Advertisement

Anxiety Disorders

  • Rajesh R. Tampi
  • Deena J. Tampi
  • Suneela Cherlopalle
  • Silpa Balachandran
Chapter

Abstract

Available evidence indicates that anxiety symptoms are very common among older adults. Although not as prevalent as anxiety symptoms, diagnosable anxiety disorders are not uncommon in these individuals. Anxiety symptoms and disorders add to the morbidities associated with aging and significantly worsen outcomes among the elderly including greater rates of mortality. Despite significant advances in the diagnosis of psychiatric disorders among older adults, anxiety disorders are often under-recognized and misdiagnosed in this population. Growing evidence from controlled studies indicate that both psychotherapy and pharmacotherapy are as effective in treating anxiety disorders among the elderly as they are in the younger population.

Keywords

Anxiety disorders Generalized anxiety disorder Panic disorder Obsessive-compulsive disorder Post-traumatic stress disorder Cognitive behavioral therapy 

References

  1. 1.
    Aging Statistics. https://aoa.acl.gov/Aging_Statistics/index.aspx. Accessed 19 Dec 2016.
  2. 2.
    Mental health and older adults. http://www.who.int/mediacentre/factsheets/fs381/en/. Accessed 19 Dec 2016.
  3. 3.
    Reynold K, Pietrzak RH, El-Gabalawy R, Mackenzie CS, Sareen J. Prevalence of psychiatric disorders in U.S. older adults: findings from a nationally representative survey. World Psychiatry. 2015;14(1):74–81.CrossRefGoogle Scholar
  4. 4.
    Flint AJ. Epidemiology and comorbidity of anxiety disorders in the elderly. Am J Psychiatry. 1994;151(5):640–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Wetherell JL, Lenze EJ, Stanley MA. Evidence-based treatment of geriatric anxiety disorders. Psychiatr Clin North Am. 2005;28(4):871–96.CrossRefPubMedGoogle Scholar
  6. 6.
    Olfson M, Broadhead EW, Weissman MM, et al. Subthreshold psychiatric symptoms in a primary care group practice. Arch Gen Psychiatry. 1996;53:880–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Himmelfarb S, Murrell SA. The prevalence and correlates of anxiety symptoms in older adults. J Psychol. 1984;116(2d Half):159–67.CrossRefPubMedGoogle Scholar
  8. 8.
    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(10):717–26.CrossRefPubMedGoogle Scholar
  9. 9.
    van Zelst WH, de Beurs E, Beekman AT, et al. Prevalence and risk factors of posttraumatic stress disorder in older adults. Psychother Psychosom. 2003;72(6):333–42.CrossRefPubMedGoogle Scholar
  10. 10.
    Kessler RC, Berglund P, Demler O, et al. 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.CrossRefPubMedGoogle Scholar
  11. 11.
    Grenier S, Préville M, Boyer R, et al. The impact of DSM-IV symptom and clinical significance criteria on the prevalence estimates of subthreshold and threshold anxiety in the older adult population. Am J Geriatr Psychiatry. 2011;19(4):316–26.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Hettema JM, Neale MC, Kendler KS. A review and meta-analysis of the genetic epidemiology of anxiety disorders. Am J Psychiatry. 2001;158(10):1568–78.CrossRefPubMedGoogle Scholar
  13. 13.
    Bienvenu OJ, Hettema JM, Neale MC, et al. Low extraversion and high neuroticism as indices of genetic and environmental risk for social phobia, agoraphobia, and animal phobia. Am J Psychiatry. 2007;164(11):1714–21.CrossRefPubMedGoogle Scholar
  14. 14.
    Afifi TO, Asmundson GJ, Taylor S, Jang KL. The role of genes and environment on trauma exposure and posttraumatic stress disorder symptoms: a review of twin studies. Clin Psychol Rev. 2010;30(1):101–12.CrossRefPubMedGoogle Scholar
  15. 15.
