Anxiety Disorders In Older Adults Research Articles

A RANDOMIZED CONTROLLED TRIAL OF SELF-HELP GUIDED BY LAY PROVIDERS FOR GENERALIZED ANXIETY DISORDER IN OLDER ADULTS

Abstract Low use of professional help for anxiety disorders in older adults may be due in part to limited access to mental health services. Self-help guided by lay providers (LPs) could help improve access to treatment. This study evaluated the efficacy and long-term outcomes of self-help guided by LPs for generalized anxiety disorder (GAD) in older adults. Participants (≥ 60 years) with threshold or subthreshold GAD were randomly assigned to an intervention group (n = 75) or a wait-list control group (n = 75). Intervention group participants used a manual presenting readings and exercises based on principles of cognitive-behavioral therapy and received weekly support calls by LPs. Groups were similar in terms of sociodemographic characteristics and initially did not differ significantly on outcomes. At post-treatment, the intervention group had decreased significantly on various measures while the wait-list group remained stable: Generalized Anxiety Disorder 7-item (GAD-7): -4.8 vs -.03; Penn State Worry Questionnaire (PSWQ): -11.7 vs .07; Geriatric Anxiety Inventory (GAI): -5.3 vs -.07. Probability of having a diagnosis of threshold GAD decreased significantly more in the intervention group (79% to 16% vs 74% to 53%). Intervention group scores on the GAD-7, the PSWQ, and the GAI as well as probability of having a diagnosis of threshold GAD remained stable at 6- and 12-month follow-ups. Results provide evidence of the efficacy of self-help guided by LPs for GAD in older adults as well as of the maintenance of improvement following this treatment.

59 The Impact of Anxiety on Memory Performance in Older Adults with Depression

Objective:Late life depression (LLD) refers to a diagnosis of major depressive disorder in people older than 60, and has been linked to significant cognitive impairment and increased risk of Alzheimer's disease. Although anxiety and depression are highly comorbid, the impact of anxiety on cognition in LLD is far less researched. This is important given that over 20% of middle aged and older adults endorse clinically significant chronic worry. Generalized anxiety disorder in older adults with major depression is associated with poorer cognition and worse treatment outcomes compared with those without anxiety. Therefore, the purpose of the study is to examine the role of anxiety on memory in LLD. We hypothesized that presence of anxiety among older depressed adults would be associated with worse cognitive performance over time.Participants and Methods:Participants included 124 individuals (69.4% female, 90.3% Caucasian) aged 60 or above (M = 71.5, SD = 7.4) who met criteria for major depression, single episode or recurrent. They completed the State Trait Anxiety Inventory, Montgomery Asberg Depression Rating Scale, and a measure of verbal episodic memory (WMS-IV Logical Memory) as part of a larger neuropsychological battery. Data were collected from baseline to three years as part of a larger NIMH-supported longitudinal study. Two-level linear mixed-effect models were fitted to predict memory. State and trait anxiety were used as time-varying predictors. The between-person (level 2) and within-person (level 1) effects of anxiety on memory were assessed controlling for the time trend, age, education, gender, race, and change in depression over time.Results:Plot trajectories across variables revealed a negative correlation such that as anxiety decreased, memory improved over time. Hierarchical linear mixed-effect models revealed that average state anxiety was a marginally significant between-person (level2) predictor for memory [B=-0.041, t(128)=-1.8, p=0.083]. Individuals with greater average state anxiety were more likely to experience memory decline compared to those with lower average state anxiety. In addition, the within-person effect (level 1) of state anxiety was significant [B=-0.096, t(253)=-2.7, p=0.007]. As an individual's anxiety increased over time, their memory declined. Trait anxiety showed a significant within-person effect on memory [B=-0.087, t(254)=-2.0, p=0.048], but a non-significant between-person effect [B=-0.005, t(124)=-0.06, p=0.95].Conclusions:Anxiety appears to increase the risk of memory decline in older adults with major depression, a cohort who are already at risk of cognitive decline. Changes in anxiety increased risk of memory decline even when accounting for changes in depression over time. Although the causal link between anxiety and cognitive impairment remains unclear, it is possible that anxiety and worry may compete for cognitive resources necessary for demanding tasks and situations, detracting from abilities, such as attention and working memory. Older adults with depression may also have difficulty coping adaptively with anxiety, which may negatively affect cognition. Finally, presence of anxiety may represent a form of mild behavioral impairment, a prodrome of cognitive decline leading to dementia. Overall, the present study highlights the negative impact of anxiety on memory performance, indicating that treatment interventions targeting anxiety in older adults are essential to help prevent cognitive decline.

