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Worries of the oldest-old.

With the emerging population of the oldest-old (those ages 85 and older), it is crucial to understand and prepare for their psychosocial needs. Worry is linked to psychological well-being and physical health, but little is known about the oldest-old's everyday worries. The authors explored four research questions: (1)What are the worries of the oldest-old? (2)What are their specific dimensions of worry? (3) How alike or different are the worry patterns over time? (4) What factors are related to variations in the pattern of change in worry? A convenience sample of 193 community-dwelling people ages 85 and older was recruited to examine various aspects of health and well-being between 1986 and 1995. This article reports on the survivors (N = 23) across three time points, waves 1,4, and 5. The findings suggest that the very old mainly worry about health and memory and that, although worry increased over the study period, there were variations in the pattern of worry over time. Results of t tests show that at wave 4 elderly respondents with a higher level of worry reported more frequent social contact than those with a lower level of worry. Implications for social work practice and future research are discussed.

KEY WORDS: oldest-old; social support; very old; worry

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Little is known about the lives of those who are very old, in particular, their everyday worries. Worry is among the more prevalent psychological conditions that people experience at all ages (Carmin, Pollard, & Gillock, 1999), conveying negative thinking about future events (Babcock, Laguna, Laguna, & Urusky, 2000), and it is associated with mental and physical well-being (Skarborn & Nicki, 1996; Wisocki, 1988; Wisocki, Handen, & Morse, 1986). With many very old people facing diminishing physical and social resources, as well as uncertain futures because of advanced age, it would seem that they could have many things to worry about, but it is unclear what their worries are, what specifically contributes to them, and if these worries increase with advancing age.

Most of the work exploring everyday worry has focused on young adults, but in recent years the topic of worry has emerged as a research area of interest among elderly people (Cappeliez, 1989; Powers, Wisocki, & Whitbourne, 1992; Skarborn & Nicki, 1996; Wisocki, 1988; Wisocki et al., 1986). Research findings show there is age variation in degree of worry as well as content of worry. In general, older adults are relatively less worried than younger adults (Babcock et al., 2000; Powers et al., 1992). Babcock and associates suggested that there are a variety of reasons for this age variation. Younger adults are developmentally in a transition stage that may cause greater reason to worry. Older adults may be less willing to acknowledge problems dealing with stressful events and less likely to be in a state of ambiguity about their future. Also, older adults tend to experience various stressful situations as they age. Over time, elderly people might have learned better coping strategies to deal with worry more effectively, resulting in less worry than their younger counterparts.

Research findings have also suggested that there are age differences in what people worry about. Powers and colleagues (1992) found that older adults expressed less worry about finances and social events than younger adults, whereas both age groups worried about health issues, although the specific dimensions of health were not identified. Similarly, Babcock and associates (2000) found that younger adults were more worried than older adults about work, relationships, and finances.

Less is known about degree of worry and content of worry among the oldest-old. A study examining worry among the oldest-old reported that the greatest worries among oldest-old subjects were related to their health and functioning, such as concerns about falls, not having enough energy, or forgetting things (Dunkle, Roberts, & Haug, 2001). Unfortunately, these comparative studies (Babcock et al., 2000; Powers et al., 1992) did not examine worries among elderly people in the oldest-old age group in relation to other age groups. Taken together, these studies indicate that type of worry as well as degree of worry vary across the life span. The young-old worry less than young adults, and the oldest-old seem to experience different types of worry than younger or older adults taken as a group.

These disparate findings from numerous studies may possibly be accounted for by sample characteristics (that is, age) as well as measurement of worry. Some of the research has been conducted with predominantly young-old and young adults (Powers et al., 1992), whereas other research has targeted elderly people 85 and older (Dunkle et al., 2001). No consistent measure of worry has been used, and no attention has been given to discerning elements of worry that are specific to the oldest-old population. Furthermore, the research addressing worry over time among the oldest-old is limited.

In an effort to further understand worry, we used a longitudinal sample of people older than 85 and examined their worries. By using available longitudinal data, we explored the pattern of worry over time. With the evidence that worry is associated with psychological and physical health problems, it is important to understand whether worry increases over time among the oldest-old, placing them at greater risk with increasing age. Last, we examined factors that influence these patterns of worry in an effort to find clues that could provide direction for intervention.

WORRY AND RELATED FACTORS

Worries are influenced by individual physical health characteristics, psychological characteristics, and social characteristics (Aldwin, Levenson, Spiro, & Bosse, 1989; Babcock et al., 2000; Krause & Markides, 1990; Powers et al., 1992; Skarborn & Nicki, 1996; Turner & Noh, 1988). With an estimated 55 percent of adults older than age 85 suffering from deficiencies in instrumental activities of daily living (IADLs) and more than 40 percent facing shortcomings in activities of daily living (ADLs), it is generally believed that physical health is a determinant of worry among the very old (Van Nostrand, Furner, & Suzman, 1993). A study conducted with participants ages 55 and older found that good physical health was associated with lower anxiety (Himmelfarb & Murrell, 1984). Wisocki (1988) also found that worriers were in poorer health, with more chronic illness compared with nonworriers.

