Treatment Considerations for Anxiety in the Elderly

CNS Spectrums ◽  
2003 ◽  
Vol 8 (S3) ◽  
pp. 6-13 ◽  
Author(s):  
Eric J. Lenze ◽  
Bruce G. Pollock ◽  
M. Katherine Shear ◽  
Benoit H. Mulsant ◽  
Ashok Bharucha ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Behavioral Therapy ◽  
Late Life ◽  
The Elderly ◽  
Anxiety Symptoms ◽  
Mood Stabilizers ◽  
Elderly Persons ◽  
Late Life Depression ◽  
Increased Risk ◽  
Treatment Considerations

AbstractAnxiety is common in the elderly and can present as a primary anxiety disorder or as a symptom of another disorder. Generalized anxiety disorder, in particular, is a common syndrome in late life. Anxiety symptoms are also common features of late-life depression and dementia. Treatment of anxiety in elderly persons has typically involved the use of benzodiazepines, which are often effective but problematic because they are associated with increased risk of cognitive impairment, falls, and fractures. Based on their safety and efficacy, antidepressants, particularly serotonergic medications, are considered first-line treatment for most anxiety disorders as well as anxiety symptoms of major depressive disorder. Psychotherapy, particularly cognitive-behavioral therapy, may be effective in these disorders as well; research is underway to adapt this therapy to the needs of elderly persons. Anxiety symptoms in dementia are poorly understood but may respond to atypical antipsychotics, serotonergic antidepressants, or mood stabilizers. Overall, the research in late-life anxiety has not caught up to the literature in late-life depression and, for the most part, treatment recommendations must be extrapolated from studies in young adults.

Mood disorders in the elderly

2012 ◽  
pp. 1550-1558
Author(s):  
Robert Baldwin
Keyword(s):  
Bipolar Disorder ◽  
Mood Disorders ◽  
Late Life ◽  
Later Life ◽  
The Elderly ◽  
Clinical Syndrome ◽  
Late Life Depression ◽  
Increased Risk

This chapter considers some of the commonly asked questions about mood disorders in later life. Is depression in later life a distinct clinical syndrome? How common is it? Is there an organic link, for example to cerebral changes, and if so, is there an increased risk of later dementia? Is it more difficult to diagnose and treat late-life depression, and once treated, is the outcome good, bad, or indifferent? The emphasis will be on depression but bipolar disorder and mania will also be considered.

scholarly journals Vascular lesions and functional limitations among older adults: does depression make a difference?

2014 ◽  
Vol 26 (9) ◽  
pp. 1501-1509 ◽  
Author(s):  
Celia F. Hybels ◽  
Carl F. Pieper ◽  
Lawrence R. Landerman ◽  
Martha E. Payne ◽  
David C. Steffens
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
White Matter ◽  
Functional Impairment ◽  
Functional Limitations ◽  
Late Life ◽  
Cognitive Status ◽  
Cerebral White Matter ◽  
Late Life Depression ◽  
Increased Risk

ABSTRACTBackground:The association between disability and depression is complex, with disability well established as a correlate and consequence of late life depression. Studies in community samples report that greater volumes of cerebral white matter hyperintensities (WMHs) seen on brain imaging are linked with functional impairment. These vascular changes are also associated with late life depression, but it is not known if depression is a modifier in the relationship between cerebrovascular changes and functional impairment.Methods:The study sample was 237 older adults diagnosed with major depression and 140 never depressed comparison adults, with both groups assessed at study enrollment. The dependent variable was the number of limitations in basic activities of daily living (ADL), instrumental ADLs, and mobility tasks. The independent variable was the total volume of cerebral white matter lesions or hyperintensities assessed though magnetic resonance imaging.Results:In analyses controlling for age, sex, race, high blood pressure, and cognitive status, a greater volume of WMH was positively associated with the total number of functional limitations as well as the number of mobility limitations among those older adults with late life depression but not among those never depressed, suggesting the association between WMH volume and functional status differs in the presence of late life depression.Conclusions:These findings suggest older patients with both depression and vascular risk factors may be at an increased risk for functional decline, and may benefit from management of both cerebrovascular risk factors and depression.

scholarly journals When Cognitive Decline and Depression Coexist in the Elderly: CSF Biomarkers Analysis Can Differentiate Alzheimer's Disease from Late-Life Depression

