Elderly patients with cognitive disorders often have faster cognitive and functional loss when accompanied by behavioral problems that may present with anxiety symptoms. Anxiety symptoms also frequently accompany patients with neurodegenerative diseases such as Alzheimer’s and Parkinson’s disease. A recent systematic review concluded that the incidence rate for anxiety disorders after cardiac arrest varies from 13% to 42%. It is well-established that depression with co-occurring anxiety has been associated with an increased risk of cardiovascular and cerebrovascular morbidity and mortality. The combination of depressive symptoms and anxiety symptoms in these patients was associated with poor glycemic control. A cross-sectional study of anxiety and depression in type 2 diabetes patients estimated prevalence to be 56.1% and 43.6%, respectively. Anxiety and depression are also highly prevalent in patients with diabetes. Anxiety in these individuals is associated with functional limitations, poorer exercise tolerance, suicidal ideation and higher frequency of hospitalizations. For example, the incidence of anxiety disorders in chronic obstructive pulmonary disease (COPD) patients is exceedingly common and ranges between 13% to 46%. Comorbid anxiety can complicate a patient’s medical treatment and outcome. It is important to note, however, that anxiety symptoms in the elderly that do not meet full DSM–V criteria can still lead to significant impairment and disability, requiring intervention.Īnxiety disorders in the elderly appear to be more likely associated with common medical conditions than those found in the general population. The most common anxiety disorders seen in older adults include generalized anxiety disorder and simple phobia. Additionally, a population-based study found that 18% of elderly patients receiving contracted home care in the United States have some type of anxiety disorder. A systematic literature review revealed that the prevalence of anxiety disorders in clinical settings ranges from 1.2% to 28% in elderly patients. Anxiety disorders are among the most prevalent mental health issues in the elderly. Additionally, the 65-and-older age group’s share of the total population will rise to nearly 24 percent from 15 percent. In addition, antipsychotics have a black box warning for increased mortality in elderly patients with dementia.Īccording to the Population Reference Bureau, the number of Americans ages 65 and older is projected to more than double from 46 million today to over 98 million by 2060. There is not enough evidence to support the use of antipsychotics or mood stabilizers given their risk of problems in both the long and short term. Benzodiazepines and beta blockers should generally be avoided when treating anxiety in the elderly. Although tricyclic/tetracyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) may be effective in the elderly, their side effect and safety profiles are suboptimal and thus are not recommended in late-life. Buspirone may have benefit, but lacks studies in elderly populations. Mirtazapine and vortioxetine are also considered safe treatment options. Those antidepressants with more favorable pharmacokinetic profiles should be considered first-line in the treatment of anxiety. Some SSRIs are strong inhibitors of the cytochrome P450 hepatic pathway whereas others have less potential for drug interaction. Both SSRIs and SNRIs are efficacious and well-tolerated in the elderly. Antidepressants are considered first line treatment. Anxiety in the elderly, often accompanied by depression, can lead to worsening physical, cognitive and functional impairments in this vulnerable population. Additionally, anxiety symptoms often accompany co-morbid psychiatric, medical, as well as neurodegenerative diseases in the older population. Anxiety disorders are common in the elderly.
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