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Late-life Anxiety Disorders: A Review

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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.

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References

Papers of particular interest, published recently, have been highlighted as: • Of Importance •• Of major importance

  1. Bryant C, Jackson H, Ames D. The prevalence of anxiety in older adults: methodological issues and a review of the literature. J Affect Disord. 2008;109:233–50.

    Article  PubMed  Google Scholar 

  2. Beekman AT, Bremmer MA, Deeg DJ, van Balkom AJ, Smit JH, De Beurs E, et al. Anxiety disorders in later life: a report from the Longitudinal Aging Study Amsterdam. Int J Geriatr Psychiatry. 1998;13:717–26.

    Article  PubMed  CAS  Google Scholar 

  3. Grant BF. Prevalence, correlates, co-morbidity and comparative disability of DSM-IV generalized anxiety disorder in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychol Med. 2005;35:1747–59.

    Article  PubMed  Google Scholar 

  4. Wetherell JL, Thorp SR, Patterson TL, Golshan S, Jeste DV, Gatz M. Quality of life in geriatric generalized anxiety disorder: a preliminary investigation. J Psychiatr Res. 2004;38:305–12.

    Article  PubMed  Google Scholar 

  5. De Beurs E, Beekman AT, van Balkom AJ, Deeg DJ, van Dyck R, van Tilburg W. Consequences of anxiety in older persons: its effect on disability, well-being and use of health services. Psychol Med. 1999;29:583–93.

    Article  PubMed  Google Scholar 

  6. van Hout HP, Beekman AT, de Beurs E, Comijs H, van Marwijk H, de Haan M, et al. Anxiety and the risk of death in older men and women. Br J Psychiatry. 2004;185:399–404.

    Article  PubMed  Google Scholar 

  7. Crockett AJ, Cranston JM, Moss JR, Alpers JH. The impact of anxiety, depression and living alone in chronic obstructive pulmonary disease. Qual Life Res. 2004;11:309–16.

    Article  Google Scholar 

  8. Strik JLMH, Denollet J, Lousberg R, Honig A. Comparing symptoms of depression and anxiety as predictors of cardiac events and increased health care consumption after myocardial infarction. J Am Coll Cardiol. 2003;42:1801–7.

    Article  PubMed  Google Scholar 

  9. Huffman JC, Smith FA, Blais MA, Januzzi JL, Fricchione GL. Anxiety, independent of depressive symptoms, is associated with in-hospital cardiac complications after acute myocardial infarction. J Psychosom Res. 2008;65:557–63.

    Article  PubMed  Google Scholar 

  10. Kim HFS, Braun U, Kuni ME. Anxiety and depression in medically ill older adults. J Clin Geropsychol. 2001;7:117–30.

    Article  Google Scholar 

  11. Beekman AT, de Beurs E, van Balkom AJ, Deeg DJ, van Dyck R, van Tilburg W. Anxiety and depression in later life: co-occurrence and communality of risk factors. Am J Psychiatry. 2000;157:89–95.

    PubMed  CAS  Google Scholar 

  12. Schoevers RA, Beekman ATF, Deeg DJH, Jonker C, Van Tilburg W. Comorbidity and risk-patterns of depression, generalised anxiety disorder and mixed anxiety-depression in later life: results from the AMSTEL study. Int J Geriatr Psychiatry. 2003;18:994–1001.

    Article  PubMed  CAS  Google Scholar 

  13. Smalbrugge M, Pot AM, Jongenelis K, Beekman AT, Eefsting JA. Prevalence and correlates of anxiety among nursing home patients. J Affect Disord. 2005;88:145–53.

    Article  PubMed  CAS  Google Scholar 

  14. Bierman EJM, Comijs HC, Jonker C, Scheltens P, Beekman ATF. The effect of anxiety and depression on decline of memory function in Alzheimer’s disease. Int Psychogeriatr. 2009;21:1142–7.

    Article  PubMed  CAS  Google Scholar 

  15. Chemerinski E, Petracca G, Manes F, Leiguarda R, Starkstein SE. Prevalence and correlates of anxiety in Alzheimer’s disease. Depress Anxiety. 2005;7:166–70.

    Article  Google Scholar 

  16. van Balkom AJ, Beekman AT, De Beurs E, Deeg DJ, van Dyck R, van Tilburg W. Comorbidity of the anxiety disorders in a community-based older population in The Netherlands. Acta Psychiatr Scand. 2008;101:37–45.

    Article  Google Scholar 

  17. Janzing JGE, van Eijndhoven P. Gegeneraliseerde angst en dementie. een studie naar de effecten van risicofactoren en comorbiditeit. Tijdschr Psychiatr. 2007;49:S103–4.

