Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-23T12:25:10.073Z Has data issue: false hasContentIssue false
  • English
  • Français

The assessment of anxiety in aged care residents: a systematic review of the psychometric properties of commonly used measures

Published online by Cambridge University Press:  10 December 2017

Alexandra S. Creighton ,
Tanya E. Davison  and
David W. Kissane
Alexandra S. Creighton
Affiliation:
School of Psychological Sciences, Monash University, Clayton, Victoria, Australia Department of Psychiatry, Monash University, Clayton, Victoria, Australia
Tanya E. Davison
Affiliation:
Department of Psychiatry, Monash University, Clayton, Victoria, Australia Institute for Health & Ageing, Australian Catholic University, Melbourne, Victoria, Australia
David W. Kissane*
Affiliation:
Department of Psychiatry, Monash University, Clayton, Victoria, Australia
*
Correspondence should be addressed to: Professor D. W. Kissane, Level 3, P Block, Monash Medical Centre, 256 Clayton Road, Clayton, Victoria, 3168, Australia. Phone: (+613) 9594 1479. Email: David.Kissane@monash.edu.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Assessing anxiety among residential aged care facility (RACF) residents is challenging, and it cannot be assumed that valid and reliable measures used within the community are also appropriate for this setting. This review systematically examined the literature to identify which anxiety measures were most commonly used with older adults in RACFs, and determine whether psychometric data support their use within this population.

Methods:

Using the PRISMA guidelines, five electronic databases were searched using key terms and subject headings. The search was limited to literature published in English. Eligible studies utilized an anxiety measure to assess anxiety symptoms among RACF residents. Based on the findings of this search, a critical review of the research into the reliability, validity, and administrative and respondent burden of the most commonly used measures (i.e. used in four or more studies) was conducted.

Results:

In total, 1,771 articles were identified, with 50 studies included in this review. Overall, 22 measures were used, with the majority of studies utilizing a clinician-administered or self-report measure. The RAID, HADS, STAI, and GAI were the most commonly used measures. While overall there is a lack of research and consensus into the psychometric properties of these measures within RACFs, strongest evidence of reliability and validity was found for the GAI.

Conclusion:

Commonly used measures of anxiety within aged care populations are not well validated for this complex subsample of older adults. Strengths and weaknesses of each measure with regards to their usefulness in aged care settings are discussed, with future research areas highlighted.

