Construction of a scale to signal personality disorders in the elderly

Till now, no specific diagnostic instruments to detect personality disorders in the elderly are available. The aim of our study was to contribute to the construction of a reliable en valid instrument for the detection of personality disorders in older adults. Therefore, a draft version of the instrument was constructed both for the patient and the informant. Both the patient and the informant version of the instrument included 52 items with the same content. These items concerned Habitual behaviour (HAB), Biographical information (BIO) and Observation of actual behaviour (OBS). 159 clients of 60 years and older of a Dutch ambulatory mental health care organisation were assessed with the screening instrument. In 96 of the 159 outpatients one or more informants were included. The results indicate that the internal consistency of seven HAB items, nine BIO items and five OBS items was moderate to good with regard to both the patient and informant instrument. Test-retest reliability of the 21 items of the patient instrument was moderate with regard to HAB, excellent with regard to BIO and moderate with regard to OBS. Interrater reliability of OBS was also moderate. The criterion validity (criterion: DSM-IV TR Axis II classification) of HAB, BIO and OBS based on the 21 items of the patient instrument was fair and with regard to the same 21 items of the informant instrument insufficient. In conclusion, sixteen out of 52 potential items of the patient's draft version of the screening instrument can be used to detect a possible personality disorder. These sixteen items from the HAB and BIO scale are named the Gerontological Personality disorder Scale (GPS). Medical doctors, psychologists and nurses working in ambulatory mental health organisation can use the GPS as a resource during the diagnostic process. Whether the GPS can be used beyond mental health organisations, for example by general practitioners is a subject for future studies.     

Personality disorders in the elderly: diagnostic aspects

This article describes the usefulness of the DSM personality disorders. In conclusion the presence of personality disorders during a lifetime is not always an enduring pattern of (the same) conduct disorders. Despite this, the DSM describes a static course of mainly interpersonal behaviour. Next to this, the utility of the DSM-Axis-II assessment and general personality assessment in relation to older adults will be discussed. In general these instruments are not very suitable for the assessment of the disposition and gravity of personality disorders in the elderly. It is proposed to develop specific profiles with regard to personality disorders in the elderly by applying the Delphi-technique on existing personality assessment. A Delphi panel of experts in the field of personality pathology in older adults can be asked to mention a certain personality disorder and describe this on a certain personality selfreport list, like the shortened version of the TCI.     

Are atypical depression,borderline personality disorder and bipolar II disorder overlapping manifestations of a common cyclothymic diathesis?

The constructs of atypical depression, bipolar II disorder and borderline personality disorder (BPD) overlap. We explored the relationships between these constructs and their temperamental underpinnings. We examined 107 consecutive patients who met DSM-IV criteria for major depressive episode with atypical features. Those who also met the DSM-IV criteria for BPD (BPD+), compared with those who did not (BPD-), had a significantly higher lifetime comorbidity for body dysmorphic disorder, bulimia nervosa, narcissistic, dependent and avoidant personality disorders, and cyclothymia. BPD+ also scored higher on the Atypical Depression Diagnostic Scale items of mood reactivity, interpersonal sensitivity, functional impairment, avoidance of relationships, other rejection avoidance, and on the Hopkins Symptoms Check List obsessive-compulsive, interpersonal sensitivity, anxiety, anger-hostility, paranoid ideation and psychoticism factors. Logistic regression revealed that cyclothymic temperament accounted for much of the relationship between atypical depression and BPD, predicting 6 of 9 of the defining DSM-IV attributes of the latter. Trait mood lability (among BPD patients) and interpersonal sensitivity (among atypical depressive patients) appear to be related as part of an underlying cyclothymic temperamental matrix.     

