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Anxiety Disorders in the Elderly

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Anxiety Disorders

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 1191))

Abstract

Recent data has linked anxiety and its disorders in late life to increased morbidity and mortality, especially related to a higher cardiovascular burden and an increased cognitive decline. Clinically, anxiety symptoms may be more difficult to elicit in older adults who are less accurate in identifying anxiety symptoms and tend to minimize symptoms and to attribute symptoms to physical illness. Although SSRIs have proven more effective than psychotherapy in late-life anxiety, many elderly anxious subjects prefer psychotherapeutic interventions. These interventions appear to work best when tailored for the needs, expectations, and cultural background of older anxious subjects.

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References

  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(3):233–50.

    Article  PubMed  Google Scholar 

  2. Wolitzky-Taylor KB, Castriotta N, Lenze EJ, Stanley MA, Craske MG. Anxiety disorders in older adults: a comprehensive review. Depress Anxiety. 2010;27(2):190–211.

    Article  PubMed  Google Scholar 

  3. Andreescu C, Varon D. New research on anxiety disorders in the elderly and an update on evidence-based treatments. Curr Psychiatry Rep. 2015;17(7):595.

    Article  Google Scholar 

  4. Lewis-Fernández R, Hinton DE, Laria AJ, Patterson EH, Hofmann SG, Craske MG, et al. Culture and the anxiety disorders: recommendations for DSM-V. Depress Anxiety. 2010;27(2):212–29.

    Article  PubMed  PubMed Central  Google Scholar 

  5. 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(6):593–602.

    Article  PubMed  Google Scholar 

  6. Flint AJ. Epidemiology and comorbidity of anxiety disorders in later life: implications for treatment. Clin Neurosci. 1997;4(1):31–6.

    CAS  PubMed  Google Scholar 

  7. 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(10):717–26.

    Article  CAS  PubMed  Google Scholar 

  8. Porensky EK, Dew MA, Karp JF, Skidmore E, Rollman BL, Shear MK, et al. The burden of late-life generalized anxiety disorder: effects on disability, health-related quality of life, and healthcare utilization. Am J Geriatr Psychiatry. 2009;17(6):473–82.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Murray CJ, Atkinson C, Bhalla K, Birbeck G, Burstein R, Chou D, et al. The state of US health, 1990–2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310(6):591–608.

    Article  CAS  PubMed  Google Scholar 

  10. Goncalves DC, Byrne GJ. Sooner or later: age at onset of generalized anxiety disorder in older adults. Depress Anxiety. 2012;29(1):39–46.

    Article  PubMed  Google Scholar 

  11. Le Roux H, Gatz M, Wetherell JL. Age at onset of generalized anxiety disorder in older adults. Am J Geriatr Psychiatry. 2005;13(1):23–30.

    Article  PubMed  Google Scholar 

  12. Chou KL. Age at onset of generalized anxiety disorder in older adults. Am J Geriatr Psychiatry. 2009;17(6):455–64.

    Article  PubMed  Google Scholar 

  13. Baldwin DS, Anderson IM, Nutt DJ, Bandelow B, Bond A, Davidson JR, et al. Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2005;19(6):567–96.

    Article  CAS  PubMed  Google Scholar 

  14. Schoevers RA, Deeg DJ, van Tilburg W, Beekman AT. Depression and generalized anxiety disorder: co-occurrence and longitudinal patterns in elderly patients. Am J Geriatr Psychiatry. 2005;13(1):31–9.

    Article  PubMed  Google Scholar 

  15. Schoevers RA, Beekman AT, Deeg DJ, 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(11):994–1001.

    Article  CAS  PubMed  Google Scholar 

  16. Schuurmans J, Comijs HC, Beekman AT, de Beurs E, Deeg DJ, Emmelkamp PM, et al. The outcome of anxiety disorders in older people at 6-year follow-up: results from the longitudinal aging study Amsterdam. Acta Psychiatr Scand. 2005;111(6):420–8.

    Article  CAS  PubMed  Google Scholar 

  17. Lenze EJ, Wetherell JL. A lifespan view of anxiety disorders. Dialogues Clin Neurosci. 2011;13(4):381–99.

    PubMed  PubMed Central  Google Scholar 

  18. Lenze EJ, Hickman S, Hershey T, Wendleton L, Ly K, Dixon D, et al. Mindfulness-based stress reduction for older adults with worry symptoms and co-occurring cognitive dysfunction. Int J Geriatr Psychiatry. 2014;29(10):991–1000.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Golden J, Conroy RM, Bruce I, Denihan A, Greene E, Kirby M, et al. The spectrum of worry in the community-dwelling elderly. Aging Ment Health. 2011;15(8):985–94.