2018 ◽  
Vol 10 ◽  
Author(s):  
Claudio Liguori ◽  
Mariangela Pierantozzi ◽  
Agostino Chiaravalloti ◽  
Giulia M. Sancesario ◽  
Nicola B. Mercuri ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Decline ◽  
Late Life ◽  
The Elderly ◽  
Csf Biomarkers ◽  
Late Life Depression

scholarly journals Analysis of potential drug interactions and adverse reactions to nonsteroidal anti-inflammatory drugs among the elderly

2016 ◽  
Vol 19 (3) ◽  
pp. 533-544 ◽  
Author(s):  
Tiago Aparecido Maschio de Lima ◽  
Adriana Antônia da Cruz Furini ◽  
Tábata Salum Calille Atique ◽  
Patricia Di Done ◽  
Ricardo Luiz Dantas Machado ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Prescription Drugs ◽  
Adverse Reactions ◽  
Drug Distribution ◽  
The Elderly ◽  
Elderly Persons ◽  
Potential Drug ◽  
Increased Risk ◽  
Chi Squared ◽  
Elderly Users

Abstract Objective: The aim of the present study was to analyze potential drug interactions and adverse reactions to NSAIDs in elderly users of a private drug distribution service. Method: A prospective, exploratory and descriptive study with a quantitative approach was performed. The elderly users of NSAIDs attended by the service were interviewed and their prescriptions analyzed between May and September, 2014. Analysis of drug interactions was performed through computerized databases. The post-sales analysis of adverse reactions was performed using the Adverse Drug Reaction Probability Scale. Statistical analysis was performed with the Chi-squared and Fisher's Exact tests. Results: The study evaluated 200 elderly persons, among whom women predominated (56.5%). The average age was 65 years ±10. The NSAIDs accounted for 38.7% of prescription drugs used, and included dipyrone (26.9%), nimesulide (22.8%) and ketoprofen (16.3%). A total of 8.5% of such drugs were considered inappropriate medications for the elderly. A total of 104 potential drug interactions were identified, of which 24% were considered highly clinically significant. The NSAIDs with the greatest risk of interactions were ketoprofen 46.2%, ketorolac 14.4%, nimesulide 12.5% and diclofenac 9.6%. In post-sales monitoring 30.5% of the elderly persons reported undesirable symptoms after the use of NSAIDs, with stomach discomfort the most prevalent (17%). Conclusion: The present study confirmed the importance of monitoring the use of NSAIDs among the elderly due to the increased risk of drug interactions and adverse reactions associated with age, concomitant diseases, multi- prescriptions and polypharmacy. The choice of appropriate drugs for the elderly, the reconciliation of all the medications taken by the patient, and effective pharmaceutical care are measures that can contribute to the rational and safe use of NSAIDs.

scholarly journals Characteristics of Cognitive Behavioral Therapy for Older Adults Living in Residential Care: Protocol for a Systematic Review (Preprint)

2018 ◽  
Author(s):  
Phoebe Chan ◽  
Sunil Bhar ◽  
Tanya E. Davison ◽  
Colleen Doyle ◽  
Bob G. Knight ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Cognitive Behavioral Therapy ◽  
Residential Care ◽  
Behavioral Therapy ◽  
Late Life ◽  
Aged Care ◽  
Residential Aged Care ◽  
Late Life Depression ◽  
Residential Settings

BACKGROUND The prevalence rates of depressive and anxiety disorders are high in residential aged care settings. Older adults in such settings might be prone to these disorders because of losses associated with transitioning to residential care, uncertainty about the future, as well as a decline in personal autonomy, health, and cognition. Cognitive behavioral therapy (CBT) is efficacious in treating late-life depression and anxiety. However, there remains a dearth of studies examining CBT in residential settings compared with community settings. Typically, older adults living in residential settings have higher care needs than those living in the community. To date, no systematic reviews have been conducted on the content and the delivery characteristics of CBT for older adults living in residential aged care settings. OBJECTIVE The objective of this paper is to describe the systematic review protocol on the characteristics of CBT for depression and/or anxiety for older adults living in residential aged care settings. METHODS This protocol was developed in compliance with the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Studies that fulfill the inclusion criteria will be identified by systematically searching relevant electronic databases, reference lists, and citation indexes. In addition, the PRISMA flowchart will be used to record the selection process. A pilot-tested data collection form will be used to extract and record data from the included studies. Two reviewers will be involved in screening the titles and abstracts of retrieved records, screening the full text of potentially relevant reports, and extracting data. Then, the delivery and content characteristics of different CBT programs of the included studies, where available, will be summarized in a table. Furthermore, the Downs and Black checklist will be used to assess the methodological quality of the included studies. RESULTS Systematic searches will commence in May 2018, and data extraction is expected to commence in July 2018. Data analyses and writing will happen in October 2018. CONCLUSIONS In this section, the limitations of the systematic review will be outlined. Clinical implications for treating late-life depression and/or anxiety, and implications for residential care facilities will be discussed. CLINICALTRIAL PROSPERO 42017080113; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=80113 (Archived by WebCite at http://www.webcitation.org/70dV4Qf54) REGISTERED REPORT IDENTIFIER RR1-10.2196/9902

