The Silent Geriatric Giant: Anxiety Disorders in Late Life

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

Disclosures

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

In This Article

Psychotherapeutic Interventions: Cognitive Behavioural Therapy

Cognitive behavioural therapy (CBT) is considered a gold standard treatment of anxiety disorders for children and young adults, and there is a growing body of evidence for its use among older adults.[24] Cognitive behavioural therapy has been shown to reduce benzodiazepine use, which, in turn, reduces the risk of falls and fall-related deaths in this age group. Historically, older adults have not been offered psychotherapy, possibly due to ageism; however, this is now changing. Of note, a recent development of "enhanced" models of CBT for older individuals, modified to better meet the needs of older adults by using large print and mnemonics to reinforce core concepts, have been shown to be more effective than standard CBT in an individual format[25] and also a group format.[26] In one recent study on an enhanced model of CBT for older adults delivered in a group format, we found moderate to large effect size reductions in depression and anxiety scores and improved scores on perceived quality of life among older persons with mixed anxiety and depressive disorders.[26] Cognitive behavioural therapy treatment of anxiety disorders is based on behavioural exposure to anxiety-provoking situations, reducing escape and avoidance behaviours, and cognitively restructuring appraisals and beliefs that increase fear. For many people, a combination of CBT and antidepressant medications is necessary for optimal management.

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