>>>> Anxiety disorders are the most common class of psychiatric
disorders in older adults—more common than either depression or
severe cognitive impairment.
Although anxiety disorders, like most psychiatric conditions, may be less common
among older adults than among younger people, epidemiological evidence suggests
that anxiety is a major problem in late life (Salzman & Lebowitz, 1991; U.S. Department
of Health & Human Services, 1999). Anxiety disorders overall appear to be the most
common class of psychiatric disorders among older people, more prevalent than
depression or severe cognitive impairment (Beekman et al., 1998; Kessler et al., 2005;
Regier et al., 1988).
ô 10 to 15% of people 65+ are coping with at least one anxiety disorder.
One study involving interviews with nearly 6000 people nationwide reported a
lifetime rate of 15.3% for DSM-IV-diagnosed anxiety disorders in respondents over age
60 (Kessler et al., 2005). Myers and colleagues (1984) report a 6-month prevalence of
anxiety disorders in late life ranging from 6.6% to 14.9% across three Epidemiologic
Catchment Area (ECA) sites.
ô Most common anxiety disorders among older adults are
Generalized Anxiety Disorders (GADs).
Phobias and GADs account for most anxiety disorders in late life (Beekman, van
Balkom, Deeg, van Dyck, & van Tilburg, 2000; LeRoux, Gatz, & Wetherell, 2005).
Among people 55 years of age and older, Douchet, LaDouceur, Freeston, and Dugas
(1998) found that 12.8% meet criteria for GAD. By comparison, ECA prevalence rates for
older adults are 1.8% for major depression, 2.8% for dysthymia, and 4.9% for severe
cognitive impairment (Blazer, 1997; Regier et al., 1988).
Gellis & McCracken Mental Health—Anxiety Disorders in Older Adults
ô Prevalence of anxiety may be higher in Primary Care settings than
in the community.
ô 30% of older adults present with GAD symptoms.
ô Since only about one third of anxiety disorder cases is detected in primary
care settings, estimates likely substantially underestimate the true
It is possible that the prevalence of anxiety is higher in primary care settings than in
the community at large. Krasucki, Howard, and Mann (1999) have found that, in
primary care settings, 30% of older adults present with generalized anxiety symptoms.
Because evidence suggests that only approximately one third of such cases are detected
in primary care (e.g., Kessler, Lloyd, Lewis, & Gray, 1999), these data likely represent a
substantial underestimate of the prevalence of anxiety in that setting. Furthermore,
Levy, Conway, Brommelhoff, and Merikengas (2003) found that, compared to younger
adults, older adults tend to minimize and underreport their anxiety symptoms. Thus
the number of older adults who experience anxiety may be underestimated (Levy et al.,
ô Subthreshold Anxiety Symptoms: Clinically significant anxiety,
including symptoms that do not meet criteria for a specific disorder,
is common among older adults (20-29%).
Clinically significant anxiety, including symptoms that do not meet criteria for a
specific disorder, is common among older adults, and the prevalence may be as high as
20-29% (Davis, Moye, & Karel, 2002; Lenze et al., 2005).
ô Many of the symptoms of anxiety are physical and overlap with
medical problems; conversely, anxiety is often associated with
common age-related medical and chronic conditions such as
asthma, thyroid disease, coronary artery disease, dementia, and
sensory loss. It is also associated with stressors, such as
bereavement and care-giving.
There is also controversy over whether the prevalence of anxiety has been
accurately determined in older adults, because DSM-IV criteria may not fit well with
this population, anxiety symptoms may be expressed as somatic features or behavior
changes (e.g., aggression, assaultive behaviors), and the clinical presentation of anxiety
in late life may be more likely to include depressive symptoms (Beck & Averill, 2004;
Diefenbach & Goethe, 2006; Fuentes & Cox, 1997; Kim, Braun, & Kunik, 2001; Palmer,
Jeste, & Sheikh, 1997).
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