Obsessive-Compulsive Disorder in Older Adults: A Comprehensive Literature Review

Abstract

We reviewed English-language articles concerning obsessive-compulsive disorder (OCD) in older adults. PubMed was searched using key words that included obsessive-compulsive disorder, geriatric, elderly, aging, and older. Of the 644 articles identified, we included 78 that were relevant to the topic. Articles that were excluded as irrelevant included studies that were not focused on OCD in older adults, animal studies, and older case reports if we identified similar more recent case reports. The literature contains very little information about the epidemiology, diagnosis, psychopathology, and treatment of OCD in older adults. Even though the diagnostic criteria for OCD are the same for older and younger adults, different manifestations and progression in older patients have been reported. While the domains and severity of symptoms of OCD do not change with age, pathologic doubt may worsen. The Yale-Brown Obsessive Compulsive Scale is used for diagnosing and evaluating illness severity, and the Obsessive-Compulsive Inventory-Revised is another valuable tool for use in older adults. Psychotherapy, specifically exposure and response prevention, is the first-line treatment for OCD because of minimal adverse effects and reported benefit. Although the US Food and Drug Administration has not approved any medications specifically for OCD in older adults, pharmacotherapy is a consideration if psychotherapy is not successful. Selective serotonin reuptake inhibitors have the fewest side effects, while the cardiovascular and anticholinergic side effects of tricyclic antidepressants are especially worrisome in older adults. OCD in older adults has received little attention, and further studies are needed.

High Intensive Exposure and Response Prevention in the Treatment of Obsessive-Compulsive Disorder for a 72-year-Old Man

“…This indicates that most older adults have a long duration of the illness, which likely negatively effects their treatment outcome (Grant et al, 2007). However, little is known about treatment options for older adults (Jazi & Asghar-Ali, 2020), and clinicians often adhere to the guidelines for adults aged 18–65 years.…”

“…For example, there has been no randomized controlled trial (RCT) of ERP in older adults with OCD (Hendriks et al, 2021). Only a few case studies have reported successful outcomes with weekly CBT, weekly CBT in combination with medication, and frequent CBT sessions in a clinical setting (Hendriks et al, 2008; Jazi & Asghar-Ali, 2020; Price & Salsman, 2010).…”