With regard to psychological factors associated with worry, researchers have examined the association with depressive symptoms and mastery. Even though this population represents a "biological elite" (Linn & Linn, 1980), the oldest-old are more vulnerable to depression than other age groups including the young-old (Blazer, 2000; Blazer, Hughes, & George, 1987), thus making it a critical concern to examine factors that are associated with depression for elderly people in this age group. Those who worry have more depressive symptoms (Skarborn & Nicki, 1996). Similarly, other studies have shown that depression is critical in fostering worries (for example, Bookwala & Schulz, 2000; Russell & Cutrona, 1991; Tyler & Hoyt, 2000). Mastery, another psychological factor related to worry, mitigates the negative effects of worry and improves the psychological well-being of both younger and older adults (Pearlin, Liberman, Menaghan, & Mullan, 1981; Turner & Noh, 1988).

Another factor influencing worry is social support. Although one study found that one's social support network was associated with worry among older adults (Babcock et al., 2000), it is not known whether this relationship holds true among the oldest-old as few studies have addressed this relationship for people older than age 85 or considered factors found to influence social support such as race and gender (Krause & Markides, 1990; Revicki & Mitchell, 1990).

In the current study, we aimed to answer four research questions:

1. What are the worries of the very old?

2. Are there specific dimensions of worry among the very old?

3. How alike or different are the worry patterns over time among the very old? Even though earlier findings have indicated that worries increase over time for people 85 and older, it is not known whether this increase is progressive.

4. What factors are related to variations in the patterns of worry? To examine this idea, we assessed the association of physical, psychological, and social factors with change in differing patterns of worry. What remains unclear is the variation in worry among the old-old.

METHOD

Sample

The data used for this article are from a longitudinal study of older American men and women conducted between 1986 and 1995 in the midwestern United States. A convenience sample of 193 community-dwelling elderly people age 85 and older was recruited from a variety of noninstitutional sources. These included waiting lists of two multilevel care facilities where the very old live independently (17 percent), as well as nutrition sites and Golden Age Senior Centers (38 percent). These sites were selected to ensure appropriate diversity on key control variables such as socioeconomic status and race. Others were recruited from community offices on aging (18 percent), a registry of elderly people interested in participating in research projects (12 percent), and referrals by other subjects (15 percent). The participants were interviewed five times over a nine-year period. The first interviews were conducted in 1986. Three follow-up interviews were conducted over an 18-month period between 1986 and 1988, and the fifth interview occurred in 1995. A more detailed sample description can be found elsewhere (Dunkle et al., 2001).

Attrition. In wave 1, 193 elderly people were interviewed. Nine years later at wave 5, the sample consisted of 23 participants; 119 had died and 51 were not able to be interviewed because of diminished physical and cognitive status.

This article reports on the 23 survivors of the nine-year study across three of the five time points, wave 1, wave 4, and wave 5. The average time interval between waves 1 and 4 was 18 months; the average time interval between waves 1 and 5 was nine years. We selected these time periods to allow enough time for noticeable change to occur. In spite of the small sample size, this study is unique in that it allowed for the examination of dimensions of worry among the very old as well as patterns of worry over time and the physical, psychological, and social factors contributing to these patterns.

With regard to sociodemographic characteristics, the mean age of the sample was 86.61 at wave 1 (SD = 1.59), 88.30 at wave 4 (SD = 1.77), and 96.22 at wave 5 (SD = 1.73). The mean education level of the sample was high school graduate, with a range of no formal education to postcollege. At wave 5, the sample consisted of 18 white adults and five African American adults and of 21 women and two men.

Measures

Worries. Severity of worries related to everyday events was measured with the Daily Geriatric Hassles Scale (Kanner, Coyne, Schaefer, & Lazarus, 1981). This scale consists of 21 items that assesses types of worries about the physical and mental health of elderly and other family members and worries about their neighborhood, financial concerns, and social relationships (Table 1). For each type of worry, degree of severity was rated on a four-point Likert scale ranging from 0 = not at all to 3 = a great deal.

Even though the Daily Geriatric Hassles Scale (Kanner et al., 1981) reflects worries that occur during late life and was developed with an older population, it is not clear whether this scale appropriately assesses worry of people in the oldest-old age group. This aggregated worry measure assumes that all worry items are equivalent, but specific worry dimensions that are more central to the very old have not been identified. Therefore, we examined specific dimensions of worry among the oldest-old.