Barriers and enablers to help-seeking behaviour for mental health reasons among community dwelling older adults with anxiety: Mixed-methods systematic review

• There is no one model that can depict the complexity of help-seeking behaviour. • Help-seeking is affected by contextual, interpersonal and individual factors. • Help-seeking represents a dynamic self-regulatory system. • Individual need factors play an important role in help-seeking. • Coherence between representations of illness, actions, immediate and higher-order goals is important. Despite their high prevalence and negative consequences, anxiety disorders in older adults remain underdiagnosed and undertreated, creating an ‘anxiety treatment gap’. To address this treatment gap, it is essential to identify barriers and enablers to help-seeking behaviour among this population. This mixed-methods systematic review used Andersen's Model and Leventhal's’ Common Sense Model (CSM) in a “best-fit” framework synthesis to explore barriers and enablers to help-seeking behaviour for mental health reasons among older adults with anxiety. A comprehensive search of six databases, last updated on 6 April 2022, led to the inclusion of thirteen records published 2011-2022. Quantitative data were synthesised using Andersen's Model, summarised using vote counting based on direction of effect, and focused mainly on factors at the individual level. Qualitative synthesis generated an extended conceptual model which includes a priori themes derived from Andersen's Model and Leventhal's CSM and new themes identified via inductive analysis. The role of individual need factors on help-seeking behaviour was corroborated by both quantitative and qualitative evidence. The overarching theme is ‘coherence’ as a multilevel concept. It was not possible to aggregate effect estimates extracted from quantitative records. The internal validity of the review is affected by scant evidence, quality of the qualitative records and lack of triangulation of evidence. There is no one model that can depict the complexity of help-seeking behaviour among older adults with anxiety. A better understanding of the role of need factors and the multi-level concept of ‘coherence’ on help-seeking behaviour is required. Conceptual Model representing the elements, phases and processes underlying illness-seeking behaviour among older adults with anxiety (print in colour)

Health care system and patient costs associated with receipt of minimally adequate treatment for depression and anxiety disorders in older adults

BackgroundDepression and anxiety disorders in older adults are associated with a great burden. Research has shown that less than 50% of adults receive adequate treatment in primary care settings for these disorders. Rare are the studies however assessing adequate treatment in older adults and associated costs from the societal perspective. Given the episodic nature of common mental disorders, this study aims to assess the three-year costs from a restricted societal perspective (including health system and patient perspectives) associated with receipt of minimally adequate treatment for depression and anxiety disorders in older adults consulting in primary care.MethodsThis primary care cohort study included 358 older adults aged 65 years and older with either a self-reported or physician diagnosis of depression or an anxiety disorder covered under Quebec’s public drug plan. Receipt of minimally adequate treatment was assessed according to Canadian guidelines and relevant reports. Outpatient and inpatient service use, medication costs and physician billing fees were obtained from provincial administrative databases. Unit costs were calculated using provincial financial and activity reports and relevant literature. A propensity score was created to estimate the probability of receiving minimally adequate treatment and the inverse probability was used as a weight in analyses. Generalized linear models, with gamma distribution and log link, were conducted to assess the association between receipt of minimally adequate treatment and costs.ResultsOverall, receipt of minimally adequate treatment was associated with increased three-year costs averaging $5752, $536, $6266 for the health system, patient and societal perspectives, respectively, compared to those not receiving minimally adequate treatment. From the health system perspective, participants receiving minimally adequate treatment had higher costs related to emergency department (ED) (difference: $457, p = 0.001) and outpatient visits (difference: $620, p < 0.001), inpatient stays (difference: $2564, p = 0.025), drug prescriptions (difference: $1243, p = 0.002) and physician fees (difference: $1224, p < 0.001). From the patient perspective, receipt of minimally adequate treatment was associated with higher costs related to loss of productivity related to ED (difference: $213, p < 0.001) and outpatient visits (difference: $89, p < 0.001).ConclusionsOlder adults receiving minimally adequate treatment for depression and anxiety disorders incurred higher societal costs reaching $2089 annually compared to older adults not receiving minimally adequate treatment. The main cost drivers were attributable to hospitalizations and prescription drug costs.

