Late-life anxiety disorders

Abstract

Anxiety disorders are among the most common and costly psychiatric disorders impacting the geriatric population. While anxiety is a normal human emotion, pathological anxiety can lead to functional impairment and suffering. The high prevalence of anxiety disorders may be explained through understanding the differential costs of missing a threat compared to anxious misery (the smoke detector principle). In the geriatric population, generalized anxiety disorder is the most common anxiety disorder, while panic disorder is less common, and fear of falling represents a specific phobia that is known to specifically affect older adults. Diagnosis is often complicated by the increased presence of comorbid systemic medical illnesses, bereavement, increased prevalence of somatic complaints, and difficulty discerning adaptive from pathological anxiety in the context of aging. A thorough clinical examination, including physical examination, and laboratory studies are required to help elucidate the differential diagnosis. Cognitive testing should be conducted in order to establish a baseline, to allow for future monitoring, and to guide treatment. Treatment should include providing psychoeducation, psychotherapeutic approaches (e.g., cognitive-behavioral, behavioral, interpersonal, and mindfulness-based psychotherapies), and pharmacotherapy. Comorbid systemic medical illnesses can pose additional challenges to management, often requiring simultaneous treatment of systemic medical and psychiatric symptoms.