Anxiety Disorders in Older Adults: LASA 6-Year Follow-Up

Introduction

The objective of Schuurman et al.'s (2005) study was an examination of the long-term consequences of late-life anxiety disorders and patients' utilization of mental health care services. To address these areas, the researchers interviewed a group of subjects over the age of 55 who had an anxiety disorder, as identified in the Longitudinal Aging Study Amsterdam (LASA).

The rate of persistence and prognostic factors for persistence of anxiety were established at a 6-year follow-up study. It was discovered that patients with a high incidence of neuroticism were at a greater risk of anxiety persistence, despite efforts to enhance appropriate referral of older adults suffering from anxiety.

This report summarizes Schuurman et al.'s research study. It begins with a brief description of the abstract, introduction, method, results, discussion, and conclusions. This report also includes the main points of the study and concludes with this author's personal reactions to the research findings.

Overview of the Study Abstract and Introduction

The abstract of the report briefly describes the four primary components of the research: objective, method, results, and conclusion. Each category is described succinctly — most often in one or two sentences — with only the results described in a short paragraph.

The title was effective, as the independent and dependent variables were identifiable: the outcome of anxiety disorders and older adult patients. This very brief synopsis gives the reader an abbreviated overview of the report's contents without going into significant detail. The abstract conveys that by utilizing 112 participants from LASA, all over the age of 55, and conducting a 6-year follow-up study, the researchers discovered that highly neurotic patients had a greater risk of anxiety persistence, despite referral efforts (Schuurman et al., 2005).

The researchers begin their study by noting that more numerous studies have focused on depression in older adults, while largely ignoring the occurrence of anxiety disorder. The authors demonstrate this gap in available research by pointing out that although there is a commonly held belief that mood disorders are more prevalent than anxiety disorders in geriatric patients, "anxiety disorders are in fact more common in older adults than depression and dysthymia" (Schuurman et al., 2005). They cite the fact that an estimated 10% of older adults suffer from anxiety disorders — a rate comparable to that of mood disorders.

Schuurman et al. note that anxiety negatively affects an older adult's quality of life and is associated with a greater incidence of non-mental health care utilization, even when patients' health status is controlled for. Furthermore, although studies have been performed on younger populations regarding the waxing and waning of anxiety symptoms and spontaneous remission rates, no data had been collected specifically regarding older adults.

Schuurman et al. (2005) state that although older adults have shown increased use of health care services in recent years, referrals to mental health care treatment remain rare. Instead, these patients often go untreated and unrecognized. Their study reports on anxiety and the use of mental health care services after a 6-year follow-up period.

Method

The method section of the study clearly describes the sample, measures, prognostic factors, and statistical analysis. Data were retrieved from the Longitudinal Aging Study Amsterdam. Schuurman et al. chose a random sample stratified by age and sex. These respondents were drawn from the population registers of 11 municipalities across three regions in the Netherlands. The study was conducted between September 1992 and September 1993, with 3,107 subjects enrolled.

In the end, 112 subjects were selected who met the criteria for having an anxiety disorder within the 6 months prior to the interview. No exclusions were made for subjects with comorbid depression. For the 6-year follow-up study, 50 participants were lost due to death, refusal to participate, illness, cognitive impairment, or migration.

The researchers used DSM-III criteria to define anxiety disorders and the Diagnostic Interview Schedule (DIS) to assess them. Four types of anxiety disorders were distinguished: generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, and phobic disorders. In order to discriminate between those with subsyndromal anxiety and those with no relevant anxiety symptoms, the Hospital Anxiety and Depression Scale (HADS-a) was utilized (Schuurman et al., 2005).

Six groups of prognostic factors were identified: demographic variables, illness severity, variables regarding physical health and functioning, social support, personality characteristics, and treatment and life changes. Demographic variables included age, sex, socioeconomic status, education level, and marital status. Chronic disease presence was detected by asking participants whether they suffered from conditions such as cardiac disease, peripheral arteriosclerosis, stroke, diabetes, or pulmonary disease. Personality characteristics — including mastery, self-efficacy, neuroticism, and social inadequacy — were measured using the Dutch Personality Inventory.

Schuurman et al. (2005) conducted both 3- and 6-year follow-up interviews to determine whether stressful life events had occurred during the intervening period. Stressful events included partner illness, partner death, relative illness or death, major conflict with others, loss of income, crime victimization, relocation, development of a chronic disease, increased functional limitations, and cognitive decline. Participants were also questioned about recent visits to physicians, use of health care and paramedical services, formal social support, and hospital admissions.