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Published Online: 7 February 2022

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Publication: Late-Life Depression and Anxiety

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Page numbers printed in boldface refer to tables and figures.
AAAs
. See Area agencies on aging
Accelerated aging,
320
Acceptance and commitment therapy (ACT),
223–224
ACE
. See Aid to Capacity Evaluation
ACED
. See Assessment of Capacity for Everyday Decision-Making
ACE inhibitors, as factor in late-life depression and anxiety,
119
ACEs
. See Adverse childhood experiences
ACT
. See Acceptance and commitment therapy
Activities of daily living (ADL),
18
Katz Index of,
150, 151
Lawton-Brody Scale of,
152153
Acute respiratory distress syndrome (ARDS), association with anxiety,
64
AD8
. See Alzheimer’s Association AD8 Dementia Screening Interview
Addison’s disease, in assessment of anxiety or depression in older adults,
110
S-adenosyl methionine (SAMe),
257, 258
ADL
. See Activities of daily living
Administration on Aging,
199
Advancing Integrated Mental Health Solutions (AIMS) Center,
199
Adverse childhood experiences (ACEs), association with late-life depression,
9
Age
accelerated aging,
320
adolescence and depression,
4
at onset of anxiety,
85–86
at onset of generalized anxiety disorder,
97
at onset of panic disorder,
74
AgingInPlace,
280
Agoraphobia
clinical features,
68
clinical presentation,
72–73
DSM-5 diagnostic criteria for,
74–75
AIDS, association with anxiety,
64
Aid to Capacity Evaluation (ACE),
151, 164
AIMS
. See Advancing Integrated Mental Health Solutions Center
Alcohol use disorder,
36–37
association with anxiety,
95
as factor in late-life depression,
115–118, 117120
Alcohol Use Disorders Identification Test (AUDIT),
165, 117
Alcohol Use Disorders Identification Test-Concise (AUDIT-C),
117
Alzheimer’s Association AD8 Dementia Screening Interview,
139, 161, 166
Alzheimer’s disease,
8, 34, 42
anxiety and,
93
cognitive impairment and,
139
criteria for depression in,
23–24
onset of,
4
rate of depression in,
6, 14
risk factors for,
56
American Association of Geriatric Psychiatry,
331
American Geriatrics Society Beers Criteria,
233, 238, 247, 281
American Medical Association,
165
American Psychiatric Association Council on Research Task Force on Novel Biomarkers and Treatments,
255
American Psychiatric Association Integrated Care,
209
American Society on Aging,
165
Amputations, association with anxiety,
65
Anemia, in assessment of anxiety or depression in older adults,
109
Antidepressants,
191, 230
interaction with other medications,
233
for treatment of late-life depression and anxiety,
277
adverse effects of,
232–233
augmentation strategies,
233–234
efficacy,
230–232
prescribing,
235–238, 236
Antiparkinsonian agents
association with late-life depression,
9
as factor in late-life depression and anxiety,
119
Anxiety
. See also Depression; Late-life depression
algorithm for treatment of late-life anxiety,
275, 276
case example of,
93–95
clinical course,
85–87
age at onset,
85–86
prognosis,
86–87
clinical presentation,
67–85, 68
comorbidities,
91–96, 97
as comorbidity of late-life depression,
33
consequences and complications of,
87–91
diagnosing,
157–160, 159
DSM-5 diagnostic criteria for,
317
due to another medical condition,
68
in early adulthood and midlife,
4
etiology,
54–60
adaptive functions of anxiety,
55
model of late-life anxiety,
57, 97
examples of maladaptive behaviors associated with age-specific challenges,
70
fight-or-flight response to,
55
management with sedativehypnotics,
238–239
medical conditions associated with,
6265
medical conditions to consider when assessing,
108, 109115, 113–115
model of late-life anxiety,
56, 57
in persons in long-term care facilities,
317
prevalence of,
66
public health impact of late-life and,
54
rating scales,
144146, 143, 147, 163
resources for patients, families, and caregivers,
98
screening for anxiety in special populations,
147–150
summary of assessment,
162
symptoms of,
72, 159
Anxiety and Depression Association of America,
98
ARDS
. See Acute respiratory distress syndrome
Area agencies on aging (AAAs),
199
Arrhythmia, in assessment of anxiety or depression in older adults,
109
Art therapy,
259, 259
Assessment of Capacity for Everyday Decision-Making (ACED),
151, 164
AUDIT
. See Alcohol Use Disorders Identification Test
AUDIT-C
. See Alcohol Use Disorders Identification Test-Concise
BAI
. See Beck Anxiety Inventory
BDI-II
. See Beck Depression Inventory-II
Beck Anxiety Inventory (BAI),
143, 145
Beck Depression Inventory-II (BDIII),
141
Behavioral activation,
220
Behavioral and psychological symptom of dementia (BPSD),
23–24
Benzodiazepines (BZDs)
