The primary aim of this study was to implement and evaluate a screening and intervention model for anxiety among older adults with vision impairments. Anxiety symptoms and disorders are associated with increased disability, lower levels of well-being, higher health care costs, and poorer rehabilitation outcomes. Anxiety is especially prevalent among elders with chronic disabilities, especially elders with age-related eye diseases who lose vision after a lifetime of being sighted. Yet, elders suffering from anxiety are often unidentified and left untreated. To address this problem, this project trained agency social work and rehabilitation staff to systematically screen, evaluate, and treat anxiety symptoms and disorders among our elderly consumers using the Problem Solving Therapy (PST) approach.
The Anxiety Disorders Intervention and Follow-Up Program (ADIFP) proceeded in four stages. First, brief in-service training programs for all social work and rehabilitation staff were held. Second, clinical staff conducted anxiety screening with as many new consumers as possible, age 65 and older, using the Beck Anxiety Inventory (BAI). In the third stage, selected social workers were trained to conduct a brief program of PST for anxiety. This intervention approach increases problem-solving efficacy, which can lead to a reduction of anxiety symptoms. The intervention for this project consisted of three counseling sessions and one follow-up session. In the fourth stage, the PST program was implemented and evaluated. Those meeting the criteria for at least mild/moderate anxiety were invited to participate in the program and were randomly assigned to the immediate treatment group (to receive PST in addition to their usual rehabilitation services), or the delayed treatment (to receive all of the usual services with the option of receiving PST in approximately two months). Pre- and post-service telephone interviews were conducted.
Recruitment of participants for PST therapy continued until the end of August 2005, with all services and follow-up interviews to be completed by November, 2005. To date, project accomplishments and findings include:
44 clinical staff members (social workers, rehabilitation professionals) were provided training in understanding anxiety disorders in later life and in using the Beck Anxiety Inventory (BAI) to screen for anxiety symptoms among older Lighthouse consumers.
7 social workers were trained to provide Problem Solving Therapy (PST) to older adults with vision impairments.
421 screenings were conducted with older Lighthouse consumers.
Almost one-third of all visually impaired older adults had at least mild anxiety symptomatology and 11% had moderate or severe anxiety.
Higher levels of anxiety were associated with younger age, being female, having more health problems, being unmarried, and not having macular degeneration.
27 older adults meeting BAI criteria agreed to participate in the Problem Solving Therapy intervention; 16 were randomized into the immediate treatment group, and 11 into the delayed treatment.
In total, 13 individuals from the immediate treatment group and 8 from the delayed treatment group received the intervention program.
Pre and post data was available for eight individuals in the immediate treatment group and eight individuals in the delayed treatment group. Analyses comparing change over time found that:
Anxiety symptoms in both groups seemed to follow the same pattern, with decreased levels of anxiety over time.
Depressive symptomatology significantly decreased in the immediate treatment group, compared to a slight, but not statistically significant decline in the delayed treatment group.
Functional disability slightly decreased in the immediate treatment group, but slightly increased in the delayed treatment group.
This pilot project for a randomized control study is important for its attempt to investigate the feasibility and applicability of a promising psychosocial intervention for older, frail, and visually impaired adults. PST has been rarely evaluated for the treatment of anxiety disorders in adults, although substantial research has identified a negative correlation between anxiety and effective problem-solving. Our experience with this program has highlighted that problems with anxiety are present for a significant subgroup of older visually impaired adults, with one-third evidencing at least mild anxiety symptoms and one-tenth with moderate to severe symptoms. Those involved in the PST intervention found it helpful, with positive self-reported assessments of the program made by consumers and staff. Furthermore, we have suggestive evidence of its positive impact on levels of anxiety, depression and functional ability.
Amy Horowitz, DSW/PhD, Principal Investigator
Joann P. Reinhardt, Co-Investigator
Zvi Dan Gellis, PhD, Co-Investigator
Thalia MacMillan, MSW, Project Coordinator
Tina Calia, M.A., Research Assistant
Rosetta Chao, CSW, Clinical Low Vision Social Worker
Sharon Danoff, CSW, Social Worker
Colleen Dillon, CSW, Social Worker
Lilly Jackanin, CSW, Senior Social Worker
Linda Kirk, CSW, Social Worker
Amy Loewenberg, CSW, Director of Independent Living Services
Linda Schulz, CSW, Director of Independent Living Services
Marsha Sideris, CSW, Social Worker
Funded by: New York State Office of the Attorney General
Project Period: May 2004 - August, 2005