Physical Characteristics. Functional abilities were assessed by measuring ADLs such as bathing, eating, and toileting and IADLs such as using the telephone, preparing own meals, or doing own housework. ADLs were measured by the Katz Index of ADL (Katz, Ford, Moskowitz, Jackson, & Jaffe, 1963); IADLs were measured by items from the Older Americans Resource Survey (Duke University Center for the Study of Aging and Human Development, 1978). The ADL scale consists of six items; Cronbach's alpha at wave 1 was .67. The IADL measure consists of seven items; Cronbach's alpha at wave 1 was .91. Degree of ability was measured on a three-point Likert scale ranging from 0 = unable to 2 = able. The range of possible total scores of ADL was 0 to 12; that of IADL was 0 to 14.

Psychological Characteristics. Depression was measured with the Symptom Checklist-90 Depression Scale (Derogatis, Rickels, & Rock, 1976). This scale consists of six items: (1) hopeless about future, (2) thoughts of ending your life, (3) thoughts of worthlessness, (4) nervousness inside, (5) feeling fearful, and (6) feeling tense. Degree of depression was measured on a four-point Likert scale ranging from 0 = not at all to 3 = quite a bit. The range of possible total scores on depression was 0 to 24. At wave 1, Cronbach's alpha was .87.

Mastery was assessed by a seven-item measure using the Pearlin Mastery Scale (Pearlin & Schooler, 1978).The seven items include (1) there is no way to solve problems I have; (2) I feel that I am being pushed around in life; (3) I have little control over the things that happen to me; (4) I can do just about anything I really set my mind to do; (5) I often feel helpless in dealing with the problems of life; (6) what happens to me in the future depends mostly on me; and (7) there is little I can do to change many of the important things in my life. Ratings of degree of mastery were made on a four-point Likert scale ranging from 0 = strongly disagree to 3 = strongly agree. Items indicating low mastery were reversed before summing so that a higher score meant a greater sense of mastery. The score ranged from 0 to 21 with a Cronbach's alpha of .64.

Social Characteristics. Social support of elderly people was assessed in two ways: potential availability of social support and frequency of social support. Potential availability of social support for companionship and assistance from others was measured using items from the Older Americans Resources and Services instrument (Duke University Center for the Study of Aging and Human Development, 1978). Respondents indicate whether there is someone they can confide in and whether there is a person who could provide occasional, short-term or long-term assistance. Categories were summed for a score ranging from 0 to 5. Cronbach's alpha was .54 at the initial interview. Frequency of social support was measured using items from the Older Americans Resources and Services instrument (Duke University Center for the Study of Aging and Human Development). Respondents noted the number of friends whom they know well enough to visit (0 = none, 1 = one to two, 2 = three to four, 3 = five or more) and the number of times a week they have social contact by phone and visits (0 = none, 1 = once a week, 2 = two to six times a week, 3 = once a day or more). These ratings were summed for a score ranging from 0 to 12. At wave 1, Cronbach's alpha was .54. Although the reliability of many of these measures is lower than desirable, it should be noted that the scales were not originally developed for use with a very old sample.

Data Analysis

The first research question ("What are the types of worries of the very old?") was answered by using frequencies as well as means for degree of severity. To answer the second question ("What are the specific dimensions of worry among the very old?"), we conducted an exploratory factor analysis of the 21 worry items from the Daily Geriatric Hassles Scale, using varimax rotation (Kaiser normalization) and oblique rotation among 193 elderly participants in wave 1. The factors were selected using a cutoff point with an eigenvalue greater than 1. On the basis of the factor analysis, internal consistency reliability tests were conducted for each factor. To address the third question ("How alike or different are the worry patterns over time among the very old?"), we examined patterns of change in worry based on the results from the exploratory factor analysis and then graphed the results over time for each respondent. That is, we plotted line graphs reflecting the various types of change in worries for each subject over three time points covering waves 1,4, and 5. We then categorized individuals on the basis of the pattern of change in their worries. To address the fourth question ("What factors are related to variations in the patterns of change in worrying?"), we examined factors influencing possible variations, using bivariate tests (t tests for continuous variables and chi-square tests for categorical variables).

RESULTS

Content, Frequency, and Severity of Worries among the Oldest-Old

A dramatic increase in frequency and severity of worry between wave 4 and wave 5 occurred (Table 1). At wave 5, all respondents worried about 14 of the 21 worry items, and 22 of the 23 respondents worried about the remaining seven items.

Specific Dimensions of Worry among the Oldest-Old

In examining the critical dimensions of worry among the very old, the exploratory factor analysis revealed that the worry measure consisted of nine factors. On the basis of the selection criteria (eigenvalue > 1), only two factors were obtained. The findings suggest two major factors that presented an acceptable level of internal consistency across the three waves. Factor 1 is described as the "health dimension." This factor included four items of worry related to health as follows: health in general, not enough personal energy, getting around, and declining physical abilities. Cronbach's alpha for the first factor was .67 at wave 1, .81 at wave 4, and .76 at wave 5. Factor 2 can be described as the "memory dimension." The two worry items included on this factor are losing things and forgetting things. Cronbach's alpha for the second factor was .71 at wave 1, .78 at wave 4, and .71 at wave 5. Together, 24.25 percent of the variance was accounted for by the two factors, which included six of the 21 original items.

