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Worry and anxiety in old age

Evidence from epidemiological studies across all age groups, as well as those specific to populations of older adults, imply that anxiety disorders in later life are prevalent enough to be clinically significant. Phobic anxiety disorder and generalized anxiety disorder (GAD) are the most prevalent anxiety disorders in older adults with rates ranging from 0.7% (Copeland et al., 1987) to 12% (Manela et al., 1996) for phobic anxiety and 1.1% (Copeland et al., 1987) to 7.1% (Uhlenhuth et al., 1983) for generalized anxiety disorder. The wide ranges of rates are due to methodological issues. The rates of anxiety causing pathology in older adults would appear to lie towards the upper ranges particularly considering the evidence that implies that older adults with subthreshold anxiety disorders are equally affected in their functioning as those with a diagnosed anxiety disorder with increased rates of disability, decreased well-being and increased use of health services (De Beurs et al., 1999). Studies to date imply that there is an overall decline in rates of anxiety disorders and severity of anxiety symptoms in older adults. In fact older adults report less of almost every negative emotional state including anxiety (Lawton et al., 1993). The reasons for the decreased rates and severity of anxiety in older adults may be due to decreased neurochemical reactivity, habituation, cohort effects, and increased mortality with subsequent survivors entering old age. Worry is a cardinal feature of anxiety disorders and of generalized anxiety disorder in particular. There is an assumption that worry is experienced similarly in older and younger adults. The evidence against this assumption is growing. Person & Borkovec (1995) found that the older adults in their study reported more frequent worries about health and the younger adults about family and finances. Lidell et al., (1991) found older adults have more frequent fears of untimely death, illness, or injury to a loved one and auto-accidents than do younger adults. If the nature of worry and anxiety in later life is different the foundation of psychopathology and treatment will be impacted. The two original papers published in this month’s journal dramatically further the work in the field of worry, anxiety and generalized anxiety disorder in older adults. They have acknowledged limitations of either small numbers or subjects not representative of a community population, but still they impact upon the phenomenology, natural history and possible underlying psychological processes involved in worry and anxiety. Clinically they offer clarification in the nature of worry in older adults and it’s identification, age groups particularly at risk and point towards possible effective psychological and social methods of management. While the evidence increasingly suggests that younger and older adults have different worries, do older adults with and without anxiety disorders worry about the same things and in the same way? Diefenbach et al., (2001) found that older adults with GAD reported a wider variety of worry topics than did normal controls but there were no differences in worry content patterns. Montorio and colleagues (this issue) studied a representative community sample using random sampling from an electoral register and examined the characteristics of worry in three groups of older adults; those without any emotional disorder, those with sub-threshold generalized anxiety disorder and those with generalized anxiety disorder according to DSM-IV criteria. The most frequent contents of worry for the total sample were within the domains of family and personal health. Worries about family constituted the main domain of worry among the non-clinical group. Participants with GAD had higher frequency scores in every domain of worry compared with non-clinical subjects. Compared with participants