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OF mental health care and mentally ill

Anxiety disorders in older adults

Anxiety disorders are as common in older adults as they are in younger populations (10–15%) with substantial numbers presenting to primary care (10–18%). There is evidence that anxiety disorders are recognised and treated even less often than depression, with the physiological symptoms (Box 15.5) being frequently over-investigated. Generalised anxiety disorder and specifi c phobias are the commonest anxiety disorders beginning over the age of 65 (Figure 15.1), and are associated with signifi cantly impaired quality of life. Panic disorder usually runs a chronic course with an early onset. New cases are unusual in late life. Post-traumatic stress disorder (PTSD) is increasingly recognised, with some evidence that symptoms may worsen later in life. Rates of PTSD for young and old following natural disasters are probably the same. As with depression, there is an association with physical illnesses that may mimic the illness (e.g. hyperthyroidism, alcohol abuse), or be the result of the insecurities engendered by the illness (e.g. falls, chronic obstructive pulmonary disease), or refl ect the perceptions of society. Comorbidity with depression is as common as in younger adults, but the impact is greater on quality of life.

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