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. 1999 Nov;45:2672–2679.

Anxiety disorders in late life.

A J Flint 1
PMCID: PMC2328686  PMID: 10587775

Abstract

OBJECTIVE: To review the epidemiology, clinical characteristics, and treatment of anxiety disorders in late life. QUALITY OF EVIDENCE: Epidemiologic and comorbidity data are derived from well designed random-sample community surveys. There are virtually no controlled data specific to treatment of anxiety in the elderly. Guidelines for treating anxiety disorders in late life, therefore, must be extrapolated from results of randomized controlled trials conducted in younger patients. MAIN MESSAGE: Generalized anxiety disorder and agoraphobia account for most cases of anxiety disorder in late life. Late-onset generalized anxiety is usually associated with depressive illness and, in this situation, the primary pharmacologic treatment is antidepressant medication. Most elderly people with agoraphobia do not give a history of panic attacks; exposure therapy is the preferred treatment for agoraphobia without panic. CONCLUSIONS: Physicians need to make more use of antidepressant medication and behavioural therapy and less use of benzodiazepines in treating anxiety disorders in late life.

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Selected References

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  1. Austin L. S., Zealberg J. J., Lydiard R. B. Three cases of pharmacotherapy of obsessive-compulsive disorder in the elderly. J Nerv Ment Dis. 1991 Oct;179(10):634–635. doi: 10.1097/00005053-199110000-00009. [DOI] [PubMed] [Google Scholar]
  2. Blanchard M. R., Waterreus A., Mann A. H. The nature of depression among older people in inner London, and the contact with primary care. Br J Psychiatry. 1994 Mar;164(3):396–402. doi: 10.1192/bjp.164.3.396. [DOI] [PubMed] [Google Scholar]
  3. Bland R. C., Newman S. C., Orn H. Prevalence of psychiatric disorders in the elderly in Edmonton. Acta Psychiatr Scand Suppl. 1988;338:57–63. doi: 10.1111/j.1600-0447.1988.tb08548.x. [DOI] [PubMed] [Google Scholar]
  4. Calamari J. E., Faber S. D., Hitsman B. L., Poppe C. J. Treatment of obsessive compulsive disorder in the elderly: a review and case example. J Behav Ther Exp Psychiatry. 1994 Jun;25(2):95–104. doi: 10.1016/0005-7916(94)90001-9. [DOI] [PubMed] [Google Scholar]
  5. Copeland J. R., Dewey M. E., Wood N., Searle R., Davidson I. A., McWilliam C. Range of mental illness among the elderly in the community. Prevalence in Liverpool using the GMS-AGECAT package. Br J Psychiatry. 1987 Jun;150:815–823. doi: 10.1192/bjp.150.6.815. [DOI] [PubMed] [Google Scholar]
  6. Copeland J. R., Gurland B. J., Dewey M. E., Kelleher M. J., Smith A. M., Davidson I. A. Is there more dementia, depression and neurosis in New York? A comparative study of the elderly in New York and London using the computer diagnosis AGECAT. Br J Psychiatry. 1987 Oct;151:466–473. doi: 10.1192/bjp.151.4.466. [DOI] [PubMed] [Google Scholar]
  7. De Boer M., Op den Velde W., Falger P. J., Hovens J. E., De Groen J. H., Van Duijn H. Fluvoxamine treatment for chronic PTSD: a pilot study. Psychother Psychosom. 1992;57(4):158–163. doi: 10.1159/000288593. [DOI] [PubMed] [Google Scholar]
  8. Flint A. J. Epidemiology and comorbidity of anxiety disorders in the elderly. Am J Psychiatry. 1994 May;151(5):640–649. doi: 10.1176/ajp.151.5.640. [DOI] [PubMed] [Google Scholar]