association with anxiety,
95
association with late-life depression,
9
dosage,
239
as factor in late-life depression and anxiety,
119
for treatment of insomnia,
39, 222, 223
for treatment of late-life anxiety,
238–239, 277
Bereavement, as factor in assessment of late-life depression,
121–122
β-Blockers
association with late-life depression,
9
as factor in late-life depression and anxiety,
119
Biopsychosocial model,
127–132, 160–161, 164
Bipolar depression
clinical presentation,
22–23
resources for patients, families, and caregivers,
279
treatment for,
243–246
Bipolar disorder
in adulthood,
4
clinical presentation,
32
BLT
. See Bright light therapy
Borderline personality disorder,
39, 224
BPSD
. See Behavioral and psychological symptom of dementia
Bright light therapy (BLT)
resources for patients, families, and caregivers,
280
for treatment of late-life depression and anxiety,
254–255
Built environment,
322
Bupropion,
132, 231
Bupropion XL, for treatment of latelife depression,
236
BZDs
. SeeBenzodiazepines
CADASIL, in assessment of anxiety or depression in older adults,
112, 114
CAGE,
116
CAGE-AID,
116
Calcium channel blockers, as factor in late-life depression and anxiety,
119
Canadian Network for Mood and Anxiety Treatments (CANMAT),
244, 256
Cancer
anxiety and increased mortality from,
89
in assessment of anxiety or depression in older adults,
112, 115
association with anxiety,
62
association with depression,
8, 29, 310
depression rating scales and,
150
medications for and association with depression and anxiety,
119120
palliative care and depression,
321
CANMAT
. See Canadian Network for Mood and Anxiety Treatments
Cannabis,
37–38. See also Substance use disorders
Capacity assessment,
324–325
Carbidopa, as factor in late-life depression and anxiety,
119
Cardiovascular disease
in assessment of anxiety or depression in older adults,
109110, 113
antidepressants and,
230
association with anxiety,
62, 89
depression and,
31, 38, 41, 42
ECT and,
250
medications for as factor in depression and anxiety,
119
PTSD and,
88
Caregivers
. See also Resources for patients, families, and caregivers
anxiety and,
90–91, 224, 324
assessment of anxiety and,
146
assessment of depression and,
141142
challenges for,
93
depression in,
227–228, 323, 324
elder abuse and,
326, 330
impact of late-life depression on,
32–33
inclusion in treatment of patient,
220, 227
psychoeducation and,
215
psychosocial risk factors,
330
public services for,
199, 208
Cariprazine, for treatment of bipolar depression,
245
Case examples
of Alzheimer’s disease,
201–203
of anxiety,
93–95
of cognitive impairment as comorbidity of anxiety,
93–95
of cognitive impairment as comorbidity of late-life depression,
35–36
of cultural assessment with depression and anxiety,
305–308
of dementia and suicide risk,
201–203
of organizational frameworks for a comprehensive assessment,
130–132, 133, 134
of psychotic depression,
20–21
of quality of life,
305–308
of specific phobia,
76–77
Catatonia, clinical presentation of,
21
CBT
. See Cognitive-behavioral therapy
CBT-I
. See Cognitive-behavioral therapy
CDR
. See Clinical Dementia Rating
Center for Epidemiologic Studies Depression Scale (CES-D),
141, 148, 308–309
Cerebrovascular disease
antidepressants and,
230
CADASIL and,
112, 114
depression and,
4–6, 5, 34–35
vascular depression and,
25–26, 42, 108, 254
CES-D
. See Center for Epidemiologic Studies Depression Scale
CHF
. See Congestive heart failure
Chinese herbal medicines,
257, 259
Chronic care model,
260–261
Chronic obstructive pulmonary disease (COPD)
in assessment of anxiety or depression in older adults,
115, 149
association with anxiety,
64, 120
benzodiazepines and,
241
ECT and,
250
insomnia and,
240
Cimetidine, as factor in late-life depression and anxiety,
119
Citalopram
adverse effects of,
232
for treatment of late-life depression,
236
Clinical Dementia Rating (CDR),
220
Clomipramine,
315
Clonidine, as factor in late-life depression and anxiety,
119
Clozapine,
191, 273
Cluster B personality disorders,
39
CMS
. See U.S. Centers for Medicare and Medicaid Services
Cognitive-behavioral therapy (CBT, CBT-I)
access to,
221
to address negative dysfunctional thoughts,
10
for management of insomnia,
218, 222–223
for management of late-life depression and anxiety,
217–222, 231–232, 274275, 276, 277
for management of bipolar depression,
246, 275
telepsychiatry delivery of,
269
third-wave,
223–224
in treatment of suicide,
193–194
well-being therapy and,
267
Cognitive impairment
case example of,
93–95
as comorbidity of anxiety,
92–93
as comorbidity of late-life depression,
33–36
case example of,
35–36
instruments for identification in older adults,
138139
screening for,
135–137, 161, 138139
