Objectives-Subthreshold anxiety refers to a condition where individuals do not meet the full symptom criteria (i.e., the number of symptoms required for a formal diagnosis is not reached) and/or do not report significant impairment or distress in functioning (i.e., the clinical significance criterion is not met). The purpose of this study was to examine how the symptom and the clinical significance criteria may affect the prevalence estimates of anxiety problems in the older adult population and whether applying these criteria results in an identifiable older group showing more severe anxiety.Setting and Participants-Data came from a large representative sample of communitydwelling older adults age 65 years and older (N = 2,784). Results-Resultsshowed that the 12-month prevalence rate of any anxiety problem varied from 5.6% when DSM-IV criteria for anxiety disorders were used to 26.2% when all subthreshold manifestations of anxiety were considered. Findings also indicated that when compared with respondents without anxiety, older adults presenting different manifestations of subthreshold or threshold anxiety appear to be more similar than different in their health and health behavior characteristics.Conclusions-Subthreshold anxiety has a high prevalence and may cause significant impairment. Both symptom and clinical significance criteria do not perfectly discriminate between older adults with or without a severe anxiety problem presenting comorbid disorders and needing psychiatric help. Anxiety disorders fulfilling DSM-IV criteria are common in community-dwelling older adults with prevalence estimates hovering between 0.1% and 15%, depending on the time period considered. 1-5 Studies suggest that late-life sub-threshold anxiety is even more prevalent 6-8 and could significantly interfere with functioning as much as disorders meeting full DSM criteria. 9-11 Subthreshold anxiety usually refers to a condition where individuals do not meet the full symptom criteria (i.e., the number of symptoms required for a formal diagnosis is not reached) and/or do not report significant impairment or distress in functioning (i.e., the clinical significance criterion is not met). [6][7][8] Despite its relevance in older adults, manifestations of subthreshold anxiety are nevertheless not considered as disorders according to the DSM-IV, particularly when the clinical significance criterion is not met. The rationale behind the introduction of the clinical significance criterion was to help identify a group of people presenting a more severe condition needing psychiatric help. 12 One of the major problems with this criterion is that no operational definition exists for measuring impairment or distress. 13 The evidence for impairment is often not clear-cut; clinicians have to rely on their own judgment to determine whether reported symptoms significantly interfere with daily functioning. Studies with younger adults suggest that the inclusion of the clinical significance criterion substantially decreases the prevalence rate of ...

ESA study data were paired with Quebec medical and pharmaceutical services records to document potentially inappropriate benzodiazepines (Bzs) prescriptions among community-dwelling adults aged 65 and older. Results indicate that 32 per cent of respondents took a mean daily dose of 6.1 mg of equivalent diazepam for, on average, 205 days per year. Almost half (48%) of Bzs users received a potentially inappropriate benzodiazepine prescription at least once during the year preceding the survey. About 23 per cent received at least one concomitant prescription of a Bz and another drug that could result in serious interaction. In addition, individuals aged 75 and older were more likely to receive Bzs for a longer period of time than those aged 65-74. Number of pharmacies used was associated with inappropriate Bzs prescriptions. Our results argue in favour of a more integrated health services system, including a regular review of older adults' drug regimens.

Benzodiazepine substance dependence is established at one tenth of community-dwelling older persons taking these medications, although a much larger proportion self-labels as dependent.

Nurses should be better positioned to identify those elderly users of BZDs who are more likely to be dependent and to address the problem through BZD withdrawal program.