Anxiety disorders in older adults: a comprehensive review
Open accessAbstract
This review aims to address issues unique to older adults with anxiety disorders in order to inform potential changes in the DSM-V. Prevalence and symptom expression of anxiety disorders in late life, as well as risk factors, comorbidity, cognitive decline, age of onset, and treatment efficacy for older adults are reviewed. Overall, the current literature suggests: (a) anxiety disorders are common among older age individuals, but less common than in younger adults; (b) overlap exists between anxiety symptoms of younger and older adults, although there are some differences as well as limitations to the assessment of symptoms among older adults; (c) anxiety disorders are highly comorbid with depression in older adults; (d) anxiety disorders are highly comorbid with a number of medical illnesses; (e) associations between cognitive decline and anxiety have been observed; (f) late age of onset is infrequent; and (g) both pharmacotherapy and CBT have demonstrated efficacy for older adults with anxiety. The implications of these findings are discussed and recommendations for the DSM-V are provided, including extending the text section on age-specific features of anxiety disorders in late life and providing information about the complexities of diagnosing anxiety disorders in older adults.
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Generalised anxiety disorder is the most common anxiety disorder among older people, with estimated prevalence rates ranging from 1.2% to 11.2%.
“Generalised anxiety disorder (GAD) is the most common anxiety disorder among older people, with estimated prevalence rates ranging from 1.2% to 11.2%.1,2”
From Acceptance and commitment therapy for older people with treatment-resistant generalised anxiety disorder: The FACTOID feasibility study (2021) · cites this paper as [2]
The Prevalence of Anxiety Disorders Among Older Adults section identifies GAD and specific phobia together as having the largest prevalence estimates; it does not identify GAD alone as the most common. It gives the GAD range as 1.2%–7.3%, not 1.2%–11.2%. A separate age-subgroup estimate is 11.5%, but it is not presented as the upper bound of that range. (LLM, conf=0.90)
Experimental — accuracy not yet measuredEstimated prevalence rates of generalised anxiety disorder among older people range from 1.2% to 11.2%.
“Generalised anxiety disorder (GAD) is the most common anxiety disorder among older people, with estimated prevalence rates ranging from 1.2% to 11.2%.1,2”
From Acceptance and commitment therapy for older people with treatment-resistant generalised anxiety disorder: The FACTOID feasibility study (2021) · cites this paper as [2]
The ‘Prevalence of Anxiety Disorders Among Older Adults’ section gives 1.2% as the lower estimate for GAD, but gives 7.3%, not 11.2%, as the upper estimate. The cited review therefore supports the lower bound but not the claimed range. (LLM, conf=0.88)
Experimental — accuracy not yet measuredGeneralised anxiety disorder is the most common anxiety disorder among older people.
“G eneralised anxiety disorder, characterised by a tendency to worry, is the most common anxiety disorder among older people.”
From Acceptance and commitment therapy for older people with treatment-resistant generalised anxiety disorder: The FACTOID feasibility study (2021) · cites this paper as [2]
The Summary and Future Directions section says that specific phobias and GAD are the most prevalent anxiety disorders among older adults. The Prevalence section likewise identifies both as having the largest estimates, so the source supports GAD as one of the most common, but not as uniquely the most common. Page numbers are not available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredGAD is a frequently undiagnosed condition in clinical practice, often being misdiagnosed as major depressive disorder with comorbid anxiety or 'mixed anxiety and depression' rather than GAD.
“GAD is a frequently undiagnosed condition in clinical practice, often being misdiagnosed as major depressive disorder with comorbid anxiety or 'mixed anxiety and depression' rather than GAD.2,89”
From Acceptance and commitment therapy for older people with treatment-resistant generalised anxiety disorder: The FACTOID feasibility study (2021) · cites this paper as [2]
The Psychiatric comorbidity section (page unavailable) reports that GAD diagnoses were not given to depressed older patients when GAD symptoms occurred only during a major depressive episode, although 27.5% would meet GAD criteria. It also mentions claims that mixed anxiety–depression is a typical clinical presentation, but says those claims lack supporting data. Neither passage establishes that GAD is frequently misdiagnosed as MDD with comorbid anxiety or as mixed anxiety and depression. (LLM, conf=0.78)
Experimental — accuracy not yet measuredEven sub-clinical anxiety symptoms predispose older adults to develop a fully symptomatic mental illness.
“Furthermore, even sub-clinical anxiety symptoms predispose older adults to develop afully symptomatic mental illness (Wolitzky-Taylor et al . 2010; Bienvenu et al . 2001).”