screening for depression and anxiety in elders with,
148
Cognitive restructuring,
221
Collaborative care
efficacy,
278
for management of late-life depression and anxiety,
262–267, 264265
model of,
198–199
resources for clinicians,
281–282
Columbia Lighthouse Project,
165–166
Columbia Suicide Severity Rating Scale (C-SSRS),
133–134, 183–184, 207, 208, 318
Communication, with family and others,
156–157, 164
Community-based interventions collaboration with,
216–217
for management of late-life depression and anxiety,
267–269
Complementary and alternative medicine, for treatment of latelife depression and anxiety,
257–260, 258259
Complicated grief,
28
Computed tomography (CT),
156
Congestive heart failure (CHF), association with anxiety,
62
COPD
. See Chronic obstructive pulmonary disease
Cornell Scale for Depression in Dementia (CSDD),
137, 163, 141
Coronary artery disease, association with anxiety,
62, 88
COVID-19
in assessment of anxiety or depression in older adults,
111
suicide risk and,
186
telepsychiatry during pandemic,
269
C-reactive protein (CRP), in midlife,
7
CRP
. See C-reactive protein
CSDD
. See Cornell Scale for Depression in Dementia
C-SSRS
. See Columbia Suicide Severity Rating Scale
CT
. See Computed tomography
Cultural Formulation Interview,
11, 124, 305, 306307, 329
case example of,
305–308
Culture
in assessment of late-life depression,
124–127
CBT and,
221–222
cultural assessment,
303–309
definition of,
11, 304, 328–329
family involvement in treatment and,
216
intergenerational obligation and,
11–12
late-life anxiety and,
59–60, 276
late-life depression and,
6, 11–12, 274275
panic disorder criteria and,
73
resources for patients, families, and caregivers,
331
risk factors for late-life anxiety,
61
screening for depression and anxiety in culturally diverse elders,
147–148
Cushing’s disease, in assessment of anxiety or depression in older adults,
110
DASH
. See Diagnostic Assessment Scale for the Severely Handicapped
DBSA
. See Depression and Bipolar Support Alliance
DBT
. See Dialectical behavior therapy
Death
as consequence of anxiety,
88–89
as consequence of late-life depression,
31–32
grief and,
27, 28
religious beliefs and death anxiety,
59
suicide at the end of life,
204–206
suicide risk and thoughts of,
189, 198
thoughts of, as symptom of depression,
19, 24, 27
DEATH (mnemonic for personal activities of daily living),
18
Decision-making capacity
assessing,
150–151
medical,
150–151
in older adults,
164
Dementia
. See also Major neurocognitive disorder
as comorbidity of anxiety,
92–93
as comorbidity of late-life depression,
33–36
depression and,
23–24, 23
suicide risk and,
200–203
Dementia syndrome of depression (DSD),
136
Depression
. See also Late-life depression
behaviors,
18
in caregivers,
323
as comorbidity of anxiety,
91–92
in dementia,
23–24, 23
describing the severity of,
219
distinguishing grief from,
27
DSM-5 other specified depressive disorder category,
157
epidemiology,
12–14
etiology
life course of depression,
4, 5
mechanisms of depression,
4, 6
neural networks involved in late-life depression,
4, 7
grief and,
26–29
instruments for assessment in older adults,
140142
making the diagnosis,
157–159, 159
medical conditions to consider when assessing,
108, 109115, 113–115
minor,
26
overview, ix
rating scales,
137, 140142, 143, 163
screening in special populations,
147–150
screening instruments in older adults,
140142
severity,
219
summary of assessment,
162
symptoms of,
18, 19, 159
treatment-resistant,
191
vascular,
24–25, 108
Depression and Bipolar Support Alliance (DBSA),
43
Depression executive dysfunction syndrome,
136
Diabetes mellitus
in assessment of anxiety or depression in older adults,
110
association with anxiety,
63, 72, 114
association with bipolar disorder,
22, 243–244
association with depression,
6, 8, 29, 32, 114
Diagnostic Assessment Scale for the Severely Handicapped (DASH),
314
Dialectical behavior therapy (DBT),
218, 223
Diphenhydramine, for treatment of insomnia,
242
Disability
association with anxiety,
54, 64, 71, 72, 89, 96
association with depression,
32, 41, 157, 226
association with panic disorder,
75, 88
frailty and,
40
involuntary commitment and,
204
Doxepin, for treatment of insomnia,
240, 241
DSD
. See Dementia syndrome of depression
DSM-IV
approach to cultural formulation in,
304–305
definition of major depressive disorder and dysthymia,
13
definition of major depressive episode,
136
DSM-5
Cross-Cultural Issues Subgroup,
305
diagnostic criteria for agoraphobia,
74–75
diagnostic criteria for anxiety disorder,
317
diagnostic criteria for GAD,
69, 71
diagnostic criteria for MDD,
15–17
diagnostic criteria for OCD,
83–85
diagnostic criteria for panic
disorder,
73–74
diagnostic criteria for PTSD,
78–83
