Anxiety and anxiety disorders in the old and very old - Results from the Berlin Aging Study (BASE)

Department of Psychiatry and Psychotherapy, Ernst Moritz Arndt Universität Greifswald, Stralsund, Germany.
Comprehensive Psychiatry (Impact Factor: 2.25). 03/2000; 41(2 Suppl 1):48-54. DOI: 10.1016/S0010-440X(00)80008-5
Source: PubMed


Within the context of the Berlin Aging Study, we examined the distribution of anxiety symptoms and disorders in a representative community sample. The participants were beyond the age of 70 years, thereby extending results from other studies not covering this age range. Additionally, we analyzed the distribution of anxiety symptoms and syndromes not fulfilling specified diagnostic criteria. A sample of 258 old (70 to 84 years) and 258 very old (85 to 103 years) subjects were examined. Anxiety disorders as defined in DSM-III-R and according to clinical judgment (diagnoses termed NOS) were assessed. In addition, items from the Geriatric Mental State-A (GMS-A) covering a wide range of symptoms of anxiety were subjected to factor analysis. The raw score distributions of anxiety subscales obtained by this procedure are examined by age, gender, education, personal living situation, and psychiatric comorbidity. The weighted overall prevalence of anxiety in the elderly community is 4.5% (n = 17), including specified (n = 8) anxiety disorders according to the DSM-III-R and unspecified (n = 9) disorders. Prevalence rates in the younger old were 4.3% and in the older old 2.3%. Weighted prevalence rates for males were 2.9% and for females 4.7%. The most common comorbid disorders were affective disorders in both age groups as well as both genders. Independently of the nosological level, 52.3% reported one or more symptoms of anxiety. Factor analysis of anxiety-related symptoms yielded 5 independent subscales, reflecting hypochondriasis, panic, phobia, worries, and vegetative anxiety. There were more phobic symptoms in the younger age group (P < .001). Except for worries and hypochondriac symptoms, females showed significantly higher anxiety in all other anxiety dimensions. There was no relation between anxiety and cognitive status or socioeconomic status (SES). Only for subjects living alone was more phobic-type anxiety found. Anxiety disorders in old and very old persons are less frequent than other psychiatric disorders of old age, and do not increase with age. Gender differences can still be observed. The symptomatic structure of anxiety seems similar to that found in younger cohorts. Thus, anxiety disorders in old age do not seem substantially different from those in younger age. Their relative contribution to the spectrum of mental disorders seems to decrease, rather than increase, with age, while at the same time anxiety symptoms are an almost daily experience.