557 - Generalized anxiety disorder in older adults: acceptability of guided self-help by a lay provider and preference among different treatment modalities

A cognitive-behavioral guided self-help conducted by lay providers (CBT-GSH-LP) had been shown to be effective in treating anxiety and may help facilitate access to treatment. The first objective of this study was to assess the acceptability the CBT-GSH-LP for the Generalised Anxiety Disorder in adults aged 60 and over. Its acceptability was compared to that of the same treatment conducted by a psychotherapist (CBT- GSH-PSY) and to that of a face-to-face cognitive behavioral therapy with a psychotherapist (CBT- PSY). The second objective was to assess the preference of the participants for these treatment modalities. As a secondary objective, variables potentially associated with acceptability or preference were explored, as well as reported reasons for treatment preference. Participants were recruited in community centers and private residences. They had to complete a sociodemographic questionnaire, read descriptions of the three treatments, and complete the Treatment Evaluation Inventory for each one, then to place those treatment in order of preference as well as indicating the reason for their preferred treatment. ANOVAs were performed to identify differences in acceptability scores between the three treatment modalities and proportions were calculated for preferred treatment and reasons associated. CBT-GSH-LP was considered moderately acceptable by participants (N = 116; mean age = 70.5 years), although significantly less acceptable than the other two treatment modalities. In addition, the proportion of participants who found CBT-GSH-LP to be at least moderately acceptable was high (59,3%), although lower than that of the other two treatment modalities (CBT-GSH-PSY: 85,8%; CBT-PSY: 91,2%). Consequently, the preferred treatment of participants was CBT-PSY followed by CBT-GSH-PSY, then CBT-GSH-LP. Among participants preferring CBT-GSH-LP, its long-lasting effect, ease of access, training of the therapist, required patient involvement, and autonomy afforded by treatment were the top reasons. Regarding characteristics, the results show that single and widowed older adults considered CBT-GSH-LP more acceptable than married, divorced, or separated people. Thus, although it is not the preferred treatment modality for older adults, CBT-GSH-LP is acceptable and would benefit from being better known and used for generalized anxiety disorder.

Mouse modeling for anxiety disorders in older adults.

Anxiety disorders are common in older adults and are strongly associated with increased risk for numerous age-related conditions. Preclinical mechanistic data are needed to identify more specific therapeutic targets for treating and preventing these disorders. Mice serve as excellent preclinical models as they have been used extensively in aging studies, and behavioral tests have been developed. A panel of tests would capture the important clinical aspects of apathy, anxiety, and psychomotor behavior and allow longitudinal testing strategies in a rigorous and minimally stressful manner.

Anxiety Disorders in Late Life: Considerations for Assessment and Cognitive-Behavioral Treatment

Anxiety disorders are among the most frequently diagnosed mental disorders in late life. As older adults comprise a growing segment of the population, evidence-based treatments for anxiety disorders in late life have come into sharper focus. Cognitive-behavioral therapy (CBT) for anxiety disorders in late life has received less empirical attention and widespread dissemination relative to other age groups. Increasing older adults’ access to timely assessment and effective treatment can help reduce the personal and societal costs of anxiety disorders. The purpose of this review paper is to discuss important considerations for the assessment of anxiety disorders in older adults and offer adaptations to CBT treatment for this population. As part of assessment considerations, we discuss how physical health conditions, cognitive impairment, and functional limitations can impact anxiety disorder diagnoses with older adults. We also outline validated self-report measures of anxiety disorder symptoms for older adults and highlight the importance of assessing older adults’ suitability for CBT. Several recommendations for adapting CBT protocols for older adults with anxiety disorders are described, such as extending psychoeducation, altered treatment pacing, use of content aids, and medical contraindications for interoceptive exposure. A case study is included that illustrates helpful assessment and treatment adaptions for an older woman with panic disorder. We highlight the pressing need to increase research and dissemination of CBT for anxiety disorders for older adults to meet the needs of an increasing segment of the population worldwide.

Self-help guided by trained lay providers for generalized anxiety disorder in older adults: study protocol for a randomized controlled trial

