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Anxiety Disorders in Late Life: An Evolving Picture

Published online by Cambridge University Press:  07 November 2014

Eric J. Lenze ,
M. Katherine Shear ,
Benoit H. Mulsant  and
Charles F. Reynolds III
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Abstract

Although anxiety disorders are the most prevalent group of disorders in the United States, little is known about the efficacy of treatments for these disorders in elderly patients. Anxiety disorders, especially generalized anxiety disorder and phobias, are highly prevalent in older people. Anxiety symptoms and disorders are associated with increased mortality and disability in older people. Risk factors for anxiety disorders include chronic medical illness, disability, low education, low social network, and poor social support. The newer antidepressant medications, in particular the selective serotonin reuptake inhibitors and venlafaxine-extended relief, are recommended as first-line pharmacotherapy of these disorders in elderly. Cognitive-behavioral therapy is recommended as first-line psychotherapy for these disorders. However, these recommendations are based on extrapolation of data from younger adults or retrospective analysis of datasets, the results need to be confirmed with controlled studies in an elderly age group.

Type
Feature Article
Information
CNS Spectrums , Volume 7 , Issue 11: Late-life Depression and Dementia , November 2002 , pp. 805 - 810
Copyright
Copyright © Cambridge University Press 2002

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References

REFERENCES

1.Regier, DA, Boyd, JH, Burke, JD, et al.One-month prevalence of mental disorders in the United States. Based on five Epidemiologic Catchment Area sites. Arch Gen Psychiatry. 1988;45:977–986.CrossRefGoogle ScholarPubMed
2.Murray, CJL, Lopez, AD. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020. Cambridge, MA: World Health Organization and Harvard University Press; 1996.Google Scholar
3.Wetherell, JL, Gatz, M, Pedersen, NL. A longitudinal analysis of anxiety and depressive symptoms. Psychol Aging. 2001;16:187–195.CrossRefGoogle ScholarPubMed
4.Harman, JS, Rollman, BL, Hanusa, BH, Lenze, EJ, Shear, MK. Physician office visits of adults for anxiety disorders in the United States: 1985-1998. J Gen Intern Med. 2002;17:165–172.CrossRefGoogle ScholarPubMed
5.Flint, AJ. Epidemiology and comorbidity of anxiety disorders in the elderly. Am J Psychiatry. 1994;151:640–649.Google ScholarPubMed
6.Jorm, AF. Does old age reduce the risk of anxiety and depression? A review of epidemiological studies across the adult life span. Psychol Med. 2000; 30:11–22.CrossRefGoogle ScholarPubMed
7.Beekman, AT, Bremmer, MA, Deeg, DJ, et al.Anxiety disorders in later life: a report from the Longitudinal Aging Study Amsterdam. Int J Geriatr Psychiatry. 1998;13:717–726.3.0.CO;2-M>CrossRefGoogle ScholarPubMed
8.Manela, M, Katona, C, Livingston, G. How common are the anxiety disorders in old age? Int J Geriatr Psychiatry. 1996;11:65–70.3.0.CO;2-M>CrossRefGoogle Scholar
9.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;155:317–329.CrossRefGoogle Scholar
10.Goenjian, AK, Najarian, LM, Pynoos, RS, et al.Posttraumatic stress disorder in elderly and younger adults after the 1988 earthquake in Armenia. Am J Psychiatry. 1994;151:895–901.Google ScholarPubMed
11.Davidson, JR, Hughes, D, Blazer, DG, George LK. Post-traumatic stress disorder in the community: an epidemiological study. Psychol Med. 1991;21:713–721.CrossRefGoogle ScholarPubMed