    Etkin A, Wager TD. Functional neuroimaging of anxiety: a meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. Am J Psychiatry. 2007;164(10):1476–88.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Woon FL, Sood S, Hedges DW. Hippocampal volume deficits associated with exposure to psychological trauma and posttraumatic stress disorder in adults: a meta-analysis. Prog Neuro-Psychopharmacol Biol Psychiatry. 2010;34(7):1181–8.CrossRefGoogle Scholar
  17. 17.
    Irle E, Ruhleder M, Lange C, et al. Reduced amygdalar and hippocampal size in adults with generalized social phobia. J Psychiatry Neurosci. 2010;35(2):126–31.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Pertusa A, Frost RO, Fullana MA, et al. Refining the diagnostic boundaries of compulsive hoarding: a critical review. Clin Psychol Rev. 2010;30(4):371–8618.CrossRefPubMedGoogle Scholar
  19. 19.
    Saxena S. Neurobiology and treatment of compulsive hoarding. CNS Spectr. 2008;13(9 Suppl 14):29–36.CrossRefPubMedGoogle Scholar
  20. 20.
    Lenze EJ, Mantella RC, Shi P, et al. Elevated cortisol in older adults with generalized anxiety disorder is reduced by treatment: a placebo-controlled evaluation of escitalopram. Am J Geriatr Psychiatry. 2011;19(5):482–90.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Marks IM, Nesse RM. Fear and fitness: an evolutionary analysis of anxiety disorders. Ethol Sociobiol. 1994;15:247–61.CrossRefGoogle Scholar
  22. 22.
    Lydiard RB. The role of GABA in anxiety disorders. J Clin Psychiatry. 2003;64(suppl 3):21–7.PubMedGoogle Scholar
  23. 23.
    Tinetti ME, Inouye SK, Gill TM, et al. Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. JAMA. 1995;273(17):1381–3.CrossRefGoogle Scholar
  24. 24.
    Dew MA, Karp JF, 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.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    de Beurs E, Beekman AT, 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(3):583–93.CrossRefPubMedGoogle Scholar
  26. 26.
    Porensky EK, Dew MA, Karp JF, 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.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Vasiliadis HM, Dionne PA, Préville M, et al. The excess healthcare costs associated with depression and anxiety. Am J Geriatr Psychiatry. 2013;21(6):536–48.CrossRefPubMedGoogle Scholar
  28. 28.
    Beekman AT, de Beurs E, van Balkom AJ, et al. Anxiety and depression in later life: co-occurrence and communality of risk factors. Am J Psychiatry. 2000;157(1):89–95.CrossRefPubMedGoogle Scholar
  29. 29.
    van Balkom AJ, Beekman AT, de Beurs E, et al. Comorbidity of the anxiety disorders in a community-based older population in The Netherlands. Acta Psychiatr Scand. 2000;101(1):37–45.CrossRefPubMedGoogle Scholar
  30. 30.
    Schoevers RA, Deeg DJ, van Tilburg W, et al. Depression and generalized anxiety disorder: co-occurrence and longitudinal patterns in elderly patients. Am J Geriatr Psychiatry. 2005;13(1):31–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Mackenzie CS, Reynolds K, Chou KL, et al. Prevalence and correlates of generalized anxiety disorder in a national sample of older adults. Am J Geriatr Psychiatry. 2011;19(4):305–15.CrossRefPubMedGoogle Scholar
  32. 32.
    Wilson RS, Begeny CT, Boyle PA, et al. Vulnerability to stress, anxiety, and development of dementia in old age. Am J Geriatr Psychiatry. 2011;19(4):327–34.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Potvin O, Forget H, Grenier S, et al. Anxiety, depression, and 1-year incident cognitive impairment in community-dwelling older adults. J Am Geriatr Soc. 2011;59(8):1421–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Ivan MC, Amspoker AB, Nadorff MR, et al. Alcohol use, anxiety, and insomnia in older adults with generalized anxiety disorder. Am J Geriatr Psychiatry. 2014;22(9):875–83.CrossRefPubMedGoogle Scholar
