Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: Epidemiological evidence suggests that anxiety disorders are a common class of psychiatric disorders among older people, with clinically significant anxiety symptoms affecting as many as 20% of community-dwelling older adults. In our review, we found few studies that have attempted to translate the evidence on geriatric assessment and treatment of anxiety into rehabilitation settings for disabled older adults. The authors present data from a pilot research program initiated to develop, refine, and test the outcomes of Brief Problem Solving Therapy in Rehabilitation Settings (PST-RS) that targets the needs of disabled community-based older adults with moderate to severe symptoms of generalized anxiety. Methods: This study is a component of a larger program of research known as Project ADAPT-VIP (Anxiety Disorders and Problem Solving Therapy for Visually Impaired Older Persons, an interdisciplinary initiative aimed to (a) develop educational materials, (b) train rehabilitation professionals to screen for late life anxiety and (c) pilot test a psychosocial intervention in a rehabilitation setting. Patients (65 years and older) with moderate to severe anxiety symptoms were recruited through physician referrals (n = 16) from a large rehabilitation organization in the New York metropolitan area. This study involved a small, randomized clinical trial comparing the impact of PST-RS to a wait-list control (WL) in a sample of older rehabilitation patients with anxiety symptoms. PST-RS was developed on the basis of cognitive-behavioral procedures with demonstrated efficacy in academic clinical trials of late-life depression with modifications to meet the needs of older rehabilitation patients. Outcome measures included the Beck Anxiety Inventory and the Center for Epidemiologic Scale for Depression. Group x Time (Pre, Post) repeated-measures ANOVAs were used to evaluate treatment effects. Results: A total of 351 patients were screened, 93 of whom screened positive for moderate to severe anxiety symptoms. Higher levels of anxiety were associated with younger age, greater health problems, being single, and not having macular degeneration. Outcome data suggested significant improvements in worry and depression after PST-RS, relative to the WL control condition. Anxiety and depressive symptoms significantly decreased in the immediate treatment group as compared to the wait-list group. Improved screening rates for geriatric anxiety were found. Implications: Authors discuss the unique problems encountered by rehabilitation providers in identifying and treating geriatric anxiety and discuss results in terms of “real-world” applicability of Problem Solving Therapy for late-life anxiety.