BackgroundOnly a small proportion of older patients with generalized anxiety disorder (GAD) seek professional help. Difficulties in accessing treatment may contribute to this problem. Guided self-help based on the principles of cognitive-behavioral therapy (GSH-CBT) is one way of promoting access to psychological treatment. Moreover, because the therapist’s role in GSH-CBT is limited to supporting the patient, this role could be assumed by trained and supervised lay providers (LPs) instead of licensed providers. The main goal of this study is to evaluate the efficacy of GSH-CBT guided by LPs for primary threshold or subthreshold GAD in older adults.MethodsWe will conduct a multisite randomized controlled trial comparing an experimental group receiving GSH-CBT guided by LPs (n = 45) to a wait-list control group (n = 45). Treatment will last 15 weeks and will be based on a participant’s manual. Weekly telephone sessions with LPs (30 min maximum) will be limited to providing support. Data will be obtained through clinician evaluations and self-assessment questionnaires. Primary outcomes will be the tendency to worry and severity of GAD symptoms. Secondary outcomes will be anxiety symptoms, sleep difficulties, functional deficit, diagnosis of GAD, and cognitive difficulties. For the experimental group, measurements will take place at pre- and post-treatment and at 6 and 12 months post-treatment. For the control group, three evaluations are planned: two pre-treatment evaluations (before and after the waiting period) and after receiving treatment (post-treatment). The efficacy of GSH-CBT will be established by comparing the change in the two groups on the primary outcomes.DiscussionThis project will provide evidence on the efficacy of a novel approach to treat GAD in older adults. If effective, it could be implemented on a larger scale and provide many older adults with much needed mental health treatment through an expanded workforce.Trial registrationThe trial was registered at ClinicalTrials.gov, number NCT03768544, on December 7, 2018.

Aquaphobia: A Case Report on the Unique Presentation of a Specific Phobia

<h3>Introduction</h3> Aquaphobia is an irrational fear of water that is classified as a specific phobia. Specific phobias are a type of anxiety disorder that cause persistent and unrealistic fear triggered by an object, person, animal, activity, or situation. The National Institute of Mental Health states that approximately 19.2 million American adults suffer from some form of a specific phobia. They often present early in life but it is important to recognize that the geriatric population may develop phobias too, especially as they experience the negative effects of medical conditions. Previous studies report up to a 10% phobia prevalence rate in people 65 or older, with specific phobias accounting for 2.1% of this group. Adult phobias often last many years and will not subside unless treated appropriately. Those who suffer from specific phobias tend to avoid the trigger and, in certain situations, this can have a major detriment to quality of life. Here, we present the case of a 69-year-old male who developed aquaphobia while undergoing treatment for non-small cell lung cancer. <h3>Methods</h3> The patient was seen and treated by the psychiatry team through multiple telehealth evaluations over a four-month period. <h3>Results</h3> Case: JY is a 69-year-old male with the diagnosis of non-small cell lung cancer, 80 pack-year smoking history, COPD, chronic kidney disease, and no past psychiatric history. He was diagnosed in 2019 after a CT chest scan showed left upper lobe and right lower lobe lung nodules. He underwent a complex surgical procedure followed by chemotherapy and radiotherapy. In June 2020, he experienced coughing spells and distressing shortness of breath and underwent thoracentesis, which confirmed malignant pleural effusion. Shortly after thoracentesis, JY presented for initial psychiatry telehealth evaluation accompanied by his wife. Following this procedure, he had been experiencing persistent and irrational fear of water. He reported episodes of intense anxiety and shortness of breath associated with any activity that involved water, including looking at a glass of water, drinking water, shaving, washing dishes, or showering. The sight of water elicited an immediate anxious reaction where he started to gasp for air and felt that he was going to die. As a result, he began to avoid situations that required contact with water. He stopped showering and shaving and he avoided drinking water to the point of frequently experiencing thirst and dehydration. He recognized that his fear was irrational and believed his condition severely interfered with his life. He was diagnosed with aquaphobia based on history and DSM-5 Criteria. He was started on sertraline 25mg daily which was titrated up to 200mg daily. Quetiapine was added as an adjuvant with a dose of 12.5mg PO QAM, noon, and 50mg bedtime. The patient was referred to psychotherapy but was unable to attend sessions. However, during telehealth sessions the psychiatrist was able to provide psychoeducation about the patient's condition and guided breathing exercises; the patient found this to be helpful. After four months of treatment, the patient reported significant improvement in symptoms and was to resume activities that involved exposure to water. <h3>Conclusions</h3> Anxiety disorders in older adults reduce quality of life yet these disorders have received little attention in the literature. In this poster, we will discuss the unique presentation of aquaphobia in an elderly patient and the potential causes and treatment options. This case highlights that specific phobias can develop in the geriatric population particularly as they experience the long-term sequelae of medical conditions. In the case of JY, it is hypothesized that his feeling of choking while drinking water, in the setting of shortness of breath due to malignant pleural effusions, triggered an irrational fear of water. The development of this condition severely decreased the patient's quality of life and had negative effects on his overall health. Effective therapeutics to aquaphobia include a pharmacological approach as well as Cognitive Behavioral Therapy (CBT) or exposure therapy. These treatments allow patients to regain control of reactions to stress and stimulus in the presence of water. In the case of JY, a pharmacological approach was found to be successful. Phobias can severely affect quality of life in the elderly and it is therefore important to promptly recognize the diagnosis to quickly enact treatment modalities. <h3>Funding</h3> No funding was provided for this case report.