12.Madakasira, S, O'Brien, KF. Acute posttraumatic stress disorder in victims of a natural disaster. J Nerv Ment Dis. 1987;175:286–290.CrossRefGoogle ScholarPubMed
13.Averill, PM, Beck, JG. Posttraumatic stress disorder in older adults: a conceptual review. J Anxiety Disord. 2000;14:133–156.CrossRefGoogle ScholarPubMed
14.Sembi, S, Tarrier, N, O'Neill, P, Burns, A, Faragher, B. Does post-traumatic stress disorder occur after stroke: a preliminary study. Int J Geriatr Psychiatry. 1998;13:315–322.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
15.Dew, MA, Roth, LH, Schulberg, HC, et al.Prevalence and predictors of depression and anxiety-related disorders during the year after heart transplantation. Gen Hosp Psychiatry 1996;18(suppl 6):48S–61S.CrossRefGoogle ScholarPubMed
16.de Beurs, E, Beekman, A, Geerlings, S, et al.On becoming depressed or anxious in late life: similar vulnerability factors but different effects of stressful life events. Br J Psychiatry. 2001;179:426–431.CrossRefGoogle ScholarPubMed
17.Penninx, BW, Beekman, ATF, Honig, A, et al.Depression and cardiac mortality: results from a community-based longitudinal study. Arch Gen Psychiatry. 2001;58:221–227.CrossRefGoogle ScholarPubMed
18.Watkins, LL, Grossman, P, Krishnan, R, Blumenthal, JA. Anxiety reduces baroreflex cardiac control in older adults with major depression. Psychosom Med. 1999;61:334–340.CrossRefGoogle ScholarPubMed
19.Lane, D, Carroll, D, Ring, C, Beevers, DG, Lip, GY. Mortality and quality of life 12 months after myocardial infarction: effects of depression and anxiety. Psychosom Med. 2001;63:221–230.CrossRefGoogle ScholarPubMed
20.Herrmann, C, Brand-Driehorst, S, Buss, U, Rueger, U. Effects of anxiety and depression on 5-year mortality in 5,057 patients referred for exercise testing. J Psychosom Res. 2000;48:455–462.CrossRefGoogle Scholar
21.Grasbeck, A, Rorsman, B, Hagnell, O, Isberg, PE. Mortality of anxiety syndromes in a normal population. The Lundby study. Neuropsychobiology. 2002;33:118–126.CrossRefGoogle Scholar
22.Lavretsky, H, Bastani, R, Gould, R, et al.Predictors of two-year mortality in a prospective “upbeat” study of elderly veterans with comorbid medical and psychiatric symptoms. Am J Geriatr Psychiatry. 2002;10:458–468.Google Scholar
23.Moser, DK, Dracup, K. Is anxiety early after myocardial infarction associated with subsequent ischemic and arrhythmic events? Psychosom Med. 1996;58:395–401.CrossRefGoogle ScholarPubMed
24.Lenze, EJ, Rogers, JC, Martire, LM, et al.The association of late-life depression and anxiety with physical disability: a review of the literature and prospectus for future research. Am J Geriatr Psychiatry 2001;9:113–135.CrossRefGoogle ScholarPubMed
25.Astrom, M. Generalized anxiety disorder in stroke patients. A 3-year longitudinal study. Stroke. 1996;27:270–275.CrossRefGoogle ScholarPubMed
26.DeBeurs, E, Beekman, ATF, van Balkom, AJ, et al.Consequences of anxiety in older persons: its effect on disability, well-being and use of health services. Psychol Med. 1999;29:583–593.CrossRefGoogle Scholar
27.Bond, J, Gregson, B, Smith, M. Outcomes following acute hospital care for stroke or hip fracture: how useful is an assessment of anxiety or depression for older people? Int J Geriatr Psychiatry. 1998;13:610.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
28.Salaffi, F, Cavalieri, F, Nolli, M. Analysis of disability in knee osteoarthritis: relationship with age and psychological variables but not with radiographic score. J Rheumatol. 1991;18:1586.Google Scholar