  35. 35.
    Kirchner JE, Zubritsky C, Cody M, et al. Alcohol consumption among older adults in primary care. J Gen Intern Med. 2007;22(1):92–7.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    El-Gabalawy R, Mackenzie CS, Shooshtari S, Sareen J. Comorbid physical health conditions and anxiety disorders: a population-based exploration of prevalence and health outcomes among older adults. Gen Hosp Psychiatry. 2011;33(6):556–64.CrossRefPubMedGoogle Scholar
  37. 37.
    van Hout HP, Beekman AT, de Beurs E, et al. Anxiety and the risk of death in older men and women. Br J Psychiatry. 2004;185:399–404.CrossRefPubMedGoogle Scholar
  38. 38.
    Holwerda TJ, Schoevers RA, Dekker J, et al. The relationship between generalized anxiety disorder, depression and mortality in old age. Int J Geriatr Psychiatry. 2007;22(3):241–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Calleo J, Stanley MA, Greisinger A, et al. Generalized anxiety disorder in older medical patients: diagnostic recognition, mental health management and service utilization. J Clin Psychol Med Settings. 2009;16(2):178–85.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Wittchen HU, Kessler RC, Beesdo K, Krause P, Höfler M, Hoyer J. Generalized anxiety and depression in primary care: prevalence, recognition, and management. J Clin Psychiatry. 2002;63(Suppl 8):24–34.PubMedGoogle Scholar
  41. 41.
    Kogan JN, Edelstein BA, McKee DR. Assessment of anxiety in older adults: current status. J Anxiety Disord. 2000;14(2):109–32.CrossRefPubMedGoogle Scholar
  42. 42.
    Seignourel PJ, Kunik ME, Snow L, et al. Anxiety in dementia: a critical review. Clin Psychol Rev. 2008;28(7):1071–82.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Stanley MA, Beck JG. Anxiety disorders. Clin Psychol Rev. 2000;20(6):731–54.CrossRefPubMedGoogle Scholar
  44. 44.
    Beck JG, Stanley MA, Zebb BJ. Characteristics of generalized anxiety disorder in older adults: a descriptive study. Behav Res Ther. 1996;34(3):225–34.CrossRefPubMedGoogle Scholar
  45. 45.
    Stanley MA, Beck JG, Zebb BJ. Psychometric properties of four anxiety measures in older adults. Behav Res Ther. 1996;34(10):827–38.CrossRefPubMedGoogle Scholar
  46. 46.
    van't Veer-Tazelaar PJ, van Marwijk HW, van Oppen P, et al. Stepped-care prevention of anxiety and depression in late life: a randomized controlled trial. Arch Gen Psychiatry. 2009;66(3):297–304.CrossRefGoogle Scholar
  47. 47.
    van't Veer-Tazelaar P, Smit F, van Hout H, et al. Cost-effectiveness of a stepped care intervention to prevent depression and anxiety in late life: randomised trial. Br J Psychiatry. 2010;196(4):319–25.CrossRefGoogle Scholar
  48. 48.
    van't Veer-Tazelaar PJ, van Marwijk HW, van Oppen P, et al. Prevention of late-life anxiety and depression has sustained effects over 24 months: a pragmatic randomized trial. Am J Geriatr Psychiatry. 2011;19(3):230–9.CrossRefGoogle Scholar
  49. 49.
    Blay SL, Marinho V. Anxiety disorders in old age. Curr Opin Psychiatry. 2012;25(6):462–7.CrossRefPubMedGoogle Scholar
  50. 50.
    Barrowclough C, King P, Colville J, et al. 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.CrossRefPubMedGoogle Scholar
  51. 51.
    Wetherell JL, Gatz M, Craske MG. Treatment of generalized anxiety disorder in older adults. J Consult Clin Psychol. 2003;71(1):31–40.CrossRefPubMedGoogle Scholar
  52. 52.
    Stanley MA, Beck JG, Novy DM, et al. Cognitive-behavioral treatment of late-life generalized anxiety disorder. J Consult Clin Psychol. 2003;71(2):309–19.CrossRefPubMedGoogle Scholar
  53. 53.
