Clinical Interviewing With Older Adults

Psychometric properties of the GAD-Q-IV and DERS in older, community-dwelling GAD patients and controls

“…The length of the measure is short relative to popular assessment tools such as GAD modules from the Structured Clinical Interview for DSM (SCID; First, Gibbon, Spitzer, & Williams, 1995) or Anxiety Disorders Interview Schedule -Revised (DiNardo, Brown, & Barlow, 1994), and a brief interview duration is particularly desirable for older patients (Mohlman et al, 2012). It may be more difficult for older adults to answer reverse-scored items on a self-report measure , making the simple format of the GAD-Q-IV attractive for use with older populations.…”

Improving recognition of late life anxiety disorders in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: observations and recommendations of the Advisory Committee to the Lifespan Disorders Work Group

“…We suggest that the key to successful use of psychiatric measures with older adults is in their administration. The following suggestions to improve sensitivity of assessment instruments are based on clinical observation and findings from empirical research (Mohlman et al ., ). If time allows, avoid a yes/no format for screening questions in favor of a more open‐ended format .…”

“… If time allows, avoid a yes/no format for screening questions in favor of a more open‐ended format . For example, extremely low panic disorder prevalence in older people may be due to a yes/no screening question that requires that the subject knows what a panic attack is, and that they have had one. Avoid numeric frequency/severity format of standard assessments, or supplement with additional probes (Mohlman et al ., ). Avoid sets of questions whose response format alternates between narrative and numerical (Mohlman et al ., ). Use the term endorsed by the individual to describe anxiety as a concept (e.g., “nerves,” “concerns”). Avoid lengthy, complex, or reverse‐coded items . Use personal timelines to aid in recall. Include informant reports .…”

“…One barrier in diagnosing anxiety disorders is the fact that older adults may not readily endorse clinical criteria of impairment and distress due to unfamiliar terminology (Grenier et al ., ), particularly including the failure to characterize the anxiety as “excessive.” One relevant study found that the prevalence of social phobia nearly doubled when ignoring the criterion of whether fear was considered to be excessive (Karlsson et al ., ). If an older patient denies excessive anxiety or worry but indicates comparable cognitive activity (e.g., thinking too much, having concerns) or avoidance, the patient's own descriptive words can be used in place of “excessive” during the remainder of the interview (Mohlman et al ., ). Questioning about how often the symptom occurs “compared to other people of your age” can be used, and also a greater emphasis on consequences and affective reactions to those consequences.…”

Guidelines for Psychological Practice with Older Adults

“…For example, stereotypes can lead health care providers to misdiagnose disorders (Mohlman et al, 2011), inappropriately lower This document is copyrighted by the American Psychological Association or one of its allied publishers.…”