    Google Scholar 

  18. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:593–602.

    Article  PubMed  Google Scholar 

  19. Le Roux H, Gatz M, Wetherell JL. Age at onset of generalized anxiety disorder in older adults. Am J Geriatr Psychiatry. 2005;13:23–30.

    PubMed  Google Scholar 

  20. Lenze EJ, Mulsant BH, Shear MK, Dew MA, Miller MD, Pollock BG, et al. Efficacy and tolerability of citalopram in the treatment of late-life anxiety disorders: results from an 8-week randomized, placebo-controlled trial. Am J Psychiatry. 2005;162:146–50.

    Article  PubMed  Google Scholar 

  21. Fuentes K, Cox B. Assessment of anxiety in older adults: a community-based survey and comparison with younger adults. Behav Res Ther. 2000;38:297–309.

    Article  PubMed  CAS  Google Scholar 

  22. Sheikh JI, Swales PJ, Carlson EB, Lindley SE. Aging and panic disorder. Phenomenology, co-morbidity and risk factors. Am J Geriatr Psychiatry. 2004;12:102–9.

    PubMed  Google Scholar 

  23. Jacobs M. [Psychodynamische psychotherapie]: Psychodynamic psychotherapy. [Leidraad Psychogeriatrie B2]: Guideline Psychogeriatrics B2. Deventer: Bohn Stafleu van Loghum; 1994.

    Google Scholar 

  24. Emmelkamp PMG. Behavior therapy with adults. In: Lambert M, editor. Bergin and Garfield’s handbook of psychotherapy and behavior change. 5th ed. New York: Wiley; 2004. p. 393–446.

    Google Scholar 

  25. Hendriks GJ, Oude Voshaar RC, Keijsers GP, Hoogduin CA, van Balkom AJ. Cognitive-behavioural therapy for late-life anxiety disorders: a systematic review and meta-analysis. Acta Psychiatr Scand. 2008;117:403–11.

    Article  PubMed  CAS  Google Scholar 

  26. Pinquart M, Duberstein PR. Treatment of anxiety disorders in older adults: a meta-analytic comparison of behavioral and pharmacological interventions. Am J Geriatr Psychiatry. 2007;15:639–51.

    Article  PubMed  Google Scholar 

  27. • Hendriks GJ, Keijsers GP, Kampman M, Oude Voshaar RC, Verbraak MJPM, Broekman TG, Hoogduin CAL. A randomized controlled study of paroxetine and cognitive-behavioral therapy for late-life panic disorder. Acta Psychiatrica Scandinavica 2010;122:11–9. This is the only published RCT on the treatment of late-life panic disorder, yielding similar effect sizes for CBT as those found in mixed-age populations.

    Article  PubMed  CAS  Google Scholar 

  28. Schuurmans J, Comijs H, Emmelkamp PM, Gundy CM, Weijnen I, van den Hout HM, et al. A randomized, controlled trial of the effectiveness of cognitive-behavioral therapy and sertraline versus a waitlist control group for anxiety disorders in older adults. Am J Geriatr Psychiatry. 2006;14:255–63.

    Article  PubMed  Google Scholar 

  29. Barrowclough C, King P, Colville J, Russell E, Burns A, Tarrier N. A randomized trial of the effectiveness of cognitive-behavioral therapy and supportive counseling for anxiety symptoms in older adults. J Consult Clin Psychol. 2001;69:756–62.

    Article  PubMed  CAS  Google Scholar 

  30. Mohlman J, Gorman JM. The role of executive functioning in CBT: a pilot study with anxious older adults. Behav Res Ther. 2003;43:447–65.

    Article  Google Scholar 

  31. • Stanley MA, Wilson NL, Novy DM, Rhoades HM, Wagener PD, Greisinger AJ, et al. Cognitive behavior therapy for generalized anxiety disorder among older adults in primary care: a randomized clinical trial. JAMA 2009;301:1460–7. This was the first RCT to test the effectiveness of CBT for late-life GAD delivered in primary care facilities; it yielded promising results.

    Article  PubMed  CAS  Google Scholar 

  32. •• Veer-Tazelaar, PJ, van Marwijk HW, van Oppen P, van Hout HP, van der Horst HE, Cuijpers P et al. Stepped-care prevention of anxiety and depression in late life: a randomized controlled trial. Arch Gen Psychiatry 2009;66:297–304. This RCT tested the effectiveness and feasibility of a stepped-care prevention program for late-life anxiety and depression in adults older than 75 years of age. It yielded impressive results in the successful recruitment of adults older than 75 years of age, as well as in providing evidence for the feasibility and effectiveness of a short problem-solving therapy intervention delivered by nurse practitioners in primary care.

