Anxiety disorders in older people

Fear and anxiety are phylogenetically ancient emotions that confer survival advantage across species. They facilitate escape from present danger and prepare the individual to deal rapidly with future threats. In contemporary life, a moderate increase in anxiety is commonly associated with increased performance. However, anxiety that is excessive or prolonged is maladaptive and may represent a mental disorder. Individual differences and contextual factors influence the final form that an anxiety disorder takes. Like many complex behaviours, anxiety disorders result from interactions between genetic and environmental factors. In older people, anxiety often complicates physical frailty and cognitive decline. From a nosological perspective, anxiety can be conceptualized as both dimensional and categorical. Both psychological and pharmacological treatments are commonly applied to anxiety disorders in older people, with moderate efficacy. This chapter deals with classification, epidemiology, scientific underpinnings, phenomenology, and modern treatment approaches to anxiety disorders in later life.