Treatment of anxiety disorders in the elderly

BACKGROUND: Although anxiety disorders are among the most prevalent psychiatric disorders in the elderly, they tend to be underdiagnosed and inadequately treated. AIM: To collect empirical evidence concerning the effectiveness of the treatment of anxiety disorders in the elderly. METHOD: Meta-analysis and randomised controlled trials. RESULTS: Meta-analysis showed that cognitive behavioural therapy (CBT) was more successful than waiting-list control or active control as a treatment for older persons with anxiety disorders. In a direct comparison of the treatment older persons with panic disorder (PD), both CBT an paroxetine were found to be more effective than waiting-list control. CBT was more successful in reducing avoidance behaviours in older persons with PD. Older persons with PD reported fewer and less severe agoraphobic cognitions than younger patients, but there was no difference between the severity of agoraphobic avoidance in older patients with PD andyounger patients with PD. CONCLUSION: There is sufficient empirical evidence to support the effectiveness of CBT in the treatment of older persons with anxiety disorders. In assessing the severity of PD in the elderly, one should carefully consider the severity of avoidance behaviours. Because no difference was found between the effectiveness of CBT and paroxetine for the treatment of PD in the elderly and because CBT was more effective in reducing avoidance behaviours in older patients with PD than inyounger patients with PD, there seems to be a slight preference for CBT in the case of older patients with PD. Older age is not associated with a poorer outcome of treatment with CBT.