Skip to main content
SpringerLink
Log in

Anxiety Disorder in Older Adults

  • Chapter
  • First Online:
Book cover Primary Care Mental Health in Older People

Abstract

This chapter addresses anxiety disorders in late life, especially generalized anxiety disorder, which is highly prevalent and overloads health services. In addition, anxious patients usually have cognitive and social functioning decline, leading to a poorer quality of life. Despite this, it is a less studied topic than geriatric depression. Neurobiological research shows the involvement of the HPA axis, and basal cortisol levels are higher in those patients. The presentation of the symptoms is usually different in comparison with younger adults, and it is frequently comorbid with other psychiatric and physical diseases, complicating its management. The treatment should involve medicines, such as SSRIs and psychotherapy, especially cognitive behavioral therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Blay SL, Marinho V. Anxiety disorders in old age. Curr Opin Psychiatry. 2012;25:462–7.

    Article  PubMed  Google Scholar 

  2. Bryant C, Mohlman J, Gum A, Stanley M, Beekman AT, Wetherell JL, Thorp SR, Flint AJ, Lenze EJ. Anxiety disorders in older adults: looking to DSM5 and beyond. Am J Geriatr Psychiatry. 2013;21(9):872–6.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Porensky EK, Dew MA, Karp JF, Skidmore E, Rollman BL, Shear MK, Lenze EJ. 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 

  4. Gum AM, King-Kallimanis B, Kohn R. Prevalence of mood, anxiety, and substance-abuse disorders for older Americans in the National Comorbidity Survey–Replication. Am J Geriatr Psychiatry. 2009;17:769–81.

    Article  PubMed  Google Scholar 

  5. King-Kallimanis B, Gum A, Kohn R. Comorbidity of depressive and anxiety disorders for older Americans in the National Comorbidity Survey—Replication. Am J Geriatr Psychiatry. 2009;17:782–92.

    Article  PubMed  Google Scholar 

  6. Byers AL, Yaffe K, Covinsky KE, Friedman MB, Bruce ML. High occurrence of mood and anxiety disorders among older adults: the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2010;67(5):489–96.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gonçalves DC, Pachana NA, Byrne GJ. Prevalence and correlates of generalized anxiety disorder among older adults in the Australian National Survey of Mental Health and Well Being. J Affect Disord. 2011;132:223–30.

    Article  PubMed  Google Scholar 

  8. Prina AM, Ferri CP, Guerra M, Brayne C, Prince M. Prevalence of anxiety and its correlates among older adults in Latin America, India and China: cross-cultural study. Br J Psychiatry. 2011;199(6):485–91.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sigström R, Östling S, Karlsson B, Waern M, Gustafson D, Skoog I. A population-based study on phobic fears and DSM-IV specific phobia in 70-year olds. J Anxiety Disord. 2011;25(1):148–53.

    Article  PubMed  Google Scholar 

  10. Scheffer AC, Schuurmans MJ, van Dijk N, van der Hooft T, de Rooij SE. Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing. 2008;37:19–24.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  12. Holwerda TJ, Schoevers RA, Dekker J, Deeg DJ, Jonker C, Beekman AT. The relationship between generalized anxiety disorder, depression and mortality in old age. Int J Geriatr Psychiatry. 2007;22(3):241–9.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. Jeste D, Blazer D, First M. Aging-related diagnostic variations: need for diagnostic criteria appropriate for elderly psychiatric patients. Biol Psychiatry. 2005;58:265–71.

    Article  PubMed  Google Scholar 

  15. Almeida OP, Draper B, Pirkis J, Snowdon J, Lautenschlager NT, Byrne G, Sim M, Stocks N, Kerse N, Flicker L, Pfaff JJ. Anxiety, depression, and comorbid anxiety and depression: risk factors and outcome over two years. Int Psychogeriatr. 2012;24(10):1622–32.

    Article  PubMed  Google Scholar 

  16. Lenze EJ, Butters MA. Consequences of anxiety in aging and cognitive decline. Am J Geriatr Psychiatry. 2016;24(10):843–5.

    Article  PubMed  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. Garfield LD, Scherrer JF, Hauptman PJ, Freedland KE, Chrusciel T, Balasubramanian S, Carney RM, Newcomer JW, Owen R, Bucholz KK, Lustman PJ. Association of anxiety disorders and depression with incident heart failure. Psychosom Med. 2014;76(2):128–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Parker G, Hyett M, Hadzi-Pavlovic D, Brotchie H, Walsh W. GAD is good? Generalized anxiety disorder predicts a superior five-year outcome following an acute coronary syndrome. Psychiatry Res. 2011;188(3):383–9.

    Article  PubMed  Google Scholar 

  20. Karg K, Burmeister M, Shedden K, Sen S. The serotonin transporter promoter variant (5-HTTLPR), stress, and depression meta-analysis revisited: evidence of genetic moderation. Arch Gen Psychiatry. 2011;68(5):444–54.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Gotlib IH, Joormann J, Minor KL, Hallmayer J. HPA axis reactivity: a mechanism underlying the associations among 5-HTTLPR,stress, and depression. Biol Psychiatry. 2008;63:847–51.

