Fellow Clinical Gerontologists,
How do we best work across disciplines to enhance psychological and physical wellness in older adults and their care providers? Articles in this issue touch on this topic from various perspectives.
Our first set of articles examine on anxiety in particular. Our first article focuses on anxiety in older adults in primary care settings. In anxious primary care patients (N = 1004) enrolled in a treatment trial, one-third of the older adults endorsed death and suicidal ideation, which was moderated by several factors including physical health and function (Petkus et al., Citation2017). Older adults with panic or social anxiety disorders had more death and suicidal ideation than younger adults with these disorders. Anxiety is also a concern in care providers. Gallego-Alberto and colleagues (Gallego-Alberto et al., Citation2017) assessed anxiety symptoms in professional caregivers in nursing homes (N = 101), finding that anxiety was associated with care burden, guilt feelings, and difficult interactions with families among other variables in multivariate analyses. Woodford and colleagues (Woodford, Farrand, Watkins, & Lewellyn, Citation2017) assessed on anxiety and depressive symptoms in caregivers of stroke survivors (N = 19), finding difficulty in adapting to the role, uncertainty, and lack of support were key themes in qualitative analyses.
Psychological function and physical function are often inter-related. In a longitudinal study of older adults following after total hip arthroplasty (N = 52), fear of falling decreased in the year following surgery but one-fourth continued to fear using stairs, sitting/standing from the floor, and walking in the neighborhood (Nagai et al., Citation2017). In an intriguing analysis of the Health and Retirement Study data (N = 9,499), depression, age, and medical burden predicted frailty, and moderate alcohol consumption was associated with decreased risk of incident frailty (Shah, Paulson, & Nguyen, Citation2017).
Three articles by new and emerging professionals focus on physical function and health information. Bardach and Schoenberg (Bardach & Schoenberg, Citation2017) interviewed older adults (N = 104) after primary care visits who said primary care clinicians who built strong relationships, addressed concerns and encouraged change, and provided instructions are most influential in changing health behaviors. Nelis and colleagues (Nelis, Thom, Jones, Hindle, & Clare, Citation2017) interviewed older adults in the “AgeWell” trial (N = 75) and found that goal setting is helpful in promoting lifestyle change, particularly in the areas of diet/health and social goals. Zapata and colleagues (Zapata et al., Citation2017) interviewed older adults (N = 20) and found they seek health information to address their anxiety most often through interpersonal sources (professionals and friends) and technology.
Our clinical comments return to the issue of physical function and anxiety. In a survey study (N = 47), those older adults with lower balance confidence reported more physical difficulties, increased pain effect on ADLs, and lower quality of life (Lucic & Grazio, Citation2017). Yoga may enhance balance, as suggested in a study of older adults with “chronic stroke” by Portz and colleagues (Portz, Waddington, Atler, Van Puymbroeck, & Schmid, Citation2016). They added Yoga to a self-management intervention for older adults finding enhanced balance, endurance, gait stability, and other factors as reported in focus groups (N = 2) and individual interviews (N = 14). Relatedly Robinson and Wetherell (Robinson & Wetherell, Citation2017) describe positive outcomes and lessons learned in a combined physical therapist and psychologist delivered intervention for two patients with fear of falling. Together these articles support the importance of team-based and integrated care to treat the often intersecting issues related to psychological and physical functioning of older adults and their care providers.
Additional information
Funding
References
- Bardach, S. H., & Schoenberg, N. E. (2017). The role of primary care providers in encouraging older patients to change their lifestyle behaviors. Clinical Gerontologist. doi:10.1080/07317115.2017.1376029
- Gallego-Alberto, L., Losada, A., Vara, C., Olazaran, J., Muniz, R., & Pillemer, K. (2017). Psychosocial predictors of anxiety in nursing home staff. Clinical Gerontologist, 1–11. doi:10.1080/07317115.2017.1370056
- Lucic, L. B., & Grazio, S. (2017). Impact of balance confidence on daily living activities of older people with knee osteoarthritis with regard to balance, physical function, pain, and quality of life – A preliminary report. Clinical Gerontologist. doi:10.1080/07317115.2018.1453907
- Nagai, K., Ikutomo, H., Tagomori, K., Miura, N., Tsuboyama, T., & Masuhara, K. (2017). Fear of falling restricts activities of daily living after total hip arthroplasty: A one-year longitudinal study. Clinical Gerontologist, 1–7. doi:10.1080/07317115.2017.1364682
- Nelis, S. M., Thom, J. M., Jones, I. R., Hindle, J. V., & Clare, L. (2017). Goal-setting to promote a healthier lifestyle in later life: Qualitative evaluation of the agewell trial. Clinical Gerontologist, 1–11. doi:10.1080/07317115.2017.1416509
- Petkus, A. J., Wetherell, J. L., Stein, M. B., Chavira, D. A., Craske, M. G., Sherbourne, C., … Roy-Byrne, P. (2017). Age differences in death and suicidal ideation in anxious primary care patients. Clinical Gerontologist, 1–11. doi:10.1080/07317115.2017.1356893
- Portz, J. D., Waddington, E., Atler, K. E., Van Puymbroeck, M., & Schmid, A. A. (2016). Self-management and yoga for older adults with chronic stroke: A mixed-methods study of physical fitness and physical activity. Clinical Gerontologist, 1–8. doi:10.1080/07317115.2016.1252453
- Robinson, J. B., & Wetherell, J. L. (2017). An Interdisciplinary intervention for fear of falling: Lessons learned from two case studies. Clinical Gerontologist, 1–8. doi:10.1080/07317115.2017.1325423
- Shah, M., Paulson, D., & Nguyen, V. (2017). Alcohol use and frailty risk among older adults over 12 years: The health and retirement study. Clinical Gerontologist, 1–11. doi:10.1080/07317115.2017.1364681
- Woodford, J., Farrand, P., Watkins, E. R., & Lewellyn, D. J. (2017). “I don’t believe in leading a life of my own, i lead his life”: A qualitative investigation of difficulties experienced by informal caregivers of stroke survivors experiencing depressive and anxious symptoms. Clinical Gerontologist, 1–15. doi:10.1080/07317115.2017.1363104
- Zapata, A. M. L., Beaudreau, S. A., O’Hara, R., Bereknyei Merrell, S., Bruce, J., Garrison-Diehn, C., & Gould, C. E. (2017). Information-seeking about anxiety and perceptions about technology to teach coping skills in older veterans. Clinical Gerontologist, 1–11. doi:10.1080/07317115.2017.1359716