No abstract

The clinical characteristics of schizophrenia in older persons vary to some extent, depending on whether the onset of illness was earlier or later in life. Regardless of age of onset, antipsychotic medications are the mainstay of treatment. Age-related physiologic changes make older persons more sensitive to the therapeutic and toxic effects of antipsychotics. There is a paucity of controlled studies on the efficacy of antipsychotic medications in older persons with schizophrenia. Existing data suggest that atypical antipsychotics are at least as efficacious as and better tolerated than the conventional agents. In late-life schizophrenia, important adverse effects of antipsychotics include sedating, anticholinergic and cardiovascular effects, extrapyramidal symptoms, and tardive dyskinesia. Certain atypical antipsychotics are associated with a risk of metabolic changes as well as agranulocytosis. Clinical recommendations include a thorough diagnostic evaluation followed by treatment with low doses of atypical antipsychotics. Medication alone is likely to be less effective than when it is combined with an appropriate psychosocial intervention.

In the population of older adults, anxiety disorders are underdiagnosed and undertreated. Epidemiologic studies have generally found that the prevalence of anxiety disorders declines with age. Recognition of anxiety disorders in older adults is, however, complicated by several age-related factors including the presence of depression, cognitive impairment, and physical illness. A variety of medications have been used to treat anxiety disorders across the life span; however, few studies have evaluated their use specifically in older adults. Choice of medication requires consideration of the effects of aging on safety, tolerability, and adherence. Available data suggest that cognitive and behavioral treatments may be effective for anxiety disorders in older adults. Appropriate medical evaluation and psychosocial interventions are recommended prior to initiating pharmacotherapy. When pharmacologic treatment is warranted, antidepressant medications at low doses may be useful for late-life anxiety disorders; other agents may be considered for augmentation or second-line use in certain types of patients.