Variations in the Pattern of Change in Worry

To examine variations of worry patterns among the very old, we used both graphical and descriptive methods. To examine the third and fourth research questions--"How alike or different are the worry patterns over time among the very old?" and "What factors are related to variations in the patterns of change in worrying?"--we reconstructed a worry scale based on the results from the second research question, from which specific dimensions of worry (health and memory) among the very old were identified through factor analysis. The new worry measure included the six types of worry that comprised the two factors identified in the factor analysis: health in general, not enough personal energy, getting around, declining physical abilities, losing things, and forgetting things. Severity ratings were the same as the original scale, ranging from 0 to 18. At the initial interview, Cronbach's alpha was .74. To this end, we summed these six items from the original 21 items of the Daily Geriatric Hassles Scale at wave 1, wave 4, and wave 5. Four different groups from among the 23 survivors were identified on the basis of changes in the severity of their worries across three time points, wave 1 (baseline), 18 months later (wave 4), and nine years later (wave 5): the increase-increase group (I-I), the no change-increase group (N-I), the decrease-increase group (D-I), and the increase-no change group (I-N).

Although worry increased for all participants from wave 1 to wave 5 (Table 1), there were variations within each of these four groups, indicating that the patterns of change were not consistent for all. The I-I group had an increase in worries between wave 1 and wave 4 and between wave 4 and wave 5 (n = 11). Given that the N-I (n = 7) and the D-I (n = 4) groups had no increase in worry between wave 1 and wave 4 but had an increase between wave 4 and wave 5, these two groups were combined for further analyses (N-I/D-I group, n = 11).The I-N group that did not increase between waves 4 and 5 was excluded from further analyses, as it included only one case.

Factors Related to Variations in the Pattern of Change in Types of Worry

To explore factors related to differing patterns of worry, we conducted bivariate tests involving the variables (that is, background characteristics, physical characteristics, psychological characteristics, and social characteristics). Chi-square tests for the categorical variables and t tests for the continuous variables were performed.

The level of worry in the six-item scale was significantly different between the two groups only at wave 4 [t(20) = 4.03, p < .001], but not significantly different between wave 1 [t(20) = 0.13, ns] or wave 5 [t(20) = 0.53, ns] (Table 1). This finding indicates that the N-I/D-I group had less severe worries than the I-I group at wave 4 but that the severity of worries of the N-I/D-I group did not differ from those of the I-I group at waves 1 and 5.

To examine the specific types of worries that contributed to the variations in the pattern, we conducted t tests for the two worry factors (that is, health dimension and memory dimension). Two-tailed t tests were used to test if two groups differed from each other. With regard to the health-related worry factor, the N-I/D-I group presented significantly fewer health-related worries than the I-I group at wave 4 [t(20) = 3.75, p < .001]. By contrast, these two groups did not differ from each other in the level of health-related worries at wave 1 [t(20) =. 17, ns] or wave 5 [t(20) = 0.27, ns]. Similarly, the N-I/ D-I group presented significantly fewer memory-related worries than the I-I group at wave 4 [t(20) = 3.00, p < .01]. The level of the worry memory factor, however, did not differ between two groups at wave 1 [t(20) = 0.00, ns] and at wave 5 [t(20) = 0.51, ns].The findings of these t tests suggested that the differing pattern of change in worry between the two groups was related to more worry about health and memory at wave 4.

Results of Bivariate Analyses for Correlates of Worry

With regard to background characteristics such as age [t(20) = 1.96, ns; t(20) = 1.47, ns; and t(20) = 0.34, ns, at waves 1, 4, and 5, respectively], gender [[chi square] (1, N = 22) = 0.00, ns, at wave 1], race [[chi square](1, N = 22) = 0.26, ns, at wave 1], and marital status [[chi square] (3, N= 22) = 1.33, ns, at wave 1],the two groups were not significantly different from each other. In terms of education, participants in the I-I group had a significantly higher levels of education than those in the N-I/D-I group [t(20) = 2.91,p < .01, at wave 1].

There were no significant differences between the two groups on physical health characteristics (Table 2), although both groups declined in ADLs and IADLs over the nine years. This suggested that the levels of functioning in ADLs and IADLs were not influential in determining the varying patterns of change in worries. Similarly, the findings showed that psychological characteristics did not differ significantly between the I-I group and the N-I/D-I group, indicating that the sense of mastery and depression might not be crucial factors in change in worrying pattern. It should be noted that depression, though, did increase for both groups and mastery declined for the group in which worry increased across the nine years of the study (the I-I group).