    Article  Google Scholar 

  33. Emmelkamp PMG, van der Hout M. Failure in treating agoraphobia. In: Foa EB, Emmelkamp PMG, editors. Failures in behavior therapy. 1st ed. New York: Wiley; 1983. p. 58–81.

    Google Scholar 

  34. Issakidis C, Andrews G. Pre-treatment attrition and dropout in an outpatient clinic for anxiety disorders. Acta Psychiatr Scand. 2004;109:426–33.

    Article  PubMed  CAS  Google Scholar 

  35. Akkerman RL, Stanley MA, Averill PM, Novy DM, Snyder AG, Diefenbach GJ. Recruiting older adults with generalized anxiety disorder. J Ment Health Aging. 2001;7:385–94.

    Google Scholar 

  36. Wetherell JL, Gatz M. Recruiting anxious older adults for a psychotherapy outcome study. J Clin Geropsychol. 2001;7:29–38.

    Article  Google Scholar 

  37. Rapaport MH, Frevert T, Babior S, Seymour S, Zisook S, Kelsoe J, et al. Comparison of descriptive variables for symptomatic volunteers and clinical patients with anxiety disorders. Anxiety. 1996;2:117–22.

    Article  PubMed  CAS  Google Scholar 

  38. Stanley MA, Beck JG, Novy DM, Averill PM, Swann AC, Diefenbach GJ, et al. Cognitive-behavioral treatment of late-life generalized anxiety disorder. J Consult Clin Psychol. 2003;71:309–19.

    Article  PubMed  Google Scholar 

  39. Wetherell JL, Gatz M, Craske MG. Treatment of generalized anxiety disorder in older adults. J Consult Clin Psychol. 2003;71:31–40.

    Article  PubMed  Google Scholar 

  40. Mohlman J, Gorenstein EE, Kleber M, de Jesus M, Gorman JM, Papp LA. Standard and enhanced cognitive-behavior therapy for late-life generalized anxiety disorder: two pilot investigations. Am J Geriatr Psychiatry. 2003;11:24–32.

    PubMed  Google Scholar 

  41. Wang PS, Bohn RL, Glynn RJ, Mogun H, Avorn J. Hazardous benzodiazepine regimens in the elderly: effects of half-life, dosage, and duration on risk of hip fracture. Am J Psychiatry. 2001;158:892–8.

    PubMed  CAS  Google Scholar 

  42. Nordhus IH, Pallesen S. Psychological treatment of late-life anxiety: an empirical review. J Consult Clin Psychol. 2003;71:643–51.

    Article  PubMed  Google Scholar 

  43. French DD, Campbell R, Spehar A, Cunningham F, Foulis P. Outpatient medications and hip fractures in the US: a national veterans study. Drugs Aging. 2005;22:877–85.

    Article  PubMed  Google Scholar 

  44. Bourin M. Use of paroxetine for the treatment of depression and anxiety disorders in the elderly: a review. Hum Psychopharmacol. 2003;18:185–90.

    Article  PubMed  CAS  Google Scholar 

  45. Trimbosinstituut: [Addendum ouderen bij de MDR angststoornissen]. Addendum older adults to the multidisciplinary guidelines for anxiety disorders. www.ggzrichtlijnen.nl.

  46. Loebach Wetherell J, Maser JD, van Balkom AJLM. Anxiety disorders in the elderly: outdated beliefs and a research agenda. Acta Psychiatr Scand. 2005;111:401–2.

    Article  Google Scholar 

  47. van Balkom AJLM, Oosterbaan D. [Leiden richtlijnen tot een betere klinische praktijk?] Do guidelines improve common clinical practice? Tijdschr Psychiatr. 2008;50:323–8.

    PubMed  Google Scholar 

  48. Bijl RV, Ravelli A, van Zessen G. Prevalence of psychiatric disorder in the general population: results of the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Soc Psychiatry Psychiatr Epidemiol. 1998;33:587–95.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department for Older Adults, GGZinGeest, Osdorpplein 880, 1068 TD, Amsterdam, The Netherlands

    Josien Schuurmans

  2. Academic Department, VU Medical Centre/GGZinGeest and EMGO+Institute, Amsterdam, The Netherlands

    Anton van Balkom

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  1. Josien Schuurmans
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Correspondence to Josien Schuurmans.

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Schuurmans, J., van Balkom, A. Late-life Anxiety Disorders: A Review. Curr Psychiatry Rep 13, 267–273 (2011). https://doi.org/10.1007/s11920-011-0204-4

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