    Article  CAS  PubMed  Google Scholar 

  22. Lenze EJ, Dixon D, Mantella RC, Dore PM, Andreescu C, Reynolds CF 3rd, Newcomer JW, Butters MA. Treatment-related alteration of cortisol predicts change in neuropsychological function during acute treatment of late-life anxiety disorder. Int J Geriatr Psychiatry. 2012;27(5):454–62.

    Article  PubMed  Google Scholar 

  23. Vreeburg SA, Zitman FG, van Pelt J, Derijk RH, Verhagen JC, van Dyck R, Hoogendijk WJ, Smit JH, Penninx BW. Salivary cortisol levels in persons with and without different anxiety disorders. Psychosom Med. 2010;72(4):340–7.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  25. 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 

  26. Mackenzie CS, Reynolds K, Cairney J, Streiner DL, Sareen J. Disorder-specific mental health service use for mood and anxiety disorders: associations with age, sex, and psychiatric comorbidity. Depress Anxiety. 2012;29(3):234–42.

    Article  PubMed  Google Scholar 

  27. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: APA; 2013.

    Book  Google Scholar 

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

    Article  PubMed  Google Scholar 

  29. Lenze EJ, Mulsant BH, Shear MK, Schulberg HC, Dew MA, Begley AE, Pollock BG, Reynolds CF 3rd. Comorbid anxiety disorders in depressed elderly patients. Am J Psychiatry. 2000;157(5):722–8.

    Article  CAS  PubMed  Google Scholar 

  30. Goncalves DC, Byrne GJ. Who worries most? Worry prevalence and patterns across the lifespan. Int J Geriatr Psychiatry. 2013;28:41–9.

    Article  PubMed  Google Scholar 

  31. Massena PN, de Araújo NB, Pachana N, Laks J, de Pádua AC. Validation of the Brazilian Portuguese version of geriatric anxiety inventory--GAI-BR. Int Psychogeriatr. 2015;27(7):1113–9.

    Article  PubMed  Google Scholar 

  32. Howland J, Lachman ME, Peterson EW, Cote J, Kasten L, Jette A. Covariates of fear of falling and associated activity curtailment. Gerontologist. 1998;38(5):549–55.

    Article  CAS  PubMed  Google Scholar 

  33. Gomez F, Curcio CL. The development of a fear of falling interdisciplinary intervention program. Clin Interv Aging. 2007;2(4):661–7.

    PubMed  PubMed Central  Google Scholar 

  34. Kempen GI, Yardley L, van Haastregt JC, Zijlstra GA, Beyer N, Hauer K, Todd C. The short FES-I: a shortened version of the falls efficacy scale-international to assess fear of falling. Age Ageing. 2008;37(1):45–50.

    Article  PubMed  Google Scholar 

  35. Gould RL, Coulson MC, Howard RJ. Efficacy of cognitive behavioral therapy for anxiety disorders in older people: a meta-analysis and meta-regression of randomized controlled trials. J Am Geriatr Soc. 2012;60(2):218–29.

    Article  PubMed  Google Scholar 

  36. Karaiskos D, Pappa D, Tzavellas E, Siarkos K, Katirtzoglou E, Papadimitriou GN, Politis A. Pregabalin augmentation of antidepressants in older patients with comorbid depression and generalized anxiety disorder-an open-label study. Int J Geriatr Psychiatry. 2013;28(1):100–5.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  38. Ungar A, Rafanelli M, Iacomelli I, Brunetti MA, Ceccofiglio A, Tesi F, Marchionni N. Fall prevention in the elderly. Clin Cases Miner Bone Metab. 2013;10(2):91–5.

    PubMed  PubMed Central  Google Scholar 

  39. Wetherell JL, Petkus AJ, White KS, Nguyen H, Kornblith S, Andreescu C, Zisook S, Lenze EJ. Antidepressant medication augmented with cognitive-behavioral therapy for generalized anxiety disorder in older adults. Am J Psychiatry. 2013;170(7):782–9.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Rosnick CB, Wetherell JL, White KS, Andreescu C, Dixon D, Lenze EJ. Cognitive-behavioral therapy augmentation of SSRI reduces cortisol levels in older adults with generalized anxiety disorder: a randomized clinical trial. J Consult Clin Psychol. 2016;84(4):345–52.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Alzheimer’s Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

    Valeska Marinho & Bruno Gherman

  2. Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil

    Sergio Luís Blay

Authors
  1. Valeska Marinho
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bruno Gherman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sergio Luís Blay
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Unité de Psychiatrie et de Psychothérapie, Centre Les Toises, Lausanne, Switzerland

    Carlos Augusto de Mendonça Lima

  2. Mental Health and Population Health, NOVA University Lisbon, Lisbon, Portugal

    Gabriel Ivbijaro

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Marinho, V., Gherman, B., Blay, S.L. (2019). Anxiety Disorder in Older Adults. In: de Mendonça Lima, C., Ivbijaro, G. (eds) Primary Care Mental Health in Older People. Springer, Cham. https://doi.org/10.1007/978-3-030-10814-4_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-10814-4_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-10812-0

  • Online ISBN: 978-3-030-10814-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation