Changing population demographics are creating a need for additional geriatric mental health care services. Late-life anxiety is a prevalent and distressing mental health problem associated with decreased functioning, life satisfaction, and increased service utilization. Among late-life anxiety disorders, generalized anxiety disorder (GAD) is one of the most common. While there have been increased research efforts recently to study late-life GAD, most research to date has been conducted in academic trials and primary care settings, and there is a clear need for extension of late-life GAD research to community settings, who serve more diverse and severely impaired older adults. One (1) step toward improving mental health services for this population is to validate effective GAD screening measures. The primary aim of this study is to determine the sensitivity and specificity of several GAD screening measures administered to a sample of frail elderly involved in a community care management organization. In accomplishing this goal this study will also establish the feasibility of recruiting and assessing participants for a subsequent research program to develop and pilot-test a cognitive-behavioral intervention for late-life GAD. The development of an effective treatment for late-life GAD will follow from an understanding of the nature and function of worry within this population. Although it is beyond the scope of this proposal to test theoretical models of late-life GAD, a secondary aim is to assess associated features and functional mechanisms of worry among frail elderly. A battery of diagnostic interviews, self-report measures, and clinician-rated scales will be administered to 70 participants who will be prescreened based upon a priori inclusion/exclusion criteria. Half of the participants will be """"""""screen positive"""""""" and the other half """"""""screen negative"""""""" for worry/anxiety. Administered measures will assess diagnostic criteria for GAD; cognitive, affective, somatic, and behavioral features of late-life anxiety; and experiential avoidance and beliefs about worry (proposed mechanisms of action of worry). These assessments will serve as a first step toward clarifying conceptualizations of late-life GAD worry to ultimately inform treatment development. Granting of this R03 proposal will support a new investigator's development of an independent late-life GAD research program. The R03 will provide pilot data to support a subsequent R34 to develop and pilot test a cognitive behavioral treatment for use within the community-based program.
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| Diefenbach, Gretchen J; Tolin, David F; Meunier, Suzanne A et al. (2009) Assessment of anxiety in older home care recipients. Gerontologist 49:141-53 |
| Diefenbach, Gretchen J; Tolin, David F; Gilliam, Christina M et al. (2008) Extending cognitive-behavioral therapy for late-life anxiety to home care: program development and case examples. Behav Modif 32:595-610 |