The association between anxiety disorders and hippocampal volume in older adults.

The hippocampus, through its mediation of fear responses is thought to play a central role in the onset and maintenance of anxiety disorders. Prevalence of anxiety disorders remains high in older populations; however, little is known about their association with hippocampal changes in this age group. Due to differing levels of cortisol as adults age, age-related decreases in hippocampal volume, and the suggestion that age-related loss of neurogenesis results in anxiety disorders, this area requires investigation. We examined the association between hippocampal volume and anxiety disorders (social anxiety disorder, generalized anxiety disorder, agoraphobia, panic disorder, obsessive compulsive disorder and posttraumatic stress disorder) in 534 older adults participating in the Enquête de Santé Psychologique-Risques, Incidence et Traitement (ESPRIT) study of late-life neuropsychiatric disorders. Anxiety disorders were diagnosed using the Mini International Neuropsychiatric Interview MINI, French version 5.00. Cross-sectional analyses adjusted for age, educational level, gender, Mini-Mental State Examination scores, National Adult Reading Test scores, whole brain volume and depression found that a diagnosis of generalized anxiety disorder was positively associated with larger hippocampal volume. No other anxiety disorder was significantly associated with hippocampal volume. The present study is the first to examine the association between several anxiety disorders and hippocampal volume in an older population and the results highlight the need for further research relating to the relationship between hippocampal volume and anxiety disorders in older adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Efficacy and effectiveness of psychological interventions on co-occurring mood and anxiety disorders in older adults: A systematic review and meta-analysis.

Co-occurring mood and anxiety disorders are common in older adult populations and are associated with worse long-term outcomes and poorer treatment response than either disorder alone. This systematic review and meta-analysis aimed to examine the efficacy and effectiveness of psychological interventions for treating co-occurring mood and anxiety disorders in older adults. The study was registered (PROSPERO CRD4201603834), databases systematically searched (MEDLINE, PSYCINFO, PubMed and Cochrane Reviews) and articles screened according to PRISMA guidelines. Participants aged ≥60 years with clinically significant anxiety and depression, psychological intervention evaluated against control in randomised controlled trial, changes in both anxiety and depression reported at post-treatment. ResultsFour studies were included (total n=255, mean age range 67-71 years). Overall, psychological interventions (cognitive behavioural therapy, mindfulness) resulted in significant benefits over control conditions (active, waitlist) for treating depression in the presence of co-occurring anxiety (Hedges' g=-0.44), and treating anxiety in the presence of depression (Hedges' g=-0.55). However, conclusions are limited; the meta-analysis was non-significant, few studies were included, several were low quality and there was high heterogeneity between studies. Benefits at follow-up were not established. Co-occurring anxiety and mood disorders can probably be treated simultaneously with psychological interventions in older adults with moderate effect sizes, however, more research is needed. Given comorbidity is common and associated with worse clinical outcomes, more high-quality clinical trials are needed that target the treatment of co-occurring anxiety and mood disorders, and report changes in diagnostic remission for both anxiety and mood disorders independently.

Digital Interventions for Depression and Anxiety in Older Adults: Protocol for a Systematic Review.

BackgroundThere is a high prevalence of older adults experiencing depression and anxiety. In response to heightened demands for mental health interventions that are accessible and affordable, there has been a recent rise in the number of digital mental health interventions (DMHIs) that have been developed and incorporated into mental health treatments. Digital interventions are promising in their ability to provide researchers, medical practitioners, and patients with personalized tools for assessing behavior, consultation, treatment, and care that can be used remotely. Reviews and meta-analyses have shown the benefits of DMHIs for the treatment and prevention of depression, anxiety, and other mental illnesses, but there is still a lack of studies that focus on the benefits and use of DMHIs in the older population.ObjectiveThe aim of this systematic review is to investigate the current evidence for the effect of technology-delivered interventions, such as smartphone/tablet applications, remote monitoring and tracking devices, and wearable technology, for the treatment and prevention of depression and anxiety in adults older than 50 years.MethodsThe academic databases SCOPUS, PsycINFO, AgeLine (EBSCO), and Medline (PubMed) will be searched from January 1, 2010, to the date of search commencement to provide a review of existing randomized controlled trial studies. The search will include 3 key concepts: “older adults,” “digital intervention,” and “depression/anxiety.” A set of inclusion criteria will be followed during screening by two reviewers. Data will be extracted to address aims and objectives of the review. The risk of bias for each study will be determined using appropriate tools. If possible, a random-effects meta-analysis will be performed, and the heterogeneity of effect sizes will be calculated.ResultsPreliminary searches were conducted in September 2020. The review is anticipated to be completed by April 2021.ConclusionsThe data accumulated in this systematic review will demonstrate the potential benefits of technology-delivered interventions for the treatment of depression and anxiety disorders in older adults. This review will also identify any gaps in current studies of aging and mental health interventions, thereby navigating a way to move forward and paving the path to more accessible and user-friendly digital health interventions for the diverse population of older adults.Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42020192532; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020192532International Registered Report Identifier (IRRID)PRR1-10.2196/22738

