A randomized trial of two forms of cognitive behaviour therapy for an older adult population with subclinical health anxiety.

Seniors have been consistently under-represented in the health anxiety treatment literature. The aim of this study was to test the efficacy of a six-session enhanced cognitive behaviour therapy (ECBT) programme for subclinical health anxiety in seniors, and to examine whether the programme fostered therapeutic alliance and motivation for psychotherapy as compared to a standard cognitive behavioural therapy (SCBT) programme and wait-list control (WLC). Fifty-seven seniors with subclinical health anxiety were randomly assigned to six weeks of SCBT, ECBT, or WLC. At pre-treatment, post-treatment, and three-month follow-up, participants completed questionnaires on health anxiety and its dimensions, and other related psychological constructs. Therapeutic alliance and motivation measures were completed after Sessions 1, 3, and 6. At post-treatment, participants in the SCBT and ECBT groups showed significantly lower health anxiety when compared to WLC, with reductions on the subscale measuring disease fear/phobia. Significantly, more participants in the SCBT (66.7%) and ECBT (55.6%) conditions demonstrated clinically significant change on health anxiety compared to the WLC condition (11%). Gains were maintained at three months. There were minimal differences found between the SCBT and ECBT groups on therapeutic alliance and motivation. The findings indicated that both forms of CBT were efficacious for reducing some of the health anxious thoughts and beliefs in seniors.

Core cognitions related to health anxiety in self-reported medical and non-medical samples.

The cognitive-behavioural model of health anxiety hypothesizes that the degree of health threat experienced by an individual is a function of the perceived: (1) likelihood of illness; (2) awfulness of illness; (3) difficulty coping with illness; and (4) inadequacy of medical services. While research has examined cognitions in health anxiety, it is not known whether these cognitions predict health anxiety in individuals who do or do not report medical conditions and whether these cognitions are uniquely related to health anxiety. After developing the Health Cognitions Questionnaire to assess these specific cognitions, we examined the extent to which the cognitions predicted health anxiety and poor response to reassurance in a healthy community sample (n = 273) and a sample who self-reported various medical conditions (n = 208). Supporting the cognitive-behavioural model, these cognitions predicted health anxiety and poor response to reassurance in both samples, with some differences observed between those who did or did not report medical conditions. The cognitions were uniquely related to health anxiety even after controlling for depression and general anxiety. Clinical and theoretical implications are discussed. Overall, the Health Cognitions Questionnaire has potential to facilitate further research on the development, maintenance, and treatment of health anxiety.

Understanding health anxiety among community dwelling seniors with varying degrees of frailty.

OBJECTIVE: In this study, we attempted to disentangle the extent to which older age vs physical health problems contribute to health anxiety. Thus, we compared the levels of health anxiety among younger adults and seniors, with either low or high levels of frailty. Predictors of health anxiety in seniors were explored. METHODS: Forty-nine seniors with high levels of frailty were compared with 63 seniors with low levels of frailty and 130 younger adults. Comparisons were made on the Illness Attitudes Scale (IAS) and on a Medically Adjusted Illness Attitudes Scale, an adapted version ensuring scores reflect health anxiety, and not greater illness. Seniors also completed measures of frailty, pain, depression, trait anxiety and coping. RESULTS: Results varied depending on the health anxiety measure. Using the traditional IAS, seniors with high frailty experienced greater levels of health anxiety than seniors with low-frailty and younger adults. Using the medically adjusted version, seniors with high frailty experienced similar levels of heath anxiety compared with younger adults; seniors with low frailty had the lowest levels of health anxiety. Using multiple regression analysis, emotional preoccupation and trait anxiety uniquely predicted health anxiety among seniors. CONCLUSIONS: Researchers and clinicians should ensure that health anxiety measures actually assess health anxiety and not physical illness. Using an appropriate health anxiety measure, the results suggest seniors with relatively fewer health problems may experience reduced health anxiety compared with other older adults and younger adults. The results are considered in the context of research on aging and anxiety. Implications for clinical practice and future research are discussed.

Patient perceptions of hospital discharge: reliability and validity of a Patient Continuity of Care Questionnaire.

BACKGROUND: Review of the literature reveals a need to develop a questionnaire that measures patient perceptions of factors impacting continuity of care following discharge from hospital. Such a measure has the potential to guide quality improvement initiatives related to continuity of care. OBJECTIVE: Our objective was to develop and examine the psychometric properties of a measure that would meet this need, the Patient Continuity of Care Questionnaire (PCCQ). METHOD: The PCCQ was administered to 204 inpatients 4 weeks after discharge. The questionnaire was assessed by item and principal components analysis. Factors derived from principal components analysis were assessed for internal consistency and construct validity. RESULTS: A principal components analysis resulted in six subscales including perceptions of: (1) relationships with providers in hospital, (2) information transfer to patients, (3) relationships with providers in community, (4) management of written forms, (5) management of follow-up and (6) management of communication among providers. These subscales were internally consistent in our sample and demonstrated construct validity through correlations with other related constructs. CONCLUSION: This initial study supports the reliability and validity of the PCCQ for measuring patient perceptions of factors central to continuity of care. The questionnaire subscales correspond to the theoretical components of continuity of care that have been proposed in the literature, namely informational, relational and management continuity. The subscales may be of value for identifying problems in continuity of care and for evaluating interventions aimed at improving continuity of care for patients after hospital discharge.

A six-month profile of community case coordinated older adults.

The purpose of this study was to assess the needs of older case coordinated clients receiving community health services, by examining changes in cognitive status, physical and mental health status, social support, risk for institutionalization, and service use over a 6-month period from initial intake into home care. Significant predictors of professional and supportive home care, as well as emergency room use and hospital days, were also examined. Standardized interviews were conducted with 234 clients at the time of referral; follow-up interviews were conducted with 179 of these clients after 6 months of case coordination. Results reveal that physical and mental health improved, while cognitive status remained stable. Although social interaction and instrumental support decreased, subjective support remained stable. Risk of institutionalization decreased. Occupational therapy, nursing, and homemaking were the most frequently used services. The best predictor of professional and supportive home care was a risk of institutionalization score. The needs of this older adult population changed even within the relatively short span of 6 months. Frequent review of needs in some form may be warranted in order to maintain effective service plans.