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    • "Moreover, subsyndromal anxiety symptoms in late life are even more prevalent, ranging between 15 to 52.3 % in community samples and 15 to 56 % in clinical samples (Bryant et al. 2008). In a representative sample of German older adults (70 to 103 years of age; N=516), Schaub and Linden (2000) reported a weighted overall prevalence of anxiety disorders of 4.5 %. Clinically significant anxiety is associated with a variety of adverse outcomes such as poor physical health, sleep problems , or urinary incontinence (e.g., Mehta et al. 2003; Strine et al. 2005). "
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    ABSTRACT: Anxiety occurs frequently among older adults, and can have deleterious impacts on the quality of daily life. Due to the dearth of well-validated elder-specific anxiety screening instruments available in the German language, this study aimed to translate the Geriatric Anxiety Scale (GAS), a reliable and valid 30-item self-report screening instrument for assessing anxiety based on DSM-IV-TR diagnostic criteria (Segal et al 2010), into German, and to validate the new measure. The German version of the GAS was developed through a translation and back translation process, with careful attention paid to culturally-sensitive expressions of anxiety in the German older adult population. The final version of the German GAS was tested in a sample of 242 community-dwelling older adults (M age = 72.0 years, SD = 6.9 years; 59% women) who completed either an online (26%) or a paper-pencil (74%) version of the questionnaire. The findings confirmed the successful translation of the GAS into German and provided psychometric support for the new measure. The validation of the factor structure based on confirmatory factor analyses was in support of a unidimensional structure of the GAS-G. Correlational analyses with inventories measuring anxiety related and non-anxiety related personality traits additionally confirmed the convergent and discriminant validity of the GAS for use as an assessment measure for anxiety among German older adults.
    Journal of Psychopathology and Behavioral Assessment 08/2015; DOI:10.1007/s10862-015-9504-z · 1.55 Impact Factor
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    • "15% to 52.3%. In addition, " anxiety symptoms are an almost daily experience " in older adults (Schaub and Linden, 2000). Even though these figures are high, they may not reveal the true scope of the presence of anxiety problems or anxiety symptomatology in older persons. "
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    ABSTRACT: Background: Research on the behavioral correlates of anxiety in older adults is sparse. The aim of this study was to explore the association of anxiety with behavioral patterns defined by health, activity, emotional and social variables. Methods: A convenience sample of 395 older adults completed measures of health, activity, emotions, social variables and experiential avoidance. Cross-sectional data were analysed using cluster analysis. Results: Five clusters were identified: active healthy, healthy, active vulnerable, lonely inactive and frail lonely. Participants in the active healthy and healthy clusters showed the highest scores on health variables (vitality and physical function), and adaptive scores on the rest of variables. They also reported the lowest scores on anxiety and included the lowest number of cases with clinically significant anxiety levels. Active vulnerable showed high scores on social support, leisure activities and capitalization on them but low scores in vitality and physical functioning. Participants in the lonely inactive cluster reported the highest mean score in experiential avoidance and high scores on boredom and loneliness, and low scores on social support, leisure activities capitalizing on pleasant activities and health variables. Frail lonely represent a particularly vulnerable profile of participants, similar to that of lonely inactive, but with significantly lower scores on health variables and higher scores on boredom and hours watching TV. Conclusions: Anxiety in older adults is not only linked to poor health, but also to dysfunctional social behavior, loneliness, boredom and experiential avoidance. Maladaptive profiles of older adults with regard to these variables have been identified.
    International Psychogeriatrics 05/2014; 27(07). DOI:10.1017/S1041610214001148 · 1.93 Impact Factor
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    • "Exceptions include one study that examined gender differences in 1-month prevalence rates of DSM-III anxiety disorders across age groups using ECA data (Regier et al., 1990) and another study that examined gender differences in the development of comorbid mood disorders across DSM-III-R anxiety disorders using NCS data (Parker and Hadzi-Pavlovic, 2001). Other studies that have examined gender effects in epidemiological parameters across anxiety disorders are restricted in age (adolescents: Wu et al., 2010; older adults: Beekman et al., 1998; Schaub and Linden, 2000). Updated, nationally representative epidemiological data examining gender effects in sociodemographic and clinical correlates of DSM-IV anxiety disorders are needed. "
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    ABSTRACT: Women have consistently higher prevalence rates of anxiety disorders, but less is known about how gender affects age of onset, chronicity, comorbidity, and burden of illness. Gender differences in DSM-IV anxiety disorders were examined in a large sample of adults (N=20,013) in the United States using data from the Collaborative Psychiatric Epidemiology Studies (CPES). The lifetime and 12-month male:female prevalence ratios of any anxiety disorder were 1:1.7 and 1:1.79, respectively. Women had higher rates of lifetime diagnosis for each of the anxiety disorders examined, except for social anxiety disorder which showed no gender difference in prevalence. No gender differences were observed in the age of onset and chronicity of the illness. However, women with a lifetime diagnosis of an anxiety disorder were more likely than men to also be diagnosed with another anxiety disorder, bulimia nervosa, and major depressive disorder. Furthermore, anxiety disorders were associated with a greater illness burden in women than in men, particularly among European American women and to some extend also among Hispanic women. These results suggest that anxiety disorders are not only more prevalent but also more disabling in women than in men.
    Journal of Psychiatric Research 03/2011; 45(8):1027-35. DOI:10.1016/j.jpsychires.2011.03.006 · 3.96 Impact Factor
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