Background/Aims: Little is known about anxiety and its associations among persons with dementia in nursing homes. This study aims to examine anxiety, anxiety symptoms, and their correlates in persons with dementia in Norwegian nursing homes. Methods: In all, 298 participants with dementia ≥65 years old from 17 nursing homes were assessed with a validated Norwegian version of the Rating Anxiety in Dementia scale (RAID-N). Associations between anxiety (RAID-N score) and demographic and clinical characteristics were analyzed with linear regression models. Results: Anxiety, according to a cutoff of ≥12 on the RAID-N, was found in 34.2% (n = 102) of the participants. Irritability (59.7%) and restlessness (53.0%) were the most frequent anxiety symptoms. The participants' general physical health, a wide range of neuropsychiatric symptoms, and anxiolytic use were significant correlates of higher RAID-N scores. Conclusion: Knowledge about anxiety, anxiety symptoms, and their correlates may enhance early detection of anxiety and planning of necessary treatment and proactive measures among this population residing in nursing homes.

Keywords:
Anxiety, Dementia, Nursing homes
1.
Garden M, Toft A: Norway; in Alzheimer Europe (eds): Dementia in Europe Yearbook 2013: National Policies Covering the Care and Support of People with Dementia and Their Cares: Including The Alzheimers Europe Annual Report 2012. Luxembourg, Alzheimer Europe, 2013, pp 132-137.
2.
Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP: The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement 2013;9:63-75.e2.
3.
Engedal K, Haugen PK: Demens: fakta og utfordringer: en lærebok, ed 5. Tønsberg, Aldring og helse, 2009.
4.
Tagai K, Nagata T, Shinagawa S, Nemoto K, Inamura K, Tsuno N, Nakayama K: Correlation between both morphologic and functional changes and anxiety in Alzheimer's disease. Dement Geriatr Cogn Disord 2014;38:153-160.
5.
Orgeta V, Qazi A, Spector A, Orrell M: Psychological treatments for depression and anxiety in dementia and mild cognitive impairment: systematic review and meta-analysis. Br J Psychiatry 2015;207:293-298.
6.
Seignourel PJ, Kunik ME, Snow L, Wilson N, Stanley M: Anxiety in dementia: a critical review. Clin Psychol Rev 2008;28:1071-1082.
7.
Gibbons LE, Teri L, Logsdon R, McCurry SM, Kukull W, Bowen J, McCormick W, Larson E: Anxiety symptoms as predictors of nursing home placement in patients with Alzheimer's disease. J Clin Geropsychol 2002;8:335-342.
8.
Orrell M, Bebbington P: Psychosocial stress and anxiety in senile dementia. J Affect Disord 1996;39:165-173.
9.
Ownby RL, Harwood DG, Barker WW, Duara R: Predictors of anxiety in patients with Alzheimer's disease. Depress Anxiety 2000;11:38-42.
10.
Teri L, Ferretti LE, Gibbons LE, Logsdon RG, McCurry SM, Kukull WA, McCormick WC, Bowen JD, Larson EB: Anxiety in Alzheimer's disease: prevalence, and comorbidity. J Gerontol A Biol Sci Med Sci 1999;54:M348-M352.
11.
Chen JC, Borson S, Scanlan JM: Stage-specific prevalence of behavioral symptoms in Alzheimer's disease in a multi-ethnic community sample. Am J Geriatr Psychiatry 2000;8:123-133.
12.
Bierman EJM, Comijs HC, Jonker C, Beekman ATF: Symptoms of anxiety and depression in the course of cognitive decline. Dement Geriatr Cogn Disord 2007;24:213-219.
13.
Bendixen AB, Engedal K: Anxiety among older psychiatric patients: a hidden comorbidity? Aging Ment Health 2016;20:1131-1138.
14.
Bergh S, Selbæk G: The prevalence and the course of neuropsychiatric symptoms in patients with dementia. Nor Epidemiol 2012;22:225-232.
15.
Shankar K, Walker M, Frost D, Orrell M: The development of a valid and reliable scale for Rating Anxiety in Dementia (RAID). Aging Ment Health 1999;3:39-49.
16.
Ballard C, Neill D, O'Brien J, McKeith IG, Ince P, Perry R: Anxiety, depression and psychosis in vascular dementia: prevalence and associations. J Affect Disord 2000;59:97-106.
17.
Mendez MF, McMurtray A, Chen AK, Shapira JS, Mishkin F, Miller BL: Functional neuroimaging and presenting psychiatric features in frontotemporal dementia. J Neurol Neurosurg Psychiatry 2006;77:4-7.
18.
Seitz D, Purandare N, Conn D: Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review. Int Psychogeriatr 2010;22:1025-1039.
19.
Neville C, Teri L: Anxiety, anxiety symptoms, and associations among older people with dementia in assisted-living facilities. Int J Ment Health Nurs 2011;20:195-201.
20.
Pachana NA, Byrne GJ, Siddle H, Koloski N, Harley E, Arnold E: Development and validation of the Geriatric Anxiety Inventory. Int Psychogeriatr 2007;19:103-114.
