults
with an anxiety disorder had one when they were younger.
Generalized anxiety
disorder (GAD) is the most common anxiety disorder among older adults,
though anxiety disorders in this population are frequently associated
with traumatic events such as a fall or acute illness.
Tips for Family by
ADAA
Worried about an
aging parent or relative? Talking to older parents or loved ones about
changes in their lives is one of the best ways to find out about
problems.
● Ask about any
changes you notice in the following areas:
● Daily routines
and activities. Is Grandma refusing to do routine activities or avoiding
social situations she used to enjoy?
● Worries. Does
Dad seem to have more worries than before? If so, do those worries seem
out of proportion to reality (such as a real threat to his safety)?
● Medication. Has
Mom recently started taking another medicine? Is she using more of a
particular medication than before? Side effects, such as breathing
problems, irregular heartbeat, or tremors, can simulate symptoms of
anxiety. An increased use of medication or alcohol may indicate an
attempt to self-medicate.
● Overall mood.
Depression and anxiety often occur together. Tearfulness, apathy, and a
loss of interest in formerly enjoyable activities are possible signs of
depression.
Anxiety Disorders Association of America Older People
More About Anxiety
Fear and anxiety are part of life. You may feel
anxious before you take a test or walk down a dark street. This kind of
anxiety is useful - it can make you more alert or careful. It usually
ends soon after you are out of the situation that caused it. But for
millions of people in the United States, the anxiety does not go away,
and gets worse over time. They may have chest pains or nightmares. They
may even be afraid to leave home. These people have anxiety disorders.
Types include
●
Panic disorder
●
Obsessive-compulsive disorder
●
Post-traumatic stress disorder
●
Phobias
● Generalized anxiety disorder (see below)
Treatment can involve medicines, therapy or both.
By National Institute of Mental Health
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