The Burden of Late-Life Generalized Anxiety Disorder: Effects on Disability, Health-Related Quality of Life, and Healthcare Utilization (original) (raw)
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Generalized anxiety in community-dwelling elderly: Prevalence and clinical characteristics
Journal of Affective Disorders, 2015
Background: Generalized anxiety disorder (GAD) is a chronic and disabling disorder with a low rate of full remission. As it is commonly assumed that cases in the elderly principally represent the continuing chronic course of early onset illness, there has been little research into the clinical characteristics, including comorbid psychiatric and physical conditions, which may be specific to older people. Methods: Lifetime GAD and psychiatric comorbidity were diagnosed in 1974 community-dwelling elderly people aged 65 or over using a standardized psychiatric examination, the MINI, based on DSM-IV criteria. Multivariate regression analyses were adjusted for socio-demographic, lifestyle, biological, and clinical variables, as well as adverse life events. Results: The lifetime prevalence of GAD was 11% (95%CI=9.6-12.4%) of whom 24.6% reported a late onset with a first episode after 50 years of age. The 6-month current prevalence was 4.6% (95%CI=3.7-5.5%). Most of the prevalent cases were recurrent but only 36.3% were receiving treatment. Fourteen percent were comorbid with major depression and 34% with phobia but their associated factors differed. The factors associated with pure GAD were being female, having cognitive impairment, lower body mass index, reporting low affective support during childhood, taking a high number of somatic medications independently of other mental health factors, e.g. psychotropic medication use, major depression, and phobia. Limitations: The study is limited by cross-sectional design. Conclusions: Our data indicate that GAD prevalence is high in elderly people with a late-life onset of GAD in 25% of cases. GAD in the elderly is not just a severity marker of depression and is clinically distinct from phobia, the other major anxiety disorder of the elderly.
Journal of Affective Disorders, 2011
Background: Generalized anxiety disorder (GAD) occurs commonly, with widespread consequences including decreased functioning and wellbeing, and increased consumption of health resources. Notwithstanding its prevalence and impact, knowledge about GAD in older adults is still scarce. Accordingly, the main goals of this study were to estimate the prevalence and analyze the correlates of 12-month DSM-IV GAD in older community-residing adults. Methods: The sample was drawn from the 2007 Australian National Survey of Mental Health and Well-Being and consisted of 3035 participants aged between 55 and 85 years, assessed by lay interviewers with the fully-structured Composite International Diagnostic Interview. Results: Eighty-four participants were diagnosed with GAD, equivalent to a weighted 12-month population prevalence of 2.8% (95% CI: 2.0, 3.7). In a multivariate logistic regression model older age (OR = 0.24, p = 0.006), functional limitations (OR = 1.07, p = 0.001), lifetime depression comorbidity (OR = 5.31, p b 0.001), concerns about having a serious illness despite doctor's reassurance (OR = 2.29, p = 0.021), and family history of anxiety or depression (OR = 2.41, p = 0.007) were the most significant predictors of 12-month GAD in older adults.
Predictors of change in quality of life in older adults with generalized anxiety disorder
International Psychogeriatrics, 2014
ABSTRACTBackground:Quality of life (QOL) is lower in older adults with generalized anxiety disorder (GAD). QOL generally improves following cognitive-behavioral treatment for GAD. Little is known, however, about additional variables predicting changes in QOL in older adults with GAD. This study examined predictors of change in QOL among older participants in a randomized clinical trial of cognitive behavioral therapy (CBT) for GAD, relative to enhanced usual care (EUC).Methods:Hierarchical multilevel mixed-model analyses were used to examine inter-individual and intra-individual factors that predicted QOL over time. Predictors were categorized into treatment, personal and clinical characteristics.Results:QOL improved over time, and there was significant variability between participants in change in QOL. Controlling for treatment condition, baseline general self-efficacy, baseline social support, within-person variation in worry and depression and average levels of depression across ...
The relationship between generalized anxiety disorder, depression and mortality in old age
International Journal of Geriatric Psychiatry, 2007
Background The association between depression and an increased risk of death in elderly persons has been established in both clinical and community studies. Co-occurrence of depression and generalized anxiety has been shown to represent more severe and more chronic psychopathology. However, little is known about the relation between generalized anxiety disorder, mixed anxiety-depression (generalized anxiety disorder and depression) and excess mortality in the elderly. Objective To investigate whether generalized anxiety and mixed anxiety-depression are associated with mortality. Method Generalized anxiety disorder, mixed anxiety-depression and depression were assessed in 4051 older persons with a ten-year follow-up of community death registers. The mortality risk of generalized anxiety, depression and mixed anxietydepression was calculated after adjustment for demographic variables, physical illness, functional disabilities and social vulnerability. Results In generalized anxiety disorder and mixed anxiety-depression no significant excess mortality was found. In depression a significant excess mortality was found in men [HR 1.44 (1.09-1.89)] but not in women [HR 1.04 (0.87-1.24)] after adjustment for the different variables. Conclusions In elderly persons depression increases the risk of death in men. Neither generalized anxiety nor mixed anxiety-depression are associated with excess mortality. Generalized anxiety disorder may even predict less mortality in depressive elderly people. The relation between generalized anxiety disorder and its possibly protective effect on mortality has to be further explored.
Treatment Response for Late-Life Generalized Anxiety Disorder
The Journal of Nervous and Mental Disease, 2011
Response to treatment for late-life generalized anxiety disorder has been defined by a variety of methods, all based on statistically significant reductions in symptom severity. However, it is unknown whether these improvements in symptom severity are associated with meaningful differences in everyday functioning. The current study used four methods to define response to treatment for 115 primary care patients, age 60 and older, with a principal or co-principal diagnosis of generalized anxiety disorder. The methods examined included percent improvement, reliable change index and minimal clinically significant differences. Agreement among classification methods and their associations with general and mental health related quality of life were assessed. Results indicated moderate agreement among symptom-based classification methods and significant associations with measures of quality of life.
Generalized Anxiety Disorder Severity Scale Validation in Older Adults
American Journal of Geriatric Psychiatry, 2008
Objectives-The Generalized Anxiety Disorder Severity Scale (GADSS) is a validated measure of Generalized Anxiety Disorder symptom severity. Given the high prevalence of Generalized Anxiety Disorder (GAD) in the elderly and the need for a validated scale to assess GAD severity in this age group, we examined the psychometric properties of the GADSS in the elderly.