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Epidemiological studies have revealed that behavioral and psychological (or non-cognitive) symptoms are risk factors for cognitive decline in older adults. This study aimed to systematically review the literature and determine which behavioral and psychological symptoms are most predictive of future cognitive decline among individuals with no pre-existing cognitive impairments. The selected studies included middle-aged or older adults without cognitive impairments. The predictors were assessed using behavioral and psychological questionnaires, or diagnostic interviews, to identify non-cognitive symptoms or psychiatric clinical conditions. The follow-up period was at least one year, and the design of the selected studies was either retrospective or prospective. This study compared individuals with and without non-cognitive manifestations and resulted in one of three outcomes: (a) a score change on a cognitive measure, (b) a diagnosis of mild cognitive impairment, or (c) a diagnosis of Alzheimer's disease or dementia. Four online databases were searched for eligible studies from the database inception to January 17, 2017: MEDLINE (PubMed), Embase (OVID), PsycINFO, and Web of Science. Pooled effect sizes were estimated using a random-effect model. Higgins I2, the Q statistic, and tau-squared were used to quantify the observed heterogeneity between the studies. Results indicate that depression and sleep duration (long and short) were the most consistent associations between behavioral or psychological symptoms and cognitive decline. This meta-analysis supports the need to assess behavioral and psychological symptoms in cognitively intact older adults to identify those who are at risk for cognitive decline.

Introduction It is generally accepted that physical activity promotes healthy aging. Recent studies suggest dance could also benefit cognition and physical health in seniors, but many styles and approaches of dance exist and rigorous designs for intervention studies are still scarce. The aim of this study was to compare the effects of Dance/Movement Training (DMT) to Aerobic Exercise Training (AET) on cognition, physical fitness and health-related quality of life in healthy inactive elderly. Methods A single-center, randomized, parallel assignment, open label trial was conducted with 62 older adults (mean age = 67.48 ± 5.37 years) recruited from the community. Participants were randomly assigned to a 12-week (3x/week, 1hr/session) DMT program, AET program or control group. Cognitive functioning, physical fitness and health-related quality of life were assessed at baseline (T-0), and post-training (T-12 weeks). Results 41 participants completed the study. Executive and non-executive composite scores showed a significant increase post-training (F(1,37) = 4.35, p = .04; F(1,37) = 7.01, p = .01). Cardiovascular fitness improvements were specific to the AET group (F(2,38) = 16.40, p Conclusions Results suggest that DMT may have a positive impact on cognition and physical functioning in older adults however further research is needed. This study could serve as a model for designing future RCTs with dance-related interventions. Registration clinicaltrials. gov Identifier NCT02455258.

Anxiety disorders are the most prevalent mental disorders. Although prevalence estimates are lower in males than females, the disability associated with anxiety disorders has been increasing in males. This review focuses on recent research studying sex differences in anxiety disorders and associated symptoms in older adults. Females are close to three times more likely than males to report most anxiety disorders. Heterogeneity exists in sex-specific lifetime and past-year estimates. Age-appropriate instruments such as the CIDI65+ show higher estimates than previous research. The profiles of females and males with anxiety with respect to depressive and somatization symptoms are different. Age-appropriate standardized mental disorder instruments have been developed and may be useful to overcome the challenges of observed heterogeneity in anxiety disorders and allow for future cross-country comparisons and a better description of the epidemiology and biopsychosocial factors associated with different types of anxiety disorders in older adults.

Objectives To estimate the 6-month prevalence of generalized anxiety disorder (GAD) in primary care patients aged 70 years and above and to describe their clinical profile, including types of worries. Methods/design Participants (N = 1193) came from the Etude sur la Sante des Aines (ESA) services study conducted in Quebec, Canada. An in-person structured interview was used to identify GAD and other anxiety/depressive disorders as well as to identify types of worries. Three groups were created (ie, patients with GAD, patients with another anxiety disorder, and patients without anxiety disorders) and compared on several sociodemographic and clinical characteristics using multinomial logistic regression analyses. Results The 6-month prevalence of GAD was 2.7%. Findings also indicated that the most common types of worries were about health, being a burden for loved ones, and losing autonomy. Compared with respondents without anxiety disorders, older patients with GAD were more likely to be women, be more educated, suffer from depression, use antidepressants, be unsatisfied with their lives, and use health services. In comparison with respondents with another anxiety disorder, those with GAD were 4.5 times more likely to suffer from minor depression. Conclusions GAD has a high prevalence in primary care patients aged 70 years and above. Clinicians working in primary care settings should screen for GAD, since it remains underdiagnosed. In addition, it may be associated with depression and life dissatisfaction. Screening tools for late-life GAD should include worry themes that are specific to aging.

Objectives To provide an estimate of 12-month and lifetime prevalence of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) anxiety disorders in older adults based on published studies on this topic and to identify the impact of gender and age. Methods/design A systematic review and meta-analysis was performed. Six databases were searched, and manual searches through reference lists of selected articles and reviews were performed. When the information was available, summary effects were calculated for the prevalence of each anxiety disorder and for every age and gender subgroups. Summary odd ratios (OR) were calculated to compare the prevalence of an anxiety disorder according to age and gender. Results A total of 6464 studies were identified, and 16 studies were included in the meta-analyses. Prevalence was significantly higher in women than men for generalized anxiety disorder (12 month OR = 6.10, P = 0.001; lifetime OR = 1.96, P = 0.001), 12-month social anxiety disorder (OR = 2.07, P = 0.01), and lifetime post-traumatic stress disorder (OR = 1.93, P = 0.002). The prevalence of specific phobia was significantly lower in both the 75 to 84 and 85 years and above age groups when compared with the 65 to 74 years age group (OR = 0.70, P = 0.004 and OR = 0.63, P = 0.01, respectively). Conclusions Our results suggest that the tendency for women to experience a greater prevalence of anxiety disorders remains present in older adults. Specific phobia was the only disorder to be less frequent with advancing age. This is likely to change with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria because this new DSM version now indicates that fear of falling is a possible type of specific phobia and fear of falling is generally more frequent in the oldest age groups.