    Gorenstein EE, Kleber MS, Mohlman J, et al. Cognitive-behavioral therapy for management of anxiety and medication taper in older adults. Am J Geriatr Psychiatry. 2005;13(10):901–9.CrossRefPubMedGoogle Scholar
  54. 54.
    Schuurmans J, Comijs H, Emmelkamp PM, 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.CrossRefPubMedGoogle Scholar
  55. 55.
    Stanley MA, Wilson NL, Novy DM, et al. Cognitive behavior therapy for generalized anxiety disorder among older adults in primary care: a randomized clinical trial. JAMA. 2009;301(14):1460–7.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Wetherell JL, Ayers CR, Sorrell JT, et al. Modular psychotherapy for anxiety in older primary care patients. Am J Geriatr Psychiatry. 2009;17(6):483–92.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Nordhus IH, Pallesen S. Psychological treatment of late-life anxiety: an empirical review. J Consult Clin Psychol. 2003;71(4):643–51.CrossRefPubMedGoogle Scholar
  58. 58.
    Thorp SR, Ayers CR, Nuevo R, et al. Meta-analysis comparing different behavioral treatments for late-life anxiety. Am J Geriatr Psychiatry. 2009;17(2):105–15.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Hall J, Kellett S, Berrios R, et al. Efficacy of cognitive behavioral therapy for generalized anxiety disorder in older adults: systematic review, meta-analysis, and meta-regression. Am J Geriatr Psychiatry. 2016;24(11):1063–73.CrossRefPubMedGoogle Scholar
  60. 60.
    Sheikh JI, Swales PJ. Treatment of panic disorder in older adults: a pilot study comparison of alprazolam, imipramine, and placebo. Int J Psychiatry Med. 1999;29(1):107–17.CrossRefPubMedGoogle Scholar
  61. 61.
    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.CrossRefPubMedGoogle Scholar
  62. 62.
    Lenze EJ, Mulsant BH, Shear MK, 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.CrossRefPubMedGoogle Scholar
  63. 63.
    Alaka KJ, Noble W, Montejo A, et al. Efficacy and safety of duloxetine in the treatment of older adult patients with generalized anxiety disorder: a randomized, double-blind, placebo-controlled trial. Int J Geriatr Psychiatry. 2014;29(9):978–86.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    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.CrossRefPubMedGoogle Scholar
  65. 65.
    Bresolin N, Monza G, Scarpini E, et al. Treatment of anxiety with ketazolam in elderly patients. Clin Ther. 1988;10(5):536–42.PubMedGoogle Scholar
  66. 66.
    Frattola L, Piolti R, Bassi S, et al. Effects of alpidem in anxious elderly outpatients: a double-blind, placebo-controlled trial. Clin Neuropharmacol. 1992;15(6):477–87.CrossRefPubMedGoogle Scholar
  67. 67.
    Small GW, Bystritsky A. Double-blind, placebo-controlled trial of two doses of abecarnil for geriatric anxiety. J Clin Psychiatry. 1997;58(Suppl 11):24–9.PubMedGoogle Scholar
  68. 68.
    By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–46.CrossRefGoogle Scholar
  69. 69.
    Wetherell JL, Petkus AJ, White KS, et al. Antidepressant medication augmented with cognitive-behavioral therapy for generalized anxiety disorder in older adults. Am J Psychiatry. 2013;170(7):782–9.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Bower ES, Wetherell JL, Mon T, Lenze EJ. Treating anxiety disorders in older adults: current treatments and future directions. Harv Rev Psychiatry. 2015;23(5):329–42.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Rajesh R. Tampi
    • 1
  • Deena J. Tampi
    • 2
  • Suneela Cherlopalle
    • 1
  • Silpa Balachandran
    • 1
  1. 1.Case Western Reserve University School of Medicine and MetrohealthClevelandUSA
  2. 2.Diamond HealthcareRichmondUSA

Personalised recommendations