Development and preliminary evaluation of the anxiety in cognitive impairment and dementia (ACID) scales.

BACKGROUND: Although rates of anxiety tend to decrease across late life, rates of anxiety increase among a subset of older adults, those with mild cognitive impairment (MCI) or dementia. Our understanding of anxiety in dementia is limited, in part, by a lack of anxiety measures designed for use with this population. This study sought to address limitations of the literature by developing a new measure of anxiety for cognitively impaired individuals, the anxiety in cognitive impairment and dementia (ACID) Scales, which includes both proxy (ACID-PR) and self-report (ACID-SR) versions. METHODS: The ACID-SR and ACID-PR were administered to 45 residents, aged 60 years and older, of three long-term care (LTC) facilities, and 38 professional caregivers at these facilities. Other measures of anxiety, and measures of depression, functional ability, cognition, and general physical and mental health were also administered. RESULTS: Initial evaluation of its psychometric properties revealed adequate to good internal consistency for the ACID-PR and ACID-SR. Evidence for convergent validity of measures obtained with the ACID-SR and ACID-PR was demonstrated by moderate-to-strong associations with measures of worry, depressive symptoms, and general mental health. Discriminant validity of measures obtained with the ACID-SR and ACID-PR was demonstrated by weak correlations with measures of cognition, functional ability, and general physical well-being. CONCLUSIONS: The preliminary results suggest that the ACID-SR and ACID-PR can obtain reliable and valid measures of anxiety among individuals with cognitive impairment. Given the subjective nature of anxiety, it may be prudent to collect self-report of anxiety symptoms even among those with moderate cognitive impairment.

Initial evaluation of the Older Adult Social-Evaluative Situations Questionnaire: a measure of social anxiety in older adults.

BACKGROUND: The assessment of social anxiety in late life has been examined in few studies (e.g. Gretarsdottir et al., 2004; Ciliberti et al., 2011). The present study describes the creation and initial psychometric evaluation of a new, content valid measure of social anxiety for older adults, the Older Adult Social-Evaluative Situations Questionnaire (OASES). METHODS: Psychometric properties of the OASES were evaluated in a community dwelling sample of older adults (N = 137; 70.8% female). Convergent validity was established by examining the relation between the OASES and the Liebowitz Social Anxiety Scale (LSAS), Social Phobia and Anxiety Inventory (SPAI), and Beck Anxiety Inventory (BAI). Discriminant validity was established by examining the relation between the OASES and measures of depression (Geriatric Depression Scale, GDS), perceived health status (Short Form Health Survey, SF-12), and demographic variables. The validity analyses of the OASES were based on a smaller sample with n values ranging from 98 to 137 depending on missing data on each questionnaire. RESULTS: Internal consistency, measured by Cronbach's α, for the OASES total score was 0.96. All items on the OASES were endorsed by participants. Convergent validity was demonstrated by medium to large correlations with the SPAI, LSAS, and BAI. Support for discriminant validity was evidenced by small to medium correlations between the OASES and GDS, SF-12, and demographic variables. CONCLUSIONS: Evidence in support of convergent and discriminant validity of the OASES is discussed. Although the results from the present study suggest that this measure may assess anxiety in and avoidance of social situations salient to older adults, future studies are needed to further examine the psychometric properties of the OASES and replicate these results in both clinical and more diverse samples of older adults.