Anxiety disorders in older adults: a comprehensive review

Purpose of Study: Subjective cognitive impairment (SCI) has been argued to reflect affective symptoms (i.e., depression and anxiety) rather than actual cognitive issues. Although a number of studies exist that look at the associations between SCI and affective symptoms, no review is available to aggregate this disparate literature. We addressed this gap by conducting a systematic review to better understand the relationships among SCI and affective symptoms among older adults in both community and clinical settings. Design and Methods: We reviewed available literature per the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Weight of evidence (WoE) ratings and narrative synthesis were completed for 58 articles. Results: A majority of studies focused on community-based samples (n = 40). Approximately half (53%) of the articles reviewed met high WoE criteria for the current review. Cross-sectional findings consistently identified a positive relationship among SCI and affective symptoms. Findings from available longitudinal studies (n = 9) were mixed but suggested a possible reciprocal relationship among SCI and depression. The relationship between SCI and anxiety appeared to be driven by fears over loss of function. Following consultation with health professionals, the association between SCI and anxiety was diminished or eliminated. Implications: Although SCI is consistently related to affective symptoms in older adults cross-sectionally, more longitudinal work is needed to understand their temporal relationship. Improved measurement of SCI would support a deeper understanding of the impact of SCI on psychological well-being.

Background: Spiritual reminiscence therapy (SRT), a type of spiritual integration in reminiscence

enzodiazepines are widely used in the treatment of anxiety and sleep problems. 1-3 The efficacy of benzodiazepines surpasses placebos in controlling a range of anxiety symptoms 4,5 and reducing the onset of sleep latency. 6 Although practice guidelines recommend newer antidepressants in place of benzodiazepines as first-line treatments for anxiety disorders, 7 there is no evidence for the superior short-term efficacy of antidepressants for anxiety disorders. 8 Moreover, practice guidelines recommend that initial approaches to the management of primary insomnia should include behavioral interventions, 9,10 although behavioral interventions and benzodiazepines yield similar short-term sleep-related outcomes. 11 When benzodiazepines are used for extended periods of time, they may lead to problems associated with discontinuation and withdrawal symptoms 12,13 and abuse. 14 In 2008, there were approximately 272 000 emergency department visits in the United States involving nonmedical use of benzodiazepines, of which 40.0% also involved alcohol, 15 which increased to approximately 426 000 visits in 2011, of which 24.2% also involved alcohol. 16 Among older individuals, medical benzodiazepine use poses risks of serious adverse effects including impaired cognitive functioning, 17 reduced mobility and driving skills, 18,19 and increased risks of falls. 20 Research further indicates that the risks of falls is greater for benzodiaz-IMPORTANCE Although concern exists regarding the rate of benzodiazepine use, especially long-term use by older adults, little information is available concerning patterns of benzodiazepine use in the United States. OBJECTIVE To describe benzodiazepine prescription patterns in the United States focusing on patient age and duration of use. DESIGN, SETTING, AND PARTICIPANTS A retrospective descriptive analysis of benzodiazepine prescriptions was performed with the 2008 LifeLink LRx Longitudinal Prescription database (IMS Health Inc), which includes approximately 60% of all retail pharmacies in the United States. Denominators were adjusted to generalize estimates to the US population. MAIN OUTCOMES AND MEASURES The percentage of adults filling 1 or more benzodiazepine prescriptions during the study year by sex and age group (18-35 years, 36-50 years, 51-64 years, and 65-80 years) and among individuals receiving benzodiazepines, the corresponding percentages with long-term (Ն120 days) benzodiazepine use, prescription of a long-acting benzodiazepine, and benzodiazepine prescriptions from a psychiatrist. RESULTS In 2008, approximately 5.2% of US adults aged 18 to 80 years used benzodiazepines. The percentage who used benzodiazepines increased with age from 2.6% (18-35 years) to 5.4% (36-50 years) to 7.4% (51-64 years) to 8.7% (65-80 years). Benzodiazepine use was nearly twice as prevalent in women as men. The proportion of benzodiazepine use that was long term increased with age from 14.7% (18-35 years) to 31.4% (65-80 years), while the proportion that received a benzodiazepine prescription from a psychi...