Anxiety Disorders in Older Patients

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Anxiety complaints are common among older people. Specific phobia is characterized by exaggerated fear to a specific object or situation. Fear of falling is one example and occurs in about 50% of older persons who have fallen recently. Polypharmacy heightens fall risks. Generalized anxiety disorder is characterized by chronic uncontrollable worry that interferes with functioning and is accompanied by restlessness and disturbed sleep. Panic disorder refers to recurrent, unexpected surges of intense fear that evidence physical and cognitive dysfunction. Cognitive behavior therapy has efficacy among psychotherapies for older anxious adults. In treating anxiety, medications that might be anxiogenic are reduced in dosage or discontinued. It is essential to monitor for suicidal ideation and symptom change. The first-selected pharmacotherapy for people with most anxiety disorders is selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors. The risk-benefit ratio of benzodiazepine pharmacotherapy in elderly patients is not favorable.

Prim Care Companion CNS Disord 2019;21(1):18nr02335