First, epidemiologic studies have produced wide variations in prevalence estimates of anxiety disorders in elderly persons. One systematic review found 28 epidemiological

studies of anxiety symptoms, or disorders, in older adults: 19 in community samples, and nine in clinical samples. The range of anxiety disorder prevalence estimates in those studies varied PF-562271 ic50 markedly, ranging from 1.2% to 15% in community samples and from 1% to 28% in medical settings. The prevalence of clinically significant anxiety symptoms Inhibitors,research,lifescience,medical ranges from 15% to 52% in community samples and 15% to 56% in medical settings.2 Second, anxiety disorders (and symptoms), already difficult to measure accurately in young adults, are more difficult to assess in older adults. In a section below, we will discuss difficulties in the assessment and diagnosis of anxiety disorders and symptoms in older Inhibitors,research,lifescience,medical adults and how these might affect

prevalence estimates. Table I Prevalence estimates for anxiety disorders in older adults from five community studies. GAD, generalized anxiety disorder; OCD, obsessive-compulsive disorder; PTSD, post-traumatic stress disorder; *prevalence estimate of GAD in EGA is from one site only; … Presentation of anxiety disorders across the lifespan Figure 1 portrays our current understanding of how different forms of anxiety disorders may predominate Inhibitors,research,lifescience,medical at different stages of the lifespan. Phobias (particularly social and specific phobias) may predominate in childhood; panic disorder and post-traumatic stress disorder (PTSD) may be at their highest prevalence in adulthood; while worry disorders (ie, GAD) may be most common in old age. Anxiety disorders with Inhibitors,research,lifescience,medical a strong autonomic nervous system component (eg, resulting in panic attacks or panic-like symptoms) are usually considered to be more common in childhood or early adulthood than later

in life, particularly with respect to social phobia and panic disorder. Age-related changes in brain structure or function or peripheral physiology likely reduce the propensity for autonomic responses.5 Here we note the caveat that Inhibitors,research,lifescience,medical specific disorders “may” peak at different times in the lifespan because these data are largely Tolmetin based on epidemiological studies. The difficulty of retrospective evaluation of age of onset of mental disorders is a limitation to this assertion,6 as is the difficulty of detecting late-onset anxiety disorders using standardized assessment tools that were developed for young adults..2 Additionally, fear of falling (FOF) is a common and uniquely geriatric syndrome7 marked by fear and avoidance. High rates of older adults in the community report a FOF,8 and in its more severe forms the consequences of this fear are very serious, including a curtailing of activities9; thus the problem is akin to agoraphobia in the more severe manifestation. However, it appears difficult to diagnose FOF as an anxiety disorder, due in large part to issues with insight and goodness of fit with existing DSM-IV nosology.