Late-life Anxiety Disorders: A Review

Abstract

Anxiety disorders are a major clinical problem in late life; estimated prevalence rates vary from 6% to 10%, and the disease impact is considerable and equal to that of depression. However, anxiety disorders often remain undetected and untreated in older adults. This discrepancy may be accounted for by a combination of patient variables (eg, a lack of help-seeking behavior and long duration of illness) and variables related to current clinical practice (eg, a lack of knowledge regarding late-life anxiety and ageism). Because anxiety disorders usually have an age at onset earlier in life, patients and mental health professionals may be inclined to attribute the anxiety and avoidance symptoms to personality factors instead of a treatable syndrome. Comorbidity with other psychiatric disorders, such as depressive disorder, may complicate the appropriate diagnosis. Identification may be further obscured because the phenomenology of anxiety disorders in older adults tends to differ from the phenomenology in younger adults. Randomized controlled trials have yielded support for the effectiveness of cognitive-behavioral therapy and serotonergic antidepressants. However, both treatments seem hampered by relatively high dropout rates, and the available data are based primarily on a relatively healthy, well-educated, and "young" older population. The dissemination of knowledge regarding late-life anxiety disorders is vital, as evidence-based treatments are available but are still rarely implemented.

Specialist prescribing of psychotropic drugs to older persons in Sweden - a register-based study of 188 024 older persons

“…Improved knowledge of geriatric psychiatry, including alternative treatments for older persons with mental disorders, would likely lead to the decrease in inappropriate prescription of drugs. However, although previous research has provided strong evidence on how to improve the care of older persons with mental disorders, translation into practice is rare [41,42]. Older persons with mental disorders are consequently subjected to lack of evidence-based care.…”

Ageism in Mental Health Assessment and Treatment of Older Adults

“…At times this will result in the underdiagnosis of depression. Schuurmans and Balkom (2011) point to the fact that while there is a high prevalence of anxiety disorders in late life, these disorders are not easily diagnosed in older adults. The authors opine that older adults with anxiety use avoidance behaviors and thus run "under the radar" -resulting in significant underidentification and under-diagnosis.…”

“…This tendency is pronounced in long-term care facilities, where a particularly high consumption is reported for benzodiazepines, antipsychotics and antidepressants (Anrys et al 2016). These trends continue despite clear evidence of the heightened risks of certain medications for the elderly -including accidents and falls, cognitive impairment, and a development of tolerance and addiction to these drugs -and despite the existence of evidence-based guidelines for prescribing (Schuurmans and Balkom 2011).…”

Systematic Review of the Clinical Application of Exposure Techniques to Community-Dwelling Older Adults with Anxiety

“…For many years, most researchers viewed late-life anxiety as a low prevalence condition and considered data gathered from younger adults to be generalizable across age groups (Schuurmans & van Balkom, 2011). Equally important is fragmentation of the information generated across studies, which occurs because the fear-eliciting stimulus can vary from object thought to situation thought or physiological state across anxiety conditions (Abramowitz, Deacon, & Whiteside, 2011).…”