title: The natural course of anxiety disorders in the elderly: a systematic review of longitudinal trials.
abstract: BACKGROUND
  The anxiety disorders are a prevalent mental health problem in older age with a considerable impact on quality of life. Until recently there have been few longitudinal studies on anxiety in this age group, consequently most of the evidence to date has been cross-sectional in nature.
  
  
  METHODS
  We undertook a literature search of Medline, PsycINFO, the Cochrane trials database and the TRIP medical database to identify longitudinal studies which would help elucidate natural history and prognosis of anxiety disorders in the elderly.
  
  
  RESULTS
  We identified 12 papers of 10 longitudinal studies in our Review. This represented 34,691 older age participants with 5,199 with anxiety disorders including anxious depression and 3,532 individuals with depression without anxiety. Relapse rates of anxiety disorders are high over 6 year follow-up with considerable migration to mixed anxiety-depression and pure depressive mood episodes. Mixed anxiety-depression appears to be a poorer prognostic state than pure anxiety or pure depression with higher relapse rates across studies. In community settings treatment rates are low with 7-44% of the anxious elderly treated on antidepressant medications.
  
  
  CONCLUSIONS
  To our knowledge this is the first Systematic Review of longitudinal trials of anxiety disorders in older people. Major longitudinal studies of the anxious elderly are establishing the high risk of relapse and persistence alongside the progression to depression and anxiety depression states. There remains considerable under-treatment in community studies. Specialist assessment and treatment and major public health awareness of the challenges of anxiety disorders in the elderly are required.
authors.affiliation: Surrey and Borders NHS Partnership Trust,18 Mole Business Park,Leatherhead,Surrey,KT22 7AD,UK.
authors.forename: Musa Basseer
authors.initials: MB
authors.lastname: Sami
authors.affiliation: Brain Science Research Unit,ACU,Holloway Hill,Chertsey,Surrey KT16 0AE,UK.
authors.forename: Ramin
authors.initials: R
authors.lastname: Nilforooshan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy* / Q000401:mortality*; D003863:Depression / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011613:Psychotherapy; D011788:Quality of Life; D012307:Risk Factors
chemical_list: D000928:Antidepressive Agents
keywords: anxiety; anxiety disorder; geriatric; longitudinal; naturalistic; old age; older