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Journal ArticleDOI

Anxiety disorders in older adults: a comprehensive review†

01 Feb 2010-Depression and Anxiety (Wiley Subscription Services, Inc., A Wiley Company)-Vol. 27, Iss: 2, pp 190-211
TL;DR: Prevalence and symptom expression of anxiety disorders in late life, as well as risk factors, comorbidity, cognitive decline, age of onset, and treatment efficacy for older adults are reviewed.
Abstract: This review aims to address issues unique to older adults with anxiety disorders in order to inform potential changes in the DSM-V. Prevalence and symptom expression of anxiety disorders in late life, as well as risk factors, comorbidity, cognitive decline, age of onset, and treatment efficacy for older adults are reviewed. Overall, the current literature suggests: (a) anxiety disorders are common among older age individuals, but less common than in younger adults; (b) overlap exists between anxiety symptoms of younger and older adults, although there are some differences as well as limitations to the assessment of symptoms among older adults; (c) anxiety disorders are highly comorbid with depression in older adults; (d) anxiety disorders are highly comorbid with a number of medical illnesses; (e) associations between cognitive decline and anxiety have been observed; (f) late age of onset is infrequent; and (g) both pharmacotherapy and CBT have demonstrated efficacy for older adults with anxiety. The implications of these findings are discussed and recommendations for the DSM-Vare provided, including extending the text section on age-specific features of anxiety disorders in late life and providing information about the complexities of diagnosing anxiety disorders in older adults. Depression and Anxiety 27:190–211, 2010. r 2010 Wiley-Liss, Inc.
Citations
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Journal ArticleDOI
TL;DR: These guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process based on global impression of efficacy, effectiveness, and side effects, using a modified version of the periodic health examination guidelines.
Abstract: Anxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated. These guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process. Data on the epidemiology, diagnosis, and treatment (psychological and pharmacological) were obtained through MEDLINE, PsycINFO, and manual searches (1980–2012). Treatment strategies were rated on strength of evidence, and a clinical recommendation for each intervention was made, based on global impression of efficacy, effectiveness, and side effects, using a modified version of the periodic health examination guidelines. These guidelines are presented in 10 sections, including an introduction, principles of diagnosis and management, six sections (Sections 3 through 8) on the specific anxiety-related disorders (panic disorder, agoraphobia, specific phobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder), and two additional sections on special populations (children/adolescents, pregnant/lactating women, and the elderly) and clinical issues in patients with comorbid conditions. Anxiety and related disorders are very common in clinical practice, and frequently comorbid with other psychiatric and medical conditions. Optimal management requires a good understanding of the efficacy and side effect profiles of pharmacological and psychological treatments.

816 citations


Cites background from "Anxiety disorders in older adults: ..."

  • ...Older patients with anxiety and related disorders report higher rates of diabetes, gastrointestinal conditions, and dementia [1325,1327,1328]....

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  • ...may have difficulty remembering symptoms [1327,1335]....

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  • ...Approximately 80% of adults ≥65 years of age have at least one chronic medical condition, and this may be even higher among those with anxiety disorders [1327]....

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  • ...Older patients with anxiety often present differently than younger patients [1327,1334]....

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Journal Article
TL;DR: The review of literature presents the conclusions of several meta-analyses that have reviewed psychosocial interventions for late-life depression and anxiety, and intervention studies concerning the effectiveness of cognitive behavioral therapy, interpersonal therapy, reminiscence therapy, and alternative therapies with depressed and/or anxious older adults are reviewed.
Abstract: Depression and anxiety are the most common psychiatric conditions in late life. Despite their prevalence, we know relatively little about their unique manifestation in older adults. And, Although the most common intervention for late-life depression and anxiety continues to be medication, research on psychosocial interventions for late-life depression and anxiety has burgeoned in the past several years. Unfortunately, this growing body of intervention research has yet to be widely translated into improved systems of care for late-life depression. This article is one step toward synthesizing the knowledge in this growing area of research. The review of literature presents the conclusions of several meta-analyses that have reviewed psychosocial interventions for late-life depression and anxiety. In addition, intervention studies concerning the effectiveness of cognitive behavioral therapy, interpersonal therapy, reminiscence therapy, and alternative therapies with depressed and/or anxious older adults are reviewed. A brief description of various approaches to psychosocial intervention with anxious and/or depressed older adults is also presented.

