Hostname: page-component-76fb5796d-skm99 Total loading time: 0 Render date: 2024-04-25T09:55:48.564Z Has data issue: false hasContentIssue false
  • English
  • Français

The natural course of anxiety disorders in the elderly: a systematic review of longitudinal trials

Published online by Cambridge University Press:  05 September 2014

Musa Basseer Sami  and
Ramin Nilforooshan
Musa Basseer Sami*
Affiliation:
Surrey and Borders NHS Partnership Trust, 18 Mole Business Park, Leatherhead, Surrey, KT22 7AD, UK
Ramin Nilforooshan
Affiliation:
Brain Science Research Unit, ACU, Holloway Hill, Chertsey, Surrey KT16 0AE, UK
*
Correspondence should be addressed to: Email: musasami@doctors.org.uk.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

The anxiety disorders are a prevalent mental health problem in older age with a considerable impact on quality of life. Until recently there have been few longitudinal studies on anxiety in this age group, consequently most of the evidence to date has been cross-sectional in nature.

Methods:

We undertook a literature search of Medline, PsycINFO, the Cochrane trials database and the TRIP medical database to identify longitudinal studies which would help elucidate natural history and prognosis of anxiety disorders in the elderly.

Results:

We identified 12 papers of 10 longitudinal studies in our Review. This represented 34,691 older age participants with 5,199 with anxiety disorders including anxious depression and 3,532 individuals with depression without anxiety. Relapse rates of anxiety disorders are high over 6 year follow-up with considerable migration to mixed anxiety-depression and pure depressive mood episodes. Mixed anxiety-depression appears to be a poorer prognostic state than pure anxiety or pure depression with higher relapse rates across studies. In community settings treatment rates are low with 7–44% of the anxious elderly treated on antidepressant medications.

Conclusions:

To our knowledge this is the first Systematic Review of longitudinal trials of anxiety disorders in older people. Major longitudinal studies of the anxious elderly are establishing the high risk of relapse and persistence alongside the progression to depression and anxiety depression states. There remains considerable under-treatment in community studies. Specialist assessment and treatment and major public health awareness of the challenges of anxiety disorders in the elderly are required.

