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Objective: To examine the potentially bidirectional relationship between anxiety symptoms and unmet needs for assistance with daily activities among older adults. Method: Data came from the National Health and Aging Trends Study, 2011 through 2016 surveys. The study sample consisted of 3,936 Medicare beneficiaries with activity limitations at baseline, aged 65 or older. Cox proportional hazards regression was used to test the proposed relationship between anxiety symptoms and unmet needs for assistance with daily activities. Result: Having unmet needs increased the risk of the onset of anxiety symptoms, and elevated anxiety symptoms increased the risk of incident unmet needs for assistance with daily activities. Conclusion: Anxiety symptoms and unmet needs form a bidirectional relationship. Integrated mental health and community-based long-term care services may help reduce the burden of late-life anxiety disorders and stressful life incidents contributing to disability.

Background: This study aimed to examine personal care aides (PCAs)' knowledge, beliefs, and attitudes towards late-life depression and their experience caring for older adults with depression. Method:This study used a mixed-methods convergent parallel design involving an online survey (n=87) and semi-structured interviews (n=22). Survey respondents were recruited using convenience sampling and interviewees using purposive sampling from private duty home care agencies in Michigan. Qualitative data analyzed using a technique involving data reduction and open coding. Survey data were analyzed using descriptive statistics. Results:Most PCAs underestimated suicide rate among older adults, overrated self-help ability of the depressed person, underrated difficulty diagnosing depression, and attributed depression to personality flaws. PCAs favored psychotherapy and informal support and generally regarded medication as unhelpful, particularly in mild/moderate depression. Despite these discordances, PCAs' self-reported practice behaviors included strategies (i.e., communication, behavioral, cognitive, emotional regulation, relational, and external) that were largely consistent with the scientific view, particularly relating to behavioral activation. A prominent theme from PCAs' narratives was individualized care, reflected in their assessment of depressive symptoms, attitude towards depression treatment, and strategies caring for clients.Conclusions: Several areas of PCAs' perceptions regarding late-life depression were discordant with the current scientific view, although their practice behaviors were largely consistent with the principles of evidence-based practice for depression. Specialized mental health training, a standard depression care protocol, and higher training standards are essential to mobilize the large number of PCAs to improve the mental health outcomes of hard-to-reach older adults.