title: Cognitive-behavioral therapy for panic disorder with agoraphobia in older people: a comparison with younger patients.
abstract: BACKGROUND
  Older adults with panic disorder and agoraphobia (PDA) are underdiagnosed and undertreated, while studies of cognitive-behavioral therapy (CBT) are lacking. This study compares the effectiveness of CBT for PDA in younger and older adults.
  
  
  METHODS
  A total of 172 patients with PDA (DSM-IV) received manualized CBT. Primary outcome measures were avoidance behavior (Mobility Inventory Avoidance scale) and agoraphobic cognitions (Agoraphobic Cognitions Questionnaire), with values of the younger (18-60 years) and older (≥ 60 years) patients being compared using mixed linear models adjusted for baseline inequalities, and predictive effects of chronological age, age at PDA onset and duration of illness (DOI) being examined using multiple linear regressions.
  
  
  RESULTS
  Attrition rates were 2/31 (6%) for the over-60s and 31/141 (22%) for the under-60s group (χ(2) = 3.43, df = 1, P = .06). Patients in both age groups improved on all outcome measures with moderate-to-large effect sizes. Avoidance behavior had improved significantly more in the 60+ group (F = 4.52, df = 1,134, P = .035), with agoraphobic cognitions showing no age-related differences. Baseline severity of agoraphobic avoidance and agoraphobic cognitions were the most salient predictors of outcome (range standardized betas 0.59 through 0.76, all P-values < .001). Apart from a superior reduction of agoraphobic avoidance in the 60+ participants (β = -0.30, P = .037), chronological age was not related to outcome, while in the older patients higher chronological age, late-onset type and short DOI were linked to superior improvement of agoraphobic avoidance.
  
  
  CONCLUSIONS
  CBT appears feasible for 60+ PDA-patients, yielding outcomes that are similar and sometimes even superior to those obtained in younger patients.
authors.affiliation: Institute of Integrated Mental Health Care "Pro Persona," Centre for Anxiety Disorders "Overwaal,", Lent, The Netherlands; Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands; Department of Psychiatry, Radboud University Medical Centre, Radboud University Nijmegen, Nijmegen, The Netherlands.
authors.forename: Gert-Jan
authors.initials: GJ
authors.lastname: Hendriks
authors.forename: Mirjam
authors.initials: M
authors.lastname: Kampman
authors.forename: Ger P J
authors.initials: GP
authors.lastname: Keijsers
authors.forename: Cees A L
authors.initials: CA
authors.lastname: Hoogduin
authors.forename: Richard C Oude
authors.initials: RC
authors.lastname: Voshaar
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000379:Agoraphobia / Q000453:epidemiology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: agoraphobia; clinical trial; cognitive behavior therapy; older age; panic disorder