The Silent Geriatric Giant: Anxiety Disorders in Late Life

Keri-Leigh Cassidy, MD; Neil A. Rector, PhD


Geriatrics and Aging. 2008;11(3):150-156. 

In This Article

Diagnosing Anxiety Disorders in Late Life

Anxiety disorders can be challenging to diagnose in older adults because older individuals have a tendency to somatize psychiatric problems, and clinicians do not always include anxiety disorders in the differential diagnosis of their older patients. Unlike the solitary anxiety disorder seen in children and young adults, late-life anxiety is often comorbid with depression or medical illness, and there is substantial symptom overlap with depression (e.g., impaired sleep, concentration, attention, and memory; and agitation) and comorbid medical problems (including chest and abdominal pain, headaches, and shortness of breath). A good history taking is key to making the diagnosis, to determine if there is a new-onset presentation that might signify a comorbid depression, a medication- or substance-induced disorder, a new medical problem, or a recurrence of a previous disorder. Knowing the criteria for anxiety disorders is helpful, as well as being aware of some of the differences seen in seniors. For a complete list of diagnostic criteria of all the anxiety disorders, see the Diagnostic and Statistical Manual of Mental Disorders, Revised Fourth Edition.[9] A list of core features and suggested screening questions for the anxiety disorders is shown in Table 1 . Useful anxiety assessment tools that have reliability for use with older adults are presented in Table 2 .


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