29.Tinetti, ME, Inouye, SK, Gill, TM, Doucette, JT. Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. JAMA. 1995;273:1348–1353.CrossRefGoogle ScholarPubMed
30.Sullivan, MD, LaCroix, AZ, Baum, C, Grothaus, LC, Katon, WJ. Functional status in coronary artery disease: a one-year prospective study of the role of anxiety and depression. Am J Med. 1997;103:348–356.CrossRefGoogle ScholarPubMed
31.Casten, RJ, Parmelee, PA, Kleban, MH, Lawton, MP, Katz, IR. The relationships among anxiety, depression, and pain in a geriatric institutionalized sample. Pain. 1995;61:271–276.CrossRefGoogle Scholar
32.Bresolin, N, Monza, G, Scarpini, E, et al.Treatment of anxiety with ketazolam in elderly patients. Clin Ther. 1988;10:536–542.Google ScholarPubMed
33.Koepke, HH, Gold, RL, Linden, ME, Lion, JR, Rickels, K. Multicenter controlled study of oxazepam in anxious elderly outpatients. Psychosomatics. 1982;23:641–645.CrossRefGoogle ScholarPubMed
34.Hanlon, JT, Homer, RD, Schmader, KE, et al.Benzodiazepine use and cognitive function among community-dwelling elderly. Clin Pharmacol Ther. 1998;64:684–692.CrossRefGoogle ScholarPubMed
35.Leipzig, RM, Cumming, RG, Tinetti, ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc. 1999;47:30–39.CrossRefGoogle ScholarPubMed
36.Ray, WA, Griffin, MR, Downey, W. Benzodiazepines of long and short elimination half-life and the risk of hip fracture. JAMA. 1989;262:3303–3307.CrossRefGoogle ScholarPubMed
37.Pomara, N, Tun, H, DaSilva, D, et al.The acute and chronic performance effects of alprazolam and lorazepam in the elderly: relationship to duration of treatment and self-rated sedation. Psychopharmacol Bull. 1998;34:139–153.Google ScholarPubMed
38.Buysse, DJ, Reynolds, CF, Houck, PR, Begley, A, Kupfer, DJ. Does adjunctive lorazepam impair the antidepressant response to nortriptyline in elderly depressed patients? Sleep Res. 1996;25:153.Google Scholar
39.Furukawa, TA, Streiner, DL, Young, LT. Is antidepressant-benzodiazepine combination therapy clinically more useful? A meta-analytic study. J Affect Disord. 2001;65:173–177.CrossRefGoogle ScholarPubMed
40.Joo, JH, Lenze, EJ, Mulsant, BH, et al.Risk factors for falls during treatment of late-life depression. J Clin Psychiatry. In press.Google Scholar
41.Bohm, C, Robinson, DS, Gammans, RE, Shrotriya, RC, Alms, DR, Leroy, A.et al.Buspirone therapy in anxious elderly patients: a controlled clinical trial. J Clin Psychopharmacol. 1990; 10(suppl):47S–51S.CrossRefGoogle ScholarPubMed
42.Wylie, ME, Miller, MD, Shear, MK, et al.Fluvoxamine pharmacotherapy of anxiety disorders in later life: preliminary open-trial data and a review of the literature. J Geriatr Psychiatry Neurol. 2000;13:43–48.CrossRefGoogle Scholar
43.Katz, IR, Reynolds, CF, Alexopoulos, GS, Hackett, D. Venlafaxine ER as a treatment for generalized anxiety disorder in older adults: pooled analysis of five randomized placebo-controlled clinical trials. J Am Geriatr Soc. 2002;50:18–24.CrossRefGoogle Scholar
44. National Institutes of Health. Computer Retrieval of Information on Scientific Projects. Available at: http:www-commons.cit.nih.gov/crisp. Accessed September 6, 2002.Google Scholar
45.Goodnick, PJ, Puig, A, De Vane, CL, Freund, BV. Mirtazapine in major depression with comorbid generalized anxiety disorder. J Clin Psychiatry. 2002;60:446–448.CrossRefGoogle Scholar
46.Ribeiro, L, Busnello, JV, Kauer-Sant'Anna, M, et al.Mirtazapine versus fluoxetine in the treatment of panic disorder. Braz J Med Biol Res. 2002;34:1303–1307.CrossRefGoogle Scholar