Anxiété et personnalité: études catégorielle et dimensionnelle de leur association et facteurs de vulnérabilité

Anxiety disorders often appear in patients with particular personality traits, and in some cases with actual personality disorders. This clinical observation may question the respective interactions between personality and anxiety disorders: Is it possible to evaluate the personality of patients with severe anxiety disorders reliably? What is the real co-morbidity between personality disorders and anxiety disorders? Are there psychopathological and etiological links between these two disorders? Studies relying on categorical approaches of personality suggest that about 40-60% of anxious patients fulfill the diagnostic criteria of at least one personality disorder. The most frequent diagnoses belong to the cluster C of the DSM-IV axis II classification, with a majority having avoidant and dependent personalities, but without any real specificity according to the types of anxiety disorders. On the other hand, dimensional studies have shown that anxiety disorders are often associated with avoidant personality traits, with very deviant scores in some cases, even after treatment of the anxiety disorder. These works support the existence of some temperament traits, underlined by psychobiological, stable, and inheritable dimensions, which may constitute early vulnerability factors for anxiety disorders in both children and adults.     

Prevalence of psychiatric disorders in U.S. older adults: findings from a nationally representative survey

Data on the prevalence of psychiatric disorders in late life are lacking. The present study addresses this gap in the literature by examining the prevalence of the broadest range of psychiatric disorders in late life to date; comparing prevalences across older adult age groups using the largest sample of adults aged 85+; and exploring gender differences in the prevalence of psychiatric disorders in late life. Using data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions, we examined the prevalence of past-year mood, anxiety, and substance use disorders, and lifetime personality disorders in a nationally representative sample of 12,312 U.S. older adults. We stratified our analyses by gender and by older age groups: young-old (ages 55-64), middle-old (ages 65-74), old-old (ages 75-84), and oldest-old (ages 85+). The proportion of older adults who experienced any past-year anxiety disorder was 11.4%, while the prevalence of any past-year mood disorder was 6.8%. A total of 3.8% of older adults met criteria for any past-year substance use disorder, and 14.5% of older adults had one or more personality disorder. We observed a general pattern of decreasing rates of psychiatric disorders with increasing age. Women experienced higher rates of mood and anxiety disorders, while men had higher rates of substance use disorders and any personality disorder. Gender differences in rates of most psychiatric disorders decreased with increasing age. These data indicate that psychiatric disorders are prevalent among U.S. older adults, and support the importance of prevention, diagnosis, and treatment of psychiatric disorders in this population.     

Clinical Practice Guidelines and Consensus Statements in Oncology – An Assessment of Their Methodological Quality

BackgroundConsensus statements and clinical practice guidelines are widely available for enhancing the care of cancer patients. Despite subtle differences in their definition and purpose, these terms are often used interchangeably. We systematically assessed the methodological quality of consensus statements and clinical practice guidelines published in three commonly read, geographically diverse, cancer-specific journals. Methods Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine’s standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents.MethodsConsensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine''s standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents.FindingsThirty-four consensus statements and 67 clinical practice guidelines were evaluated. The rigour of development score for consensus statements over the three journals was 32% lower than that of clinical practice guidelines. The editorial independence score was 15% lower for consensus statements than clinical practice guidelines. One journal scored consistently lower than the others over both domains. No journals adhered to all the items related to the transparency of document development. One journal’s consensus statements endorsed a product made by the sponsoring pharmaceutical company in 64% of cases.ConclusionGuidance documents are an essential part of oncology care and should be subjected to a rigorous and validated development process. Consensus statements had lower methodological quality than clinical practice guidelines using AGREE II. At a minimum, journals should ensure that that all consensus statements and clinical practice guidelines adhere to AGREE II criteria. Journals should consider explicitly requiring guidelines to declare pharmaceutical company sponsorship and to identify the sponsor’s product to enhance transparency.     

Psychiatric Comorbidity in Patients from the Addictive Disorders Assistance Units of Galicia: The COPSIAD Study

The objective of this study is to assess the prevalence of psychiatric comorbidity in patients under treatment within the addictive disorders assistance units of Galicia (Spain).

Material and Methods

A total of 64 healthcare professionals performed clinical diagnosis of mental disorders (on DSM IV-TR criteria) in 2300 patients treated throughout March 2010 in 21 addictive disorders assistance units.

Results

56.3% of patients with substance abuse/dependency also showed some other mental disorder, 42.2% of patients suffering from at least an Axis I condition and 20.2% from some Axis II condition. Mood and anxiety disorders and borderline and antisocial personality disorders were the most frequent disorders in both axes.

Conclusions

A high comorbidity was found between mental and substance use disorders (SUD) in patients seen at the addictive disorders assistance units of Galicia.     