Emotion processing in depression and anxiety disorders in older adults: systematic review.

Emotional cognition and effective interpretation of affective information is an important factor in social interactions and everyday functioning, and difficulties in these areas may contribute to aetiology and maintenance of mental health conditions. In younger people with depression and anxiety, research suggests significant alterations in behavioural and brain activation aspects of emotion processing, with a tendency to appraise neutral stimuli as negative and attend preferentially to negative stimuli. However, in ageing, research suggests that emotion processing becomes subject to a 'positivity effect', whereby older people attend more to positive than negative stimuli. This review examines data from studies of emotion processing in Late-Life Depression and Late-Life Anxiety to attempt to understand the significance of emotion processing variations in these conditions, and their interaction with changes in emotion processing that occur with ageing. We conducted a systematic review following PRISMA guidelines. Articles that used an emotion-based processing task, examined older persons with depression or an anxiety disorder and included a healthy control group were included. In Late-Life Depression, there is little consistent behavioural evidence of impaired emotion processing, but there is evidence of altered brain circuitry during these processes. In Late-Life Anxiety and Post-Traumatic Stress disorder, there is evidence of interference with processing of negative or threat-related words. How these findings fit with the positivity bias of ageing is not clear. Future research is required in larger groups, further examining the interaction between illness and age and the significance of age at disease onset.

Prevalence of Common mental disorders in older adults: Results from the National Mental Health Survey of India

We estimate the prevalence of common mental disorders (CMD) among older adults and compare them with that of younger adults at the national level. We analysed data on older adults from the National Mental Health Survey of India undertaken across 6 regions and 12 states of India during 2015-16. Multi-stage cluster sampling technique was adopted which permitted state level and subsequently pooled national estimates. Mini International NeuroPsychiatric Interview (MINI) adult version 6.0 was used for measuring psychiatric morbidity. Older adults had a higher lifetime (6.93%) and current (3.53%) prevalence of depressive disorders as compared to the younger adults (4.96% and 2.54%). There was no difference in the prevalence of anxiety disorders in different agegroups. The most prevalent anxiety disorder in older adults was specific phobias (1.72%) followed by agoraphobia (1.6%). All CMD in the older population were more common in females, those living in urban metros, the unemployed, who were not currently married and those with lower household income. These findings support planning better mental health policies and programs for older adults in India.

Sex Differences in Anxiety Disorders in Older Adults

Anxiety disorders are the most prevalent mental disorders. Although prevalence estimates are lower in males than females, thedisability associated withanxiety disorders has been increasingin males. This review focuses on recent research studying sex differences in anxiety disorders and associated symptoms in older adults. Females are close to three times more likely than males to report most anxiety disorders. Heterogeneity exists in sex-specific lifetime and past-year estimates. Age-appropriate instruments such as the CIDI65+ show higher estimates than previous research. The profiles of females and males with anxiety with respect to depressive and somatization symptoms are different. Age-appropriate standardized mental disorder instruments have been developed and may be useful to overcome the challenges of observed heterogeneity in anxiety disorders and allow for future cross-country comparisons and a better description of the epidemiology and biopsychosocial factors associated with different types of anxiety disorders in older adults.

Optimising the acceptability and feasibility of acceptance and commitment therapy for treatment-resistant generalised anxiety disorder in older adults

