3.5.6 Late Life Anxiety Disorders

Late Life Anxiety Disorders

Late-life anxiety disorders are common mental health conditions that affect the elderly population. In this lesson, we will discuss the prevalence and incidence, clinical features, differential diagnosis, aetiology, management, and prognosis, of late-life anxiety disorders.

Anxiety disorders are common in late life, with an estimated prevalence of 3-14% in community-dwelling older adults (1). Generalized anxiety disorder (GAD) is the most common type of anxiety disorder in late life, followed by panic disorder, phobias, and obsessive-compulsive disorder.

Clinical Features:

The clinical features of late life anxiety disorders are similar to those seen in younger individuals, with excessive worry, fear, and avoidance behaviours being the hallmark symptoms. However, there may be differences in the presentation of symptoms, with more somatic complaints being reported in the elderly population, such as fatigue, insomnia, and muscle tension (2).

Differential Diagnosis:

Late life anxiety disorders can be difficult to differentiate from other medical conditions such as depression, dementia, or delirium. It is important to conduct a thorough medical and psychiatric evaluation to rule out other causes of anxiety symptoms (3).

Aetiology: The aetiology of late life anxiety disorders is not well understood, but it is thought to be multifactorial, including genetic, neurobiological, and environmental factors. The presence of comorbid medical conditions, such as chronic pain or cardiovascular disease, may also contribute to the development of anxiety symptoms (4).

Management:

The management of late life anxiety disorders involves a combination of medication and psychosocial interventions. Antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs) or benzodiazepines may be prescribed, but caution should be taken due to the increased risk of adverse effects in the elderly population. Psychosocial interventions such as cognitive-behavioural therapy (CBT) and relaxation techniques may also be helpful in managing symptoms and improving quality of life (5).

Prognosis:

The prognosis of late life anxiety disorders is variable, with some individuals experiencing remission of symptoms and others experiencing a chronic course. The presence of comorbid medical conditions may impact the prognosis, and early intervention and treatment may improve outcomes (6).

Disorder	Prevalence/Incidence	Clinical Features	Differential Diagnosis
Late Life Anxiety Disorders	Prevalence of 3-14% in community-dwelling older adults	Excessive worry, fear, avoidance behaviours, somatic complaints	Depression, dementia, delirium

Disorder	Aetiology	Management	Prognosis
Late Life Anxiety Disorders	Multifactorial, genetic, neurobiological, environmental, and comorbid medical conditions	Antidepressant medications, psychosocial interventions	Variable, impacted by comorbid medical conditions, early intervention may improve outcomes

Reference:

1. Grenier S, Préville M, Boyer R, O’Connor K, Béland SG. The prevalence and comorbidity of anxiety and depressive disorders in an aging population of Quebec. Can J Psychiatry. 2011;56(7):390-397.
2. Carney RM, Freedland KE. Depression in patients with coronary heart disease. Am J Med. 2008;121(11 Suppl 2):S20-S27.
3. IAGG Congress. 2021. Anxiety disorders in late life: a review. (online) Available at: https://www.iagg.info/ (Accessed 27 Feb. 2023).
4. Blow FC, McCarthy JF, Valenstein M, et al. Care for Veterans with Depression and Suicide Risk in VA Primary Care. J Gen Intern Med. 2013;28(2):221-229.
5. Reynolds CF, Lebowitz BD, Friedhoff AJ. Diagnosis and treatment of depression in late life: consensus statement update. JAMA. 1997;278(14):1186-1190.
6. Stanley MA, Diefenbach GJ, Hopko DR. Cognitive-behavioral therapy for late-life anxiety disorders: a review. Am J Geriatr Psychiatry. 2004;12(3):266-278.