Anxiety in Aging: A Newly Chartered Territory

Abstract

said this to capture a series of thoughts which are highly relevant for our thinking on anxiety and aging. In terms of demography, it is only a very recent development that so many of us become so old. This is an ongoing process, arguably moving at a far greater pace than the corresponding development of our sociocultural and economic institutions. Similarly, the demographic revolution taking place in many parts of the world can in no way be accommodated by a parallel genetic or evolutionary development in the human genome. The effect would be to leave both our genes and our environments unfit or unprepared to accommodate the adaptations necessary for successful ageing. What would be the emotional concomitant of this? For a long time, our primary focus has been on depression and loss. Both later life and our postwar era have been called an age of melancholy. An impressive series of epidemiological studies has examined the hypothesis that aging would be accompanied with an increase in depression and has found this idea to be largely false. Although depressive symptoms and disorders are indeed common in later life, this is true for all ages and the prevalence does not change dramatically over the lifespan. What about anxiety? In his introductory lectures, Freud wrote that “on what occasion anxiety appears, will depend to a large extent on the state of a person’s knowledge and on his sense of power visa-vis the external world.” Under appropriate circumstances, the result may be that the individual experiences realistic anxiety, developing in the face of anticipated danger or damage. About neurotic anxiety Freud wrote, “in the first place we find a kind of freely floating anxiety which is ready to attach itself to any idea that is in any way suitable, which influences judgment, selects what is to be expected and lies in wait for any opportunity that will allow it to justify itself.” Given the above, both realistic and neurotic anxiety may be expected to be very common in later life. Older people have to cope with a great many circumstances that may be characterized as appropriate to develop anxiety. However, as was the case in depression, recent studies have shown that the prevalence of anxiety does not rise with age. Anxiety is common at all ages, including later life. But, just as later life is not an age of melancholy, it also is not an age of apprehension. Making adequate and age-sensitive distinctions between adaptive, signal-type anxiety, and anxiety as a symptom, signifying pathology is a difficult task. This is true at all ages, but may be especially so in later life. There is as yet very little age sensitive theory or empirical evidence to help making this distinction. Moreover, anxiety and depression are often considered to be two of a kind. The symptoms overlap to a large degree, many of the risk factors are shared and similar treatments are effective in both anxiety and depression. In terms of developmental psychopathology, many patients debut with an anxiety disorder early in life, going on to develop depression later on. Considering specific anxiety disorders, especially generalized anxiety disorder (GAD) may well be better classified within the domain of the affective disorders. Rearranging the classification of anxiety and depression, accommodating both the