With regard to social characteristics, the findings showed that the frequency level of social support differed significantly between the two groups at wave 4 It(20) = 2.66,p < .05] and at wave 5 [t(20) = 1.86,p < .10], whereas there was no significant difference in frequency of social support at wave 1 [t(20) = 1.30, ns]. The findings indicated that individuals in the I-I group had a higher frequency of social support than those in N-I/D-I group at waves 4 and 5. Additional t tests with each item of frequency of social support indicated that two items among four in the scale were significantly different between the two groups. Elderly participants in the I-I group reported more frequent visits than those in N-I/D-I group [t(20) = 2.7,p < .05] at wave 4. Similarly, elderly respondents in the I-I group also reported knowing more people well enough to visit than did those in N-I/D-I group at wave 4 [t(20) = 2.14, p < .05) and at wave 5 [t(20) = 2.63,p < .05]. This finding suggests that the different frequency levels of social support at waves 4 and 5 might be related to the two groups' different pattern of worry between wave 4 and wave 5. By contrast, the results showed that there was no significant difference in potential availability of social support between two groups across the three waves, indicating individuals in both groups reported similar levels of available social support.

DISCUSSION

This study examined the content, frequency, and severity of worries as well as specific dimensions of worry among the oldest-old over a nine-year period. Furthermore, we examined the variations in the pattern of change in worry as well as the factors related to the variations in the pattern of change.

Frequency and Severity of Worry

To date, examination of increase in worry among very old people has not occurred. The dramatic increase in range of content, frequency, and severity of worry over the seven years between waves 4 and 5 was startling. Possibly this significant increase in worry among the oldest-old is related to issues of a decreasing sense of control triggered by increasing memory and physical limitations. Furthermore, these results underscore the almost universal problem of worrying that faces the oldest-old population. Whereas age variability in worry has been reported by others (Babcock et al., 2000; Powers et al., 1992), it has never been reported among a group of oldest-old.

Dimensions of Worry among the Oldest-Old

By factor analyzing a scale used to identify the worry and concerns of older adults, we identified factors that were salient to elderly people ages 85 and older. The findings indicate that health and memory were predominant domains of worry among the very old. This is not surprising given the increased health and memory problems faced by adults with increasing age. Other studies (Powers et al., 1992) have also noted health worries among elderly people in general but have not specified certain health arenas.

Variations in the Pattern of Worry Change

To date, the age variability in worry has been examined among college-age and older adults but has been overlooked among oldest-old, even though the importance of studying heterogeneity in psychological factors in gerontological research has been noted (Nelson & Dannefer, 1992). Although cross-sectional studies reported that older adults were less likely to worry than younger adults (Babcock et al., 2000; Powers et al., 1992), Dunkle and colleagues (2001) found that the level of worry increased with increasing age, indicating that worry was related to declining strength, physical abilities, health, energy, and other physical and cognitive abilities. The decreasing ability in ADLs and IADLs limited self-sufficiency among the oldest-old in this study whose mean age was 96 at wave 5. As a result, even though the overall level of worry was low at the initial interview and at wave 4, it increased significantly at wave 5. The findings reported here extend Dunkle and associates' earlier research by showing that there were variations in the patterns of worry over time. For some individuals, worry continued to increase over the nine years, whereas for others the pattern fluctuated. Even though all the participants who survived to their 90s at wave 5 increased in worry over the nine-year period of the study, they did not each experience the same pattern of worry. This is an important discovery. Although worry increased for all oldest-old participants eventually, the pattern was not consistent for each person.

Factors Related to the Variation in Worry Change

The final issue examined was the identification of factors related to variations in the pattern of change in worrying over nine years of elders in this oldest-old age group. Our study suggests that elderly people whose worry steadily increased over the nine years of the study (I-I group) had more social support with increasing worry than did those in the N-I group and those in the D-I group, where worry remained stable or even decreased in earlier waves before increasing between waves 4 and 5.

Greater frequency of social support might be viewed as a type of coping strategy among the oldest-old who experience worry in daily life. The oldest-old who reported an increasing level of worry over time might have a higher need to contact more people as a way of coping with their worries. Another possible explanation for inconsistent findings with the Babcock and associates (2000) study might be the measurement of social support. The current study examined enacted frequency of social support, whereas Babcock and associates measured satisfaction with social support. Our findings were also inconsistent with earlier research, whereas Babcock and associates found that social support was related to less worry. Possibly greater worry about health and memory fostered greater social contact.