    Article  PubMed  Google Scholar 

  20. Sami MB, Nilforooshan R. The natural course of anxiety disorders in the elderly: a systematic review of longitudinal trials. Int Psychogeriatr. 2015;27(7):1061–9.

    Article  PubMed  Google Scholar 

  21. Zhang X, Norton J, Carriere I, Ritchie K, Chaudieu I, Ancelin ML. Generalized anxiety in community-dwelling elderly: prevalence and clinical characteristics. J Affect Disord. 2015;172:24–9.

    Article  PubMed  Google Scholar 

  22. 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. 2000;101(1):37–45.

    Article  PubMed  Google Scholar 

  23. Cairney J, Corna LM, Veldhuizen S, Herrmann N, Streiner DL. Comorbid depression and anxiety in later life: patterns of association, subjective Well-being, and impairment. Am J Geriatr Psychiatry. 2008;16(3):201–8.

    Article  PubMed  Google Scholar 

  24. 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(1):89–95.

    Article  CAS  PubMed  Google Scholar 

  25. Lenze EJ, Mulsant BH, Shear MK, Schulberg HC, Dew MA, Begley AE, et al. Comorbid anxiety disorders in depressed elderly patients. Am J Psychiatry. 2000;157(5):722–8.

    Article  CAS  PubMed  Google Scholar 

  26. Hopko DR, Bourland SL, Stanley MA, Beck JG, Novy DM, Averill PM, et al. Generalized anxiety disorder in older adults: examining the relation between clinician severity ratings and patient self-report measures. Depress Anxiety. 2000;12(4):217–25.

    Article  CAS  PubMed  Google Scholar 

  27. Jeste ND, Hays JC, Steffens DC. Clinical correlates of anxious depression among elderly patients with depression. J Affect Disord. 2006;90(1):37–41.

    Article  PubMed  Google Scholar 

  28. DeLuca AK, Lenze EJ, Mulsant BH, Butters MA, Karp JF, Dew MA, et al. Comorbid anxiety disorder in late life depression: association with memory decline over four years. Int J Geriatr Psychiatry. 2005;20(9):848–54.

    Article  PubMed  Google Scholar 

  29. Flint AJ, Rifat SL. Anxious depression in elderly patients. Response to antidepressant treatment. Am J Geriatr Psychiatry. 1997;5(2):107–15.

    CAS  PubMed  Google Scholar 

  30. BH M. In: BA W, editor. Psychological treatment of older adults: an introductory text. New York: Plenum Press; 1996. p. 91–101.

    Google Scholar 

  31. Andreescu C, Lenze EJ, Dew MA, Begley AE, Mulsant BH, Dombrovski AY, et al. Effect of comorbid anxiety on treatment response and relapse risk in late-life depression: controlled study. Br J Psychiatry. 2007;190:344–9.

    Article  PubMed  Google Scholar 

  32. Dombrovski AY, Lenze EJ, Dew MA, Mulsant BH, Pollock BG, Houck PR, et al. Maintenance treatment for old-age depression preserves health-related quality of life: a randomized, controlled trial of paroxetine and interpersonal psychotherapy. J Am Geriatr Soc. 2007;55(9):1325–32.

    Article  PubMed  Google Scholar 

  33. Schultz SK, Moser DJ, Bishop JR, Ellingrod VL. Phobic anxiety in late-life in relationship to cognition and 5HTTLPR polymorphism. Psychiatr Genet. 2005;15. England:305–6.

    Article  PubMed  Google Scholar 

  34. Butters MA, Bhalla RK, Andreescu C, Wetherell JL, Mantella R, Begley AE, et al. Changes in neuropsychological functioning following treatment for late-life generalised anxiety disorder. Br J Psychiatry. 2011;199(3):211–8.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Sinoff G, Werner P. Anxiety disorder and accompanying subjective memory loss in the elderly as a predictor of future cognitive decline. Int J Geriatr Psychiatry. 2003;18(10):951–9.

    Article  PubMed  Google Scholar 

  36. Andreescu C, Teverovsky E, Fu B, Hughes TF, Chang CC, Ganguli M. Old worries and new anxieties: behavioral symptoms and mild cognitive impairment in a population study. Am J Geriatr Psychiatry. 2014;22(3):274–84.