Social Dimensions of Mental Illness among Rural Elderly Populations

1988 ◽  
Vol 26 (3) ◽  
pp. 169-190 ◽  
Author(s):  
Jon Hendricks ◽  
Howard B. Turner
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Physical Health ◽  
Elderly People ◽  
The Elderly ◽  
Rural Elderly ◽  
Policy Implications ◽  
Elderly Persons ◽  
Increased Risk ◽  
Elderly Populations

Despite growing concern with rural elderly populations, little attention has focused on their mental health, ways it may correlate with physical health, or how rural mental health patterns compare to urban. Popular wisdom contends that elderly people in general, and rural elderly persons in particular, are at increased risk for mental illness. This article examines these questions. A review of available literature suggests that elderly people may be at only slightly greater risk of mental illness than the population at large, though there are some indications that rates of depression may be somewhat higher among the elderly population. Much of this same literature implies that objective environmental conditions play a significant role in the incidence of depression. Analysis of data gathered in a statewide random poll ( N = 743) indicates that while physical health tends to be poorer among rural populations, when health is held constant there is actually an inverse relationship between age and depression. Therefore, rural elderly persons are no more likely to be depressed than their urban counterparts despite harsher living conditions. Both conceptual and policy implications are discussed.

Prevalence of 25-hydroxyvitamin D deficiency in subgroups of elderly persons with anemia: association with anemia of inflammation

Blood ◽  
2011 ◽  
Vol 117 (10) ◽  
pp. 2800-2806 ◽  
Author(s):  
Todd S. Perlstein ◽  
Reena Pande ◽  
Nancy Berliner ◽  
Gary J. Vanasse
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Serum Levels ◽  
The Elderly ◽  
Vitamin D Supplementation ◽  
World Health ◽  
Elderly Persons ◽  
Increased Risk ◽  
Health Organization ◽  
Anemia Of Inflammation

AbstractAnemia and vitamin D deficiency are conditions that both result in significant morbidity and increase with age. The potential relationship between them remains poorly understood, particularly in the elderly. We used the Third National Health and Nutrition Examination Survey to examine the association of vitamin D deficiency with anemia subtypes in persons aged ≥ 60 years. Vitamin D deficiency was defined as serum levels < 20 ng/mL, and anemia was defined according to World Health Organization criteria. Vitamin D deficiency was associated with anemia prevalence independent of age, sex, or race/ethnicity (odds ratio, 1.47; 95% confidence interval, 1.06-2.05; P = .02) and varied significantly by anemia subtype (P overall = .003). The prevalence of vitamin D deficiency was 33.3% in the nonanemic population, 56% in anemia of inflammation (AI; P = .008), and 33.0% in unexplained anemia (P = .55). Non-Hispanic blacks had a 7-fold increased risk of AI compared with whites, and this was partially attenuated after adjusting for vitamin D deficiency. These data show that vitamin D deficiency is associated with specific subtypes of anemia in the elderly, especially in those with AI. Vitamin D may suppress inflammatory pathways, and studies to determine whether vitamin D supplementation ameliorates AI are warranted.