BackgroundThe effect of alcohol consumption on cognitive decline is not clear. We aimed to study the association between alcohol consumption and cognitive functioning controlling for functional heath status.MethodsA total of 1610 older adults with a score ≥26 on the Mini-Mental State Examination (MMSE) were followed to assess the change in scores at the 3-year follow-up. Information on alcohol consumption as well as socio-demographic, lifestyle, psychosocial and clinical factors, as well as health service use were assessed at baseline and 3-year follow-up interviews. Linear mixed models with repeated measures were used stratifying by functional status.ResultsClose to 73% reported consuming alcohol in the past 6 months, of which 11% were heavy drinkers (≥11 and ≥16 drinks for women and men). A significant decrease in MMSE scores was observed in low functioning non-drinkers (−1.48; 95% CI: −2.06, −0.89) and light to moderate drinkers (−0.99; 95% CI: −1.54, −0.44) and high functioning non-drinkers (−0.51; 95% CI: −0.91, −0.10).ConclusionsAlcohol consumption did not contribute to cognitive decline. Cognitive decline was greater in individuals reporting low functional status. Research should focus on the interaction between changing patterns of alcohol consumption and social participation in individuals with low and high functioning status.

A relationship between generalized anxiety disorder (GAD) and fear of falling (FOF) has long been proposed but never specifically studied. This study aimed at analyzing the relationship between FOF and GAD or anxiety symptoms, while controlling for major depressive episodes (MDE), depressive symptoms, fall risk, and sociodemographic variables.Twenty-five older adults participated in this pilot study. Assessments included the following: Anxiety Disorder Interview Schedule, Geriatric Anxiety Inventory, Geriatric Depression Scale, Falls-Efficacy Scale-International. A multidisciplinary team evaluated fall risk.FOF was significantly correlated with GAD, MDE, anxiety and depressive symptoms, and fall risk, but not with sociodemographic variables. Multiple regression analyses indicated that GAD and anxiety symptoms were significantly and independently associated with FOF.Although the results of this pilot study should be replicated with larger samples, they suggest that FOF is associated with GAD and anxiety symptoms even when considering physical factors that increase the risk of falling.Treatment of FOF in patients with GAD may present a particular challenge because of the central role of intolerance of uncertainty, which may prevent patients from regaining confidence despite the reduction of fall risk. Clinicians should screen for GAD and anxiety symptoms in patients with FOF to improve detection and treatment.

We investigated the association between fear of falling (FoF) and motor imagery (MI) abilities in older people. Cross-sectional data from 3552 French older adults were used to conduct a multiple linear regression analysis looking at the association between FoF and MI abilities after controlling for several factors (e.g. gender, age, history of falls). MI abilities were significantly lower in older adults reporting a FoF compared with those without this fear. The presence of lower MI abilities, reflecting deficits in gait control, may explain why older people with a FoF are at higher risk of falling.

Falls are a consequence of gait instability. Cortical and subcortical abnormalities have been associated with gait instability but not yet with falls. This study aims to compare the global and regional brain subvolumes between healthy older fallers and non-fallers. A total of 77 healthy older individuals (23 fallers and 54 non-fallers, 69.8 ± 3.5 years; 45.5 % female) were included in this study using a cross-sectional design. Based on an a priori hypothesis, the following brain subvolumes were quantified from three-dimensional T1-weighted MRI using FreeSurfer software: total white matter abnormalities, total white matter, total cortical and subcortical gray matter, hippocampus, motor cortex, somatosensory cortex, premotor cortex, prefrontal cortex and parietal cortex volumes. Gait performances were also recorded. Age, sex, body mass index, comorbidities, use of psychoactive drugs, far-distance visual acuity, lower-limb proprioception, depressive symptoms and cognitive scores (Mini-Mental State Examination, Frontal Assessment Battery) were used as covariates. Fallers have more frequently depressive symptoms (P = 0.048), a lower far distance visual acuity (P = 0.026) and a higher coefficient of variation of stride time (P = 0.008) compared to non-fallers. There was a trend to greater subvolumes for the somatosensory cortex (P = 0.093) and the hippocampus (P = 0.060) in the falls group. Multiple logistic regressions showed that subvolumes of the somatosensory cortex and the hippocampus (P

Background Long-term benzodiazepine (BZD) use among seniors is mostly inappropriate and associated with adverse health outcomes. To prevent these consequences, withdrawal is crucial, yet knowledge is limited about what predicts BZD discontinuation. Until now, most studies have focused on sociodemographic and BZD intake factors as predictors while neglecting psychological factors. This research addresses this issue by studying how the intensity of depressive symptoms, social support satisfaction, self-perceived competence in the ability to withdraw, and overall quality of sleep predict discontinuation in long-term older consumers. Method Seventy-three participants aged 60 years and older were enrolled in this study. There were four time measures: before discontinuation (T1), after (T2), 3 months after (T3), and 12 months after (T4). Data were collected in the “Programme d’Aide du Succes au SEvrage” (PASSE-60+) study. Results Social support satisfaction predicted discontinuation at T2 and T4. Self-perceived competence in the ability to withdraw and depressive symptoms predicted discontinuation at T4. This later prediction was counterintuitive; higher depressive symptoms at T1 were linked with higher discontinuation success. BZD intake factors (length of use and dose) were good predictors for short term discontinuation. Psychological factors were moderate predictors for short term and good predictors for long term discontinuation. Conclusion Psychological factors are good predictors of discontinuation and are better predictors than BZD intake factors of long-term discontinuation. Discontinuation programs should focus on social support and self-perceived competence to improve their efficacy. Further studies are needed to acquire a more complete picture of the psychological predictors of discontinuation success. ClinicalTrials.gov Identifier: NCT02281175.