    Article  PubMed  Google Scholar 

  37. Palmer K, Berger AK, Monastero R, Winblad B, Backman L, Fratiglioni L. Predictors of progression from mild cognitive impairment to Alzheimer disease. Neurology. 2007;68(19):1596–602.

    Article  CAS  PubMed  Google Scholar 

  38. Forsell Y, Winblad B. Anxiety disorders in non-demented and demented elderly patients: prevalence and correlates. J Neurol Neurosurg Psychiatry. 1997;62(3):294–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Hwang TJ, Masterman DL, Ortiz F, Fairbanks LA, Cummings JL. Mild cognitive impairment is associated with characteristic neuropsychiatric symptoms. Alzheimer Dis Assoc Disord. 2004;18(1):17–21.

    Article  PubMed  Google Scholar 

  40. Geda YE, Smith GE, Knopman DS, Boeve BF, Tangalos EG, Ivnik RJ, et al. De novo genesis of neuropsychiatric symptoms in mild cognitive impairment (MCI). Int Psychogeriatr. 2004;16(1):51–60.

    Article  PubMed  Google Scholar 

  41. Seignourel PJ, Kunik ME, Snow L, Wilson N, Stanley M. Anxiety in dementia: a critical review. Clin Psychol Rev. 2008;28(7):1071–82.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Schulkin J, McEwen BS, Gold PW. Allostasis, amygdala, and anticipatory angst. Neurosci Biobehav Rev. 1994;18(3):385–96.

    Article  CAS  PubMed  Google Scholar 

  43. Mantella RC, Butters MA, Amico JA, Mazumdar S, Rollman BL, Begley AE, et al. Salivary cortisol is associated with diagnosis and severity of late-life generalized anxiety disorder. Psychoneuroendocrinology. 2008;33(6):773–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Narita K, Murata T, Hamada T, Kosaka H, Sudo S, Mizukami K, et al. Associations between trait anxiety, insulin resistance, and atherosclerosis in the elderly: a pilot cross-sectional study. Psychoneuroendocrinology. 2008;33(3):305–12.

    Article  CAS  PubMed  Google Scholar 

  45. Simon NM, Smoller JW, McNamara KL, Maser RS, Zalta AK, Pollack MH, et al. Telomere shortening and mood disorders: preliminary support for a chronic stress model of accelerated aging. Biol Psychiatry. 2006;60(5):432–5.

    Article  CAS  PubMed  Google Scholar 

  46. Sibille E, Su J, Leman S, Le Guisquet AM, Ibarguen-Vargas Y, Joeyen-Waldorf J, et al. Lack of serotonin1B receptor expression leads to age-related motor dysfunction, early onset of brain molecular aging and reduced longevity. Mol Psychiatry. 2007;12(11):1042–56.. 975

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Ballard C, Neill D, O’Brien J, McKeith IG, Ince P, Perry R. Anxiety, depression and psychosis in vascular dementia: prevalence and associations. J Affect Disord. 2000;59(2):97–106.

    Article  CAS  PubMed  Google Scholar 

  48. Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA. 2002;288(12):1475–83.

    Article  PubMed  Google Scholar 

  49. Starkstein SE, Jorge R, Petracca G, Robinson RG. The construct of generalized anxiety disorder in Alzheimer disease. Am J Geriatr Psychiatry. 2007;15(1):42–9.

    Article  PubMed  Google Scholar 

  50. Donovan NJ, Locascio JJ, Marshall GA, Gatchel J, Hanseeuw BJ, Rentz DM, et al. Longitudinal Association of Amyloid Beta and Anxious-Depressive Symptoms in Cognitively Normal Older Adults. Am J Psychiatry. 2018: appiajp201717040442.

    Google Scholar 

  51. Pietrzak RH, Lim YY, Neumeister A, Ames D, Ellis KA, Harrington K, et al. Amyloid-beta, anxiety, and cognitive decline in preclinical Alzheimer disease: a multicenter, prospective cohort study. JAMA Psychiat. 2015;72(3):284–91.

    Article  Google Scholar 

  52. Pietrzak RH, Scott JC, Neumeister A, Lim YY, Ames D, Ellis KA, et al. Anxiety symptoms, cerebral amyloid burden and memory decline in healthy older adults without dementia: 3-year prospective cohort study. Br J Psychiatry. 2014;204:400–1.

    Article  PubMed  Google Scholar 

  53. Krell-Roesch J, Lowe VJ, Neureiter J, Pink A, Roberts RO, Mielke MM, et al. Depressive and anxiety symptoms and cortical amyloid deposition among cognitively normal elderly persons: the Mayo Clinic study of aging. Int Psychogeriatr. 2018;30(2):245–51.

