Objective: To find the prevalence, incidence and risk factor of anxiety in the elderly.
Design: Search in MEDLINE and PsychLit
Results: Anxiety disorders are claimed to be common among elderly, but at the same time uncommon primary diagnosis among elderly. The prevalence of the disorders varies across epidemiological studies. Panic and obsessive-compulsive disorders are reported to be prevalent in less than 1% of most studies, whereas the prevalence rate for general anxiety (GAD) is reported to vary between 1.1-7.3 and for phobic disorders 0.6-12% in subjects 65 years and above. Little is known about the prevalence of substance-induced anxiety and post-traumatic stress disorder (PTSD).
Most commonly, anxiety is seen as a co-morbid syndrome in depression, acute and chronic physical disorders, dementia, delirium and psychosis, where the prevalence rate are reported to be 20-40%. The discrepancy between the reported prevalence rates is probably largely due to methodological differences between studies such as the definition and operationalization of anxiety, the use of hierarchies in the diagnosis of anxiety, and the use of a wide variety of psychiatric instruments. Very few studies have reported incidence rates of anxiety disorders; hence there is limited knowledge of how age-related factors influence the occurrence of anxiety. Studies from England reported that at least half of the prevalent cases started earlier in life, not in the later years. Psychosocial factors are considered to be the most important risk and vulnerability factors, although we have no evidence for this assumption, except for major unexpected, negative life events.
Systematic study of risk factors has not been undertaken. One study reported that anxiety is seen more in women, in persons with a smaller contact network, in person with loss of external locus of control, in chronic physical ill persons and in persons with lower level of education. To date, there has been little research into the biological and genetic aspect of anxiety disorders in the elderly, and we do not know if anxiety could be caused by structural or biochemical changes in the aging brain, and in various dementia disorders. There is a strong inverse temporal relationship between the anxiety disorders and cognitive impairment. Anxiety can be difficult to diagnose. Firstly, anxiety is a common co-morbid condition with other psychiatric and somatic disorders, and psychiatric and somatic complaints can mask the diagnosis. Secondly, somatic presentations are common and can confuse the diagnosis. The true prevalence and incidence rate is, therefore difficult to estimate.
Conclusion: Anxiety disorders in the elderly have been a neglected research area compared to research in other age-related psychogeriatric disorders. We need to know why anxiety occurs in elderly persons. To start adequate treatment, the interrelationship between anxiety and other physical, and psychiatric disorders should be understood.
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