Keywords

residential aged carenursing homelong-term carescreeningassessmentanxietyassessment measures
Type
Review Article
Information
International Psychogeriatrics , Volume 30 , Issue 7: Issue Theme: Benzodiazepines and Hypnotics , July 2018 , pp. 967 - 979
Copyright
Copyright © International Psychogeriatric Association 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexopoulos, G. S., Abrams, R., Young, R. C. and Shamoian, C. A. (1988). Cornell scale for depression in dementia. Biological Psychiatry, 23, 271–284. doi: 10.1016/0006-3223(88)90038-8.Google Scholar
Andresen, E. M. (2000). Criteria for assessing the tools of disability outcomes research. Archives of Physical Medicine and Rehabilitation, 81 (12 Suppl. 2), S15–S20. doi: 10.1053/apmr.2000.20619.Google Scholar
Australian Institute of Health and Welfare (2015). Residential Aged Care and Home Care 2014–15. Canberra: Australian Institute of Health and Welfare.Google Scholar
Azcurra, D. J. L. S. (2012). A reminiscence program intervention to improve the quality of life of long-term care residents with Alzheimer's disease. A randomized controlled trial. Revista Brasileira de Psiquiatria, 34, 422–433. doi: 10.1016/j.rbp.2012.05.008.Google Scholar
Baldacchino, D. R. and Bonello, L. (2013). Anxiety and depression in care homes in Malta and Australia: part 1. British Journal of Nursing, 22, 677–683.Google Scholar
Beekman, A. T. F., De Beurs, E., Van Balkom, A. J. L. M., Deeg, D. J. H., Van Dyck, R. and Van Tilburg, W. (2000). Anxiety and depression in later life: co-occurrence and communality of risk factors. American Journal of Psychiatry, 157, 89–95.Google Scholar
Bergua, V. et al. (2012). The STAI-Y trait scale: psychometric properties and normative data from a large population-based study of elderly people. International Psychogeriatrics, 24, 1163–1171. doi: 10.1017/S1041610212000300.Google Scholar
Bergua, V. et al. (2016). Short STAI-Y anxiety scales: validation and normative data for elderly subjects. Aging and Mental Health, 20, 987–995. doi: 10.1080/13607863.2015.1051511.Google Scholar
Boddice, G., Pachana, N. A. and Byrne, G. J. (2008). The clinical utility of the geriatric anxiety inventory in older adults with cognitive impairment. Nursing Older People, 20, 36–39. doi: https://doi.org/10.7748/nop2008.10.20.8.36.c6809.Google Scholar
Bosmans, J. E. et al. (2014). Cost-effectiveness of a stepped care programme to prevent depression and anxiety in residents in homes for the older people: a randomised controlled trial. International Journal of Geriatric Psychiatry, 29, 182–190. doi: 10.1002/gps.3987.Google Scholar
Bryant, C., Jackson, H. and Ames, D. (2009). Depression and anxiety in medically unwell older adults: Prevalence and short-term course. International Psychogeriatrics, 21, 754–763. doi: 10.1017/S1041610209009399.Google Scholar
Byrne, G. J., Pachana, N. A., Goncalves, D. C., Arnold, E., King, R. and KeatKhoo, S. (2010). Psychometric properties and health correlates of the geriatric anxiety inventory in Australian community-residing older women. Aging and Mental Health, 14, 247–254. doi: 10.1080/13607861003587628.Google Scholar
Cooke, M. L., Moyle, W., Shum, D. H. K., Harrison, S. D. and Murfield, J. E. (2010). A randomized controlled trial exploring the effect of music on agitated behaviours and anxiety in older people with dementia. Aging & Mental Health, 14, 905–916. doi: 10.1080/13607861003713190.Google Scholar
Creighton, A. S., Davison, T. and Kissane, D. W. (2016). The correlates of anxiety among older adults in nursing homes and other residential aged care facilities: a systematic review. International Journal of Geriatric Psychiatry, 32, 141–154.Google Scholar
Creighton, A. S., Davison, T. E. and Kissane, D. W. (2015). The prevalence of anxiety among older adults in nursing homes and other residential aged care facilities: a systematic review. International Journal of Geriatric Psychiatry, 31, 555–566. doi: 10.1002/gps.4378.Google Scholar