    Article  PubMed  Google Scholar 

  54. Andreescu C, Tudorascu D, Sheu LK, Rangarajan A, Butters MA, Walker S, et al. Brain structural changes in late-life generalized anxiety disorder. Psychiatry Res. 2017;268:15–21.

    Article  PubMed Central  Google Scholar 

  55. Bisht K, Sharma K, Tremblay ME. Chronic stress as a risk factor for Alzheimer’s disease: roles of microglia-mediated synaptic remodeling, inflammation, and oxidative stress. Neurobiol Stress. 2018;9:9–21.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Emdin CA, Odutayo A, Wong CX, Tran J, Hsiao AJ, Hunn BH. Meta-analysis of anxiety as a risk factor for cardiovascular disease. Am J Cardiol. 2016;118(4):511–9.

    Article  PubMed  Google Scholar 

  57. Delvecchio G, Stanley JA, Altamura AC, Brambilla P. Metabolic alterations in generalised anxiety disorder: a review of proton magnetic resonance spectroscopic studies. Epidemiol Psychiatr Sci. 2017;26(6):587–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Meier SM, Mattheisen M, Mors O, Mortensen PB, Laursen TM, Penninx BW. Increased mortality among people with anxiety disorders: total population study. Br J Psychiatry. 2016;209(3):216–21.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Byrne G, Rosenfeld G, Leung Y, Qian H, Raudzus J, Nunez C, et al. Prevalence of anxiety and depression in patients with inflammatory bowel disease. Can J Gastroenterol Hepatol. 2017;2017:6496727.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Lustman PJ, Griffith LS, Clouse RE, Cryer PE. Psychiatric illness in diabetes mellitus. Relationship to symptoms and glucose control. J Nerv Ment Dis. 1986;174(12):736–42.

    Article  CAS  PubMed  Google Scholar 

  61. Todaro JF, Shen BJ, Raffa SD, Tilkemeier PL, Niaura R. Prevalence of anxiety disorders in men and women with established coronary heart disease. J Cardiopulm Rehabil Prev. 2007;27(2):86–91.

    Article  PubMed  Google Scholar 

  62. Ittermann T, Volzke H, Baumeister SE, Appel K, Grabe HJ. Diagnosed thyroid disorders are associated with depression and anxiety. Soc Psychiatry Psychiatr Epidemiol. 2015;50(9):1417–25.

    Article  PubMed  Google Scholar 

  63. Tully PJ, Baker RA, Knight JL. Anxiety and depression as risk factors for mortality after coronary artery bypass surgery. J Psychosom Res. 2008;64(3):285–90.

    Article  PubMed  Google Scholar 

  64. Machado S, Sancassiani F, Paes F, Rocha N, Murillo-Rodriguez E, Nardi AE. Panic disorder and cardiovascular diseases: an overview. Int Rev Psychiatry. 2017;29(5):436–44.

    Article  PubMed  Google Scholar 

  65. Lambiase MJ, Kubzansky LD, Thurston RC. Prospective study of anxiety and incident stroke. Stroke. 2014;45(2):438–43.

    Article  PubMed  Google Scholar 

  66. Tully PJ, Harrison NJ, Cheung P, Cosh S. Anxiety and cardiovascular disease risk: a review. Curr Cardiol Rep. 2016;18(12):120.

    Article  PubMed  Google Scholar 

  67. Simoni-Wastila L, Yang HK. Psychoactive drug abuse in older adults. Am J Geriatr Pharmacother. 2006;4(4):380–94.

    Article  PubMed  Google Scholar 

  68. Wu LT, Blazer DG. Substance use disorders and psychiatric comorbidity in mid and later life: a review. Int J Epidemiol. 2014;43(2):304–17.

    Article  PubMed  Google Scholar 

  69. Wu LT, Blazer DG. Illicit and nonmedical drug use among older adults: a review. J Aging Health. 2011;23(3):481–504.

    Article  PubMed  Google Scholar 

  70. Schulden JD, Lopez MF, Compton WM. Clinical implications of drug abuse epidemiology. Psychiatr Clin North Am. 2012;35(2):411–23.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Maree RD, Marcum ZA, Saghafi E, Weiner DK, Karp JF. A systematic review of opioid and benzodiazepine misuse in older adults. Am J Geriatr Psychiatry. 2016;24(11):949–63.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Airagnes G, Pelissolo A, Lavallee M, Flament M, Limosin F. Benzodiazepine misuse in the elderly: risk factors, consequences, and management. Curr Psychiatry Rep. 2016;18(10):89.