The psychometric properties of the Dutch version of the Telephone Interview Cognitive Status (TICS)

The Telephone Interview Cognitive Status (TICS) is an instrument to screen for dementia in older persons by telephone. Although the psychometric properties of the TICS have been studied in various countries, the quality of the Dutch version of the TICS was yet unknown. This paper presents the Dutch version of the TICS and reports on its reliability and validity among 51 patients of Maastricht University Hospital, The Netherlands. The Pearson and intra-class correlations for test-retest reliability were 0.93 and 0.92, respectively. The Pearson and intra-class correlations for inter-rater reliability were 0.91 and 0.90, respectively. Sensitivity and specificity were studied in relation to the Mini Mental State Examination (MMSE, cut-off point 23/ 24) and the diagnosis of dementia as assessed according to DSM-IV criteria. When using the TICS cut-off point of 26/27, the coefficients for sensitivity and specificity were at least 0.80. The percentages ROC under the curve were 90% and 93% with the MMSE and the diagnosis dementia as criterion, respectively. We conclude that the Dutch version of the TICS is an acceptable instrument for screening for dementia in older persons, particularly when face-to-face contact is not possible.     

The efficacy of cognitive–behavioral therapy for older adults with ADHD: a randomized controlled trial

Older adults with ADHD exhibit significant functional impairment, yet there is little research to guide clinicians in evidence-based care of these adults. This study examined response to treatment in older adults who participated in a previous study of the efficacy of cognitive–behavioral treatment (CBT) in adult ADHD. It was hypothesized that older adults would respond less well to CBT than younger adults, given the cognitive demands of the treatment. As described in the original publication, 88 adults who met DSM-IV criteria for ADHD were randomized to receive either a manualized 12-week CBT group intervention targeting executive dysfunction or a parallel Support group. In the current study, outcomes for 26 adults, aged 50 or older, were compared with those of 55 younger adults with respect to inattentive symptoms assessed on a structured interview by a blind clinician, as well as on ratings by self and/or collateral on measures of attention, executive dysfunction, and comorbidity. Contrary to the hypothesis, older and younger adults were equally responsive to CBT on measures of attention. The older adults also responded as well to Support as to CBT on several outcome measures. The results provide preliminary evidence that CBT is an effective intervention for older adults with ADHD. The unexpected response to support highlights a possible age-specificity of effective therapeutic intervention that requires further investigation.     

Deliberate self-harm in substance-dependent patients and relationship with alexithymia and personality disorders: a case-control study

The aim of this study Is to evaluate differences in the prevalence of deliberate self-harm (DSH), alexithymia, and clinical personality patterns and syndromes between treatment-seeking substance-dependents and a comparison group, and to investigate the relationship of DSH with alexithymia, and personality disorders. One hundred and fifty-four subjects participated in the study (77 substance-dependent inpatients and 77 comparison group). DSM-IV diagnoses of substance dependence were made by the clinicians of the Addiction Services following assessment that included clinical observation. Participants were evaluated by the Deliberate Self Harm Inventory, Toronto Alexithymia Scale, and Millon Clinical Multiaxial Inventory. An Identifying Information Form was used to collect demographic information (e.g. age, educational history, marital status, and employment status). Only to the clinical sample information was added on: types of substance used, age at first substance use, age at regular substance use, and previous treatment attempts. Significant group differences were found for all measures (DSH, TAS-20, MCMI-III). Among substance-dependent patients there was a significant difference between groups with and without DSH in terms of previous treatment attempts, Hypomania and Borderline personality disorder. DSH were significantly correlated with difficulty in identifying feelings in all cases in both the comparison group and in the personality disorders group, and with difficulty describing feelings in the personality disorders group. Personality disorder and drug dependency were predictors for DSH. This study suggests that treatment of substance-dependents should involve screening for deliberate self-harm behavior, difficulty identifying and describing feelings, and personality disorders. Probably, when these problems are detected, specific psychological intervention should be integrated to usual treatment for substance-dependent patients.     

Signs of mood and anxiety disorders in chimpanzees

Background

In humans, traumatic experiences are sometimes followed by psychiatric disorders. In chimpanzees, studies have demonstrated an association between traumatic events and the emergence of behavioral disturbances resembling posttraumatic stress disorder (PTSD) and depression. We addressed the following central question: Do chimpanzees develop posttraumatic symptoms, in the form of abnormal behaviors, which cluster into syndromes similar to those described in human mood and anxiety disorders?