  9. Flint A. J., Rifat S. L. Two-year outcome of elderly patients with anxious depression. Psychiatry Res. 1997 Jan 15;66(1):23–31. doi: 10.1016/s0165-1781(96)02964-2. [DOI] [PubMed] [Google Scholar]
  10. Forsell Y., Winblad B. Anxiety disorders in non-demented and demented elderly patients: prevalence and correlates. J Neurol Neurosurg Psychiatry. 1997 Mar;62(3):294–295. doi: 10.1136/jnnp.62.3.294. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Forsell Y., Winblad B. Feelings of anxiety and associated variables in a very elderly population. Int J Geriatr Psychiatry. 1998 Jul;13(7):454–458. doi: 10.1002/(sici)1099-1166(199807)13:7<454::aid-gps795>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
  12. Gilbert A., Owen N., Innes J. M., Sansom L. Trial of an intervention to reduce chronic benzodiazepine use among residents of aged-care accommodation. Aust N Z J Med. 1993 Aug;23(4):343–347. doi: 10.1111/j.1445-5994.1993.tb01433.x. [DOI] [PubMed] [Google Scholar]
  13. Goenjian A. K., Najarian L. M., Pynoos R. S., Steinberg A. M., Manoukian G., Tavosian A., Fairbanks L. A. Posttraumatic stress disorder in elderly and younger adults after the 1988 earthquake in Armenia. Am J Psychiatry. 1994 Jun;151(6):895–901. doi: 10.1176/ajp.151.6.895. [DOI] [PubMed] [Google Scholar]
  14. Jenike M. A. Geriatric obsessive-compulsive disorder. J Geriatr Psychiatry Neurol. 1991 Jan-Mar;4(1):34–39. doi: 10.1177/089198879100400107. [DOI] [PubMed] [Google Scholar]
  15. Jonas B. S., Franks P., Ingram D. D. Are symptoms of anxiety and depression risk factors for hypertension? Longitudinal evidence from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. Arch Fam Med. 1997 Jan-Feb;6(1):43–49. doi: 10.1001/archfami.6.1.43. [DOI] [PubMed] [Google Scholar]
  16. Kawachi I., Sparrow D., Vokonas P. S., Weiss S. T. Symptoms of anxiety and risk of coronary heart disease. The Normative Aging Study. Circulation. 1994 Nov;90(5):2225–2229. doi: 10.1161/01.cir.90.5.2225. [DOI] [PubMed] [Google Scholar]
  17. Kennedy B. L., Schwab J. J. Utilization of medical specialists by anxiety disorder patients. Psychosomatics. 1997 Mar-Apr;38(2):109–112. doi: 10.1016/S0033-3182(97)71478-6. [DOI] [PubMed] [Google Scholar]
  18. Klein D. F. Anxiety reconceptualized. Compr Psychiatry. 1980 Nov-Dec;21(6):411–427. doi: 10.1016/0010-440x(80)90043-7. [DOI] [PubMed] [Google Scholar]
  19. Kluznik J. C., Speed N., Van Valkenburg C., Magraw R. Forty-year follow-up of United States prisoners of war. Am J Psychiatry. 1986 Nov;143(11):1443–1446. doi: 10.1176/ajp.143.11.1443. [DOI] [PubMed] [Google Scholar]
  20. Kohn R., Westlake R. J., Rasmussen S. A., Marsland R. T., Norman W. H. Clinical features of obsessive-compulsive disorder in elderly patients. Am J Geriatr Psychiatry. 1997 Summer;5(3):211–215. doi: 10.1097/00019442-199700530-00004. [DOI] [PubMed] [Google Scholar]
  21. Kuch K., Cox B. J. Symptoms of PTSD in 124 survivors of the Holocaust. Am J Psychiatry. 1992 Mar;149(3):337–340. doi: 10.1176/ajp.149.3.337. [DOI] [PubMed] [Google Scholar]
  22. Leng N. A brief review of cognitive-behavioural treatments in old age. Age Ageing. 1985 Sep;14(5):257–263. doi: 10.1093/ageing/14.5.257. [DOI] [PubMed] [Google Scholar]
  23. Lindesay J., Briggs K., Murphy E. The Guy's/Age Concern survey. Prevalence rates of cognitive impairment, depression and anxiety in an urban elderly community. Br J Psychiatry. 1989 Sep;155:317–329. [PubMed] [Google Scholar]
