[Anxiety disorders in the elderly: Clinical and therapeutic aspects]

Few studies have been specifically devoted to anxiety disorders in the elderly. Nevertheless, various factors can expose this population to relevant levels of anxiety: development of somatic disorders, bereavements, isolation, changes of life, use of anxiogenic drugs, etc. Prevalence rates weaker than in the general population are usually found, but with high rates, however, for generalized anxiety disorder and agoraphobia. The clinical aspect of these anxious states is often dominated by somatic symptoms and complaints, and some topics seem of special concern: fear of death and disease, displacement phobias related to the fear of falling or being attacked. Some consequences should be particularly watched over (diverse somatic affections, depression, dementia, and even suicidal tendencies), which justify an accurate clinical evaluation. Treatment must often be multidisciplinary involving medical but also psychological, and institutional aspects. The therapeutic strategies are largely identical to what they are in the other groups of age. Anxiolytic drugs and antidepressants, cognitive-behavioral therapies can be proposed, even if some adaptation of drug posology or methods of non pharmacological interventions should be needed. Particular attention should be paid to the risk of benzodiazepine dependence, drugs which are widely used by elderly subjects. As a conclusion, anxiety disorders in the elderly present clinical and therapeutic particularities, which require a special approach and the development of specific epidemiological, physiopathologic and therapeutic researches.