From Effectiveness of a training programme based on acceptance and commitment therapy aimed at older adults – no moderating role of cognitive functioning (2021) · cites this paper as Wolitzky-Taylor et al . 2010
The ‘Symptoms of anxiety disorders’ section (page unavailable) says older adults may have subclinical anxiety symptoms that do not meet diagnostic criteria. It does not say those symptoms predispose them to develop a fully symptomatic mental illness; searches for subthreshold anxiety and subsequent disorder onset did not establish that progression. (LLM, conf=0.82)
Experimental — accuracy not yet measured
Psychiatric comorbidity is known to be common in GAD.
“psychiatric comorbidity is known to be common in GAD, 2”
From Acceptance and commitment therapy for older people with treatment-resistant generalised anxiety disorder: The FACTOID feasibility study (2021) · cites this paper as [2]
CBT appears less effective for anxiety in older adults than in younger adults.
“CBT does not appear to ameliorate anxiety for older adults as well as it does for younger adults (Wolitzky-Taylor, Castriotta, Lenze, Stanley, & Craske, 2010).”
From Acceptance and Commitment Therapy for generalized anxiety disorder in older adults: a preliminary report. (2011) · cites this paper as Wolitzky-Taylor, Castriotta, Lenze, Stanley, & Craske, 2010
The effect sizes for CBT in anxious older adults are relatively small.
“However, researchers suggest investigating other treatment approaches as well, since the effect sizes for CBT in anxious older adults are relatively small and several analyses suggest that older adults benefit less from CBT for anxiety than the younger adult population [2, 6, 28, 31, 32].”
Anxiety symptoms and anxiety disorders frequently go unrecognized and untreated in older adults.
“Unfortunately, anxiety symptoms (and anxiety disorders as well) frequently go unrecognized and untreated in older adults [1–3].”
Older adults benefit less from CBT for anxiety than the younger adult population.
“However, researchers suggest investigating other treatment approaches as well, since the effect sizes for CBT in anxious older adults are relatively small and several analyses suggest that older adults benefit less from CBT for anxiety than the younger adult population [2, 6, 28, 31, 32].”
Anxiety and depression are highly co-morbid in older adults.
“Another possible benefit of ACT is its transdiagnostic approach, since anxiety and depression are highly co-morbid in older adults [1, 2, 45].”
Of the 35,820 people who received the information letter, only 683 registered for study participation; this is a small number considering the high prevalence of anxiety in later life.
“Second, of the 35,820 people who received the information letter, only 683 registered for study participation; this is a small number considering the high prevalence of anxiety in later life [1-3].”
CBT is not as efficacious in the treatment of anxiety among older adults as it is for those at younger ages.
“Research examining the utility of CBT, has found that it is not as ef fi cacious in the treatment of anxiety among older adults as it is for those at younger ages (Wolitzky-Taylor et al., 2010).”
From Acceptance and Commitment Therapy in the treatment of anxiety: A systematic review (2013) · cites this paper as Wolitzky-Taylor et al., 2010
Anxiety is a common problem among the elderly.
“anxiety is a common problem among the elderly (Wolitzky-Taylor, Castriotta, Lenze, Stanley, & Craske, 2010)”
From Acceptance and Commitment Therapy in the treatment of anxiety: A systematic review (2013) · cites this paper as Wolitzky-Taylor, Castriotta, Lenze, Stanley, & Craske, 2010
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References 177 · Cited by 726
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- Authors
- Wolitzky-Taylor, K. B., Castriotta, N., Lenze, E. J., Stanley, M. A., & Craske, M. G.
- Affiliations
- University of California, Los Angeles (US)
- Washington University in St. Louis (US)
- Baylor College of Medicine (US)
- Corresponding author
- Craske, Michelle G.
- Venue
- Depression and Anxiety
- Publisher
- Wiley
- Published
- 2010-02
- Volume
- 27
- Issue
- 2
- Pages
- 190-211
- ISSN
- 1091-4269 (ISSN-L)
- 1520-6394
- OpenAlex
- W2169363431
- Cited by
- 726
- References
- 177
- Citations by year
- 2026: 38 · 2025: 32 · 2024: 49 · 2023: 43 · 2022: 38 · 2021: 60 · 2020: 98 · 2019: 40 · 2018: 33 · 2017: 51 · 2016: 48 · 2015: 42 · 2014: 46 · 2013: 45 · 2012: 30
- FWCI
- 4.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R01MH070547)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- anxiety disorders, older adults, old age, DSM-V, diagnostic criteria, prevalence, presenting symptoms, comorbid depression, comorbidities, cognitive decline, age of onset, pharmacotherapy, cognitive behavioral therapy
- MeSH terms
- Aged, Anxiety Disorders, Humans, Severity of Illness Index, Diagnostic and Statistical Manual of Mental Disorders
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