Davies, K. N., Burn, W. K., McKenzie, F. R., Brothwell, J. A. and Wattis, J. P. (1993). Evaluation of the hospital anxiety and depression scale as a screening instrument in geriatric medical inpatients. International Journal of Geriatric Psychiatry, 8, 165–169. doi: 10.1002/gps.930080209.Google Scholar
Davison, T. E., Eppingstall, B., Runci, S. and O'Connor, D. W. (2016). A pilot trial of acceptance and commitment therapy for symptoms of depression and anxiety in older adults residing in long-term care facilities. Aging & Mental Health, 1–8. doi: 10.1080/13607863.2016.1156051.Google Scholar
Dennis, R. E., Boddington, S. J. A. and Funnell, N. J. (2007). Self-report measures of anxiety: Are they suitable for older adults? Aging and Mental Health, 11, 668–677. doi: 10.1080/13607860701529916.Google Scholar
Diefenbach, G. J., Tolin, D. F., Meunier, S. A. and Gilliam, C. M. (2009). Assessment of anxiety in older home care recipients. Gerontologist, 49, 141–153. doi: 10.1093/geront/gnp019.Google Scholar
Dozeman, E. et al. (2012). Contradictory effects for prevention of depression and anxiety in residents in homes for the elderly: a pragmatic randomized controlled trial. International Psychogeriatrics, 24, 1242–1251. doi: 10.1017/S1041610212000178.Google Scholar
Drageset, J., Dysvik, E., Espehaug, B., Natvig, G. K. and Furnes, B. (2015). Suffering and mental health among older people living in nursing homes-A mixed-methods study. Peer J. doi: 10.7717/peerj.1120.Google Scholar
Drageset, J., Eide, G. E. and Ranhoff, A. H. (2013). Anxiety and depression among nursing home residents without cognitive impairment. Scandinavian Journal of Caring Sciences, 27, 872–881. doi: 10.1111/j.1471-6712.2012.01095.x.Google Scholar
Edelstein, B. A., Woodhead, E. L., Segal, D. L., Bower, E. H., Lowery, A. J. and Stoner, S. A. (2007). Older adult psychological assessment. Clinical Gerontologist, 31, 1–35.Google Scholar
Gerolimatos, L. A., Gregg, J. J. and Edelstein, B. A. (2013). Assessment of anxiety in long-term care: examination of the geriatric anxiety inventory (GAI) and its short form. International Psychogeriatrics, 25, 1533–1542. doi: 10.1017/S1041610213000847.Google Scholar
Gonçalves, D. C., Pachana, N. A. and Byrne, G. J. (2011). Prevalence and correlates of generalized anxiety disorder among older adults in the Australian national survey of mental health and well-being. Journal of Affective Disorders, 132, 223–230. doi: http://dx.doi.org/10.1016/j.jad.2011.02.023.Google Scholar
Goyal, A. R., Bergh, S., Engedal, K., Kirkevold, M. and Kirkevold, Ø. (2016). Norwegian version of the rating anxiety in dementia scale (RAID-N): a validity and reliability study. Aging and Mental Health, 1–6. doi: 10.1080/13607863.2016.1220921.Google Scholar
Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 50–55.Google Scholar
Hancock, G. A., Woods, B., Challis, D. and Orrell, M. (2006). The needs of older people with dementia in residential care. International Journal of Geriatric Psychiatry, 21, 43–49.Google Scholar
Haslam, C., Haslam, S. A., Jetten, J., Bevins, A., Ravenscroft, S. and Tonks, J. (2010). The social treatment: the benefits of group interventions in residential care settings. Psychology & Aging, 25, 157–167. doi: 10.1037/a0018256.Google Scholar
Haugan, G. (2015). The FACIT-Sp spiritual well-being scale: an investigation of the dimensionality, reliability and construct validity in a cognitively intact nursing home population. Scandinavian Journal of Caring Sciences, 29, 152–164. doi: 10.1111/scs.12123.Google Scholar
Haugan, G. and Drageset, J. (2014). The hospital anxiety and depression scale - dimensionality, reliability and construct validity among cognitively intact nursing home patients. Journal of Affective Disorders, 165, 8–15. doi: 10.1016/j.jad.2014.04.042.Google Scholar
Johnco, C., Knight, A., Tadic, D., Wuthrich, V. M., Pachana, N. A. and Oude Voshaar, R. C. (2015). Psychometric properties of the geriatric anxiety inventory (GAI) and its short-form (GAI-SF) in a clinical and non-clinical sample of older adults. International Psychogeriatrics, 27, 1089–1097. doi: 10.1017/S1041610214001586.Google Scholar