728 citations

Journal ArticleDOI
TL;DR: More vigorous clinical interventions supporting judicious benzodiazepine use may be needed to decrease rates of long-term benzodiazine use in older adults.
Abstract: Importance Although concern exists regarding the rate of benzodiazepine use, especially long-term use by older adults, little information is available concerning patterns of benzodiazepine use in the United States. Objective To describe benzodiazepine prescription patterns in the United States focusing on patient age and duration of use. Design, Setting, and Participants A retrospective descriptive analysis of benzodiazepine prescriptions was performed with the 2008 LifeLink LRx Longitudinal Prescription database (IMS Health Inc), which includes approximately 60% of all retail pharmacies in the United States. Denominators were adjusted to generalize estimates to the US population. Main Outcomes and Measures The percentage of adults filling 1 or more benzodiazepine prescriptions during the study year by sex and age group (18-35 years, 36-50 years, 51-64 years, and 65-80 years) and among individuals receiving benzodiazepines, the corresponding percentages with long-term (≥120 days) benzodiazepine use, prescription of a long-acting benzodiazepine, and benzodiazepine prescriptions from a psychiatrist. Results In 2008, approximately 5.2% of US adults aged 18 to 80 years used benzodiazepines. The percentage who used benzodiazepines increased with age from 2.6% (18-35 years) to 5.4% (36-50 years) to 7.4% (51-64 years) to 8.7% (65-80 years). Benzodiazepine use was nearly twice as prevalent in women as men. The proportion of benzodiazepine use that was long term increased with age from 14.7% (18-35 years) to 31.4% (65-80 years), while the proportion that received a benzodiazepine prescription from a psychiatrist decreased with age from 15.0% (18-35 years) to 5.7% (65-80 years). In all age groups, roughly one-quarter of individuals receiving benzodiazepine involved long-acting benzodiazepine use. Conclusions and Relevance Despite cautions concerning risks associated with long-term benzodiazepine use, especially in older patients, long-term benzodiazepine use remains common in this age group. More vigorous clinical interventions supporting judicious benzodiazepine use may be needed to decrease rates of long-term benzodiazepine use in older adults.

572 citations

Journal ArticleDOI
TL;DR: This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions.
Abstract: This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees.

475 citations


Cites background from "Anxiety disorders in older adults: ..."

  • ...Many elderly patients are troubled by anxiety symptoms, but anxiety disorders in those over 65 years may be less common than in younger age groups [IV] (Wolitzky-Taylor et al., 2010)....

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Journal ArticleDOI
TL;DR: Social network type was found to be associated with each of the well-being indicators after adjusting for demographic and health confounders and can serve as a basis for risk assessment as well as a means for determining the efficacy of interventions.
Abstract: Purpose: The study considers the social networks of older Americans, a population for whom there have been few studies of social network type. It also examines associations between network types and well-being indicators: loneliness, anxiety, and happiness. Design and Methods: A subsample of persons aged 65 years and older from the first wave of the National Social Life, Health, and Aging Project was employed (N = 1,462). We applied K-means cluster analysis to derive social network types using 7 criterion variables. In the multivariate stage, the well-being outcomes were regressed on the network type construct and on background and health characteristics by means of logistic regression. Results: Five social network types were derived: “diverse,” “friend,” “congregant,” “family,” and “restricted.” Social network type was found to be associated with each of the well-being indicators after adjusting for demographic and health confounders. Respondents embedded in network types characterized by greater social capital tended to exhibit better well-being in terms of less loneliness, less anxiety, and greater happiness. Implications: Knowledge about differing network types should make gerontological practitioners more aware of the varying interpersonal milieus in which older people function. Adopting network type assessment as an integral part of intake procedures and tracing network shifts over time can serve as a basis for risk assessment as well as a means for determining the efficacy of interventions.

321 citations

References
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Journal ArticleDOI
TL;DR: Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups.
Abstract: Context Little is known about lifetime prevalence or age of onset of DSM-IV disorders. Objective To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Design and Setting Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Participants Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Main Outcome Measures Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Results Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. Conclusions About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.