Methodology/Principal Findings

In phase 1 of this study, we accessed case reports of chimpanzees who had been reportedly subjected to traumatic events, such as maternal separation, social isolation, experimentation, or similar experiences. We applied and tested DSM-IV criteria for PTSD and major depression to published case reports of 20 chimpanzees identified through PrimateLit. Additionally, using the DSM-IV criteria and ethograms as guides, we developed behaviorally anchored alternative criteria that were applied to the case reports. A small number of chimpanzees in the case studies met DSM-IV criteria for PTSD and depression. Measures of inter-rater reliability, including Fleiss'' kappa and percentage agreement, were higher with use of the alternative criteria for PTSD and depression. In phase 2, the alternative criteria were applied to chimpanzees living in wild sites in Africa (n = 196) and chimpanzees living in sanctuaries with prior histories of experimentation, orphanage, illegal seizure, or violent human conflict (n = 168). In phase 2, 58% of chimpanzees living in sanctuaries met the set of alternative criteria for depression, compared with 3% of chimpanzees in the wild (p = 0.04), and 44% of chimpanzees in sanctuaries met the set of alternative criteria for PTSD, compared with 0.5% of chimpanzees in the wild (p = 0.04).

Conclusions/Significance

Chimpanzees display behavioral clusters similar to PTSD and depression in their key diagnostic criteria, underscoring the importance of ethical considerations regarding the use of chimpanzees in experimentation and other captive settings.     

Telefonisch Interview Cognitieve Status (TICS): psychometrische aspecten

The psychometric properties of the Dutch version of the Telephone Interview Cognitive Status (TICS). The Telephone Interview Cognitive Status (TICS) is an instrument to screen for dementia in older persons by telephone. Although the psychometric properties of the TICS have been studied in various countries, the quality of the Dutch version of the TICS was yet unknown. This paper presents the Dutch version of the TICS and reports on its reliability and validity among 51 patients of Maastricht University Hospital, the Netherlands. The Pearson and intra-class correlations for test-retest reliability were 0,93 and 0,92, respectively. The Pearson and intra-class correlations for inter-rater reliability were 0,91 and 0,90, respectively. Sensitivity and specificity were studied in relation to the Mini Mental State Examination (MMSE, cut-off point 23/24) and the diagnosis of dementia as assessed according to DSM-IV criteria. When using the TICS cut-off point of 26/27, the coefficients for sensitivity and specificity were at least 0,80. The percentages ROC under the curve were 90% and 93% with the MMSE and the diagnosis dementia as criterion, respectively. We conclude that the Dutch version of the TICS is an acceptable instrument for screening for dementia in older persons, particularly when face-to-face contact is not possible.     

Validation and User Evaluation of a Sensor-Based Method for Detecting Mobility-Related Activities in Older Adults

Regular physical activity is essential for older adults to stay healthy and independent. However, daily physical activity is generally low among older adults and mainly consists of activities such as standing and shuffling around indoors. Accurate measurement of this low-energy expenditure daily physical activity is crucial for stimulation of activity. The objective of this study was to assess the validity of a necklace-worn sensor-based method for detecting time-on-legs and daily life mobility related postures in older adults. In addition user opinion about the practical use of the sensor was evaluated. Twenty frail and non-frail older adults performed a standardized and free movement protocol in their own home. Results of the sensor-based method were compared to video observation. Sensitivity, specificity and overall agreement of sensor outcomes compared to video observation were calculated. Mobility was assessed based on time-on-legs. Further assessment included the categories standing, sitting, walking and lying. Time-on-legs based sensitivity, specificity and percentage agreement were good to excellent and comparable to laboratory outcomes in other studies. Category-based sensitivity, specificity and overall agreement were moderate to excellent. The necklace-worn sensor is considered an acceptable valid instrument for assessing home-based physical activity based upon time-on-legs in frail and non-frail older adults, but category-based assessment of gait and postures could be further developed.     