It is important to note areas of difference between the two groups. The group of elderly people whose worry increased over the three waves (I-I group) had significantly more education than the N-I/D-I group in which worry did not increase steadily. Even though education might not directly influence worry, it might influence elderly people to identify their worrisome issues in everyday life. Given that there is little research available to examine the relationship between education and worry, it needs further examination. Furthermore, the oldest-old in the I-I group, whose worry steadily increased, also had less mastery at wave 4 than the N-I/D-I group, even though there was no significant difference between the groups in mastery. This study found that elderly people with higher levels of worry reported more social contact than those with lower levels of worry, but these results do not offer evidence of a causal relationship between social support and worry. Possibly, these worried elderly participants reached out to others or others were concerned and reached out to them. To provide effective social work programs, future studies need to examine whether frequency of social support contributes to worry or vice versa. But even with this limited perspective, the I-I group whose worry increased over the nine-year period were in social contact and potentially more visible to the service community. Because of their higher level of education, the I-I group may be more likely to reach out to find information to stifle their worries.

Implications for Gerontological Social Work Practice

With the increased number of elderly people reaching ages 85 and older, there is a need to develop social work intervention knowledge about people in this age group. Our study suggests several implications for gerontological social work with the oldest-old.

First, the oldest-old worry about a wide range of issues, especially when they reach their mid-90s. With worrying being very common in this age group, it is important for practitioners to provide information to allay their concerns. Remembering that worries are future oriented and centered on the unknown, social workers are in a good position to help these oldest-old worriers get the information necessary to effectively cope with the fears that fuel their worries.

Second, our findings point to the most salient aspects of worry among the oldest-old. The factor structure of worry suggests that the major dimensions of worry of the oldest-old are composed of health and memory factors. Thus, when gerontological social workers work with very old clients, it is important to assess their concerns about health- and memory-related issues and to directly address these concerns. It may be something as simple as referring them to a doctor to get an accurate diagnosis. It also could involve linking the elderly client to support groups for memory impairment.

Third, our findings show that worry changes over time in different ways. The worries of the oldest-old increase over time with variations in the course of worrying. Thus, social work practitioners need to realize that although worry increases for all elderly people over age 85, not all experience a continuous increase in worry. In particular, certain elderly participants whose worries increased over the nine years of the study had more social contact and were less isolated, making them potentially more visible to service providers. It is also possible that those who have more social contact are more aware of their losses because they can compare them with those of others they encounter. It is also possible that they are more educated and therefore more informed about agency issues.

Fourth, given that worry increases in the oldest-old over time, gerontological social workers face an emerging need to provide mental health services to elderly clients in this age group. Unfortunately, the utilization rate of mental health services among older adults tends to be lower than among younger adults (Harwood et al., 2003; Hastings, 1993), making service delivery to these elderly people more difficult.

Limitations and Future Directions

There are several limitations to consider in interpreting the findings. First, because the current sample is a convenience sample from midwestern U.S. cities, the findings may not generalize to the oldest-old from various racial and ethnic groups or other geographic areas. In addition, because the participants are community dwellers, the findings are not representative of those living in institutions. Furthermore, the combination of the D-I and N-I groups may have obscured some of the differences between these groups and the I-I group.

The current longitudinal study is limited in its power by the small sample size. The study included only 23 individuals who survived across all three waves. Therefore, future longitudinal studies with a larger sample size would allow more sophisticated research methodologies, such as multilevel analyses, to capture factors related to the variations in change in worry among the very old. In spite of the small sample size, using a small sample was effective in examining the pattern of change in worry and providing an understanding of worry among the oldest-old.

Original manuscript received January 3, 2006 Final revision received July 17, 2006 Accepted July 20, 2006

REFERENCES

Aldwin, C. M., Levenson, M. R., Spiro, A. F., & Bosse, R. (1989). Does emotionality predict stress? Findings from the normative aging study. Journal of Personality and Social Psychology, 56, 618-624.

Babcock, R. L., Laguna, L. B., Laguna, K. D., & Urusky, D.A. (2000). Age differences in the experience of worry. Journal of Mental Health and Aging, 6, 227-235.

Blazer, D. G. (2000). Psychiatry and the oldest old. American Journal of Psychiatry, 157, 1915-1924.

Blazer, D., Hughes, D. C., & George, L. K. (1987). The epidemiology of depression in an elderly community population. Gerontologist, 27, 281-287.

Bookwala, J., & Schulz, R. (2000). A comparison of primary stressors, secondary stressors, and depressive symptoms between elderly caregiving husbands and wives: The caregiver health effects study. Psychology and Aging, 15, 607-616.

Cappeliez, P. (1989). Daily worries and coping strategies: Implications for therapists. Clinical Gerontologist, 8, 70--71.

Carmin, C. N., Pollard, C.A., & Gillock, K. L. (1999). Assessment of anxiety disorders in the elderly. In R A. Lichtenberg (Ed.), Handbook of assessment in clinical gerontology (pp. 59-90). Hoboken, NJ: John Wiley & Sons.

Derogatis, L. R., Rickels, K., & Rock, A. F. (1976). The SCL-90 and the MMPI: A step in the validation of a new self-report scale. British Journal of Psychiatry, 128, 280-289.

Duke University Center for the Study of Aging and Human Development. (1978). Multidimensional functional assessment: The OARS methodology (2nd ed.). Durham, NC: Duke University.

