26 The difficulty in differentiating anxiety from medical disorders and the overall ubiquity of sleep difficulties in late life might have led to the limited reliability of the somatic items of anxiety measures used with older respondents. Nevertheless, somatic experiences are core aspects of many anxiety disorders and to ignore them would be equivalent to exclude crucial symptoms of anxiety. 5, 10, 11, 24, 25 Due to their original use with younger adults, existing anxiety diagnostic criteria and measures for older adults were heavily weighted with somatic items, making the differentiation between medical and psychological causes of anxiety complicated in this population. Since there has been an increase in the incidence of physical illness with the growing age of individuals, 23 a higher rate of medical comorbidity and correlated pharmacotherapies often complicate the diagnosis and evaluation of anxiety in elderly. It is unclear if many of the current tools take into account the uniqueness of the experience and phenomenology of anxiety in older adults. 20 This evidence suggests the presence of multiple and important implications for anxiety assessment. 20 – 22 This tendency could explain the diminished reliability associated with items of anxiety measures using words like “never” or “always”. 17 – 19 Additionally, they are less likely to endorse statements that use absolute terms on mental health measures. For example, in discussing negative emotions, older adults are often more reluctant to report than younger adults and thus more likely to minimize their own psychological symptoms. Importantly, age-related factors also arise in self-reported communication of the experiences of anxiety. 14 For example, older adults report more concern about health compared to younger adults, whose worries are more focused on finances and family 15 report less of virtually every negative affective factor (eg, depression, anxiety, guilt, shyness, and hostility) than younger adults 14 are more likely to experience anxiety directly (eg, fearful, scared, afraid) compared to younger adults, whose anxiety was more characterized by shame or guilt (eg, ashamed of something, guilty, like you did something wrong) 14 and report particular fear situations or objects generally not included on existing fear surveys, such as fear of being a burden on their families. 5 Research on affect phenomenology has shown that older adults may experience affect or interpret affective terms differently. Finally, guidance for clinical evaluation and future research are proposed in an effort to highlight the importance of clinical assessment in the promotion of clinically relevant therapeutic choices.Īging-related differences in anxiety symptoms are well known. In particular, information about reliability, validity evidence based on data from clinical and nonclinical samples of older adults, and availability of age-appropriate norms are provided. For each tool, psychometric data is investigated in depth. This review covers commonly and currently used self-report inventories for assessing anxiety in older adults. Unfortunately, the detection of anxiety disorders in late life is complicated by a series of factors that make it different from assessment in younger cohorts, such as differential symptom presentation, high comorbidity with medical and mental disorders, the aging process, and newly emergent changes in life circumstances. With increasing numbers of older adults in the general population, anxiety will become a widespread problem in late life and one of the major causes of health care access contributing to high societal and individual costs.
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