High prevalence of anxiety symptoms in spouses of persons suffering from persons Ingun Ulstein*, Norwegian Centre for Dementia Research, Department of Geriatric Medicine, Oslo University Hospital, Ullevål, Oslo, Norway Kari Kvaal, Oslo University College, Mental Health Programme, Oslo and Institute of Mental Health and Social Sciences, Hedmark University College, Elverum, Norway

Content Anxiety and older people The studys Background Hypotheses Material Methods Results Conclusion – implication for intervention

Background There are few studies concerning anxiety in older people probably due to the high association between anxiety and depression. Flint, 1994; Beekman et al., 2000; Kessler et al., 2002, Kvaal et al., 2002 Anxiety symptoms are according to several studies prevalent among older people suffering from any chronic physical disorders Balkom et al., 2000; Hocking and Koening, 1995; Yohannes et al., 2000 In a systematic review of anxiety among carers of people suffering from dementia, anxiety was found to be more common among carers than in matched healthy controls Cooper et al., 2007 Anxiety influences the capacity of giving care and leads to dysfunctional coping and less emotional support Li et al., 2011

Material 76 spouses of patients in a mild to moderate stage of dementia recruited from seven memory clinics in Norway 98 geriatric in-patients acutely admitted to a geriatric ward due to a serious somatic condition 68 healthy controls recruited from citizen centres in Oslo

Hypotheses The level of anxiety among patients admitted to a geriatric ward due to an acute somatic illness is higher compared with the two other groups The spouses of persons suffering from dementia are considered to be healthy, but due to the burden of care we expect them to score higher on the STAI than the healthy controls Coping failure is associated with anxiety among carers of persons suffering from dementia

Method Anxiety symptoms were assessed by means of the 12-items version of the State-Trait Anxiety Inventory (STAI-X-1) Demographics such as age, gender, educational and occupational status of the three groups were collected Study 1 The STAI scores of the three groups were compared Study 2 Multiple linear regression was used to identify carer and patients characteristics associated with anxiety symptoms Coping failure were tapped from the GHQ-30

Comparison of anxiety in geriatric patients and carers Study 1 Comparison of anxiety in geriatric patients and carers

Background characteristics All, N=242 Spouses of demented patients, N=76 Geriatric patients, N=98 Healthy controls, N=68 p-value Age, mean (SD)a 79.8 (6.1) 76.6 (4.7) 81.8 (5.8) 80.5 (6.6) <0.001 Females (%)a 148 (61.2) 36 (47.4) 36 (67.3) 46 (67.6) 0.01 Age < 80 years, n (%) 121 (50.0) 57 (75.0) 36 (36.7) 28 (41.2) Married, n (%) 119 (49.2) 76 (100) 27 (27.6) 16 (23.5) Living alone, n (%) 109 (45.0) 0 (0.0) 64 (65.3) 45 (66.2) Education < 9 years, n (%) 77 (32.2) 12 (16.0)1 45 (45.9) 20 (29.4) 0.08 SD=Standard deviation; a=comparison performed by use of ANOVA; b= comparison with chi-square with linear trend; 1=3 missing

Background characteristics All, N=242 Spouses of demented patients, N=76 Geriatric patients, N=98 Healthy controls, N=68 p-value Age, mean (SD)a 79.8 (6.1) 76.6 (4.7) 81.8 (5.8) 80.5 (6.6) <0.001 Females (%)a 148 (61.2) 36 (47.4) 36 (67.3) 46 (67.6) 0.01 Age < 80 years, n (%) 121 (50.0) 57 (75.0) 36 (36.7) 28 (41.2) Married, n (%) 119 (49.2) 76 (100) 27 (27.6) 16 (23.5) Living alone, n (%) 109 (45.0) 64 (65.3) 45 (66.2) Education < 9 years, n (%) 77 (32.2) 12 (16.0)1 45 (45.9) 20 (29.4) 0.08 SD=Standard deviation; a=comparison by use of ANOVA; b= comparison with chi-square with linear trend; 1=3 missing

Bivariate associations between STAI and possible explanatory factors Variables Mean (SD) p-value Gender a   Female (N=148), mean (SD) 21. 3 (7.85) 0.09 Male (N=94), mean (SD) 19.6 (6.99) Civil statusb Married (N=120) 21.5 (7.48) 0.18 Single (N=10) 18.8 (8.18) Divorced (N=13) 22.9 (7.73) Widower (N=99) 19.63 (7.50) Living alone a Yes (N=109) 19.9 (7.57) 0.15 No (N=133) 21.3 (7.52) High schoola Yes (N=65) 19.3 (7.27) No (N=176) 21.2 (7.63) Agea < 80 years old (N=121) 21.2 (7.41) 0.26 > 80 years old (N=121) 20.1 (7.69) Groupb Carers (N=76) 22.5 (7.43) < 0.001 Geriatric patients (N=98) 23.4 (7.60) Healthy controls (N=68) 14.7 (3.04) a= T-test; b=ANOVA

Bivariate associations between STAI and possible explanatory factors Variables Mean (SD) p-value Gender a   Female (N=148), mean (SD) 21. 3 (7.85) 0.09 Male (N=94), mean (SD) 19.6 (6.99) Civil statusb Married (N=120) 21.5 (7.48) 0.18 Single (N=10) 18.8 (8.18) Divorced (N=13) 22.9 (7.73) Widower (N=99) 19.63 (7.50) Living alone a Yes (N=109) 19.9 (7.57) 0.15 No (N=133) 21.3 (7.52) High schoola Yes (N=65) 19.3 (7.27) No (N=176) 21.2 (7.63) Agea < 80 years old (N=121) 21.2 (7.41) 0.26 > 80 years old (N=121) 20.1 (7.69) Groupb Carers (N=76) 22.5 (7.43) < 0.001 Geriatric patients (N=98) 23.4 (7.60) Healthy controls (N=68) 14.7 (3.04) a= T-test; b=ANOVA

Adjusted associations between STAI- and characteristics of the three groups Variables STAI   β p-value Gender (female=0, male=1) -0.14 0.01 Carer (no=0, yes=1) 0.51 <0.001 Geriatric patient (no=0, yes=1) 0.57 R2 (%) 26

Results 1 No significant differences in reported anxiety according to the STAI between the carers and the geriatric inpatients The healthy controls scored significantly lower on each STAI- item compared with the two other groups Females are reporting more anxiety symptoms than males

Anxiety and caregiving Study 2 Anxiety and caregiving

Adjusted associations between STAI- and patient characteristics Variables STAI   β p-value Gender (female=0, male=1) -0.18 0.10 Age -0.06 0.57 NPI (FxI) 0.39 <0.001 R2 (%) 14 Other patientcharacteristics such as cognitive decline (MMSE), ADL-deficits (DAD), duration of dementia symptoms and ability to stay alone did not contribute

Adjusted associations between STAI- and carer characteristics Variables STAI   β p-value Gender (female=0, male=1) -0.09 0.38 Age -0.16 0.10 GHQ-copingfailure 0.54 <0.001 NPI-distress 0.22 0.03 R2 (%) 39

Conclusions Anxiety symptoms are prevalent in elderly people facing stressful events such as an acute somatic illnesses living in a household with a partner suffering from dementia Anxiety may have a negative impact on the spouse’s capacity of giving care to the demented partner due to coping failure Distress associated with neuropsychiatric symptoms increases anxiety in the carers Anxiety as well as the neurospychiatric symptoms of the patients has to be taken into account when creating interventions for carers

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