generalised anxiety disorder (GAD) is common in later life with a prevalence of 3-12%. Many only partially respond to cognitive behavioural therapy or pharmacotherapy and can be classified as treatment resistant. These patients experience poor quality of life, and are at increased risk of comorbid depression, falls and loneliness. Acceptance and commitment therapy (ACT) is an emerging therapy, which may be particularly suited to this population, but has not been tailored to their needs. to optimise the acceptability and feasibility of ACT for older adults with treatment-resistant GAD. a person-based approach to ground the adapted ACT intervention in the perspectives and lives of those who will use it. first, we conducted qualitative interviews with 15 older adults with GAD and 36 healthcare professionals to develop guiding principles to inform the intervention. Second, we consulted service users and clinical experts and interviewed the same 15 older adults using 'think aloud' techniques to enhance its acceptability and feasibility. in Stage 1, older adults' concerns and needs were categorised in four themes: 'Expert in one's own condition', 'Deep seated coping strategies', 'Expert in therapy' and 'Support with implementation'. In Stage 2, implications for therapy were identified that included an early focus on values and ACT as a collaborative partnership, examining beliefs around 'self as worrier' and the role of avoidance, validating and accommodating individuals' knowledge and experience and compensating for age-related cognitive changes. Our systematic approach combined rigour and transparency to develop a therapeutic intervention tailored to the specific needs of older adults with treatment-resistant GAD.

When worry may be good for you: Worry severity and limbic-prefrontal functional connectivity in late-life generalized anxiety disorder

BackgroundLate-life generalized anxiety disorder (GAD) is one of the most common anxiety disorders in older adults. However, its neural markers have received relatively little attention. In this study, we explored the association between worry severity and limbic-prefrontal connectivity during emotional reactivity in late-life GAD. MethodsWe recruited 16 anxious (GAD) and 20 non-anxious (HC) older adults to perform the faces/shapes emotional reactivity task during functional magnetic resonance imaging (fMRI). We investigated the functional connectivity of both the amygdala and the bed nucleus of stria terminalis (BNST) with the prefrontal cortex (PFC) using generalized psychophysiological interaction (gPPI) analysis. We tested for (1) group differences in connectivity, (2) association between worry severity and connectivity, and (3) interaction between group and worry severity and its association with connectivity. ResultsAmygdala-PFC and BNST-PFC functional connectivity were associated with worry severity in an inverse U-shape, and was independent of depression severity, global anxiety, neuroticism, and general cognitive function. LimitationsOur limitations include slightly skewed PSWQ distributions, lack of non-anxious individuals with high worry, small sample size, and low depression comorbidity in a sample of late-life GAD that may not generalize to GAD in younger populations. ConclusionsThis suggests that moderate worry is associated with maximum engagement of the limbic-PFC connectivity, while severe worry is associated with failure of the limbic-PFC emotional regulation circuit. This may explain the aberrant and exaggerated responses to negative stimuli observed in participants with pathological worry.

Associations between grip strength and generalized anxiety disorder in older adults: Results from the Irish longitudinal study on ageing

BackgroundAssociations between grip strength and mental health disorders have been established; however, associations between grip strength and Generalized Anxiety Disorder (GAD) remain unstudied. Therefore, this study investigates associations between grip strength and prevalent and incident GAD. MethodsA prospective cohort design was utilized. At baseline, participants aged ≥50 years (N = 3,952) completed a hand grip strength assessment and abbreviated Penn State Worry Questionnaire (PSWQ) and were divided into sex-specific tertiles based on strength. A score of ≥23 on the PSWQ defined caseness of GAD. At two-year follow-up, GAD was assessed with the Composite International Diagnostic Interview—Short Form. ResultsPrevalence and incidence of GAD were 18.2% (N = 718) and 0.9% (N = 29), respectively. Adjusting for age, sex, waist circumference, social class, smoking status, and physical activity, a one-standard-deviation (1-SD) increase in strength was associated (OR, 95%CI) with 12.1% (OR = 0.88, 0.80–0.96; p < 0.01) lower odds of prevalent GAD, and middle and high strength tertiles were associated with 27.3% (OR = 0.73, 0.59–0.89; p < 0.01) and 23.1% (OR = 0.77, 0.62–0.95; p < 0.05) lower odds, respectively. A 1-SD increase in strength was non-significantly associated with 24.2% (OR = 0.76, 0.50–1.14) lower odds of incident GAD, and middle and high strength tertiles were non-significantly associated with 31.4% (OR = 0.69, 0.30–1.58) and 66.5% (OR = 0.34, 0.11–1.00) lower odds, respectively (all p > 0.05). There was no significant interaction between strength tertiles and sex. LimitationsThe observational nature of the study limits inferring causality. ConclusionsIncreased hand grip strength may be associated with lower odds of developing GAD in older adults. Larger investigations of prospective associations are needed.