21.
Goyal AR, Bergh S, Engedal K, Kirkevold M, Kirkevold Ø: Norwegian version of the Rating Anxiety in Dementia scale (RAID-N): a validity and reliability study. Aging Ment Health 2016, Epub ahead of print.
22.
WHO: ICD-10: psykiske lidelser og adfærdsmæssige forstyrrelser: klassifikation og diagnostiske kriterier. København, Munksgaard, 2011.
23.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, American Psychiatric Association, 2013.
24.
Hofmans-Okkes IM, Lamberts H: The International Classification of Primary Care (ICPC): new applications in research and computer-based patient records in family practice. Fam Pract 1996;13:294-302.
25.
O'Bryant SE, Waring SC, Cullum CM, Hall J, Lacritz L, Massman PJ, Lupo PJ, Reisch JS, Doody R: Staging dementia using Clinical Dementia Rating Scale Sum of Boxes scores: a Texas Alzheimer's Research Consortium study. Arch Neurol 2008;65:1091-1095.
26.
Alexopoulos GS, Abrams RC, Young RC, Shamoian CA: Cornell Scale for Depression in Dementia. Biol Psychiatry 1988;23:271-284.
27.
Barca ML, Engedal K, Selbæk G: A reliability and validity study of the Cornell Scale among elderly inpatients, using various clinical criteria. Dement Geriatr Cogn Disord 2010;29:438-447.
28.
Kaufer DI, Cummings JL, Ketchel P, Smith V, MacMillan A, Shelley T, Lopez OL, DeKosky ST: Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory. J Neuropsychiatry Clin Neurosci 2000;12:233-239.
29.
Lawton MP, Brody EM: Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179-186.
30.
Lyketsos CG, Galik E, Steele C, Steinberg M, Rosenblatt A, Warren A, Sheppard JM, Baker A, Brandt J: The General Medical Health Rating: a bedside global rating of medical comorbidity in patients with dementia. J Am Geriatr Soc 1999;47:487-491.
31.
WHO Collaborating Centre for Drug Statistics Methodology: International language for drug utilization research: ATC/DDD. Oslo, Norwegian Institute of Public Health, 2009.
32.
Aalten P, de Vugt ME, Lousberg R, Korten E, Jaspers N, Senden B, Jolles J, Verhey FR: Behavioral problems in dementia: a factor analysis of the Neuropsychiatric Inventory. Dement Geriatr Cogn Disord 2003;15:99-105.
33.
Selbæk G, Engedal K: Stability of the factor structure of the Neuropsychiatric Inventory in a 31-month follow-up study of a large sample of nursing-home patients with dementia. Int Psychogeriatr 2012;24:62-73.
34.
Wergeland JN, Selbæk G, Bergh S, Soederhamn U, Kirkevold Ø: Predictors for nursing home admission and death among community-dwelling people 70 years and older who receive domiciliary care. Dement Geriatr Cogn Dis Extra 2015;5:320-329.
35.
Rokstad AMM, Røsvik J, Kirkevold Ø, Selbaek G, Saltyte Benth J, Engedal K: The effect of person-centred dementia care to prevent agitation and other neuropsychiatric symptoms and enhance quality of life in nursing home patients: a 10-month randomized controlled trial. Dement Geriatr Cogn Disord 2013;36:340-353.
36.
Selbæk G, Kirkevold Ø, Engedal K: The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes. Int J Geriatr Psychiatry 2007;22:843-849.
37.
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J: The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314.
38.
Regier NG, Gitlin LN: Towards defining restlessness in individuals with dementia. Aging Ment Health 2017; 21:543-552.
39.
Calleo JS, Kunik ME, Reid D, Kraus-Schuman C, Paukert A, Regev T, Wilson N, Petersen NJ, Snow AL, Stanley M: Characteristics of generalized anxiety disorder in patients with dementia. Am J Alzheimers Dis Other Demen 2011;26:492-497.
40.
Ballard C, Boyle A, Bowler C, Lindesay J: Anxiety disorders in dementia sufferers. Int J Geriatr Psychiatry 1996;11:987-990.
41.
Bendixen AB, Hartberg CB, Selbæk G, Engedal K: Symptoms of anxiety in older adults with depression, dementia, or psychosis: a principal component analysis of the geriatric anxiety inventory. Dement Geriatr Cogn Disord 2016;42:310-322.
42.
Schoevers RA, Deeg D, Van Tilburg W, Beekman A: Depression and generalized anxiety disorder: co-occurrence and longitudinal patterns in elderly patients. Am J Geriatr Psychiatry 2005;13:31-39.
43.
Lyketsos CG, Steinberg M, Tschanz JT, Norton MC, Steffens DC, Breitner JC: Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. Am J Psychiatry 2000;157:708-714.
44.
Smalbrugge M, Pot A, Jongenelis K, Beekman A, Eefsting J: Prevalence and correlates of anxiety among nursing home patients. J Affect Disord 2005;88:145-153.
© 2017 S. Karger AG, Basel
2017
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.