Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.


Psychological and Brain Sciences

Committee Chair

Meeks, Suzanne

Author's Keywords

Anxiety; dementia; nursing home; long-term care; older adult


Senile dementia; Nursing home patients--Mental health; Anxiety in old age; Depression in old age


Dementia, depression, and anxiety are the most common psychiatric disorders among long-term care residents and, because dementia is associated with behavioral problems that can be difficult to manage, the growing number of long-term care residents with dementia and mental health disorders presents a challenge for providing quality care. Research has established the co-occurrence of depression and anxiety and anxiety and agitation in this population. However, a consensus on the conceptualization of the co-occurrence of these constructs has not been reached. It has also been postulated that older adults with dementia may not be able to experience anxiety as conceptualized due to cognitive impairment. Many older adults with anxiety report having anxiety throughout their lives, suggesting those with dementia would continue to experience anxiety despite cognitive decline. The purpose of this study is to examine the relationships among depression, anxiety, and agitation in long-term care residents with dementia emphasizing the roles of cognitive functioning and mental health history. Residents (N = 65) completed measures of mental health history, anxiety, and affect, while their nursing assistants completed measures of anxiety and agitation. Measures of depression and cognitive functioning were gathered from Minimum Data Sets. Confirmatory factor analyses and factorial ANOVAs were used to test the hypotheses. The results demonstrated depression, anxiety, and agitation in long-term care residents with dementia represented an overarching construct of distress. Significant relationships existed between current anxiety and agitation, as well as history of anxiety and current anxiety, irrespective of cognitive functioning. The results of this study suggest depression and anxiety in long-term care residents with dementia may be structurally different than in younger adults and other older adult populations. Differentiating agitation from other indicators of affective distress was not possible in this sample. Instead, depression, anxiety, and agitation may all be manifestations of a global construct of distress associated with dementia. Nevertheless, history of anxiety disorder was a predictor of current anxiety. The continuity of anxiety across the lifespan, maintenance of anxiety throughout the progression of dementia, and risk for increased co-morbidity highlights the need for screening for anxiety in long-term care facilities to provide optimal care.