Kabacoff, R. I., Segal, D. L., Hersen, M. and Van Hasselt, V. B. (1997). Psychometric properties and diagnostic utility of the beck anxiety inventory and the state-trait anxiety inventory with older adult psychiatric outpatients. Journal of Anxiety Disorders, 11, 33–47. doi: 10.1016/S0887-6185(96)00033-3.Google Scholar
Keister, K. J. (2006). Predictors of self-assessed health, anxiety, and depressive symptoms in nursing home residents at week 1 postrelocation. Journal of Aging & Health, 18, 722–742.Google Scholar
Kogan, J. N., Edelstein, B. A. and McKee, D. R. (2000). Assessment of anxiety in older adults: current status. Journal of Anxiety Disorders, 14, 109–132. doi: 10.1016/S0887-6185(99)00044-4.Google Scholar
Kvaal, K., Ulstein, I., Nordhus, I. H. and Engedal, K. (2005). The Spielberger state-trait anxiety inventory (STAI): the state scale in detecting mental disorders in geriatric patients. International Journal of Geriatric Psychiatry, 20, 629–634. doi: 10.1002/gps.1330.Google Scholar
Leong, I. Y. and Nuo, T. H. (2007). Prevalence of pain in nursing home residents with different cognitive and communicative abilities. Clinical Journal of Pain, 23, 119–127.Google Scholar
Lin, Y. and Taylor, A. G. (1998). Effects of therapeutic touch in reducing pain and anxiety in an elderly population. Integrative Medicine, 1, 155–162.Google Scholar
Lopes, T. S., Afonso, R. M. L. B. M. and Ribeiro, Ó. M. (2016). A quasi-experimental study of a reminiscence program focused on autobiographical memory in institutionalized older adults with cognitive impairment. Archives of Gerontology and Geriatrics, 66, 183–192. doi: 10.1016/j.archger.2016.05.007.Google Scholar
Luppa, M., Luck, T., Weyerer, S., König, H., Brähler, E. and Riedel-Heller, S. G. (2010). Prediction of institutionalization in the elderly: a systematic review. Age and Ageing, 39, 31–38. doi: 10.1093/ageing/afp202.Google Scholar
McCabe, M. P., Mellor, D., Karantzas, G., Von Treuer, K., Davison, T. and O'Connor, D. W. (2017). Organizational factors related to the confidence of workers in working with residents with dementia or depression in aged care facilities. Aging & Mental Health, 21, 487–493. doi: 10.1080/13607863.2015.1118011.Google Scholar
Moher, D., Liberati, A., Tetzlaff, J. and Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 6, e1000097. doi: 10.1371/journal.pmed.1000097.Google Scholar
Morrison, A. et al. (2012). The effect of English-language restriction on systematic review-based meta-analyses: a systematic review of empirical studies. International Journal of Technology Assessment in Health Care, 28, 138–144. doi: 10.1017/s0266462312000086.Google Scholar
Nagatomo, I., Nomaguchi, M. and Takigawa, M. (1995). Anxiety and quality of life in residents of a special nursing home. International Journal of Geriatric Psychiatry, 10, 541–545. doi: 10.1002/gps.930100703.Google Scholar
Neville, C. and Teri, L. (2011). Anxiety, anxiety symptoms, and associations among older people with dementia in assisted-living facilities. International Journal of Mental Health Nursing, 20, 195–201. doi: 10.1111/j.1447-0349.2010.00724.x.Google Scholar
Pachana, N. A., Byrne, G. J., Siddle, H., Koloski, N., Harley, E. and Arnold, E. (2007). Development and validation of the geriatric anxiety inventory. International Psychogeriatrics, 19, 103–114. doi: 10.1017/S1041610206003504.Google Scholar
Potvin, O. et al. (2011). Norms and associated factors of the STAI-Y State anxiety inventory in older adults: results from the PAQUID study. International Psychogeriatrics, 23, 869–879. doi: 10.1017/S1041610210002358.Google Scholar
Richmond, R. L., Law, J. and Kay-Lambkin, F. (2011). Physical, mental, and cognitive function in a convenience sample of centenarians in Australia. Journal of the American Geriatrics Society, 59, 1080–1086. doi: 10.1111/j.1532-5415.2011.03404.x.Google Scholar
Roberts, M. H., Fletcher, R. B. and Merrick, P. L. (2014). The validity and clinical utility of the hospital anxiety and depression scale (HADS) with older adult New Zealanders. International Psychogeriatrics, 26, 325–333. doi: 10.1017/S104161021300197X.Google Scholar