A Web-Based Delphi Study for Eliciting Helpful Criteria in the Positive Diagnosis of Hemophagocytic Syndrome in Adult Patients

The diagnosis of the reactive form of hemophagocytic syndrome in adults remains particularly difficult since none of the clinical or laboratory manifestations are specific. We undertook a study in order to elicit which features constitute helpful criteria for a positive diagnosis. In this Delphi study, the features investigated in the questionnaire and the experts invited to participate in the survey were issued from a bibliographic search. The questionnaire was iteratively proposed to experts via a web-based application with a feedback of the results observed at the preceding Delphi round. Experts were asked to label each investigated criterion in one of the following categories: absolutely required, important, of minor interest, or not assessable in the routine practice environment. A positive consensus was a priori defined as at least 75% answers observed in the categories absolutely required and important. The questionnaire investigated 26 criteria and 24 experts originating from 13 countries participated in the second and final Delphi round. A positive consensus was reached for the nine following criteria: unilineage cytopenia, bicytopenia, pancytopenia, presence of hemophagocytosis pictures on a bone marrow aspirate or on a tissue biopsy, high ferritin level, fever, organomegaly, presence of a predisposing underlying disease, and high level of lactate dehydrogenase. A negative consensus was reached for 13 criteria, and an absence of consensus was observed for 4 criteria. The study constitutes the first initiative to date for defining international guidelines devoted to the positive diagnosis of the reactive form of hemophagocytic syndrome.     

What Are Priorities for Deprescribing for Elderly Patients? Capturing the Voice of Practitioners: A Modified Delphi Process

Polypharmacy and inappropriate medication use among older adults contribute to adverse drug reactions, falls, cognitive impairment, noncompliance, hospitalization and mortality. While deprescribing - tapering, reducing or stopping a medication - is feasible and relatively safe, clinicians find it difficult to carry out. Deprescribing guidelines would facilitate this process. The aim of this paper is to identify and prioritize medication classes where evidence-based deprescribing guidelines would be of benefit to clinicians. A modified Delphi approach included a literature review to identify potentially inappropriate medications for the elderly, an expert panel to develop survey content and three survey rounds to seek consensus on priorities. Panel participants included three pharmacists, two family physicians and one social scientist. Sixty-five Canadian geriatrics experts (36 pharmacists, 19 physicians and 10 nurse practitioners) participated in the survey. Twenty-nine drugs/drug classes were included in the first survey with 14 reaching the required (≥ 70%) level of consensus, and 2 new drug classes added from qualitative comments. Fifty-three participants completed round two, and 47 participants completed round three. The final five priorities were benzodiazepines, atypical antipsychotics, statins, tricyclic antidepressants, and proton pump inhibitors; nine other drug classes were also identified as being in need of evidence-based deprescribing guidelines. The Delphi consensus process identified five priority drug classes for which expert clinicians felt guidance is needed for deprescribing. The classes of drugs that emerged strongly from the rankings dealt with mental health, cardiovascular, gastroenterological, and neurological conditions. The results suggest that deprescribing and overtreatment occurs through the full spectrum of primary care, and that evidence-based deprescribing guidelines are a priority in the care of the elderly.     

Single-item screening for agoraphobic symptoms: validation of a web-based audiovisual screening instrument

The advent of web-based treatments for anxiety disorders creates a need for quick and valid online screening instruments, suitable for a range of social groups. This study validates a single-item multimedia screening instrument for agoraphobia, part of the Visual Screener for Common Mental Disorders (VS-CMD), and compares it with the text-based agoraphobia items of the PDSS-SR. The study concerned 85 subjects in an RCT of the effects of web-based therapy for panic symptoms. The VS-CMD item and items 4 and 5 of the PDSS-SR were validated by comparing scores to the outcomes of the CIDI diagnostic interview. Screening for agoraphobia was found moderately valid for both the multimedia item (sensitivity.81, specificity.66, AUC.734) and the text-based items (AUC.607-.697). Single-item multimedia screening for anxiety disorders should be further developed and tested in the general population and in patient, illiterate and immigrant samples.     