17,213 citations


"Anxiety disorders in older adults: ..." refers background or methods or result in this paper

  • ...Indeed, the NCS-R used projected lifetime risk analyses to determine that fewer than 1% of individuals will develop an anxiety disorder after the age of 65.([7]) Specifically, fewer than 1% of individuals will develop: (a) PD after age 62; (b) SP after age 64; (c) SOP after age 52; (d) GAD after age 74; (e) PTSD after age 71; and (f) OCD after age 54....

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  • ...6%,([7]) indicating that GAD may be chronic and stable over time....

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  • ...8% for all adults over the age of 18.([7]) Similarly, data from a large Australian nationally representative sample were used to compare the prevalence of PTSD across age groups for those who reported experiencing a traumatic event....

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  • ...2% in 18–29 year olds.([7]) These findings suggest that, overall, anxiety disorders are more prevalent among younger adults than older adults....

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  • ...The onset of PTSD in late life is somewhat higher than the average across anxiety disorders, with 5% developing a new case after the age of 61 and 10% after the age of 53.([7]) Given the linkage of the diagnosis of PTSD with the occurrence of traumatic events, it is not surprising that age of onset may be more variable across the lifespan than is the case for other anxiety 195 Review: Anxiety in Older Adults...

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Journal ArticleDOI
TL;DR: One-month prevalence results were determined from 18571 persons interviewed in the first-wave community samples of all five sites that constituted the National Institute of Mental Health Epidemilogic Catchment Area Program as mentioned in this paper.
Abstract: • One-month prevalence results were determined from 18571 persons interviewed in the first-wave community samples of all five sites that constituted the National Institute of Mental Health Epidemilogic Catchment Area Program. US population estimates, based on combined site data, were that 15.4% of the population 18 years of age and over fulfilled criteria for at least one alcohol, drug abuse, or other mental disorder during the period one month before interview. Higher prevalence rates of most mental disorders were found among younger people (

1,663 citations

Journal ArticleDOI
TL;DR: Findings lend support to recent life span theories of emotion and indicate that personality, contextual, and sociodemographic variables, as well as their interactions, are all needed to fully understand the age-affect relationship.
Abstract: The effect of age on happiness, as defined by positive and negative affect, was examined in a survey of 2,727 persons of a broad age range (25-74) conducted by the MacArthur Foundation Research Network on Successful Midlife Development. The age-affect association was examined, controlling for a host of sociodemograp hic, personality, and contextual influences. Among women, age was related to positive affect nonlineariy but was unrelated to negative affect. Among men, age interacted with 2 key variables in predicting affect: extraversion and marital status. These findings lend support to recent life span theories of emotion and indicate that personality, contextual, and sociodemographic variables, as well as their interactions, are all needed to fully understand the age-affect relationship.

1,457 citations

Journal ArticleDOI
TL;DR: Age differences in emotional experience over the adult life span were explored, focusing on the frequency, intensity, complexity, and consistency of emotional experience in everyday life, and individual factor analyses computed for each participant revealed that age was associated with more differentiated emotional experience.
Abstract: Age differences in emotional experience over the adult life span were explored, focusing on the frequency, intensity, complexity, and consistency of emotional experience in everyday life. One hundred eighty-four people, age 18 to 94 years, participated in an experience-sampling procedure in which emotions were recorded across a 1-week period. Age was unrelated to frequency of positive emotional experience. A curvilinear relationship best characterized negative emotional experience. Negative emotions declined in frequency until approximately age 60, at which point the decline ceased. Individual factor analyses computed for each participant revealed that age was associated with more differentiated emotional experience. In addition, periods of highly positive emotional experience were more likely to endure among older people and periods of highly negative emotional experience were less stable. Findings are interpreted within the theoretical framework of socioemotional selectivity theory.

1,449 citations

Journal ArticleDOI
TL;DR: Epidemiological evidence covering prevalence, incidence, course, and risk factors of anxiety disorders among children and adolescents is reviewed for improved early recognition and differential diagnosis as well as prevention and treatment.

1,351 citations


"Anxiety disorders in older adults: ..." refers methods in this paper

  • ...It is generally agreed that the majority of anxiety disorders develop sometime between childhood and young adulthood.([20,21]) Indeed, the NCS-R used projected lifetime risk analyses to determine that fewer than 1% of individuals will develop an anxiety disorder after the age of 65....

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