Anxiety And Aging: Anxiety Disorder

Content provided by the Faculty of the Harvard Medical School

Anxiety and aging

Anxiety disorders are the most common mental health disorders among older adults. Approximately 11% of people ages 55 and over suffer from an anxiety disorder, while less than 4% experience major depression. Although most anxiety disorders start in early adulthood, they tend to last well into the later years. In addition to enduring anxiety disorders from their youth, older adults become increasingly susceptible to anxiety that's caused by illness or a medication. That's because both illness and the need for medication become more common with age (see "Medical conditions that provoke or mimic symptoms of anxiety disorder" and "Substance-induced anxiety disorder").

Anxiety in older adults has received relatively little scientific attention. Most of what's known comes from studies of young and middle-aged adults, but the findings on anxiety medications don't all hold true for older people. Age-related changes in the absorption and metabolism of drugs tend to make drugs linger longer in the body, increasing the risk for harmful effects even at doses considered safe for younger people. In addition, older adults are more likely to use medications for a variety of conditions, and some of these drugs can interact with anxiety medications.

Anxiety disorders in older adults Approximately 11% of adults age 55 or over have an anxiety disorder.

Because of the greater risk of side effects, doctors often prescribe anti-anxiety drugs in lower doses or recommend different therapies. Benzodiazepines are avoided whenever possible because they cause more side effects, such as sedation and impaired cognition, than some newer drugs, such as buspirone (BuSpar). If benzodiazepines are used, the best choices are the short-acting versions, such as lorazepam (Ativan), oxazepam (Serax), or temazepam (Restoril), which don't linger in the body as long as long-acting ones, for example, diazepam (Valium), clonazepam (Klonopin), or chlordiazepoxide (Librium). In general, short-acting drugs cause less sedation and cognitive impairment, making them safer for people who need to drive.

Buspirone is thought to be safer than the benzodiazepines; it doesn't cause sedation or cognitive impairment, and it doesn't lead to adverse interactions when taken with a variety of drugs commonly used by older adults, including certain heart medications and drugs to control blood pressure. However, research on buspirone has been disappointing, with a number of studies finding it less effective than benzodiazepines in treating anxiety. And buspirone carries two other drawbacks: It takes several weeks to take effect, and it does not improve insomnia, a frequent complaint among older people with anxiety.

Preliminary studies have found that cognitive behavioral therapy is effective for older individuals with panic disorder and social phobia. When used along with medication, it may reduce the amount of time the drug is needed. For older people who can't tolerate anti-anxiety medications, this form of therapy can be used by itself.

Last updated:	September 05, 2008