Treating Late Life Depression

2017 ◽  
Author(s):  
Dolores Gallagher-Thompson ◽  
Larry W. Thompson
Keyword(s):  
Mental Health Professionals ◽  
Health Professionals ◽  
Behavioral Therapy ◽  
The Elderly ◽  
Phase Iii ◽  
Late Life Depression ◽  
Behavioral Skills ◽  
Therapy Goals ◽  
Three Phase ◽  
User Friendly

This therapist guide is designed to give mental health professionals the necessary tools to assess and treat depression, with or without accompanying anxiety, in the elderly. Designed specifically for use with older adults, the three-phase cognitive—behavioral therapy (CBT) treatment described generally is delivered over the course of 16–20 sessions. Phase I provides an introduction to therapy, Phase II helps the client acquire the cognitive and behavioral skills needed to meet the therapy goals, and Phase III deals with termination and how to maintain the gains obtained in therapy. Step-by-step instructions for administering therapy are provided in a user-friendly format, along with information on screening and assessment. Complete with sample dialogues, at-home assignments, and lists of materials needed, this comprehensive guide includes all the tools necessary for facilitating effective treatment.

Late-life depression

2014 ◽  
Vol 29 (S3) ◽  
pp. 577-577 ◽  
Author(s):  
K. Ritchie
Keyword(s):  
Depressive Symptomatology ◽  
Late Onset ◽  
Late Life ◽  
Later Life ◽  
The Elderly ◽  
Conclusive Evidence ◽  
First Episode ◽  
Hormonal Changes ◽  
Late Life Depression ◽  
Incident Cases

Late-life depression is highly heterogeneous in clinical presentation, and is also commonly resistant to treatment. While some cases are a continuation of the chronic course of illness beginning in early adulthood, a large number of persons will have a first episode of depression in later life following alife-time of relatively good mental health. While incident cases of major depression tend to decrease with age, the number of persons with clinically significant depressive symptomatology rises. À distinction has often been made between early-onset and late-onset depression, however, there is no conclusive evidence to suggest these are distinct clinical entities. On the other hand observations from a fifteen year prospective population study of psychiatric disorder in the elderly (the ESPRIT Study) supports the alternative idea that depression may be divided into sub-types according to postulated aetiology; for example depression with a strong genetic component, related to hormonal changes, the consequence of trauma; the result of cerebrovascular insult. Exposure to these putative causes may be more common at different points in the life span, thus suggesting age-differences. Our research further suggests that even cases of depression appearing for the first time in late-life, may be initially triggered by risk factors occurring decades before. Our findings suggest, for example, that childhood events may lead to changes in the biology of stress management, which continue throughout life, increasing vulnerability to depression and persisting even after effective treatment of symptoms. Together these observations suggest it may be more meaningful to classify depression in the elderly according to probable principle precipitating factors rather than age.

scholarly journals Prevalence and Correlates of Physical Disability and Functional Limitation among Elderly Rural Population in Nigeria

2011 ◽  
Vol 2011 ◽  
pp. 1-13 ◽  
Author(s):  
I. S. Abdulraheem ◽  
A. R. Oladipo ◽  
M. O. Amodu
Keyword(s):  
Physical Disability ◽  
Assessment Tool ◽  
Functional Limitations ◽  
Functional Limitation ◽  
Sampling Technique ◽  
Female Gender ◽  
The Elderly ◽  
Elderly Persons ◽  
Cross Sectional ◽  
Increased Risk

Background. The number of people surviving into old age is increasing, and it has now become a global phenomenon. Studies on the prevalence and correlates of physical disability and functional limitation among elderly Nigerians are scanty.Methodology. This is a community-based cross-sectional study conducted in 3 local government areas (LGAs) in Nigeria, using a multistage sampling technique. Functional limitations of 1824 elderly persons were tested using Tinetti performance-oriented mobility assessment tool (TPOMAT) and self-reported activities of daily living (ADL). ADL disability of ten, six, and five basic items were compared.Results. The prevalence ratios (PRs) of physical disability using the ten, six, and five basic ADL items were 28.3 (95% CI 25.2–31. 5), 15.7 (95% CI 13.4–19.8), and 12.1 (95% CI 9.8–15.3), respectively, while functional limitation was 22.5 (95% CI 18.1–24.4). Increased risk of disability was independently associated with female gender PR 3.6 (95% CI 1.5–7.4), advanced age ≥75 years; PR 22.2 (95% CI 14.5, 36.8), arthritis PR 3.7 (95% CI 2.6–4.6), stroke PR 4.8 (95% CI 3.7–7.9) and diabetes PR 6.1 (95% CI 4.3–7.1).Conclusions. The findings from this study are pointers to unmet needs of the elderly disabled Nigerians.

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