ANTIDEPRESSANTS FOR ANXIETY DISORDERS IN LATE-LIFE: A SYSTEMATIC REVIEW

Introduction Anxiety disorders are encountered frequently in late life, and contribute to distress, disability, and increased mortality. Late-life GAD has been linked to increased risk of incident stroke [3]. Anxiety is associated with an increased risk for cognitive impairment and dementia in community dwelling older adults independent of psychosocial risk factors [6]. Despite these impairments, late-life anxiety disorders are largely untreated in primary care, with only 36.3% of recurrent cases in a community sample receiving treatment [7]. Antidepressants are considered to be first-line pharmacological treatment for anxiety disorders [8]. Current evidence for the treatment of anxiety disorders in the elderly is extrapolated from studies on younger adults. However, older adults suffer from medical conditions that affect renal, hepatic, and cardiac function. Pharmacokinetic considerations such as variable drug absorption and decreased volume of distribution may also contribute to reduced safety and tolerability of antidepressants in the elderly [5]. To date, there has not been a systematic review on the use of antidepressants for anxiety disorders in older adults. The aim of this systematic review is to provide updated information on the efficacy and tolerability of antidepressants in treatment of anxiety disorders among older adults from randomized controlled studies. Methods This systematic review was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The objective of this review is to summarize the results from published randomized controlled clinical trials of antidepressants for late-life anxiety. We performed a literature search of PubMed, MEDLINE, EMBASE, PsychINFO, and Cochrane collaboration databases through October 18th, 2018, using the following keywords: “late life”, “elderly”, aged, “senior citizen”, or “geriatric” combined with the keywords “anxiety” or “anxiety disorder”, and “antidepressant” or “antidepressive agents” or their pharmaceutical names. The search was restricted to English-language studies conducted in human subjects. We reviewed the bibliographic databases of the published articles for additional studies. Results Our search yielded a total of 12 randomized controlled trials. Two of these studies [14, 15] were pooled analyses of randomized controlled trials, which have been included as they fulfilled our selection criteria. We found 8 trials of selective serotonin reuptake inhibitors (SSRIs): 3 studies on sertraline [16, 17, 18], 2 each on citalopram [19, 20] and escitalopram [21, 22], and 1 trial of paroxetine [23]. We found 3 studies on serotonin-norepinephrine reuptake inhibitors (SNRIs), including 1 study on duloxetine [24], and 1 study each on duloxetine [14] and venlafaxine [15] reporting pooled analyses. There was 1 study of a tricyclic antidepressant (TCA), namely imipramine [25]. Three studies were rated “good”, 8 were rated “fair” and 1 was rated “poor” according to our quality appraisal criteria. Conclusions This systematic review supports the use of antidepressants as an efficacious and well-tolerated treatment option for late-life anxiety. Future research should focus on other anxiety disorders such as phobias and post-traumatic stress disorders, and should include older adults as well as those with cognitive impairment to increase their generalizability to community settings. Long term trials are needed to assess the efficacy of antidepressants in maintenance and prevention of relapse of anxiety, and provide necessary data on long-term tolerability. Head-to-head trials of antidepressants and other agents used for anxiety such as gabapentin and quetiapine are needed to compare their efficacy and safety. Future studies should include treatment modalities commonly used in the elderly such as problem-solving therapy, as well as newer modes of service delivery such as tele-psychiatry and home-visits to conceptualize efficacious treatment options for anxiety disorders in late-life that are commonly encountered in clinical settings. This research was funded by The authors did not receive any funding for this study

Prevalence of anxiety disorder among older adults in Spain: A meta-analysis.

Anxiety disorders are recognized as one of the most prevalent mental disorders in late-life. However, the prevalence of anxiety disorders in older Spanish people has not yet been determined. The aim was to review epidemiological studies systematically to calculate the overall prevalence of anxiety in Spanish older adults by using meta-analytic techniques. We searched relevant published studies in electronic databases up to January 2018 providing data on the prevalence of anxiety among people aged 65+ years in Spain. Overall anxiety prevalence estimates were calculated using random-effects models. Sources of heterogeneity were explored by means of univariate meta-regressions. A total of 9 studies were included in the meta-analysis (N = 12,577). Pooled overall prevalence of anxiety was 11% (95% confidence interval (CI): 6%-18%) representing 1958,471 people aged 65+ (95%CI: 1068,257-3204,771). Point, 12-month and lifetime prevalence of anxiety disorders were 12%, 6% and 19%, respectively. We detected a small publication bias effect for life-time prevalence of anxiety. The use of different diagnostic methods across the studies would have required separate analyzes. Some heterogeneity was found across studies, probably due to different methodological issues. Overall, the pooled prevalence of anxiety disorders in Spanish older adults was lower than that observed in other countries. Due to the negative consequences of anxiety disorders in older adults, detection and treatment should be a priority in this population.