Few studies have examined the effect of anti-dementia drugs (i.e., acetylcholinesterase inhibitors and N-methyl-d-aspartate receptor antagonists) on gait performance. Past studies have focused on the stride time (i.e., gait cycle duration) but not on the mental imagery of gait. To compare mental imagery of gait and spatiotemporal gait parameters in patients with dementia [i.e., Alzheimer’s disease (AD) and non-AD] before and after the use of anti-dementia drugs (i.e., acetylcholinesterase inhibitors and memantine) and in controls (i.e., patients with dementia who did not take anti-dementia drugs). A total of 112 patients (mean age 82.5 ± 4.2 years, 68.8 % female) with mild-to-moderate AD and non-AD dementia were included in this non-randomized open-label trial (n = 56 in the Intervention group, and n = 56 in the Control group matched for age, sex, and stage and type of dementia) nested in a cohort study (mean follow-up 238.5 ± 79.8 days). Mental imagery of gait was assessed with the actual and imagined Timed Up and Go tests (aTUG and iTUG) and the difference between aTUG and iTUG (i.e., delta-TUG). Spatiotemporal gait parameters were measured with the GAITRite® system during normal walking. Participants in the Intervention group had a longer iTUG time (p < 0.001) and a lower delta-TUG value (p = 0.001) at the follow-up compared with those in the Control group. There was a significant increase in iTUG (p = 0.001) and decrease in delta-TUG (p < 0.001) from baseline to the follow-up only in the Intervention group. Multiple linear regression showed that the use of anti-dementia drugs was associated with a longer iTUG time and a lower delta-TUG value (best performance, p < 0.002). Our findings showed an improvement in mental imagery of gait with the use of anti-dementia drugs, but no changes in actual gait performance. NCT01315704.

Fear of falling and other fall-related psychological concerns (FRPCs), such as falls-efficacy and balance confidence, are highly prevalent among community-dwelling older adults. Anxiety and FRPCs have frequently, but inconsistently, been found to be associated in the literature. The purpose of this study is to clarify those inconsistencies with a systematic review and meta-analysis and to evaluate if the strength of this relationship varies based on the different FRPC constructs used (e.g., fear of falling, falls-efficacy or balance confidence). A systematic review was conducted through multiple databases (e.g., MEDLINE, PsycINFO) to include all articles published before June 10th 2015 that measured anxiety and FRPCs in community-dwelling older adults. Active researchers in the field were also contacted in an effort to include unpublished studies. The systematic review led to the inclusion of twenty relevant articles (n = 4738). A random-effect meta-analysis revealed that the mean effect size for fear of falling and anxiety is r = 0.32 (95% CI: 0.22–0.40), Z = 6.49, p < 0.001 and the mean effect size for falls-efficacy or balance confidence and anxiety is r = 0.31 (95% CI: 0.23–0.40), Z = 6.72, p < 0.001. A Q-test for heterogeneity revealed that the two effect sizes are not significantly different (Q(19) = 0.13, p = n.s.). This study is the first meta-analysis on the relationship between anxiety and FRPCs among community-dwelling older adults. It demonstrates the importance of considering anxiety when treating older adults with FRPCs.

Les donnees de l’etude ESA ont ete appariees aux donnees d’utilisation des services medicaux et pharmaceutiques de la Regie d’assurance maladie du Quebec pour documenter la prescription potentiellement non appropriee de benzodiazepines chez les personnes âgees. Nos resultats indiquent que 32% des repondants ont pris une dose journaliere moyenne de 6.1 mg de l’equivalent diazepam pour une duree moyenne de 205 jours par annee. Nos resultats indiquent aussi que presque la moitie, 48% des utilisateurs de benzodiazepines, ont recu au moins une prescription de benzodiazepine potentiellement non appropriee pendant les 12 mois qui precedaient l’etude. Pres de 23% des consommateurs ont recu au moins une prescription concomitante de Bzs et d’un autre medicament pouvant resulter en une interaction serieuse. De plus, les personnes âgees de 75 ans et plus avaient plus de chances de recevoir une Bz pour une longue periode de temps que les personnes âgees de 65–74 ans. Cette etude a montre que la duree d’utilisation des benzodiazepines augmentait avec le nombre de prescripteurs et avec le nombre de pharmacies consultees pendant l’annee. Le nombre de pharmacies utilisees a aussi ete associe avec la presence d’une ordonnance non appropriee de benzodiazepines pendant la meme annee. Nos resultats plaident en faveur d’un systeme de sante plus integre, incluant une revision reguliere des medicaments pris par les personnes âgees. Abstract: ESA study data were paired with Quebec medical and pharmaceutical services records to document potentially inappropriate benzodiazepines (Bzs) prescriptions among community-dwelling adults aged 65 and older. Results indicate that 32 per cent of respondents took a mean daily dose of 6.1 mg of equivalent diazepam for, on average, 205 days per year. Almost half (48%) of Bzs users received a potentially inappropriate benzodiazepine prescription at least once during the year preceding the survey. About 23 per cent received at least one concomitant prescription of a Bz and another drug that could result in serious interaction. In addition, individuals aged 75 and older were more likely to receive Bzs for a longer period of time than those aged 65–74. Number of pharmacies used was associated with inappropriate Bzs prescriptions. Our results argue in favour of a more integrated health services system, including a regular review of older adults’ drug regimens.