Rozzini, L. et al. (2009). Anxiety symptoms in mild cognitive impairment. International Journal of Geriatric Psychiatry, 34, 300–305.Google Scholar
Selwood, A., Thorgrimsen, L. and Orrell, M. (2005). Quality of life in dementia – a one-year follow-up study. International Journal of Geriatric Psychiatry, 20, 232–237.Google Scholar
Shankar, K. K., Walker, M., Frost, D. and Orrell, M. W. (1999). The development of a valid and reliable scale for rating anxiety in dementia (RAID). Aging and Mental Health, 3, 39–49. doi: 10.1080/13607869956424.Google Scholar
Smith, M. et al. (2008). Anxiety symptoms among assisted living residents: implications of the “no difference” finding for participants with and without dementia. Research in Gerontological Nursing, 1, 97–104. doi: 10.3928/19404921-20080401-06.Google Scholar
Smith, M., Buckwalter, K. C., Kang, H., Ellingrod, V. and Schultz, S. K. (2008). Dementia-specific assisted living: clinical factors and psychotropic medication use. Journal of the American Psychiatric Nurses Association, 14, 39–49.Google Scholar
Snow, A. L. et al. (2012). Psychometric properties of a structured interview guide for the rating for anxiety in dementia. Aging and Mental Health, 16, 592–602. doi: 10.1080/13607863.2011.644518.Google Scholar
Spielberger, C. D., Gorush, R. L., Lushene, R., Vagg, P. R. and Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory STAI (Form Y): Self-Evaluation Questionnaire. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
Spinhoven, P., Ormel, J., Sloekers, P. P. A., Kempen, G. I. J. M., Speckens, A. E. M. and Van Hemert, A. M. (1997). A validation study of the hospital anxiety and depression scale (HADS) in different groups of dutch subjects. Psychological Medicine, 27, 363–370. doi: 10.1017/S0033291796004382.Google Scholar
Stanley, M. A., Beck, J. G. and Zebb, B. J. (1996). Psychometric properties of four anxiety measures in older adults. Behaviour Research and Therapy, 34, 827–838. doi: 10.1016/0005-7967(96)00064-2.Google Scholar
Stanley, M. A., Novy, D. M., Bourland, S. L., Beck, J. G. and Averill, P. M. (2001). Assessing older adults with generalized anxiety: a replication and extension. Behaviour Research and Therapy, 39, 221–235. doi: 10.1016/S0005-7967(00)00030-9.Google Scholar
Sung, H., Chang, A. M. and Lee, W. (2010). A preferred music listening intervention to reduce anxiety in older adults with dementia in nursing homes. Journal of Clinical Nursing, 19, 1056–1064. doi: 10.1111/j.1365-2702.2009.03016.x.Google Scholar
Sung, H., Lee, W. L., Li, T. L. and Watson, R. (2012). A group music intervention using percussion instruments with familiar music to reduce anxiety and agitation of institutionalized older adults with dementia. International Journal of Geriatric Psychiatry, 27, 621–627. doi: 10.1002/gps.2761.Google Scholar
Therrien, Z. and Hunsley, J. (2012). Assessment of anxiety in older adults: a systematic review of commonly used measures. Aging and Mental Health, 16, 1–16. doi: 10.1080/13607863.2011.602960.Google Scholar
Twelftree, H. and Qazi, A. (2006). Relationship between anxiety and agitation in dementia. Aging and Mental Health, 10, 362–367. doi: 10.1080/13607860600638511.Google Scholar
Ward, L. C., Wadsworth, A. P. and Peterson, L. P. (1994). Concurrent validity of measures of anxiety, depression, and somatization in elderly, demented, male patients. Clinical Gerontologist, 15, 3–13. doi: 10.1300/J018v15n01_02.Google Scholar
Wenborn, J. et al. (2013). Providing activity for people with dementia in care homes: a cluster randomised controlled trial. International Journal of Geriatric Psychiatry, 28, 1296–1304. doi: 10.1002/gps.3960.Google Scholar
Zigmond, A. and Snaith, R. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.Google Scholar
Zuidema, S. U., Derksen, E., Verhey, F. R. J. and Koopmans, R. T. C. M. (2007). Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. International Journal of Geriatric Psychiatry, 22, 632–638. doi: 10.1002/gps.1722.Google Scholar