Keywords

anxietyanxiety disorderold ageoldergeriatricnaturalisticlongitudinal
Type
Review Article
Information
International Psychogeriatrics , Volume 27 , Special Issue 7: Late Life Anxiety , July 2015 , pp. 1061 - 1069
Copyright
Copyright © International Psychogeriatric Association 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Allgulander, C. and Lavori, P. W. (1993). Causes of death among 936 elderly patients with ‘pure’ anxiety neurosis in Stockholm County, Sweden, and in patients with depressive neurosis or both diagnoses. Comprehensive Psychiatry, 34, 299–302.Google Scholar
Almeida, O. P. et al. (2012a). Anxiety, depression, and comorbid anxiety and depression: risk factors and outcome over two years. International Psychogeriatrics, 24, 1622–1632.CrossRefGoogle ScholarPubMed
Almeida, O. P. et al. (2012b). Factors associated with suicidal thoughts in a large community study of older adults. British Journal of Psychiatry, 201, 466–472.CrossRefGoogle Scholar
Beekman, A. T. et al. (2000). Anxiety and depression in later life: co-occurrence and communality of risk factors. American Journal of Psychiatry, 157, 89–95.Google Scholar
Bierman, E. J., Comijs, H. C., Jonker, C. and Beekman, A. T. (2005). Effects of anxiety versus depression on cognition in later life. American Journal of Geriatric Psychiatry, 13, 686–693.Google Scholar
Bierman, E. J., Comijs, H. C., Rijmen, F., Jonker, C. and Beekman, A. T. (2008). Anxiety symptoms and cognitive performance in later life: results from the longitudinal aging study Amsterdam. Aging & Mental Health, 12, 517–523.Google Scholar
Bland, R. C., Newman, S. C. and Orn, H. (1988). Prevalence of psychiatric disorders in the elderly in Edmonton. Acta psychiatrica Scandinavica. Supplementum, 338, 57–63.Google Scholar
Blay, S. L. and Marinho, V. (2012). Anxiety disorders in old age. Current Opinion in Psychiatry, 25, 462–467.Google Scholar
Brenes, G. A. et al. (2007). Scared to death: results from the health, aging, and body composition study. American Journal of Geriatric Psychiatry, 15, 262–265.Google Scholar
Bryant, C., Jackson, H. and Ames, D. (2008). The prevalence of anxiety in older adults: methodological issues and a review of the literature. Journal of Affective Disorders, 109, 233–250.CrossRefGoogle Scholar
Cairney, J. et al. (2007). Epidemiology of social phobia in later life. American Journal of Geriatric Psychiatry, 15, 224–233.Google Scholar
Chou, K. L. (2009a). Social anxiety disorder in older adults: evidence from the national epidemiologic survey on alcohol and related conditions. Journal of Affective Disorders, 119, 76–83.Google Scholar
Chou, K. L. (2009b). Specific phobia in older adults: evidence from the national epidemiologic survey on alcohol and related conditions. American Journal of Geriatric Psychiatry, 17, 376–386.CrossRefGoogle ScholarPubMed
Chou, K. L. (2010). Panic disorder in older adults: evidence from the national epidemiologic survey on alcohol and related conditions. International Journal of Geriatric Psychiatry, 25, 822–832.CrossRefGoogle ScholarPubMed
Copeland, J. R. et al. (1987). Range of mental illness among the elderly in the community. Prevelance in Liverpool using the GMS-AGECAT package. British Journal of Psychiatry, 150, 815–823.CrossRefGoogle Scholar
de Beurs, E., Beekman, A. T., Deeg, D. J., Van Dyck, R. and van Tilburg, W. (2000). Predictors of change in anxiety symptoms of older persons: results from the longitudinal aging study Amsterdam. Psychological Medicine, 30, 515–527.CrossRefGoogle ScholarPubMed
DeLuca, A. K. et al. (2005). Comorbid anxiety disorder in late life depression: association with memory decline over four years. International Journal of Geriatric Psychiatry, 20, 848–854.CrossRefGoogle ScholarPubMed
Flint, A. J. (1994). Epidemiology and comorbidity of anxiety disorders in the elderly. American Journal of Psychiatry, 151, 640–649.Google ScholarPubMed
Flint, A. J. and Rifat, S. L. (1997). Two-year outcome of elderly patients with anxious depression. Psychiatry Research, 66, 23–31.Google Scholar
Gale, C. R. et al. (2011). Factors associated with symptoms of anxiety and depression in five cohorts of community-based older people: the HALCyon (healthy ageing across the life course) programme. Psychological Medicine, 41, 2057–2073.CrossRefGoogle ScholarPubMed
Golden, J., Conroy, R. M. and Lawlor, B. A. (2009). Social support network structure in older people: underlying dimensions and association with psychological and physical health. Psychology, Health & Medicine, 14, 280–290.CrossRefGoogle ScholarPubMed
Gonçalves, D. C. and Byrne, G. J. (2012). Interventions for generalized anxiety disorder in older adults: systematic review and meta-analysis. Journal of Anxiety Disorders, 26, 1–11.CrossRefGoogle ScholarPubMed
Henderson, S., Andrews, G. and Hall, W. (2000). Australia's mental health: an overview of the general population survey. Australian & New Zealand Journal of Psychiatry, 34, 197–205.Google Scholar
Holwerda, T. J. et al. (2007). The relationship between generalized anxiety disorder, depression and mortality in old age. International Journal of Geriatric Psychiatry, 22, 241–249.Google Scholar
Lenze, E. J. et al. (2005). Generalized anxiety disorder in late life: lifetime course and comorbidity with major depressive disorder. American Journal of Geriatric Psychiatry, 13, 77–80.Google Scholar