Background: Specific phobias have received little attention among older adults. This study is aimed at determining the 12-month prevalence rates of fear subtypes in older adults with a full or subthreshold DSM diagnosis of specific phobia as well as to examine differences among these conditions according to health and health behavior characteristics potentially associated with the severity of anxious symptoms. Methods: Data came from a representative sample of community-dwelling older adults aged 65 years and older (N = 2784). Diagnoses were established by in-home semi-structured interviews. DSM-IV criteria for specific phobia were slightly modified in line with recommendations for DSM-V. Results: The 12-month prevalence rates of specific phobias and subthreshold fears were, respectively, 2.0 and 8.7%. More than half of the respondents with a specific phobia did not recognize the “excessiveness” of their fears. Situational and natural environment fears were the most frequent subtypes. Compared to respondents with no symptoms of anxiety, older adults with a full- or subthreshold-specific phobia reported more chronic physical health problems, more comorbid depressive disorders and a higher use of benzodiazepines. However, older adults with specific phobia reported more comorbid anxiety disorders than respondents with subthreshold fears. Conclusions: The present study provides evidence for the fact that subthreshold fears have a high prevalence among older adults. Since several older people with specific phobia do not recognize the “excessiveness” of their fears, it is recommended that DSM-V criteria allow clinicians to rely on their own judgment to assess whether the perceived danger is out of proportion. Depression and Anxiety, 2011. © 2011 Wiley-Liss, Inc.

Anxiety disorders fulfilling DSM-IV criteria are common in community-dwelling older adults with prevalence estimates hovering between 0.1% and 15%, depending on the time period considered.1–5 Studies suggest that late-life sub-threshold anxiety is even more prevalent6–8 and could significantly interfere with functioning as much as disorders meeting full DSM criteria.9–11 Subthreshold anxiety usually refers to a condition where individuals do not meet the full symptom criteria (i.e., the number of symptoms required for a formal diagnosis is not reached) and/or do not report significant impairment or distress in functioning (i.e., the clinical significance criterion is not met).6–8 Despite its relevance in older adults, manifestations of subthreshold anxiety are nevertheless not considered as disorders according to the DSM-IV, particularly when the clinical significance criterion is not met. The rationale behind the introduction of the clinical significance criterion was to help identify a group of people presenting a more severe condition needing psychiatric help.12 One of the major problems with this criterion is that no operational definition exists for measuring impairment or distress.13 The evidence for impairment is often not clear-cut; clinicians have to rely on their own judgment to determine whether reported symptoms significantly interfere with daily functioning. Studies with younger adults suggest that the inclusion of the clinical significance criterion substantially decreases the prevalence rate of anxiety disorders by minimizing false positive (i.e., instances in which individuals who do not have a given psychiatric disorder are mistakenly diagnosed as having the disorder) and negative cases (i.e., instances in which individuals with a given psychiatric disorder are mistakenly diagnosed as not having the disorder).12–14 However, the use of this criterion with older adults may conversely increase the number of false-negative cases, since they are usually less active and less likely to perceive themselves as disabled than younger adults.15 In addition, because older adults are more likely to somatize their distress and to report less emotional disturbances,8,16–18 the symptom criteria may be harder to satisfy in this population. Knowing that the symptom and the clinical significance criteria may pose problems in the older adult population, the aim of the current study was to answer the following questions: (a) how these criteria affect the prevalence estimates of anxiety problems in this population and (b) do these criteria identify a group of older adults presenting a more severe condition needing psychiatric help? To answer these questions, respondents with a full anxiety disorder were compared with respondents presenting different patterns of subthreshold anxiety on their sociodemographic, health, and health behavior characteristics. Since respondents’ health and health behavior characteristics were chosen on the basis of their potential association with the severity of anxiety,19–22 they should distinguish older adults having a more severe condition, as a full anxiety disorder, from respondents with subthreshold anxiety as well as distinguishing older adults reporting subthreshold anxiety from others without symptoms of anxiety.

Background Anxiety symptoms are highly prevalent in elders with mild cognitive disorders, but little is known about the associations of specific anxiety disorders to mild cognitive disorders. Objective To identify the clinical and subclinical anxiety disorders associated with cognitive impairment no dementia (CIND) and to determine whether these associations differ depending on sex and concomitant depressive episodes. Method Participants constituted a random sample (n = 2414) of community-dwelling adults aged 65–96 years. The following clinical and subclinical DSM-IV anxiety disorders were identified with a semi-structured interview: specific phobia, social phobia, agoraphobia, panic disorder, obsessive–compulsive, and generalized anxiety disorder (GAD). Major depressive episodes or minor depression (MDE/MD) were also determined based on the DSM-IV criteria. CIND cases were defined based on Mini-Mental State Examination (MMSE) cut-offs (15th percentile) stratified for age, education, and sex. Potentially confounding variables (age, education, MDE/MD, chronic diseases, and psychotropic drug use) were statistically controlled. Results In men, after adjusting for confounding variables, CIND was associated with subclinical GAD (odds ratio (OR): 4.93, 95% confidence interval: 1.84–13.23). Further analyses showed that in men, CIND was related to clinical/subclinical GAD whether MDE/MD was present (7.05, 1.88–26.43) or absent (9.33, 3.24–26.83). In women, CIND was not linked to any clinical or subclinical anxiety disorder. Conclusions These results suggest that in community-dwelling elders, GAD is the main anxiety disorder associated with poor global cognitive functioning. Moreover, this association is modified by sex, but not by the presence of depressive episodes. Copyright © 2010 John Wiley & Sons, Ltd.