Sleep disorders in elderly, the sleep apnea syndrome in particular: are they a cause of insomnia? A review of literature

In this publication a review is presented based on the findings resulting from sleep-wake investigations searching for sleep disorders associated with insomnia in relatively healthy elderly. 44 Relevant journal articles published between 1980-1998 were found. The four most important sleep disorders which can be accompanied by sleeplessness in relatively healthy elderly people are periodic leg movements disorder (PLM), restless legs syndrome (RLS), REM sleep behaviour disorder (RBD) and sleep apnea syndrome (SAS). Of these disorders, sleep apnea and periodic leg movements occur most frequently, in a quarter of the elderly. The latter, however, seldom complain about sleeplessness. Within the category of older people disorders characterized by movements during sleep increase significantly with age, nightly respiration disorders do not. SAS, PLM and RBD appear most frequently in men and RLS in women. The disorders characterized by movements during sleep (especially RLS and RBD) are often accompanied by sleeplessness. SAS, however, is more closely associated with day-time sleepiness than with sleeplessness. No combination of demographic variables and symptoms allows a reliable prediction of these sleep disorders. Fortunately, these disorders are not a major threat to the health of older people.     

Anxious or Depressed and Still Happy?

This study aimed to examine cross-sectionally to what extent persons with higher symptom levels or a current or past emotional disorder report to be less happy than controls and to assess prospectively whether time-lagged measurements of extraversion and neuroticism predict future happiness independent of time-lagged measurements of emotional disorders or symptom severity. A sample of 2142 adults aged 18–65, consisting of healthy controls and persons with current or past emotional disorder according to DSM-IV criteria completed self-ratings for happiness and emotional well-being and symptom severity. Lagged measurements of personality, symptom severity and presence of anxiety and depressive disorder at T0 (year 0), T2 (year 2) and T4 (year 4) were used to predict happiness and emotional well-being at T6 (year 6) controlling for demographics. In particular persons with more depressive symptoms, major depressive disorder, social anxiety disorder and comorbid emotional disorders reported lower levels of happiness and emotional well-being. Depression symptom severity and to a lesser extent depressive disorder predicted future happiness and emotional well-being at T6. Extraversion and to a lesser extent neuroticism also consistently forecasted future happiness and emotional well-being independent of concurrent lagged measurements of emotional disorders and symptoms. A study limitation is that we only measured happiness and emotional well-being at T6 and our measures were confined to hedonistic well-being and did not include psychological and social well-being. In sum, consistent with the two continua model of emotional well-being and mental illness, a ‘happy’ personality characterized by high extraversion and to a lesser extent low neuroticism forecasts future happiness and emotional well-being independent of concurrently measured emotional disorders or symptom severity levels. Boosting positive emotionality may be an important treatment goal for persons personally inclined to lower levels of happiness.     

Neuroticism in the elderly. The utility of the shortened DPQ-scales

This article reports on the relation between aging and personal adjustment. Current personality scales are not developed for older persons. Scales contain items which are not valid for an aging population and contain too many items for administration in older populations. As part of the Longitudinal Aging Study Amsterdam (LASA) Neuroticism in older persons was measured with a shortened version of the Inadequacy (IN) and Social Inadequacy (SI) scales of the Dutch Personality Questionnaire (DPQ). The utility of these shortened scales was assessed based on internal consistency, inter-item correlations, test-retest reliability and factor analysis. The consistency of the personality dimension Neuroticism was assessed based on cohort-differences and a 6-year longitudinal comparison. The research-population contained 2118 respondents at baseline, aged between 55 and 85 years, 49% were male and they were not living in an institution. The shortened scales appeared to be reliable and valid instruments to measure Neuroticism in the elderly. The gaining of time due to the administration of the shortened scales enlarges the feasibility of the scales for measuring Neuroticism in older persons. Results showed no significant age-difference on the IN-scale, but revealed a significant difference on the SI-scale (p < .01). The 65+ elderly (65-74 and 75-85) have higher scores on Social Inadequacy than the youngest elderly (55-64). Longitudinal analyses showed an interaction between age at baseline and the stability and change of the level of Neuroticism. On both scales the youngest age-group showed a significant decline in mean level of Neuroticism (p < .01). The mean level of Social Inadequacy in the oldest age-group showed an increase during the 6-year follow-up period (p < .05). However, the differences were very small. Future research is needed to assess the effect of related variables on Neuroticism in older persons.