47.Pande, AC, Davidson, JR, Janney, JW, et al.Treatment of social phobia with gabapentin: a placebo-controlled study. J Clin Psychopharmacol. 2002;19:341–348.CrossRefGoogle Scholar
48.Pande, AC, Pollack, MH, Crockatt, J, et al.Placebo-controlled study of gabapentin treatment of panic disorder. J Clin Psychopharmacol. 2000;20:467–471.CrossRefGoogle ScholarPubMed
49.Butterfield, MI, Becker, ME, Connor, KM. Olanzapine in the treatment of posttraumatic sterss disorder: a pilot study. Clin Psychopharmacol. 2001;16:201.Google Scholar
50.Mintzer, J, Faison, W, Street, JS. Olanzapine in the treatment of anxiety symptoms due to Alzheimer's disease: a post-hoc analysis. Int J Geriatr Psychiatry. 2001;16:71–77.3.0.CO;2-M>CrossRefGoogle ScholarPubMed
51.Kaplan, M. Atypical antipsychotics for treatment of mixed depression and anxiety. J Clin Psychiatry. 2000;61:389.CrossRefGoogle ScholarPubMed
52.Weizman, R, Weizman, A. Use of atypical antipsychotics in mood disorders. Curr Opin Investig Drugs. 2001;2:945.Google ScholarPubMed
53.Miller, MD, Frank, E, Reynolds, CF. The art of clinical management in pharmacologic trials with depressed elderly patients—Lessons from the Pittsburgh study of maintenance therapies in late-life depression. Am J Geriatr Psychiatry. 1999;7:228–234.CrossRefGoogle ScholarPubMed
54.Stanley, MA, Beck, JG, Glassco, JD. Treatment of generalized anxiety in older adults: a preliminary comparison of cognitive-behavioral and supportive approaches. Behav Ther. 1996;27:565–581.CrossRefGoogle Scholar
55.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;69:756–762.CrossRefGoogle ScholarPubMed
56.Arean, PA, Hegel, MT, Reynolds, CF. Treating depression in older medical patients with psychotherapy. Journal of Clinical Geropsychology. 2001;7:93–104.CrossRefGoogle Scholar
57.Mohlman, J, Papp, L, Gorenstein, E, Kleber, M. Efficacy of two versions of individual CBT for late-life GAD. Paper presented at: Anxiety Disorders Association of American National Conference; March 21-24, 2002; Austin, TX.Google Scholar
58.Flint, AJ. Management of anxiety in late life. J Geriatr Psychiatry Neurol. 1998;11:194–200.CrossRefGoogle ScholarPubMed
59.Lenze, EJ, Mulsant, BH, Shear, MK, et al.Comorbid anxiety disorders in depressed elderly patients. Am J Psychiatry. 2000;157:722–728.CrossRefGoogle ScholarPubMed
60.Bartels, SJ, Coakley, E, Oxman, TE, et al.Suicidal and death ideation in older primary care patients with depression, anxiety and at-risk alcohol use. Am J Geriatr Psychiatry. In press.Google Scholar
61.Allgulander, C, Lavori, PW. Causes of death among 936 elderly patients with ‘pure’ anxiety neurosis in Stockholm County, Sweden, and in patients with depressive neurosis or both diagnoses. Compr Psychiatry. 1993;34:299–302.CrossRefGoogle ScholarPubMed
62.Flint, AJ, Rifat, SL. Anxious depression in elderly patients. Response to anti-depressant treatment. Am J Geriatr Psychiatry. 1997;5:107–115.Google Scholar
63.Dew, MA, Reynolds, CF, Houck, PR, et al.Temporal profiles of the course of depression during treatment: predictors of pathways toward recovery in the elderly. Arch Gen Psychiatry. 1997;54:1016–1024.CrossRefGoogle ScholarPubMed
64.Mulsant, BH, Reynolds, CF, Shear, MK, Sweet, RA, Miller, MD. Comorbid anxiety disorders in late-life depression. Anxiety. 1996;2:242–247.3.0.CO;2-O>CrossRefGoogle ScholarPubMed
65.Lenze, EJ, Mulsant, BH, Dew, MA, et al.Good treatment outcomes in late-life depression with comorbid anxiety. J Affect Disord. In press.Google Scholar