Anxiety disorders in elderly patients.

BACKGROUND

Late-life anxiety disorders, commonly seen in primary care settings, can coexist with other medical and psychiatric illnesses. A variety of effective treatment options is available for these patients.

METHODS

MEDLINE was searched for articles published from 1970 to 1996 using the key words "anxiety," "elderly," "aged," "geriatric," "panic," "obsessive-compulsive," "phobia," and "generalized anxiety disorder." Studies of patients older than 65 years were reviewed.

RESULTS

Generalized anxiety disorder, phobias, panic disorder, and obsessive-compulsive disorder are the most common late-life anxiety problems seen by primary care physicians. Patients with these disorders complain of diffuse multisystem symptoms, motor restlessness, and such physiologic symptoms as tachycardia or tachypnea. Comorbid illnesses include depression, alcoholism, drug use, and multisystem disease. Behavioral strategies to address anxiety include an open discussion of the issue, an anxiety diary, psychosocial support, and cognitive-behavioral techniques. Pharmacologic strategies include carefully monitored benzodiazepine, buspirone, or antidepressant therapy.

CONCLUSIONS

Clinical trials of all anxiety interventions are needed for elderly primary care patients to clarify further whether findings from mixed-age population studies are generalizable to the elderly.