Background Sleep disturbances are frequently reported in the older adult population and benzodiazepines are the drugs most often prescribed to treat these problems. Nearly 25% of the older adult population uses these drugs and 83% of benzodiazepine users report sleep problems. Although the College des Medecins du Quebec suggests a maximum length of use of 3 months, according to most studies the mean length of benzodiazepine use is longer. The goal of this study was to document the association between length of benzodiazepine use and sleep quality as reported by adults 65 years older and over. Methods Data used in this study came from the Seniors' Health Survey (ESA) conducted in a representative sample of the community-dwelling older population in Quebec, Canada. Inclusion criteria included the ability to speak and understand French. Data were analyzed using a structural equation modeling strategy. Results Long-term benzodiazepine users were more likely to report poor sleep quality. Sleep quality of initial probable problematic sleepers tended to increase over 1 year but sleep quality in benzodiazepines users increased less rapidly than in non-users. Also, women were more likely to report using benzodiazepines and having poorer sleep quality. Conclusion Longitudinal studies using incident cases of benzodiazepine use should be conducted to better determine the causal relationship between sleep quality and benzodiazepine use in the older population. Copyright © 2010 John Wiley & Sons, Ltd.

Objective:To examine the incidence of psychiatric disorders in the Quebec older adult population.Method:Data from the Enquěte sur la Santé des Aînés (ESA) study conducted in 2005 to 2008 using a representative sample (n = 2784) of community-dwelling adults aged 65 years and older were used.Results:The ESA study's results indicate that 12.0% of the respondents met the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, criteria for depression, mania, anxiety disorders, or benzodiazepine drug dependency at the baseline interview. Our results also indicate that the 12-month rate of incident cases of DSM-IV disorders was 6.2%. The proportion of incident cases was higher for the depression group (3.4%) than for the anxiety disorders group (2.3%). The results showed that the probability to develop an incident psychiatric condition after 1 year of follow-up, compared with the noncases group, varied according to sex (OR 2.18; 95% CI 1.39 to 3.44). Our results also showed that the number of chronic health problems (OR 1.20; 95% CI 1.09 to 1.33) and the change in the number of chronic health problems reported between the baseline and the second interview (OR 1.14; 95% CI 1.01 to 1.30) increased the probability to be an incident case at Time 2. The results indicated that social support did not influence the probability to develop a psychiatric disorder.Conclusion:These results indicate that sex and physical health status have an impact on the incidence of DSM-IV disorders in the elderly. This finding underscores the need for improved recognition and treatment of psychiatric disorders associated with physical illness in the older population.

The purpose of this study was to determine OCD prevalence among older adults living in the community and to examine its correlates. Data were drawn from a large population survey using a representative sample of older adults aged 65 years and over ( N = 2798). The 12-month prevalence rate of OCD was 1.5%. Results showed that older adults with OCD were more likely to be men compared to those having another anxiety disorder or a mood disorder. They were also more afflicted with difficulties in social functioning than respondents presenting another anxiety disorder. In spite of social disabilities, respondents with OCD had the lowest rate of health services use among those reporting anxiety or mood disorders. It is suggested that older adults with OCD did not feel the need to seek treatment because they perceived their physical and mental health more positively than others and because they were surrounded by supportive peers.

The current study reports a case series examining (1) the variation in strength of obsessional doubt and belief in consequences of the doubt; and (2) the interaction between these cognitive components and symptom measures of duration and severity of obsessive-compulsive disorder (OCD), over 24 weeks of cognitive behaviour therapy. Eight participants diagnosed with OCD, four with contamination-related rituals and four with checking behaviours, were selected on the basis of the Yale-Brown obsessive-compulsive scale (Y-BOCS) and Padua ratings. All participants completed daily diaries measuring strength of principal obsessional doubt (0-100), strength of belief in consequences of the doubt (0-100) and the duration of the compulsive rituals throughout the 24 weeks of therapy. Severity of symptomatology was measured pre- and post-treatment using the Y-BOCS. Change in all measures was analysed over time following the procedure outlined by Storchheim and O'Mahoney (2006). Results showed that decrease in belief in secondary consequences is always accompanied by a decrease in strength of obsessions, but the converse does not hold. Furthermore, change in OCD symptomatology may precede cognitive changes.

The main objective of this study was to examine the efficacy of a guided self-help treatment based on cognitive behavioral principles (CBT-GSH) for generalized anxiety disorder (GAD) in older adults.Three older adults aged from 66 to 70 and diagnosed with GAD were included in a single-case experimental multiple-baseline protocol. Data were collected using daily self-monitoring, standardized clinician ratings, and self-report questionnaires at pretest, posttest, and 6-month and 12-month follow-ups. Treatment consisted of awareness training, worry interventions, relaxation training, pleasant activities scheduling, and relapse prevention. Participants used a manual presenting weekly readings and at-home practice exercises. They also received weekly supportive phone calls from a therapist.At posttest, participants showed improvement on worries and GAD severity, on psychological process variables targeted by treatment (intolerance of uncertainty, negative problem orientation, cognitive avoidance, and perceived usefulness of worry), and on secondary variables associated with GAD (anxiety, depression, sleep difficulties, cognitive functioning, and disability). These results were generally maintained at 12 months after the end of treatment. Participants had favorable opinions toward the treatment.The results of this study suggest that CBT-GSH is both feasible and effective for the treatment of GAD in older adults.

Our goal was to build a systemic model of chronic use among community-dwelling mature benzodiazepine (BZD) users. BZDs are commonly prescribed for symptoms of anxiety and/or insomnia despite their documented side effects over time.We conducted in-depth interviews with 23 mature (50 years and over) users, 14 women and 9 men, as well as 9 general practitioners and 11 pharmacists. We chose the grounded theory approach for our analysis.Results yielded a systemic model of chronic BZD use, illustrating onset and maintenance of use, and taking into account individual life context, intervening conditions (e.g. family and doctor--patient interactions) and structural factors (medicalization, ageism, influence of the media and pharmaceutical industry, etc.). Based on our findings, we suggest that intervention should go beyond medical issues and extend to the individual's perception of aging in the modern society, as well as attitudes of families and health professionals regarding long-term BZD use. Family members should be involved in the weaning process and adoption of new life habits. General practitioners should be better trained regarding geriatric psychosocial issues and offer alternatives to prescribe psychotropic drugs such as cognitive behavior therapy for insomnia. Also, as a society, we should reconsider the highly medicalized stance we take to compensate for age-related losses. The influential role of the pharmaceutical industry in the process is discussed.We conclude that a predominantly biomedical perspective on human development diminishes patient-centered care within a socially contextualized, individual perspective.

