Lauderdale Sean A, Sheikh Javaid I
Mental Illness Research, Education, and Clinical Center (MIRECC), Veteran's Affairs Palo Alto Health Care System, 795 Willow Road, 116A\MPD, Menlo Park, CA 94025, USA.
Clin Geriatr Med. 2003 Nov;19(4):721-41. doi: 10.1016/s0749-0690(03)00047-8.
Recent epidemiologic surveys indicate that anxiety disorders in older adults are more common than previously believed. Despite this, knowledge regarding the clinical characteristics of anxiety disorders in elderly patients is emerging slowly. In addition, detection of anxiety symptoms in elders is complicated by several factors, including a confounding of symptom picture by high medical comorbidity, frequent use of multiple prescribed and over-the-counter medications, difficulty of differentiating anxiety from depression, and a tendency of some older adults to resist psychiatric evaluation. Nonetheless, a comprehensive evaluation that includes a clinical interview, self-report measures, and laboratory results, can improve detection and accurate assessment of anxiety in elderly patients. Empirically validated knowledge regarding appropriate pharmacologic interventions in elderly patients is still sparse, and inferences from data in young and middle-aged populations typically form the basis of clinical practice in elderly patients. SSRIs and SNRIs are considered first-line interventions because of their efficacy and relative tolerability in elderly patients. Psychotherapy, particularly cognitive-behavioral therapy, also has been found to be efficacious for older adults with anxiety disorders. Collaborative care models that address physician, patient, and healthcare service delivery barriers, also hold promise for adequately treating anxiety disorders experienced by older adults.
近期的流行病学调查表明，老年人焦虑症比之前认为的更为常见。尽管如此，关于老年患者焦虑症临床特征的认识仍在缓慢形成。此外，老年人焦虑症状的检测因多种因素而变得复杂，包括高医疗合并症对症状表现的混淆、频繁使用多种处方药和非处方药、难以区分焦虑与抑郁，以及一些老年人抗拒精神科评估的倾向。尽管如此，包括临床访谈、自我报告测量和实验室检查结果在内的综合评估，可以提高对老年患者焦虑症的检测和准确评估。关于老年患者适当药物干预的经实证验证的知识仍然匮乏，基于年轻和中年人群数据的推断通常构成老年患者临床实践的基础。由于其在老年患者中的疗效和相对耐受性，选择性5-羟色胺再摄取抑制剂（SSRIs）和5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）被视为一线干预措施。心理治疗，尤其是认知行为疗法，也被发现对患有焦虑症的老年人有效。解决医生、患者和医疗服务提供障碍的协作护理模式，也有望充分治疗老年人经历的焦虑症。