Dunkle, R., Roberts, B., & Haug, M. (2001). The oldest old in everyday life: Self perception, coping with change, and stress. New York: Springer.

Harwood, H., Mark, T., McKusick, D., Coffey, R., King, E., & Genuardi, J. (2003). National spending on mental health and substance abuse treatment by age of clients, 1997. Journal of Behavioral Health Services & Research, 30, 433-443.

Hastings, M. M. (1993). Aging and mental health services: An introduction. Journal of Mental Health Administration, 20, 186-190.

Himmelfarb, S., & Murrell, S. A. (1984). The prevalence and correlates of anxiety symptoms in older adults. Journal of Psychology, 116, 159-167.

Kanner, A. D., Coyne, J. C., Schaefer, C., & Lazarus, R. S. (1981). Comparison of two modes of stress measurement: Daily hassles and uplifts versus major life events. Journal of Behavioral Medicine, 4, 1-39.

Katz, S., Ford, A. B., Moskowitz, R.W., Jackson, B. A., & Jaffe, M.W. (1963). Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. JAMA, 185, 914-919.

Krause, N., & Markides, K. (1990). Measuring social support among older adults. International Journal of Aging and Human Development, 30, 37-53.

Linn, B. S., & Linn, M.W. (1980). Objective and self-assessed health in the old and very old. Social Science and Medicine, 14A, 311-315.

Nelson, E.A., & Dannefer, D. (1992). Aged heterogeneity: Fact or fiction? The fate of diverse logical research. Gerontologist, 32, 17-23.

Pearlin, L. I., Liberman, M.A., Menaghan, E. G., & Mullan, J.T. (1981).The stress process. Journal of Health and Social Behavior, 22, 337-356.

Pearlin, L. I., & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 19, 2-21.

Powers, C., Wisocki, P., & Whitbourne, S. (1992). Age differences and correlates of worrying in young and elderly adults. Gerontologist, 32, 82-88.

Revicki, D.A., & Mitchell, J. P. (1990). Strain, social support, and mental health in rural elderly individuals. Journals of Gerontology: Social Sciences and Psychological Sciences, 45B, S267-S274.

Russell, D.W., & Cutrona, C. E. (1991). Social support, stress, and depressive symptoms among the elderly: Test of a process model. Psychology and Aging, 6, 190-201.

Skarborn, M., & Nicki, R. (1996). Worry among Canadian seniors. International Journal of Aging & Human Development, 43, 169-178.

Turner, R.J., & Noh, S. (1988). Physical disability and depression: A longitudinal analysis. Journal of Health and Social Behavior, 29, 23-37.

Tyler, K.A., & Hoyt, D. R. (2000). The effects of an acute stressor on depressive symptoms among older adults: The moderating effects of social support and age. Research on Aging, 22, 143-164.

Van Nostrand, J., Furner, S. E., & Suzman, R. (1993). Introduction. In U.S. Department of Health and Human Services, Vital and health statistics. Washington, DC: U.S. Government Printing Office.

Wisocki, P.A. (1988). Worry as a phenomenon relevant to the elderly. Behavior Therapy, 19, 369-379.

Wisocki, P. A., Handen, B., & Morse, C. K. (1986). The worry scale as a measure of anxiety among home bound and community active elderly. Behavior Therapist, 5, 91-95.

Hae-Sook Jeon, PhD, is lecturer, Catholic University, Seoul, Korea. Ruth Dunkle, PhD, is Wilbur Cohen Collegiate Professor, School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48104; e-mail: redunkle@umich.edu. Beverly L. Roberts, PhD, FAAN, FGSA, is Annabel Davis Jenks Endowed Professor for Teaching and Research in Clinical Nursing Excellence, University of Florida, Gainesville.
Table 1: Frequency and Severity of Worries among the Oldest-Old
(N = 23)

 Wave 1

Worry Frequency M SD

Concerns about weight 2 0.22 0.74
Concerns about sleep 4 0.39 0.94
Not enough personal energy 7 0.52 0.95
Concerns about falling 4 0.22 0.52
Declining physical abilities 3 0.26 0.69
Taking medications 0 0.00 0.00
Concerns about forgetting things 7 0.48 0.79
Concerns about getting around 4 0.35 0.83
Concerns about health in general 4 0.35 0.83
Concerns about physical appearance 3 0.22 0.60
Too much time on hands 3 0.17 0.49
Not enough time to do the things
 you need to do 5 0.39 0.84
Difficulties with friends 1 0.09 0.42
Concerns about money 2 0.09 0.29
Difficulties with family 1 0.13 0.63
Concerns about inner conflict 0 0.00 0.00
Concerns about misplacing or losing things 6 0.43 0.84
Concerns about troublesome neighbors 0 0.00 0.00
Concerns about neighborhood crime 6 0.57 1.04
Health of family members 12 1.13 1.29

