Depression and Anxiety in Late Life: Diagnostic Insights and Therapeutic Options

Abstract

Depression and anxiety represent a sizeable public-health problem for older Americans. Effective treatment of depression and anxiety in late-life patients can improve outcomes directly related to those diseases as well as to comorbid medical diseases. A variety of approaches has been shown to be effective in older adults and is easily accessible to the primary care, specialty, and inpatient practitioner. Because of the etiologic complexity associated with mood disturbance in late life, it is helpful to consider depression and anxiety in late life as a geriatric syndrome similar to frailty, falls, incontinence, and impaired cognition. These syndromes have multiple causes of associated disability, yielding a multitude of avenues for intervention. However, translating the science of care for depression and anxiety into improved mental-health services for older adults and their families remains a challenge to providers and policy-makers alike. In the Tables, the authors offer measures for screening and response evaluation as well as guidance for pharmacotherapy and psychotherapeutic interventions that may be incorporated into primary care.

A new perspective on behavioral inconsistency and neural noise in aging: compensatory speeding of neural communication

“…For example, if there is a spillover of beta rhythm activity into the gamma range, then neural activity related to the focusing of attention would tap into the oscillatory signals that normally reflect increased anxiety. Overlapping rhythms could be an explanation for the increased occurrence of depression and anxiety amongst seniors (Kastenschmidt and Kennedy, 2011). Furthermore, affective inconsistency in seniors has been linked to deficits across physical and cognitive domains (Strauss et al, 2002).…”

Problem Adaptation Therapy for Older Adults With Major Depression and Cognitive Impairment

“…Late-life major depression, cognitive impairment and disability contribute to impaired social and interpersonal functioning and increase the risk for poor medical outcomes, nursing home placement, and all-cause-mortality [3–10] . Reducing depression and disability may delay or prevent these adverse outcomes [11] .…”

Anxiety Symptoms in 74+ Community-Dwelling Elderly: Associations with Physical Morbidity, Depression and Alcohol Consumption

“…Conversely, the impact of anxiety in late-life is extensively being associated with significant functional limitations and impaired quality of life [11]. Also, according to patients, anxiety is the most disturbing condition associated with chronic diseases [12]. Despite the high impact on everyday life, limited literature data are currently available on the features related to anxiety among community-dwelling older adults, especially among community dwelling persons above age 74.…”