Objective: To compare cognitive behaviour therapy (CBT) with CBT plus medication; medication alone; and placebo in the treatment of adult obsessive–compulsive disorder (OCD). Method: Forty-eight participants (43 completers) were recruited into two protocols. In the first protocol, 21 people with OCD were randomly allocated to either a standard medication (fluvoxamine) or standard placebo condition for a 5-month period. Both these groups subsequently received CBT for a further 5 months. In the second protocol, 22 people with OCD received CBT, one group was already stabilized on an antidepressant of choice; the second group was drug naive. Results: All active treatments, but not the placebo, showed clinical improvement. There was no difference in treatment response to CBT regardless of whether participants had previously received medication or placebo. Conclusion: CBT has a more specific antiobsessional effect than medication but CBT plus medication shows greatest overall clinical improvement in mood.

Objective: To document the 6-month prevalence of posttraumatic stress syndrome (PTSS) in the older adult population and the validity of a PTSS Scale in an epidemiologic setting. Method: Data came from the Enquête sur la santé des aînés et l'utilisation des services de santé (ESA Services Study) conducted during 2012–2013 using a probability sample of older adults seeking medical services in primary health clinics. Results: Results showed that a first-order PTSS measurement model consisting of 3 indicators—the number of lifetime traumatic events, the frequency of reactions and symptoms of distress associated with the traumatic events, and the presence of consequences on the social functioning—was plausible. Reliability of the PTSS was 0.82. According to the PTSS, 11.1% of the older adult patients presented with PTSS, but only 21.7% of them reported an impact of their symptoms on their social functioning. The prevalence of older adults meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for full posttraumatic stress disorder (PTSD) reached 1.8%, and 1.8% of older adults reached criteria for partial PTSD. Our results also showed that women were more at risk to report PTSS than men and that older adults aged 75 years and older were less likely to report these symptoms than those aged between 65 and 74 years. Conclusions: PTSS is a common mental health problem among adults aged 65 and older and seeking health services in the general medical sector.

Background:Several studies have suggested that cognitive training is a potentially effective way to improve cognition and postpone cognitive decline in older adults with mild cognitive impairment (MCI). The MEMO+ study is a randomized, controlled, single-blind trial designed to test the efficacy, specificity, and long-term effect of a cognitive training intervention and a psychosocial intervention in persons with MCI.Methods:One hundred and sixty-two participants with MCI will be recruited. They will be randomized into three groups: cognitive training, psychosocial intervention, and no-contact. Each intervention will last for eight weeks (one session per week) and a booster training session will be provided three months after the end of the intervention. Various proximal and distal outcomes will be measured at pre-intervention as well as at one week, three months, and six months post-training. Proximal outcomes include memory and psychological health measures. Distal outcomes focus on self-rated functioning in complex daily activities and strategies used in daily life to enhance function. Socio-demographic factors (age, gender, and education), general cognition, personality traits, engagement in activities, and self-efficacy will be used as moderators. Enrolment began in April 2012 and will be completed by December 2014.Conclusions:This study is likely to have a significant impact on the well-being of persons with MCI by contributing to the development of adapted and scientifically supported cognitive and psychosocial interventions.

The present study was conducted to determine whether anxiety among community-dwelling elders is associated with cognitive decline over a period of one year as well as to verify whether there are sex differences in the association between anxiety and cognitive decline. Participants (n=1942) were community-dwelling adults aged 65-96 years assessed at study entry (T0) and one year later (T1). Anxiety was identified with a semi-structured interview and cognitive functioning was assessed using the Mini-Mental State Examination. Results revealed that the presence of a clinically significant anxiety disorder did not predict cognitive decline in men and women. Subclinical anxiety symptoms predicted cognitive decline in women only. Moreover, for men, the presence of symptoms from at least two anxiety disorders predicted cognitive decline. For women, cognitive decline was predicted by the presence of symptoms from one anxiety disorder only. Overall, the results illustrate the role of anxiety in cognitive decline in community-dwelling older adults.

Over the years, psychotropic drugs have been prescribed for symptoms of anxiety and/or insomnia. Elderly women are especially at risk of chronic use and ensuing side-effects. We examined psychosocial processes associated with long-term psychotropic drug use. We conducted in-depth interviews with 21 frail elderly women in a home care program and 14 of their primary caregivers. Results yielded a descriptive model of chronic use that takes into account antecedents of use, initial and subsequent prescription processes, individual contextual circumstances, the effect of the social context, and the women's cognitive strategies employed to make prolonged use coherent with their self-image.

