A Systematic Review and Meta-analysis of Diagnostic Remission, Treatment Response, Attrition and Relapse Following Cognitive Behavior Therapy (CBT), Other Psychological Therapies and Pharmacological Treatments for Anxiety Disorders in Older Adults.

OBJECTIVE

This systematic review and meta-analysis examined rates of diagnostic remission, treatment response, attrition and relapse following psychological and pharmacological treatments for anxiety disorders in older adults (≥60 years). A key limitation of existing meta-analyses is their conflation of diagnostic and treatment response definitions, obscuring true treatment effects and rendering outcomes limited for guiding treatment decisions.

METHODS

22 randomized controlled trials were included (N = 2,321).

RESULTS

Meta-analytically weighted remission following Cognitive Behavioral Therapy (CBT) was 54% (95% CI = 35%-73%). Remission was significantly higher following CBT than inactive control (OR = 7.14; 59% versus 18%), with similar patterns compared to active control (44%-48% versus 19%-50%). Remission was significantly higher following pharmacotherapy (36%) than placebo (19%), OR = 2.50. Definitions of treatment response varied widely (eight across 12 CBT trials; seven across 10 pharmacological trials). Overall treatment response rate for CBT was 53%. Treatment response was significantly higher for CBT than inactive control (OR = 3.17; 45% versus 19%), but not active control (OR = 2.26; 61% versus 44%). Response was significantly higher following pharmacotherapy (62%) than placebo (35%), OR = 3.25. Pooled CBT attrition rate was 19% (95% CI = 14%-26%), with no difference between CBT and inactive control (OR = 1.17; 19% versus 16%) or active control (OR = 1.25; 22% versus 19%), and no difference between pharmacotherapy and placebo (OR = 1.02; 20% versus 17%). Average relapse rate after CBT was 33% (95% CI = 18%-49%), while no pharmacotherapy trials reported relapse.

CONCLUSION

Overall, results suggest potential superiority of CBT as a first-line treatment for late-life anxiety, and provide a benchmark for clinical implementation and efforts to optimize treatment for late-life anxiety disorders.