Epidemiology and comorbidity of anxiety disorders in later life: implications for treatment

Anxiety disorders have a peak age of onset in early adulthood and their prevalence and incidence decline in later life. Most cases of anxiety disorder in late life are chronic, having persisted from younger years. Generalized anxiety and agoraphobia account for most cases of late-onset anxiety. Late-onset generalized anxiety is usually associated with a depressive illness. On the other hand, most individuals with late-onset agoraphobia do not have comorbid depression or a history of panic attacks, and the illness often starts after a traumatic event. Case reports and uncontrolled trials indicate that older persons with anxiety disorders can respond to the same treatments that have been found to be efficacious in younger patients, although it is unknown whether the two groups have similar rates of response. The current clinical reality is that most cases of anxiety disorder in late life are undetected and, when treatment is given, benzodiazepines are overused and antidepressants and behavioral treatments are underused. The high rate of comorbidity between late-onset generalized anxiety and depression in old age suggests that antidepressant medication, rather than benzodiazepines, should be the treatment of choice for this condition.