To examine in men and women the independent associations between anxiety and depression and 1-year incident cognitive impairment and to examine the association of cognitive impairment, no dementia (CIND) and incident cognitive impairment with 1-year incident anxiety or depression.Prospective cohort study.General community.Population-based sample of 1,942 individuals aged 65 to 96.Two structured interviews 12 months apart evaluated anxiety and mood symptoms and disorders according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Incident cognitive impairment was defined as no CIND at baseline and a follow-up Mini-Mental State Examination score at least 2 points below baseline and below the 15th percentile according to normative data. The associations between cognitive impairment and anxiety or depression were assessed using logistic regression adjusted for potential confounders.Incident cognitive impairment was, independently of depression, associated with baseline anxiety disorders in men (odds ratio (OR)=6.27, 95% confidence interval (CI)=1.39-28.29) and anxiety symptoms in women (OR=2.14, 95%=1.06-4.34). Moreover, the results indicated that depression disorders in men (OR=8.87, 95%=2.13-36.96) and anxiety symptoms in women (OR=4.31, 95%=1.74-10.67) were particularly linked to incident amnestic cognitive impairment, whereas anxiety disorders in men (OR=12.01, 95%=1.73-83.26) were especially associated with incident nonamnestic cognitive impairment. CIND at baseline and incident cognitive impairment were not associated with incident anxiety or depression.Anxiety and depression appear to have different relationships with incident cognitive impairment according to sex and the nature of cognitive impairment. Clinicians should pay particular attention to anxiety in older adults because it may shortly be followed by incident cognitive treatment.

To assess the prevalence rate of mood disorders, anxiety disorders, benzodiazepine dependence, and insomnia in older men and women with probable cognitive impairment no dementia (CIND) and to examine the independent associations between each disorder and CIND.Participants were a random sample of community-dwelling individuals aged 65-96 (N = 2414). Semi-structured in-home interviews based on DSM-IV-TR (DSM, Diagnostic and Statistical Manual of Mental Disorders) criteria evaluated the prevalence rates of mood disorders, anxiety disorders, benzodiazepine dependence, and insomnia. Participants were classified as probable CIND based on their Mini-Mental State Examination score using sex, age, and education-stratified cut-offs (lower than the 15th percentile).In men, 22.7% of individuals with probable CIND and 12.1% of those with normal cognition had at least one psychiatric disorder (crude odds ratio (OR): 2.13, 95% confidence interval (CI): 1.23-3.69). More specifically, mood disorders (3.43, 1.74-6.75), benzodiazepine dependence (5.10, 1.23-21.11), and comorbid anxiety and mood disorders (8.67, 2.00-37.68) were significantly associated with probable CIND, but not anxiety disorders alone and insomnia. The prevalence rate of psychiatric disorders was similar in women with probable CIND (23.1%) and in women without CIND (23.9%; 0.95, 0.64-1.42). No specific psychiatric disorder was significantly associated with probable CIND in women. All associations remained unchanged after adjustments for potential confounders.The association between psychiatric disorders and probable CIND appears to be sex-specific. In clinical practice, mood disorders, and benzodiazepine dependence should receive particular attention since these disorders are associated with a condition increasing the risk of dementia.

Background: Several neuropsychiatric symptoms observed in elders with cognitive impairment no dementia (CIND) can be part of a major depressive episode (MDE) or a “subthreshold” depressive episode. Certain neuropsychiatric symptoms of CIND are essential symptoms of MDE (e.g. dysphoria, anhedonia), while other are non-essential symptoms (NESD; e.g. fatigue, insomnia, cognitive complaint). Contrary to essential symptoms, NESD are not specific to MDE and are present in other disorders. It is unknown whether NESD are linked to CIND in absence of MDE or subthreshold MDE. The present study examined the association between NESD and probable CIND in elders without essential MDE symptoms.Methods: Participants were 2028 community-dwelling individuals aged 65–96 years who had not experienced dysphoria/anhedonia during the year preceding the interview. Semi-structured in-home interviews evaluated the following NESD: alteration of appetite, sleep disturbance, psychomotor alteration, fatigue/loss of energy, worthlessness/guilt, and cognitive complaints. Probable CIND cases were defined based on the Mini-mental State Examination cut-offs (15th percentile) stratified for age, education and sex.Results: Symptoms of fatigue/loss of energy (OR: 2.41, 95% CI: 1.42–4.09), sleep disturbance (OR: 3.04 CI: 1.69–5.46) and cognitive complaints (OR: 2.86 CI: 1.71–4.77) were significantly associated with CIND. These associations were not modified after adjustments for potential confounders (age, education level, sex, benzodiazepine use, chronic diseases, and brain disorders).Conclusion: A psychiatric symptomatology occurs in older adults with CIND in the absence of MDE or subthreshold MDE. NESD encountered in the absence of dysphoria/anhedonia should receive particular attention by clinicians since they can be linked to cognitive difficulties.

Objective:To document the remission and persistence of psychiatric disorders in Quebec's older adult population.Method:Data came from the Enquěte sur la santé des aînés (ESA) study conducted in 2005–2008 using a representative sample ( n = 2784) of community-dwelling older adults.Results:The ESA study results indicate that 12% of respondents met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for depression, mania, anxiety disorders, or benzodiazepine drug dependency at the baseline interview. The results also indicate that the 12-month rate of patients with a persistent psychiatric condition was 19.4%. Sixty-seven percent of the patients in remission experienced a total recovery of their symptoms during the following year. The probability of presenting a persistent psychiatric condition or a partial remission after 1 year of follow-up, compared with those in total remission, did not vary according to sociodemographic characteristics. The results also showed that social support and the number of chronic health problems did not influence mental health at follow-up. However, results indicated that the use of health services (OR 7.4; 95% CI 3.72 to 14.55) and the change in the number of chronic health problems reported between baseline and the second interview (OR 1.2; 95% CI 1.06 to 1.34) increased the probability of patients with prevalent disorders at Time 1 having persistent disorders at Time 2.Conclusion:Results suggest that a deterioration of physical health status was associated with the persistence of DSM-IV disorders in the elderly. These results also suggest that the use of mental health services is associated with severity of the mental illness.

