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The literature on late-life anxiety has grown exponentially in the last two decades, and a wide array of research questions are being explored by an ever-growing cadre of clinicians and scientists internationally. In fact, in the last decade, there have been several special journal issues devoted to aspects of anxiety in later life – for example, American Journal of Geriatric Psychiatry (2011, vol. 19, issue 4), Journal of Anxiety Disorders (2013, vol. 27, issue 6), International Psychogeriatrics (2015, vol. 27, issue 7), and Clinical Gerontologist (2017, vol. 40, issue 3). All have made the point that while our understanding of the etiology, diagnosis, assessment, and treatment of such disorders has grown and continues to increase, there are still many areas requiring further research attention. In addition, experimental techniques to study the biological mechanisms underpinning anxiety continue to grow in sophistication and access.
Historically, clinicians and researchers interested in the mental health of older people have focused on depression and dementia and have given little attention to anxiety except as a complication of depression or dementia. Over recent years, however, research into anxiety in older people has increased substantially, leading to both a burgeoning scientific literature and increasing clinical interest in the field.
Anxiety disorders in later life have historically been overshadowed by strong clinical and epidemiological interest in mood disorders and cognitive disorders. This chapter reviews the key scientific literature on the epidemiology of anxiety disorders in older people and putative risk and protective factors.
Historically, clinicians and researchers have focused on depression and dementia in older people, paying little attention to anxiety except as a complication of these disorders. However, increased research into late-life anxiety has seen a growth in scientific literature and clinical interest. This important book brings together international experts to provide a comprehensive overview of current knowledge in relation to anxiety in older people, highlighting gaps in both theory and practice, and pointing towards the future. Early chapters cover the broader aspects of anxiety disorders, including epidemiology, risk factors, diagnostic issues, association with insomnia, impaired daily functioning, suicidality, and increased use of healthcare services. The book then explores cross-cultural issues, clinical assessment, and pharmacological and psychological interventions across a variety of settings. An invaluable resource for mental health professionals caring for older people including researchers, psychiatrists, psychologists, specialist geriatric nurses and social workers.
Driving and stopping driving present challenging issues for older people living with memory problems and the family members supporting them. Changes to driving status impact the individual stopping driving and their family members. CarFreeMe is an existing, effective driving cessation program for older people that may be applicable to older people living with dementia. The purpose of this study was to adapt the program and explore feasibility and key stakeholder perspectives.
The Medical Research Council guidelines for conducting research into complex interventions guided the development, acceptability and feasibility piloting. A multidisciplinary approach was taken, and key stakeholders were involved throughout the process. This included an adaptation process, followed by expert reference group feedback and case series pilot study.
The background research indicated that some key changes were required to meet the needs of people living with dementia. Aspects of the content, language, format and activities were adapted and an additional module was created for family members – whose involvement was identified as important. A more personalized, flexible approach was recommended. The expert reference group [psychologists (n = 2), occupational therapists (n = 3) and dementia behavior consultants (n = 2)] indicated the program was appropriate and needed, and made recommendations for feasibility. Pilot testing with three families indicated acceptability.
A driving cessation program adapted for use with people living with dementia and their families required some changes to meet the needs and situations based on feedback from key stakeholders. Future studies will evaluate implementation outcomes across a range of settings.