 Wave 4

Worry Frequency M SD

Concerns about weight 3 0.26 0.75
Concerns about sleep 6 0.48 0.95
Not enough personal energy 10 0.74 0.92
Concerns about falling 8 0.61 0.89
Declining physical abilities 7 0.48 0.79
Taking medications 0 0.00 0.00
Concerns about forgetting things 10 0.61 0.84
Concerns about getting around 5 0.52 1.08
Concerns about health in general 5 0.39 0.84
Concerns about physical appearance 6 0.52 0.99
Too much time on hands 4 0.35 0.83
Not enough time to do the things
 you need to do 8 0.65 1.03
Difficulties with friends 2 0.09 0.29
Concerns about money 4 0.26 0.62
Difficulties with family 1 0.04 0.21
Concerns about inner conflict 3 0.22 0.60
Concerns about misplacing or losing things 11 0.73 0.94
Concerns about troublesome neighbors 2 0.13 0.46
Concerns about neighborhood crime 4 0.35 0.83
Health of family members 9 0.65 1.03

 Wave 5

Worry Frequency M SD

Concerns about weight 23 1.09 0.42
Concerns about sleep 23 1.30 0.63
Not enough personal energy 23 1.52 0.73
Concerns about falling 23 1.70 0.82
Declining physical abilities 23 1.48 0.85
Taking medications 23 1.09 0.29
Concerns about forgetting things 23 1.68 0.84
Concerns about getting around 23 1.59 0.91
Concerns about health in general 23 1.43 0.73
Concerns about physical appearance 22 1.41 0.73
Too much time on hands 23 1.22 0.52
Not enough time to do the things
 you need to do 22 1.05 0.21
Difficulties with friends 22 1.14 0.47
Concerns about money 23 1.30 0.63
Difficulties with family 22 1.23 0.61
Concerns about inner conflict 22 1.14 0.35
Concerns about misplacing or losing things 23 1.91 0.79
Concerns about troublesome neighbors 22 1.05 0.21
Concerns about neighborhood crime 22 1.59 0.80
Health of family members 23 1.96 1.58

Table 2: Worry and Key Variables in the Increase-Increase (I-I) Group
and the No Change-Increase/Decrease-Increase (N-I/D-I) Group among
the Oldest-Old

 Wave 1 Wave 4

Worry and Key Variables M SD M SD

Worry
 I-I 2.18 3.34 5.55 3.75 ***
 N-I/D-I 2.00 3.25 0.73 1.27
Factor 1: Health
 I-I 1.36 2.73 3.36 2.66 **
 N-I/D-I 1.18 2.14 0.27 0.65
Factor 2: Memory
 I-I 0.82 1.17 2.18 1.78 ***
 N-I/D-I 0.82 1.66 0.45 0.69
ADLs
 I-I 11.82 0.41 11.73 0.47
 N-I/D-I 11.82 0.41 11.73 0.47
IADLs
 I-I 13.00 0.89 13.09 1.22
 N-I/D-I 13.45 1.30 13.55 0.93
Depression
 I-I 1.55 2.02 2.18 2.68
 N-I/D-I 0.55 1.21 0.82 1.83
Mastery
 I-I 13.55 4.32 13.32 3.23
 N-I/D-I 12.70 2.32 13.56 3.46
ASS
 I-I 4.18 1.08 4.36 1.03
 N-I/D-I 4.09 1.04 4.21 0.83
FSS
 I-I 10.36 1.50 10.82 0.87 *
 N-I/D-I 9.55 1.44 8.73 2.45

 Wave 5

Worry and Key Variables M SD

Worry
 I-I 9.82 3.09
 N-I/D-I 9.09 3.36
Factor 1: Health
 I-I 6.09 2.47
 N-I/D-I 5.80 2.52
Factor 2: Memory
 I-I 3.73 1.19
 N-I/D-I 3.40 1.71
ADLs
 I-I 10.36 2.46
 N-I/D-I 10.18 2.36
IADLs
 I-I 8.55 3.05
 N-I/D-I 9.55 4.03
Depression
 I-I 3.55 4.95
 N-I/D-I 3.89 3.79
Mastery
 I-I 10.91 4.30
 N-I/D-I 12.70 3.59
ASS
 I-I 4.09 0.70
 N-I/D-I 4.18 1.17
FSS
 I-I 10.27 1.19 ([dagger])
 N-I/D-I 8.55 2.84

Notes: t tests between I-I and N-I/D-I were conducted for each wave.
ADLs = activities of daily living; IADLs = instrumental activities of
daily living; ASS = available social support; FSS = frequency of
social support.

([dagger]) p < .10. * p < .05. ** p < .01. *** p < .001.
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Author:Jeon, Hae-Sook; Dunkle, Ruth; Roberts, Beverly L.
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Date:Nov 1, 2006
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