Despite the important role of doubt in understanding obsessive-compulsive disorder (OCD), current cognitive models of OCD usually do not separate this initial doubt from the anticipated consequence of not ritualizing. The current study evaluates belief in the obsessional doubt as a real probability as an additional cognitive dimension of obsessive-compulsive (OC) beliefs.One hundred and fifteen participants with OCD completed four clinical scales measuring different OC beliefs in: (a) the real probability of obsessional doubt; (b) the realism of anticipated consequences; (c) the degree of conviction in the need to perform rituals; and (d) the perceived ability to resist rituals. The severity of symptomatology was also evaluated.Using cross-sectional and longitudinal data, correlational analyses were performed to determine the relationship between OC beliefs as well as to observe how these beliefs may be related to the severity of symptomatology and how they fluctuated over time. Regression analyses were also employed to verify which OC beliefs better predicted the perceived ability to resist rituals.Belief in the obsessional doubt as a real probability was significantly related to other OC beliefs. Also, levels of belief for the same doubt remained stable for a period of two weeks, but different levels of belief were observed for distinct obsessional doubts measured at the same time. Finally, belief in the obsessional doubt as a real probability better predicted the perceived ability to resist rituals than other OC beliefs.Belief in the obsessional doubt as a real probability may be an important dimension to consider when evaluating OC beliefs in treatment resistant OCD, particularly in people who have low perceived ability to resist rituals.

Objective:To document the prevalence of psychiatric disorders in Quebec's older adult population.Method:Data came from the Enquête sur la santé des aînés study conducted in 2005–2006 using a representative sample ( n = 2798) of community-dwelling older adults.Results:Our results indicate that 12.7% of the respondents met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for depression, mania, anxiety disorders, or benzodiazepine dependency. The 12-month prevalence rate of major depression was 1.1% and the prevalence of minor depression 5.7%. A total of 5.6% of the respondents reported an anxiety disorder. The most prevalent anxiety disorders were specific phobia (2.0%), obsessive–compulsive disorder (OCD) (1.5%), and generalized anxiety disorder (GAD) (1.2%). Agoraphobia without panic disorder and panic disorder were reported by 0.3% and 0.6% of the respondents, respectively. The prevalence rate of benzodiazepine dependency was 2.3%. The 12-month comorbidity prevalence rate between any psychiatric disorders was 2.2%. Among those with depressive disorder, the most frequent comorbidity was observed between minor depression and specific phobia (4.3%), GAD (4.3%), OCD (3.7%), and mania (1.3%). Further, only 39% of those having at least one active DSM-IV diagnosis reported having used health services for their psychological distress symptoms during the previous 12 months. Among those who consulted health services, 85% visited a general practitioner.Conclusions:Our results indicate that a large proportion of the elderly population in Quebec presents mental health needs. Longitudinal research focusing on the individual and social consequences of mental health problems reported by older adults is needed to avoid misinterpretation of this finding.

Objective: Cognitive-behavioural therapy (CBT) has proved effective in treating delusions, both in schizophrenia and delusional disorder (DD). Clinical trials of DD have mostly compared CBT with either treatment as usual, no treatment, or a wait-list control. This current study aimed to assess patients with DD who received CBT, compared with an attention placebo control (APC) group. Method: Twenty-four individuals with DD were randomly allocated into either CBT or APC groups for a 24-week treatment period. Patients were diagnosed on the basis of structured clinical interviews for mental disorders and the Maudsley Assessment of Delusion Schedule (MADS). Results: Completers in both groups ( n = 11 for CBT; n = 6 for APC) showed clinical improvement on the MADS dimensions of Strength of Conviction, Insight, Preoccupation, Systematization, Affect Relating to Belief, Belief Maintenance Factors, and Idiosyncrasy of Belief. Conclusion: When compared with APC, CBT produced more impact on the MADS dimensions for Affect Relating to Belief, Strength of Conviction, and Positive Actions on Beliefs.

Introduction At the moment, population-based data on the subjective sleep characteristics related to anxiety disorders in older adults are scarce and the few results do not agree with the view proposed by the DSM concerning sleep difficulties related to anxiety. This study examines the subjective sleep characteristics specific to anxiety and depression in older adults. Materials and methods The sample comprises a random population-based sample of 2393 individuals aged 65 years or older. Anxiety and depression were identified by a structured interview and categorized using DSM-5 criteria for phobias, panic disorder, generalized anxiety disorder, unspecified anxiety disorder, major depressive episode (MDE) and depressive episode with insufficient symptoms (DEIS). Subjective sleep characteristics were measured using the Pittsburgh Sleep Quality Index (PSQI). The association between subjective sleep characteristics and anxiety/depression were assessed using logistic regression adjusted for age, education level, cognitive functioning, subjective health, anxiolytic/sedative/hypnotic use, antidepressants use, cardiovascular conditions, and the number of chronic diseases. Results The prevalence of poor sleep (PSQI > 5) was 64% in participants with anxiety disorder (Adjusted odds ratio: 2.16, 95% CI: 1.30–3.60) and 55% in participants with unspecified anxiety disorders (1.59, 1.12–2.26) compared to 37% in those without anxiety. Nearly all PSQI subscales were significantly associated with anxiety, but these subscales shared variance and only short sleep duration, sleep disturbance and daytime functioning subscales were independently related to anxiety. Within these significant subscales, the main specific sleep complaints associated with anxiety were daytime sleepiness and sleep disturbances related to breathing, coughing/snoring, feeling hot or cold, pain, and bad dreams. The prevalence of poor sleep was 54% in participants with MDE (1.07, 0.70–1.64) and 58% in participants with DEIS (1.70, 1.22–2.36) compared to 36% in those without depression. The use of sleeping medication was the only specific sleep characteristic associated with depression. Conclusion These results suggest that in older adults, symptoms of short sleep duration, daytime sleepiness and sleep disturbances are specific related to anxiety while the use of sleep medication is associated to depression. Acknowledgements This study was supported by research grants from the Canadian Institutes of Health Research (CIHR) and the Fonds de recherche en sante du Quebec. Olivier Potvin is supported by a fellowship award from the CIHR.