    Article  PubMed  Google Scholar 

  73. Markota M, Rummans TA, Bostwick JM, Lapid MI. Benzodiazepine use in older adults: dangers, management, and alternative therapies. Mayo Clin Proc. 2016;91(11):1632–9.

    Article  CAS  PubMed  Google Scholar 

  74. Bogunovic OJ, Greenfield SF. Practical geriatrics: use of benzodiazepines among elderly patients. Psychiatr Serv. 2004;55(3):233–5.

    Article  PubMed  Google Scholar 

  75. Minerbi A, Hauser W, Fitzcharles MA. Medical Cannabis for older patients. Drugs Aging. 2019;36(1):39–51.

    Article  PubMed  Google Scholar 

  76. Smith JP, Randall CL. Anxiety and alcohol use disorders: comorbidity and treatment considerations. Alcohol Res. 2012;34(4):414–31.

    PubMed  PubMed Central  Google Scholar 

  77. Pasche S. Exploring the comorbidity of anxiety and substance use disorders. Curr Psychiatry Rep. 2012;14(3):176–81.

    Article  PubMed  Google Scholar 

  78. Therrien Z, Hunsley J. Assessment of anxiety in older adults: a systematic review of commonly used measures. Aging Ment Health. 2012;16(1):1–16.

    Article  PubMed  Google Scholar 

  79. Wetherell JL, Petkus AJ, McChesney K, Stein MB, Judd PH, Rockwell E, et al. Older adults are less accurate than younger adults at identifying symptoms of anxiety and depression. J Nerv Ment Dis. 2009;197(8):623–6.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Flint A, Bradwejn J, Vaccarino F, Gutkowska J, Palmour R, Koszycki D. Aging and panicogenic response to cholecystokinin tetrapeptide: an examination of the cholecystokinin system. Neuropsychopharmacology. 2002;27(4):663–71.

    CAS  PubMed  Google Scholar 

  81. Gagnon N, Flint AJ, Naglie G, Devins GM. Affective correlates of fear of falling in elderly persons. Am J Geriatr Psychiatry. 2005;13(1):7–14.

    Article  PubMed  Google Scholar 

  82. Roane DM, Landers A, Sherratt J, Wilson GS. Hoarding in the elderly: a critical review of the recent literature. Int Psychogeriatr. 2017;29(7):1077–84.

    Article  PubMed  Google Scholar 

  83. Andreescu C, Belnap BH, Rollman BL, Houck P, Ciliberti C, Mazumdar S, et al. Generalized anxiety disorder severity scale validation in older adults. Am J Geriatr Psychiatry. 2008;16(10):813–8.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Balsamo M, Cataldi F, Carlucci L, Fairfield B. Assessment of anxiety in older adults: a review of self-report measures. Clin Interv Aging. 2018;13:573–93.

    Article  PubMed  PubMed Central  Google Scholar 

  85. 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(3):583–93.

    Article  PubMed  Google Scholar 

  86. Sirey JA, Bruce ML, Alexopoulos GS, Perlick DA, Friedman SJ, Meyers BS. Stigma as a barrier to recovery: perceived stigma and patient-rated severity of illness as predictors of antidepressant drug adherence. Psychiatr Serv. 2001;52(12):1615–20.

    Article  CAS  PubMed  Google Scholar 

  87. Arean PA, Alvidrez J, Barrera A, Robinson GS, Hicks S. Would older medical patients use psychological services? Gerontologist. 2002;42(3):392–8.

    Article  PubMed  Google Scholar 

  88. Mohlman J. A community based survey of older adults’ preferences for treatment of anxiety. Psychol Aging. 2012;27(4):1182–90.

    Article  PubMed  Google Scholar 

  89. 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(8):639–51.

    Article  PubMed  Google Scholar 

  90. Goncalves DC, Byrne GJ. Interventions for generalized anxiety disorder in older adults: systematic review and meta-analysis. J Anxiety Disord. 2012;26(1):1–11.

    Article  PubMed  Google Scholar 

  91. Pollock B, Forsyth C, Bies R. The critical role of clinical pharmacology in geriatric psychopharmacology. Clin Pharmacol Ther. 2009;85(1):89–93.

    Article  PubMed  Google Scholar 

  92. B.H. M. In: Thakur MB, Blazer DG, Steffens, DC, editor. Clinical manual of geriatric psychiatry. Washington DC: American Psychiatric Publishing, Inc; 2014.