  24. Lindesay J. Phobic disorders in the elderly. Br J Psychiatry. 1991 Oct;159:531–541. doi: 10.1192/bjp.159.4.531. [DOI] [PubMed] [Google Scholar]
  25. Macleod A. D. The reactivation of post-traumatic stress disorder in later life. Aust N Z J Psychiatry. 1994 Dec;28(4):625–634. doi: 10.1080/00048679409080786. [DOI] [PubMed] [Google Scholar]
  26. Man G. C., Hsu K., Sproule B. J. Effect of alprazolam on exercise and dyspnea in patients with chronic obstructive pulmonary disease. Chest. 1986 Dec;90(6):832–836. doi: 10.1378/chest.90.6.832. [DOI] [PubMed] [Google Scholar]
  27. Menza M. A., Robertson-Hoffman D. E., Bonapace A. S. Parkinson's disease and anxiety: comorbidity with depression. Biol Psychiatry. 1993 Oct 1;34(7):465–470. doi: 10.1016/0006-3223(93)90237-8. [DOI] [PubMed] [Google Scholar]
  28. Moser D. K., Dracup K. Is anxiety early after myocardial infarction associated with subsequent ischemic and arrhythmic events? Psychosom Med. 1996 Sep-Oct;58(5):395–401. doi: 10.1097/00006842-199609000-00001. [DOI] [PubMed] [Google Scholar]
  29. Raj B. A., Corvea M. H., Dagon E. M. The clinical characteristics of panic disorder in the elderly: a retrospective study. J Clin Psychiatry. 1993 Apr;54(4):150–155. [PubMed] [Google Scholar]
  30. Regier D. A., Boyd J. H., Burke J. D., Jr, Rae D. S., Myers J. K., Kramer M., Robins L. N., George L. K., Karno M., Locke B. Z. One-month prevalence of mental disorders in the United States. Based on five Epidemiologic Catchment Area sites. Arch Gen Psychiatry. 1988 Nov;45(11):977–986. doi: 10.1001/archpsyc.1988.01800350011002. [DOI] [PubMed] [Google Scholar]
  31. Rickels K., Schweizer E., Csanalosi I., Case W. G., Chung H. Long-term treatment of anxiety and risk of withdrawal. Prospective comparison of clorazepate and buspirone. Arch Gen Psychiatry. 1988 May;45(5):444–450. doi: 10.1001/archpsyc.1988.01800290060008. [DOI] [PubMed] [Google Scholar]
  32. Robinson S., Rapaport J., Durst R., Rapaport M., Rosca P., Metzer S., Zilberman L. The late effects of Nazi persecution among elderly Holocaust survivors. Acta Psychiatr Scand. 1990 Oct;82(4):311–315. doi: 10.1111/j.1600-0447.1990.tb01391.x. [DOI] [PubMed] [Google Scholar]
  33. Rocca P., Fonzo V., Scotta M., Zanalda E., Ravizza L. Paroxetine efficacy in the treatment of generalized anxiety disorder. Acta Psychiatr Scand. 1997 May;95(5):444–450. doi: 10.1111/j.1600-0447.1997.tb09660.x. [DOI] [PubMed] [Google Scholar]
  34. Sheikh J. I., King R. J., Taylor C. B. Comparative phenomenology of early-onset versus late-onset panic attacks: a pilot survey. Am J Psychiatry. 1991 Sep;148(9):1231–1233. doi: 10.1176/ajp.148.9.1231. [DOI] [PubMed] [Google Scholar]
  35. Steinberg J. R. Anxiety in elderly patients. A comparison of azapirones and benzodiazepines. Drugs Aging. 1994 Nov;5(5):335–345. doi: 10.2165/00002512-199405050-00003. [DOI] [PubMed] [Google Scholar]
  36. Sutker P. B., Allain A. N., Jr, Winstead D. K. Psychopathology and psychiatric diagnoses of World War II Pacific theater prisoner of war survivors and combat veterans. Am J Psychiatry. 1993 Feb;150(2):240–245. doi: 10.1176/ajp.150.2.240. [DOI] [PubMed] [Google Scholar]
  37. Uhlenhuth E. H., Balter M. B., Mellinger G. D., Cisin I. H., Clinthorne J. Symptom checklist syndromes in the general population. Correlations with psychotherapeutic drug use. Arch Gen Psychiatry. 1983 Nov;40(11):1167–1173. doi: 10.1001/archpsyc.1983.01790100013001. [DOI] [PubMed] [Google Scholar]

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