Anxiety in the elderly. Course and treatment

Despite increasing research interest in the area of anxiety in younger age groups, few systematic studies of the course and treatment of anxiety disorders in the elderly have been performed. Data from Epidemiologic Catchment Area (ECA) studies suggest that anxiety disorders remain among the most prevalent of all psychiatric disorders in this age group. There is little information available about the late onset of anxiety disorders except for some evidence regarding panic disorder that suggests a distinct subtype with late onset and differences in vulnerability factors and phenomenology. Any evaluation of anxiety in the elderly should take into account multiple medical illnesses and medications that can produce a similar symptom picture. Thus, the importance of good history-taking, empathy to the patient's psychosocial situation, and awareness of the possibility of an underlying medical condition cannot be overemphasized. A variety of compounds including benzodiazepines, buspirone, antidepressants, and beta blockers seems to show effectiveness for various anxiety disorders of the elderly. One needs to be cognizant of the great individual variation among the elderly and should be ready and willing to tailor usage of medications or cognitive-behavioral techniques to the patient's special needs. Proper education of the patient, leading to better compliance with the treatment regimen, and recent advances in treatment will almost certainly improve the outlook for these patients in the future for better functioning and a more optimistic prognosis.