1. 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

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

3. 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

4. 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

5. 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

6. 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

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. Anxiety and caregiving
Study 2
Anxiety and caregiving

15. 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

16. 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

17. 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

18. Thanks for your attention!