Depression and anxiety in late life: diagnostic insights and therapeutic options

Depression and anxiety represent a sizeable public-health problem for older Americans. Effective treatment of depression and anxiety in late-life patients can improve outcomes directly related to those diseases as well as to comorbid medical diseases. A variety of approaches has been shown to be effective in older adults and is easily accessible to the primary care, specialty, and inpatient practitioner. Because of the etiologic complexity associated with mood disturbance in late life, it is helpful to consider depression and anxiety in late life as a geriatric syndrome similar to frailty, falls, incontinence, and impaired cognition. These syndromes have multiple causes of associated disability, yielding a multitude of avenues for intervention. However, translating the science of care for depression and anxiety into improved mental-health services for older adults and their families remains a challenge to providers and policy-makers alike. In the Tables, the authors offer measures for screening and response evaluation as well as guidance for pharmacotherapy and psychotherapeutic interventions that may be incorporated into primary care.