Symptoms of anxiety and depression are frequent in the elderly. A previous study employing the Spielberger’s State-Trait Anxiety Inventory revealed a disturbingly high prevalence of anxiety symptoms among geriatric in-patients and no decline after discharge.
Objective: To test the hypothesis that typical characteristics of geriatric patients are associated with a higher level of anxiety symptomatology.
Design: Cross-sectional based upon factor and path analyses.
Materials and Methods: The data came from the Norwegian Health Survey 1995, a random population study which was carried out by Statistics Norway and had citizens not living in institutions or homes for the elderly as sampling frame. The response rate was 78%. We used records from participants aged 60-79 years (N=1377). The outcome was the 25-item version of the Hopkins Symptoms Checklist (HSCL), which primarily measures emotional symptoms. Two items regarding sexuality and suicide ideation were dropped. The interviewees filled in a questionnaire measuring symptoms occurring during the last fortnight. All HSCL items have score range 1-4 where 1 reflects no and 4 very much. Factor analyses were based upon polychoric correlations, and the factors were regressed linearly upon covariates at stake, all coded binary 0/1.
Results: The mean HSCL item score in this sample was 1.2, and 5.1% scored above a caseness level of 1.75 on the mean item score. The mean score was significantly higher among females, participants living alone, and subjects with lower education, one or more chronic disorders, problems getting out of the house, and home-nursing / home help. A three-factor model was needed to explain the HSCL items adequately, and according to their item content they were named somatic, depressive and anxiety symptoms. These correlated significantly with shared variance in the range 0.6-0.8. In the path model, the factors were regressed linearly upon the items found to be significant in the bivariate analyses. The final model explained somatic symptoms (R2=0.10) and depressive symptoms (R2 =0.08) markedly better than anxiety symptoms (R2=0.03). The effect of gender was restricted to the factor somatic where women scored significantly higher (p<0.01), and to live alone related solely to depressive symptoms (p<0.002). A worse economy was associated with a higher level of somatic as well as depressive symptoms. To receive home help/home nursing, which to a large extent seemed to be caused by mobility problems, related strongly and significantly to all three factors.
Conclusion: This population-based study of elderly outside institution reveals that typical characteristics of geriatric patients, e.g. to live alone, a worse economy, and to receive home help or home nursing relate to a higher score on the HSCL. In the elderly, the emotional parts of the 25-item HSCL, i.e. depressive and anxiety symptoms, are heavily confounded by what appear to be somatic symptoms. Users of home help/home nursing seem particularly prone to anxiety symptoms.
Back to Epidemiological aspects of psychogeriatric practice
Back to Oral and Poster Sessions
Back to The IPA European Regional Meeting (1-4 April 2003) of IPA