Lindesay, J., Briggs, K. and Murphy, K. (1989). The Guy's/age concern survey. Prevalance rates of cognitive impairment, depression and anxiety in an urban elderly community. British Journal of Psychiatry, 155, 317–329.Google Scholar
Livingston, G., Watkin, V., Milne, B., Manela, M. V. and Katona, C. (1997). The natural history of depression and the anxiety disorders in older people: the Islington community study. Journal of Affective Disorders, 46, 255–262.Google Scholar
MacDonald, R., Crum, R. M., Storr, C. L., Schuster, A. and Bienvenu, O. J. (2011). Sub-clinical anxiety and the onset of alcohol use disorders: longitudinal associations from the Baltimore ECA follow-up, 1981–2004. Journal of Addictive Diseases, 30, 45–53.Google Scholar
Mulsant, B. H., Reynolds, C. F., Shear, M. K., Sweet, R. A. and Miller, M. (1996). Comorbid anxiety disorders in late-life depression. Anxiety, 2, 242–247.Google Scholar
Newman, S. C., Sheldon, C. T. and Bland, R. C. (1998). Prevalence of depression in an elderly community sample: a comparison of GMS-AGECAT and DSM-IV diagnostic criteria. Psychological Medicine, 28, 1339–1345.CrossRefGoogle Scholar
Ní Mhaoláin, A. M. et al. (2012). Frailty, depression, and anxiety in later life. International Psychogeriatrics, 24, 1265–1274.Google Scholar
Pachana, N. A. et al. (2006). Development and validation of the geriatric anxiety inventory. International Psychogeriatrics, 19, 103–114.Google Scholar
Préville, M. et al. (2010). Persistence and remission of psychiatric disorders in the quebec older adult population. Canadian Journal of Psychiatry, 55, 514–522.Google Scholar
Prina, A. M., Ferri, C. P., Guerra, M., Brayne, C. and Prince, M. (2011). Prevalence of anxiety and its correlates among older adults in Latin America, India and China: cross-cultural study. British Journal of Psychiatry, 199, 485–491.Google Scholar
Regier, D. A. et al. (1993). One-month prevalence of mental disorders in the United States and sociodemographic characteristics: the epidemiologic catchment area study. Acta psychiatrica Scandinavica, 88, 35–47.CrossRefGoogle ScholarPubMed
Schoevers, R. A., Beekman, A. T., Deeg, D. J., Jonker, C. and van Tilburg, W. (2003). Comorbidity and risk-patterns of depression, generalised anxiety disorder and mixed anxiety-depression in later life: results from the AMSTEL study. International Journal of Geriatric Psychiatry, 18, 994–1001.Google Scholar
Schoevers, R. A., Deeg, D. J., van Tilburg, W. and Beekman, A. T. (2005). Depression and generalized anxiety disorder: co-occurrence and longitudinal patterns in elderly patients. The American Journal of Geriatric Psychiatry, 13, 31–39.CrossRefGoogle ScholarPubMed
Schuurmans, J. et al. (2005). The outcome of anxiety disorders in older people at 6-year follow-up: results from the longitudinal aging study Amsterdam. Acta psychiatrica Scandinavica, 111, 420–428.Google Scholar
Shrestha, S., Robertson, S. and Stanley, M. A. (2011). Innovations in research for treatment of late-life anxiety. Aging & Mental Health, 15, 811–821.CrossRefGoogle ScholarPubMed
Sinoff, G., Ore, L., Zlotogorsky, D. and Tamir, A. (1999). Short anxiety screening test–a brief instrument for detecting anxiety in the elderly. International Journal of Geriatric Psychiatry, 14, 1062–1071.Google Scholar
Sinoff, G. and Werner, P. (2003). Anxiety disorder and accompanying subjective memory loss in the elderly as a predictor of future cognitive decline. International Journal of Geriatric Psychiatry, 18, 951–959.Google Scholar
Steffens, D. C. and McQuoid, D. R. (2005). Impact of symptoms of generalized anxiety disorder on the course of late-life depression. American Journal of Geriatric Psychiatry, 13, 40–47.Google Scholar
Therrien, Z. and Hunsley, J. (2012). Assessment of anxiety in older adults: a systematic review of commonly used measures. Aging & Mental Health, 16, 1–16.Google Scholar
van Hooren, S. A. et al. (2005). Relation between health status and cognitive functioning: a 6-year follow-up of the maastricht aging study. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 60, P57–P60.Google Scholar
van Hout, H. P. et al. (2004). Anxiety and the risk of death in older men and women. British Journal of Psychiatry, 185, 399–404.CrossRefGoogle ScholarPubMed
Volkert, J., Schulz, H., Härter, M., Wlodarczyk, O. and Andreas, S. (2013). The prevalence of mental disorders in older people in western countries - a meta-analysis. Ageing Research Reviews, 12, 339–353.CrossRefGoogle ScholarPubMed
Wittchen, H. U. et al. (2011). The size and burden of mental disorders and other disorders of the brain in Europe 2010. European Neuropsychopharmacology, 21, 655–679.Google Scholar
Wolitzky-Taylor, K. B., Castriotta, N., Lenze, E. J., Stanley, M. A. and Craske, M. G. (2010). Anxiety disorders in older adults: a comprehensive review. Depression and Anxiety, 27, 190–211.Google Scholar
Supplementary material: File

Sami Supplementary Material

Table

Download Sami Supplementary Material(File)
File 26.1 KB
Supplementary material: File

Sami and Nilforooshan Supplementary Material

Table 1

Download Sami and Nilforooshan Supplementary Material(File)
File 26.7 KB
Supplementary material: File

Sami and Nilforooshan Supplementary Material

Table 2

Download Sami and Nilforooshan Supplementary Material(File)
File 14.9 KB