    Google Scholar 

  93. Zubenko GS, Sunderland T. Geriatric psychopharmacology: why does age matter? Harv Rev Psychiatry. 2000;7(6):311–33.

    Article  CAS  PubMed  Google Scholar 

  94. Brooks JO, Hoblyn JC. Neurocognitive costs and benefits of psychotropic medications in older adults. J Geriatr Psychiatry Neurol. 2007;20(4):199–214.

    Article  PubMed  Google Scholar 

  95. Benitez CI, Smith K, Vasile RG, Rende R, Edelen MO, Keller MB. Use of benzodiazepines and selective serotonin reuptake inhibitors in middle-aged and older adults with anxiety disorders: a longitudinal and prospective study. Am J Geriatr Psychiatry. 2008;16(1):5–13.

    Article  PubMed  Google Scholar 

  96. Olfson M, Marcus SC, Wan GJ, Geissler EC. National trends in the outpatient treatment of anxiety disorders. J Clin Psychiatry. 2004;65(9):1166–73.

    Article  PubMed  Google Scholar 

  97. Olfson M, King M, Schoenbaum M. Benzodiazepine use in the United States. JAMA Psychiat. 2015;72(2):136–42.

    Article  Google Scholar 

  98. Bresolin N, Monza G, Scarpini E, Scarlato G, Straneo G, Martinazzoli A, et al. Treatment of anxiety with ketazolam in elderly patients. Clin Ther. 1988;10(5):536–42.

    CAS  PubMed  Google Scholar 

  99. Koepke HH, Gold RL, Linden ME, Lion JR, Rickels K. Multicenter controlled study of oxazepam in anxious elderly outpatients. Psychosomatics. 1982;23(6):641–5.

    Article  CAS  PubMed  Google Scholar 

  100. 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(1):146–50.

    Article  PubMed  Google Scholar 

  101. Lenze EJ, Rollman BL, Shear MK, Dew MA, Pollock BG, Ciliberti C, et al. Escitalopram for older adults with generalized anxiety disorder: a randomized controlled trial. JAMA. 2009;301(3):295–303.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  102. Schuurmans J, Comijs H, Emmelkamp PM, Gundy CM, Weijnen I, van den Hout M, 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(3):255–63.

    Article  PubMed  Google Scholar 

  103. Katz IR, Reynolds CF 3rd, 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(1):18–25.

    Article  PubMed  Google Scholar 

  104. Davidson J, Allgulander C, Pollack MH, Hartford J, Erickson JS, Russell JM, et al. Efficacy and tolerability of duloxetine in elderly patients with generalized anxiety disorder: a pooled analysis of four randomized, double-blind, placebo-controlled studies. Hum Psychopharmacol. 2008;23(6):519–26.

    Article  CAS  PubMed  Google Scholar 

  105. Laghrissi-Thode F, Pollock BG, Miller MC, Mulsant BH, Altieri L, Finkel MS. Double-blind comparison of paroxetine and nortriptyline on the postural stability of late-life depressed patients. Psychopharmacol Bull. 1995;31(4):659–63.

    CAS  PubMed  Google Scholar 

  106. Gebara MA, Lipsey KL, Karp JF, Nash MC, Iaboni A, Lenze EJ. Cause or effect? Selective serotonin reuptake inhibitors and falls in older adults: a systematic review. Am J Geriatr Psychiatry. 2015;23(10):1016–28.

    Article  PubMed  Google Scholar 

  107. Kerse N, Flicker L, Pfaff JJ, Draper B, Lautenschlager NT, Sim M, et al. Falls, depression and antidepressants in later life: a large primary care appraisal. PLoS One. 2008;3(6):e2423.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  108. Yuan Y, Tsoi K, Hunt RH. Selective serotonin reuptake inhibitors and risk of upper GI bleeding: confusion or confounding? Am J Med. 2006;119(9):719–27.

    Article  CAS  PubMed  Google Scholar 

  109. Diem SJ, Blackwell TL, Stone KL, Yaffe K, Haney EM, Bliziotes MM, et al. Use of antidepressants and rates of hip bone loss in older women: the study of osteoporotic fractures. Arch Intern Med. 2007;167(12):1240–5.

    Article  PubMed  Google Scholar 

  110. Fabian TJ, Amico JA, Kroboth PD, Mulsant BH, Corey SE, Begley AE, et al. Paroxetine-induced hyponatremia in older adults: a 12-week prospective study. Arch Intern Med. 2004;164(3):327–32.

