Psychometric Concerns in the Assessment of Trauma-Related Symptoms in Older Adults

Assessment of posttraumatic stress disorder (PTSD) in older adults is still in its infancy despite reflections on this subject in past literature. Factors that influence assessment are traumas that occurred long in the past, lower prevalence, the fact that older people complain less, more misinterpretation of avoiding and intrusion symptoms, more somatic comorbidity, and higher risk of cognitive impairment. The Clinician Administered PTSD Scale is mostly used to diagnose PTSD, but is less researched in older individuals. Only two screening instruments have been validated specifically for older adults, the PTSD Checklist (PCL) and the Self-Rating Inventory for PTSD. The PCL scale has been used more often, has been translated in various languages, and is also suitable for clinician rating, which is considered more appropriate for older adults. The PCL-5, based on the new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria was researched in older veterans but needs further validation. Biological measures have not yet been adapted for assessment in the complex biological systems of older age. Multimethod assessment and computerized screening are becoming more important and can address many of the difficulties in this field. Finally, much can be learned from knowledge already acquired from younger adults.

REJECTION OF CARE IN PERSONS WITH DEMENTIA

Most individuals with dementia develop significant behavioral problems, also known as neuropsychiatric symptoms (NPS). One problem that continues to plague measurement of NPS is inconsistency of terminology used to describe NPS. For example, in the Neuropsychiatric Inventory-Clinician Rating Scale (NPI-C), a gold standard for measuring NPS, rejection of care (rejection) is not differentiated from agitation or aggression. Rather, behaviors indicative of rejection are categorized as agitation. Using data from 250 persons with dementia who participated in the Dementia Behavior Study, principle components analysis of the NPI-C domain of Agitation identified four behavioral clusters: 1=rejection of care, 2=restlessness, 3=exiting behaviors, and 4=hiding/hoarding. Rejection was associated with a more distant relationship with the caregiver, lower cognitive status, and more negative caregiver communication style. Rejection was predictive of higher levels of caregiver burden. Findings support the argument that rejection is a clinically distinct NPS, and likely requires different nonpharmacological management than agitation.

Assessment Of Mania With Self Rating Scale

Introduction: Patients with mania are generally considered unreliable informants about their illness and most of the mania rating scales are clinician administered. There are few self-rating scales in mania and the utility of which is immense.Objective: The study was aimed to compare the co-relation between the self-rating scales and clinician rating scales in mania.Method: Forty-two patients with mania in the tertiary care center of North Indian setting were applied with Clinician Administered Rating Scale for Mania,Altman Self-Rating Mania scale, Hamilton Rating Scale for Depression and Clinical Global Impression Scale at base line and consecutive four weeks. The scores were analyzed for correlation.Result: The Pearson’s correlation coefficient rho between self rated vs. clinician in the first week scores was 0.368 with p value of <0.05. On the subsequent weeks the rho value progressively increased and became highly significant (p<0.01).Conclusion: Self-reporting by mania is reliable in looking at the symptoms. Self rating scale is not very reliable when the patient is very severely ill, at least to predict the severity /improvement, but, reliable when the patient improves from very severe illness to moderate or milder degree. The scale can be utilized as an augmentation to the clinical interview.