Mohammed T. Abou-Saleh

542 PRINCIPLES AND PRACTICE OF GERIATRIC PSYCHIATRYTable 98.1 One year prevalence rates (%) of generalized anxiety(different exclusionary criteria) by age. ECA study 12AgeGeneralizedanxiety/noexclusionsGeneralized anxiety/no panic or majordepressionlikely to become cases than men. Many cases did remit during the3 years between interviews, but most original cases continued toexperience some symptoms at follow-up.FINDINGS FROM THE EPIDEMIOLOGICALCATCHMENT AREA SURVEYGeneralizedanxiety/no DSMdiagnosis530 4.83 3.51 2.3530–44 3.58 2.12 1.4645–64 3.74 2.81 1.7565+ 2.22 1.92 1.05Table 98.2 Cumulative prevalence by age of onset of cases of generalizedanxiety (no panic or major depression). ECA study 12By age Cumulative prevalence (%)19 20.624 40.129 56.544 79.564 97.0Table 98.3 Use of inpatient and outpatient general health services by ageand diagnosis of generalized anxiety. ECA study 12AgeGeneralizedanxiety (%)Outpatient useNo generalizedanxiety (%)Generalizedanxiety (%)Inpatient useNo generalizedanxiety (%)45–64 37.0 52.8 10.3 5.765+ 53.5 60.8 38.4 12.0The most detailed estimates of specific neurotic disorders arederived from the ECA surveys in the USA. The National Instituteof Mental Health Multi-Site Epidemiologic Catchment Area(ECA) Program was a collaborative study that combinedcommunity and institutional surveys of five communities in theUSA—New Haven, CT; Baltimore, MD; Durham, NC; St Louis,MO; and Los Angeles, CA. The large overall sample (over 18 000subjects), coupled with oversamples of older persons in three ofthe five sites, provided the most comprehensive estimates of theprevalence of specific anxiety disorders among community-dwellingelders from any extant study. The instrument used to establishcases was the Diagnostic Interview Schedule (DIS).The prevalence of generalized anxiety disorder at three of theECA sites by age is presented in Table 98.1. The patternspresented hold for both males and females and for Whites, Blacksand Hispanics (although the patterns for male Hispanics are lessobvious than for the other age, sex and race groups). In all groups,the prevalence for generalized anxiety is relatively high, but islower in the 65+ age group than for other ages. Prevalence ispresented when the symptoms of generalized anxiety are present,regardless of the symptoms of other disorders, when generalizedanxiety is present without evidence of panic or major depression,and when generalized anxiety is diagnosed with no other DIS/DSM-III disorders. The patterns by age are the same regardless.In a study from Liverpool, Copeland et al. 9 found the prevalenceof cases of anxiety among females 65+ years of age to be 1.52%,yet nearly 16% of males and females were classified as subcases.Generalized anxiety is more frequent among persons withdementing disorders than without.In a further analysis of the ECA data, the age of onset ofgeneralized anxiety is presented in Table 98.2 for Durham, NC.Virtually all cases of generalized anxiety have their onset beforethe age of 65 in this community sample. Age of onset is evenlydistributed across the life cycle except for individuals aged 65+.In Table 98.3, the use of inpatient and outpatient general healthservice, with and without generalized anxiety disorder, arecompared by age (persons 65+ years of age and persons 45–64). Older persons are more likely to report use of inpatientphysical health services if they report a current episode ofgeneralized anxiety. In contrast, older persons who suffer generalizedanxiety are no more likely to use outpatient services. Thetrend in older persons is similar to trends in younger persons forboth inpatient and outpatient use.In Table 98.4, data are presented on other selected neuroticdisorders by age and sex from the ECA study. In most cases, forboth sexes, the prevalence of neurotic disorders decreases withage. Age differences in the rates of phobic disorder are not aspronounced as those seen for other disorders. Older persons havethe lowest rates of panic disorder of any age group, whereaspersons in the 30–44 age group have the highest rates. This trendoccurs for Whites and Blacks but not for Hispanics. Not only doolder persons appear to experience a lower prevalence of panicdisorder in late life currently, they also appear to have a lower lifetimeprevalence of panic disorder. This lower lifetime prevalencecould be explained by the fact that persons with panic disordersare less likely to reach old age. In addition, the cohortphenomenon, which is described frequently throughout thisbook (i.e. persons in late life currently have been uniquelyprotected against a number of psychiatric disorders) may beoperative for panic disorders as well. One must also consider,however, the possibility that older persons in these communitysurveys fail to recall episodes of panic in the distant past becausethey have not experienced them recently or they may find suchepisodes embarrassing to report.Table 98.4One year prevalence rates (%) of selected neurotic disorders by age and gender18–29 30–44 45–64 65+Disorder Male Female Male Female Male Female Male FemalePhobic disorder 13 6.5 13.4 6.1 16.1 6.7 11.6 4.9 8.8Panic disorder 13 0.6 1.1 6.7 1.9 0.7 1.1 0.04 0.4Obsessive-compulsive disorder 14 1.8 2.6 1.9 2.2 0.8 1.2 0.8 0.9Hypochondriasis 9 0.5 0.5