    Article  CAS  PubMed  Google Scholar 

  111. Baldwin DS, Waldman S, Allgulander C. Evidence-based pharmacological treatment of generalized anxiety disorder. Int J Neuropsychopharmacol. 2011;14(5):697–710.

    Article  CAS  PubMed  Google Scholar 

  112. Montgomery S, Chatamra K, Pauer L, Whalen E, Baldinetti F. Efficacy and safety of pregabalin in elderly people with generalised anxiety disorder. Br J Psychiatry. 2008;193(5):389–94.

    Article  PubMed  Google Scholar 

  113. Mokhber N, Azarpazhooh MR, Khajehdaluee M, Velayati A, Hopwood M. Randomized, single-blind, trial of sertraline and buspirone for treatment of elderly patients with generalized anxiety disorder. Psychiatry Clin Neurosci. 2010;64(2):128–33.

    Article  CAS  PubMed  Google Scholar 

  114. Merideth C, Cutler AJ, She F, Eriksson H. Efficacy and tolerability of extended release quetiapine fumarate monotherapy in the acute treatment of generalized anxiety disorder: a randomized, placebo controlled and active-controlled study. Int Clin Psychopharmacol. 2012;27(1):40–54.

    Article  PubMed  Google Scholar 

  115. Kreys TJ, Phan SV. A literature review of quetiapine for generalized anxiety disorder. Pharmacotherapy. 2015;35(2):175–88.

    Article  CAS  PubMed  Google Scholar 

  116. Mezhebovsky I, Magi K, She F, Datto C, Eriksson H. Double-blind, randomized study of extended release quetiapine fumarate (quetiapine XR) monotherapy in older patients with generalized anxiety disorder. Int J Geriatr Psychiatry. 2013;28(6):615–25.

    Article  PubMed  Google Scholar 

  117. Morinigo A, Blanco M, Labrador J, Martin J. Noval D. Risperidone for resistant anxiety in elderly persons. Am J Geriatr Psychiatry. 2005;13. England:81–2.

    Article  PubMed  Google Scholar 

  118. Finkel S, Kozma C, Long S, Greenspan A, Mahmoud R, Baser O, et al. Risperidone treatment in elderly patients with dementia: relative risk of cerebrovascular events versus other antipsychotics. Int Psychogeriatr. 2005;17(4):617–29.

    Article  PubMed  Google Scholar 

  119. Bullock R, Saharan A. Atypical antipsychotics: experience and use in the elderly. Int J Clin Pract. 2002;56(7):515–25.

    CAS  PubMed  Google Scholar 

  120. Gareri P, De Fazio P, Manfredi VG, De Sarro G. Use and safety of antipsychotics in behavioral disorders in elderly people with dementia. J Clin Psychopharmacol. 2014;34(1):109–23.

    Article  CAS  PubMed  Google Scholar 

  121. Ray WA, Chung CP, Murray KT, Hall K, Stein CM. Atypical antipsychotic drugs and the risk of sudden cardiac death. N Engl J Med. 2009;360(3):225–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  122. Schutters SI, Van Megen HJ, Van Veen JF, Denys DA, Westenberg HG. Mirtazapine in generalized social anxiety disorder: a randomized, double-blind, placebo-controlled study. Int Clin Psychopharmacol. 2010;25(5):302–4.

    Article  PubMed  Google Scholar 

  123. Rampello L, Alvano A, Raffaele R, Malaguarnera M, Vecchio I. New possibilities of treatment for panic attacks in elderly patients: escitalopram versus citalopram. J Clin Psychopharmacol. 2006;26(1):67–70.

    Article  CAS  PubMed  Google Scholar 

  124. Sheikh JI, Lauderdale SA, Cassidy EL. Efficacy of sertraline for panic disorder in older adults: a preliminary open-label trial. Am J Geriatr Psychiatry. 2004;12. England:230.

    Article  PubMed  Google Scholar 

  125. English BA, Jewell M, Jewell G, Ambrose S, Davis LL. Treatment of chronic posttraumatic stress disorder in combat veterans with citalopram: an open trial. J Clin Psychopharmacol. 2006;26(1):84–8.

    Article  CAS  PubMed  Google Scholar 

  126. Chung MY, Min KH, Jun YJ, Kim SS, Kim WC, Jun EM. Efficacy and tolerability of mirtazapine and sertraline in Korean veterans with posttraumatic stress disorder: a randomized open label trial. Hum Psychopharmacol. 2004;19(7):489–94.

    Article  CAS  PubMed  Google Scholar 

  127. Raskind MA, Peskind ER, Hoff DJ, Hart KL, Holmes HA, Warren D, et al. A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder. Biol Psychiatry. 2007;61(8):928–34.

    Article  CAS  PubMed  Google Scholar 

  128. Hofmann SG, Smits JA. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry. 2008;69(4):621–32.

    Article  PubMed  PubMed Central  Google Scholar 

  129. 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(2):309–19.

    Article  PubMed  Google Scholar 

  130. Wetherell JL, Gatz M, Craske MG. Treatment of generalized anxiety disorder in older adults. J Consult Clin Psychol. 2003;71(1):31–40.

    Article  PubMed  Google Scholar 

  131. Thorp SR, Ayers CR, Nuevo R, Stoddard JA, Sorrell JT, Wetherell JL. Meta-analysis comparing different behavioral treatments for late-life anxiety. Am J Geriatr Psychiatry. 2009;17(2):105–15.

    Article  PubMed  PubMed Central  Google Scholar 

  132. Wetherell JLHD, Diefenbach GJ, et al. Cognitive-behavioral therapy for late-life generalized anxiety disorder: who gets better? Behav Ther. 2005;36:147–56.

    Article  Google Scholar 

  133. Mohlman J, Gorman JM. The role of executive functioning in CBT: a pilot study with anxious older adults. Behav Res Ther. 2005;43(4):447–65.

    Article  PubMed  Google Scholar 

  134. Mohlman J. Executive skills in older adults with GAD: relations with clinical variables and CBT outcome. J Anxiety Disord. 2013;27(1):131–9.

    Article  PubMed  Google Scholar 

  135. Mohlman J, Price RB, Vietri J. Attentional bias in older adults: effects of generalized anxiety disorder and cognitive behavior therapy. J Anxiety Disord. 2013;27(6):585–91.

    Article  PubMed  Google Scholar 

  136. 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(5):756–62.

    Article  CAS  PubMed  Google Scholar 

  137. Stanley MA, Wilson N, Shrestha S, Amspoker AB, Armento M, Cummings JP, et al. Calmer life: a culturally tailored intervention for anxiety in underserved older adults. Am J Geriatr Psychiatry. 2016;24(8):648–58.

    Article  PubMed  Google Scholar 

  138. Brenes GA, Danhauer SC, Lyles MF, Anderson A, Miller ME. Effects of telephone-delivered cognitive-behavioral therapy and nondirective supportive therapy on sleep, health-related quality of life, and disability. Am J Geriatr Psychiatry. 2016;24(10):846–54.

    Article  PubMed  PubMed Central  Google Scholar 

  139. Hobbs MJ, Mahoney AEJ, Andrews G. Integrating iCBT for generalized anxiety disorder into routine clinical care: treatment effects across the adult lifespan. J Anxiety Disord. 2017;51:47–54.

    Article  PubMed  Google Scholar 

  140. Wetherell JL, Stoddard JA, White KS, Kornblith S, Nguyen H, Andreescu C, et al. Augmenting antidepressant medication with modular CBT for geriatric generalized anxiety disorder: a pilot study. Int J Geriatr Psychiatry. 2011;26(8):869–75.

    Article  PubMed  Google Scholar 

  141. Wetherell JL, Ayers CR, Sorrell JT, Thorp SR, Nuevo R, Belding W, et al. Modular psychotherapy for anxiety in older primary care patients. Am J Geriatr Psychiatry. 2009;17(6):483–92.

    Article  PubMed  PubMed Central  Google Scholar 

  142. Hazlett-Stevens H, Singer J, Chong A. Mindfulness-based stress reduction and mindfulness-based cognitive therapy with older adults: a qualitative review of randomized controlled outcome research. Clin Gerontol. 2018;

    Google Scholar 

  143. Wetherell JL, Afari N, Ayers CR, Stoddard JA, Ruberg J, Sorrell JT, et al. Acceptance and commitment therapy for generalized anxiety disorder in older adults: a preliminary report. Behav Ther. 2011;42(1):127–34.

    Article  PubMed  Google Scholar 

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Andreescu, C., Lee, S. (2020). Anxiety Disorders in the Elderly. In: Kim, YK. (eds) Anxiety Disorders. Advances in Experimental Medicine and Biology, vol 1191. Springer, Singapore. https://doi.org/10.1007/978-981-32-9705-0_28

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