diagnostic criteria for prolonged grief disorder,
28–29
other specified depressive disorder category,
157
Duloxetine, for treatment of late-life depression,
236
ECT
. See Electroconvulsive therapy
Educational attainment, in assessment of late-life depression,
123–124
Elder abuse,
164
cultural assessment of,
325–327
identification and screening,
326
risk factors for,
326
screening for,
151, 154, 330
Electroconvulsive therapy (ECT),
192
resources for patients, families, and caregivers,
280
for treatment of bipolar depression,
245–246
for treatment of late-life depression and anxiety,
249–253, 252, 277
for treatment of psychotic depression,
243
Emergency departments, cultural assessment of adults and,
317–319, 319
Endocrine disease
in assessment of anxiety or depression in older adults,
113–114
association with anxiety,
63
End-stage renal disease, association with anxiety,
64
Engage (adaptation of CBT),
227
Epidemiologic Catchment Area study,
40
Erikson, Erik,
228
Escitalopram, for treatment of late-life depression,
236
Esketamine, for treatment of late-life depression and anxiety,
255–257
Estrogens, as factor in late-life depression and anxiety,
119
Eszopiclone, for treatment of insomnia,
39, 241
Ethical considerations
involuntary commitment,
203–204
suicide at the end of life,
204–206
Ethnicity
in assessment of late-life depression,
125–126
rating scales and,
147
suicide rates and,
180
Ethnic minority elders,
3, 9, 90, 219, 221–222, 230, 252, 253, 308–309
challenges faced by,
12
depression and anxiety and,
11, 19, 29, 124, 306307
late-life anxiety and,
66
Executive dysfunction syndrome,
25, 221
Exercise
for management of late-life depression and anxiety,
228–229, 278
resources for patients, families, and caregivers,
280
FAB
. See Frontal Assessment Battery
Failure to thrive (FTT), as comorbidity of late-life depression,
40–41
Falls,
232, 233
Familismo,
11
Family
anxiety and,
90–91
communicating with,
156–157, 164
impact of late-life depression on,
32–33
patient support and,
323
psychoeducation of,
214–217, 215
resources for anxiety,
98
resources for assessment of latelife depression and anxiety,
164–165
resources for cultural assessment of the older adult with depression and anxiety,
331
resources for late-life depression,
43
resources for suicide,
208
Fear of falling,
76, 77, 88–89
Filial piety,
11
Firearms, in suicide attempt,
179–180
Fish oil,
257, 258
Fluoxetine,
315
Folic acid,
257, 258
Frailty, as comorbidity of late-life depression,
40–41
Friendship Line,
208
Frontal Assessment Battery (FAB),
139
FTT
. See Failure to thrive
GAD
. See Generalized anxiety disorder
GAD-7
. See Generalized Anxiety Disorder-7
GAI
. See Geriatric Anxiety Inventory
GAI-SF
. See Geriatric Anxiety Inventory-Short Form
GAS
. See Geriatric Anxiety Scale
GDS
. See Geriatric Depression Scale
Gender
. See also LGBTQ+ older adults;Men; Women
in assessment of late-life depression,
124–125
suicide rates and,
180
Generalized anxiety disorder (GAD),
309
age at onset,
97
chronic,
33
clinical features,
68
clinical presentation,
69, 72
description of,
160
DSM-5 diagnostic criteria for,
71
quality of life with,
72, 88
Generalized Anxiety Disorder-7 (GAD-7),
131–132, 144, 147, 163
Genetic disease, in assessment of anxiety or depression in older adults,
112, 114
Genetics, late-life depression and,
8
Genomics Used to Improve Depression Decisions (GUIDED),
231
Geriatric Anxiety Inventory (GAI),
145, 147, 166
Geriatric Anxiety Inventory-Short Form (GAI-SF),
147
Geriatric Anxiety Scale (GAS),
123, 144, 147
Geriatric Depression Scale (GDS),
137, 140, 163, 318
GeriatricsCareOnline,
281
Glasgow Anxiety Scale,
314
Grief
complicated,
28
depression and,
26–29
distinguishing depression from,
27
DSM-5 diagnostic criteria for prolonged grief disorder,
29
as factor in assessment of late-life depression,
121–122
GUIDED
. See Genomics Used to Improve Depression Decisions
H2 antihistamines, as factor in latelife depression and anxiety,
119
HADS
. See Hospital Anxiety and Depression Scale
Hamilton Anxiety Rating Scale,
149
Hamilton Depression Rating Scale (HDRS),
313
Harvard Medical School,
280
Hazeldon Betty Ford Foundation,
164
HDRS
. See Hamilton Depression Rating Scale
Health
literacy, in assessment of late-life depression,
123–124
screening acutely ill elders for depression and anxiety,
149–150
social determinants of,
322–324, 324
unrecognized mental health disorders,
320
worry about,
98
Health care utilization, anxiety and,
89–90
Health in Aging,
98, 280
Health Literacy Tool Shed,
124, 165
Healthy IDEAS,
265, 268, 269, 281
Healthy migrant effect,
11
Heart failure, in assessment of anxiety or depression in older adults,
109
HelpGuide,
278
Herbal supplements, for treatment of insomnia,
242
HIV, in assessment of anxiety or depression in older adults,
115, 111
Hoarding disorder, clinical presentation of,
85
Home health care,
67
Hospice, cultural assessment of older adults and,
321
Hospital Anxiety and Depression Scale (HADS),
140, 143, 145
Howell, Timothy,
127
HPA axis
. See Hypothalamic-pituitary-adrenal axis
HRS
. See U.S. Health and Retirement Study
Hydralazine, as factor in late-life depression and anxiety,
119
Hydrochlorothiazide,
305
Hydroxyzine, for treatment of insomnia,
242
Hypercalcemia, in assessment of anxiety or depression in older adults,
114, 111
Hyperhidrosis,
232
Hyperhomocysteinemia, in assessment of anxiety or depression in older adults,
114
Hyperparathyroidism, in assessment of anxiety or depression in older adults,
114
Hypersomnia,
39
Hypochondriasis,
95–96
Hypoglycemia, in assessment of anxiety or depression in older adults,
110
Hyponatremia,
232
Hypothalamic-pituitary-adrenal (HPA) axis
anxiety and,
58
depression in younger adults and,
8
Hypothyroidism, in assessment of anxiety or depression in older adults,
110
Hypovitaminosis, in assessment of anxiety or depression in older adults,
111
ID
. See Intellectual disability
Illness anxiety disorder,
96
Immigrant status, and anxiety and depression
309
IMPACT
. See Improved Mood—Promoting Access to Collaborative Care Treatment
Improved Mood—Promoting Access to Collaborative Care Treatment (IMPACT),
190–191, 198, 220, 263, 264, 266, 267, 281
Incarceration, cultural assessment of older adults and,
320–321
Infectious disease, in assessment of anxiety or depression in older adults,
111, 115
Inpatient medical units, cultural assessment of older adults and,
319–320
Insomnia,
39
chronic obstructive pulmonary disease and,
240
management with sedativehypnotics,
240–243, 241
Integrated Telehealth Education and Activation of Mood (I-TEAM),
265, 268, 269
Intellectual disability (ID)
older adults with,
313–315
treatment for depression and anxiety and,
316
Interferon alpha, as factor in late-life depression and anxiety,
119
International Society for Bipolar Disorders (ISBD),
244
International Society for ECT and Neurostimulation,
280
Interpersonal psychotherapy (IPT)
for management of late-life depression and anxiety,
217–218, 218, 224–226, 274275, 275
suicide risk reduction and,
193
Interpersonal social rhythm therapy (IPSRT), for treatment of bipolar depression,
246
Involuntary commitment,
203–204
Involutional melancholia,
2, 14
IPSRT
. See Interpersonal social rhythm therapy
IPT
. See Interpersonal psychotherapy
ISBD
. See International Society for Bipolar Disorders
I-TEAM
. See Integrated Telehealth Education and Activation of Mood
Japan Gerontological Evaluation Study,
322–323
Joint Commission’s National Patient Safety Goal,
182–183
Ketamine
resources for patients, families, and caregivers,
280
side effects of,
257
for treatment of bipolar depression,
246
for treatment of late-life depression and anxiety,
255–257
Kraepelin, Emil,
2
Lamotrigine
for treatment of bipolar depression,
245
for treatment of late-life depression,
236, 278
Late-life depression (LLD)
. See alsoDepression
assessment
anxiety rating scales,
143, 144147, 147
assessing decision-making capacity,
150–151
bedside assessment,
132–147
communicating with family and others,
156–157
cultural and spiritual factors,
124–127
gender and sexual identity,
124–125
religion and spirituality,
126–127
educational attainment and health literacy,
123–124
functional,
150, 151153, 164
grief, loss, and bereavement,
121–122
laboratory, imaging, and other assessments,
154–156, 155156
making the diagnosis,
157–160
organizational frameworks for a comprehensive assessment,
127–132
biopsychosocial-spiritual framework,
128129
case example of,
130–132, 133, 134
Wisconsin Star Method,
130
personality traits and disorders,
118, 120
predisposing, precipitating, and perpetuating factors
alcohol, other substances, and medications,
115–118, 117, 119120
medical conditions,
108, 109115, 113–115
resources for patients, families, and caregivers,
164–166
screening for cognitive impairment,
135–137, 138139
screening for depression in special populations,
147–150
screening instruments for depression in older adults,
140142
social support,
122–123
socioeconomic status and financial stressors,
123
summary,
162
beliefs and values contributing to,
10
capacity assessment and,
324–325
care of older adults with,
328–330
clinical course,
29–30, 42
clinical presentation,
14–29, 41
prevalence of specific symptoms,
19, 19
typical presentations,
17–20
comorbidities,
33–41
consequences and complications of,
30–33
cultural and spiritual factors,
11–12
cultural assessment of patients with depression,
305–305
case examples of,
305–308
Cultural Formulation Interview,
11, 124, 306307
incarcerated older adults,
320–321
in inpatient medical units,
319–320
in long-term care facilities,
316–317
in palliative care and hospice,
321
in ethnic and racial minority elders,
308–309
etiology,
41
life course of,
4, 5
mechanisms of,
4, 6
neural networks involved in,
4, 7
heritability,
8
implementing a treatment algorithm for,
273–277, 274276
life review and reminiscence,
228
management of,
213–214
with antidepressants,
230–238, 236
community-based interventions,
267–269
complementary and alternative medicine,
257–260, 258259
exercise,
228–229
framework for psychoeducational interventions,
215
psychoeducation of patients and families,
214–217
psychotherapy,
217–228
public health interventions,
260–270
barriers to effective identification and treatment of older adults,
261262
collaborative care,
262–267, 264265
somatic treatments
bright light therapy,
254–255
ECT,
249–253, 252
ketamine and esketamine,
255–257
repetitive transcranial magnetic stimulation,
253–254
telepsychiatry,
269–270
neurobiology,
4–9
in older adults with intellectual disability,
313–315
treatment,
315, 316
personality factors contributing to,
10
progression of,
41
psychosocial, psychological, and personality factors,
9–10, 10
public health impact of,
2–3
resources for patients, families, and caregivers,
43, 278–281
screening for elder abuse,
151, 154
social determinants of anxiety and,
322–324, 324
socioeconomic factors contributing to,
10
stressful life events and,
10
Lawton-Brody Scale of Instrumental Activities of Daily Living,
150, 152153
Legal issues
involuntary commitment,
203–204
suicide at the end of life,
204–206
Levodopa, as factor in late-life depression and anxiety,
119
LGBTQ+ older adults
. See also Gender; Sexual identity
cultural assessment of,
309–311, 312
discrimination against,
3
mental health in,
329
prevalence of anxiety disorders in,
66
prevalence of late-life depression in,
14
Light therapy
. See Bright light therapy
Lithium,
191
for treatment of bipolar depression,
244, 245
for treatment of late-life depression,
236, 278
LLD
. See Late-life depression
Long-term care facilities,
316–317
elder abuse in,
327
resident-to-resident abuse,
327
screening elder residents for depression and anxiety,
148–149
suicide in,
203
Loss, as factor in assessment of latelife depression,
121–122
Lung disease, in assessment of anxiety or depression in older adults,
112
Lurasidone
for treatment of bipolar depression,
245
for treatment of late-life depression,
237, 278
Lyme disease, in assessment of anxiety or depression in older adults,
111
MacArthur Competence Assessment Tool (MacCAT-T),
325
MacCA-T
. See MacArthur Competence Assessment Tool
Major depressive disorder (MDD),
2–3
diagnosis,
14, 158
DSM-IV definition of,
13, 136
DSM-5 diagnostic criteria for,
15–17
late in life,
4
prevalence of,
12–13
psychotherapy for treatment of,
217
Major neurocognitive disorder,
137. See also Dementia
Malignancy, in assessment of anxiety or depression in older adults,
112
MAOIs
. See Monoamine oxidase inhibitors
Massage,
258
Mayo Clinic,
280
MBCT
. See Mindfulness-based cognitive therapy
MBSR
. See Mindfulness-based stress reduction
MDD
. See Major depressive disorder
Means reduction,
194
Medical factors
anxiety due to a medical condition,
68
late-life anxiety and,
60
medical conditions associated with anxiety,
6265
Medication
as factor in late-life depression and anxiety,
115–118, 117, 119120
misuse of,
161
use of psychotropic medication in adults with intellectual disabilities,
316
psychiatric medications for suicide risk assessment,
191–192
safety resources,
279–280
Melancholia,
2
Melatonin, for treatment of insomnia,
242
Men
alcohol consumption by,
116
risk for falls,
88–89
suicide rates,
179
Menopause
anxiety and,
58
in later life,
8
Mental Health America,
98, 279
Mental retardation
. See Intellectual disability
Metabolic disease, in assessment of anxiety or depression in older adults,
111
Methyldopa, as factor in late-life depression and anxiety,
119
L-methylfolate,
258
Migration, in assessment of late-life depression,
125–126
Mild cognitive impairment, association with anxiety,
63
Mild neurocognitive disorder,
137
Mindfulness-based cognitive therapy (MBCT),
223–224
Mindfulness-based stress reduction (MBSR),
223–224
MINI
. See Mini-International Neuropsychiatric Instrument
Mini-Cog,
161, 166, 138
Mini-International Neuropsychiatric Instrument (MINI),
148
Mini-Mental State Examination (MMSE),
138, 220
Minor depression,
12, 157
clinical presentation,
26
Minorities
. See Ethnic minorities; LGBTQ+ older adults;Race
Mirtazapine,
231, 315
for treatment of insomnia,
242
for treatment of late-life depression,
236
MMSE
. See Mini-Mental State Examination
MoCA
. See Montreal Cognitive Assessment
Models
biopsychosocial model,
127–132, 160–161, 164
chronic care model,
260–261
collaborative care model,
198–199, 278
of late-life anxiety,
56, 57
of psychoeducation program,
216
of screening for, assessing, and addressing suicidality in older adults,
182
stress threshold model,
93
Monoamine oxidase inhibitors (MAOIs),
232
Montreal Cognitive Assessment (MoCA),
138, 166
MS
. See Multiple sclerosis
MTHFR deficiency, in assessment of anxiety or depression in older adults,
112, 114
Multiple sclerosis (MS), association with anxiety,
64
Music therapy,
258, 259
NAMI
. See National Alliance on Mental Illness
National Action Alliance for Suicide Prevention,
200
National Aging Network,
199
National Alliance on Mental Illness (NAMI),
195, 208, 279, 282
National Association of Area Agencies on Aging,
208
National Center on Aging,
331
National Center on Elder Abuse,
331
National Comorbidity Survey Replication (NCS-R),
13, 66
National Institute for Mental Health (NIMH),
43, 279, 331
National Institute on Aging (NIA),
43
National Ombudsman System,
327
National Research Center on LGBT Aging,
331
National Resource Center on LGBT Aging,
165
National Strategy for Suicide Prevention,
199–200
National Suicide Prevention Lifeline,
43, 196, 197, 199, 208, 272, 280
NCS-R
. See National Comorbidity Survey Replication
Neoplastic disease
in assessment of anxiety or depression in older adults,
112
association with anxiety,
62
Neurobiology
late-life anxiety and,
56–58
late-life depression and,
4–9
Neurological disease
in assessment of anxiety or depression in older adults,
109, 113
association with anxiety,
6364
Neuropsychiatric Inventory Questionnaire (NPI-Q),
142, 146, 163
Neurosyphilis, in assessment of anxiety or depression in older adults,
111
Neuroticism, as factor in assessment of late-life depression and anxiety,
118
NIA
. See National Institute on Aging
Nicotine dependence,
38
NIMH
. See National Institute for Mental Health
Northern Light Technologies,
255
Nortriptyline, for treatment of latelife depression,
236
NPI-Q
. See Neuropsychiatric Inventory Questionnaire
Nursing facilities, residents with latelife anxiety in,
67
Obsessive-compulsive disorder (OCD),
159–160
clinical presentation,
83–85
DSM-5 diagnostic criteria for,
83–85
Obstructive sleep apnea (OSA),
40
in assessment of anxiety or depression in older adults,
115
OCD
. See Obsessive-compulsive disorder
OCF
. See Outline for Cultural Formulation
Olanzapine
and fluoxetine for treatment of bipolar depression,
244, 245
and sertraline for psychotic depression,
243
Opioids,
38
association with anxiety,
95
association with late-life depression,
9
as factor in late-life depression and anxiety,
119
Optimizing Outcomes of Treatment-Resistant Depression in Older Adults (OPTIMUM),
233, 234
OSA
. See Obstructive sleep apnea
Osteoporosis,
232
OPTIMUM
. See Optimizing Outcomes of Treatment-Resistant Depression in Older Adults
Outline for Cultural Formulation (OCF),
304–305
Palliative care, cultural assessment of older patients and,
321
Panic attack,
72–73
Panic disorder
age at onset,
74
characteristics,
72–73
clinical features,
68
clinical presentation,
72–76
DSM-5 diagnostic criteria for,
73–74
Parkinson’s Anxiety Scale (PAS),
149–150
Parkinson’s disease
in assessment of anxiety or depression in older adults,
109, 113
onset of,
4
rate of depression in,
6
Paroxetine,
225, 233, 236, 248, 314, 315
PAS
. See Parkinson’s Anxiety Scale
PATH
. See Problem adaptation therapy
Patient Health Questionnaire (PHQ-2),
183, 206, 208
Patient Health Questionnaire (PHQ-2+9),
133, 140, 183
Patient Health Questionnaire (PHQ-9),
131, 133, 183, 206, 318
Patients
interviewing,
271
psychoeducation of,
214–217, 215
resources for anxiety,
98
resources for assessment of latelife depression and anxiety,
164–165
resources for cultural assessment of the older adult with depression and anxiety,
331
resources for late-life depression,
43
resources for suicide,
208
support from family,
323
PEARLS
. See Program to Encourage Active, Rewarding Lives for Seniors
Penn State Worry Questionnaire (PSWQ, PSWQ-A),
147
Persistent depressive disorder (dysthymia),
159
clinical presentation,
25–26
Personality disorders,
161
as comorbidity of late-life depression,
38–39
as factor in assessment of late-life depression,
118, 120
Personality factors
association with late-life depression,
10
in late-life anxiety,
58–59
in late-life depression,
9–10, 10
Pheochromocytoma, in assessment of anxiety or depression in older adults,
110
PHQ-2
. See Patient Health Questionnaire
PHQ-2+9
. See Patient Health Questionnaire
PHQ-9
. See Patient Health Questionnaire
PIMRA
. See Psychopathology Inventory for Mentally Retarded Adults
Polypharmacy, avoiding and addressing,
246–249, 247, 249, 277
Posttraumatic stress disorder (PTSD)
age at onset,
86
in assessment of anxiety and depression,
121
association with suicide attempts,
87
bereavement and,
27
clinical course,
87
clinical presentation,
78–83
cognitive impairment in older adults with,
92
DSM-5 diagnostic criteria for,
78–83
in older women,
83
morbidity and comorbidity,
88, 92
prevalence,
66, 67
substance use and,
95
trauma and assessment of late-life depression and anxiety,
120–121
treatment,
220, 256
Practice Guideline for the Assessment and Treatment of Patients With Suicidal Behaviors,
185
President’s New Freedom Commission on Mental Health,
198
Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT),
26, 181, 198, 264, 273
Pride generation,
310. See also LGBTQ+ older adults
Primary care patients, late-life anxiety and,
67
Problem adaptation therapy (PATH),
227
for management of late-life depression and anxiety,
218
Problem-solving therapy (PST),
193–194
for management of late-life depression and anxiety,
217, 218, 226–227, 277
Progesterone, as factor in late-life depression and anxiety,
119
Program to Encourage Active, Rewarding Lives for Seniors (PEARLS),
264, 268, 281
Propranolol, as factor in late-life depression and anxiety,
119
PROSPECT
. See Prevention of Suicide in Primary Care Elderly: Collaborative Trial
Pseudodementia,
135–136. See also Cognitive impairment; Dementia
PST
. See Problem-solving therapy
PSWQ
. See Penn State Worry Questionnaire
Psychodynamic psychotherapy, for management of late-life depression and anxiety,
227–228
Psychoeducation
about late-life depression,
277
framework for psychoeducational interventions,
215
of patients and families,
214–217
Psychological factors
in late-life anxiety,
58–59
in late-life depression,
9–10, 10
Psychopathology Inventory for Mentally Retarded Adults (PIMRA),
314
Psychosocial factors
as interventions for suicide risk assessment,
194–195
in late-life anxiety,
58–59
in late-life depression,
9–10, 10
Psychotherapy
for late-life management of depression and anxiety,
217–228, 277
overview,
217–219, 218219
for patients in palliative care and hospice,
321
for suicide risk reduction
192–194
for treatment of major depressive disorder,
217
Psychotic depression
case example of,
20–21
clinical presentation,
20
treatment for,
243
Psycom,
279
PTSD
. See Posttraumatic stress disorder
Public health
impact of late-life anxiety on,
54
impact of late-life depression on,
2–3
Public services, for the health and wellbeing of older adults,
199
Pulmonary embolism, in assessment of anxiety or depression in older adults,
109
Quality of life
case example of,
305–308
with generalized anxiety disorder,
72, 88
meaning, purpose, and social connection in late life,
327–328
Quetiapine
for treatment of bipolar depression,
245
for treatment of late-life depression,
236, 278
Race
addressing racial disparities in the provision of mental health care,
282
in assessment of late-life depression,
125–126
cultural assessment with depression and anxiety and,
308–309
RAID
. See Rating Anxiety in Dementia
Ramelteon, for treatment of insomnia,
240, 241
Rapid Estimate of Adult Literacy in Medicine—Short Form (REALM-SF),
124
Rapid eye movement (REM) sleep,
39
Rating Anxiety in Dementia (RAID),
148, 163, 146
REALM-SF
. See Rapid Estimate of Adult Literacy in Medicine—Short Form Religion. See also
in assessment of late-life depression,
126–127
women and,
312
REM
. See Rapid eye movement sleep
Reminiscence therapy,
259
for management of late-life depression and anxiety,
228, 218
Repetitive transcranial magnetic stimulation (rTMS),
192
resources for patients, families, and caregivers,
280
for treatment of late-life depression and anxiety,
253–254, 277–278
Reserpine, as factor in late-life depression and anxiety,
119
Respiratory disease
in assessment of anxiety or depression in older adults,
112, 115
association with anxiety,
64
Retirement,
305–308, 322–323
rTMS
. See Repetitive transcranial magnetic stimulation
SAFE-T
. See Suicide Assessment Five-Step Evaluation and Triage
Safety
developing a suicide safety plan,
272
planning in suicide risk assessment,
195–197, 196, 318
Saint Louis University Mental Status (SLUMS) examination,
132, 136–137, 138, 161, 168
SAMe
. See S-adenosyl methionine
SAMHSA
. See Substance Abuse and Mental Health Services Administration
SAS
. See Zung Self-Rating Anxiety Scale
Scale for Suicide Ideation,
198
SCID
. See Structured Clinical Interview for DSM Disorders
Screening Tool of Older Persons’ Prescriptions and Screening Tool to Alert to Right Treatment (STOPP/START),
247
SDS
. See Severity of Dependence Scale; Zung Self-Rating Depression Scale
Sedative-hypnotics
for management of anxiety,
238–239
for management of insomnia,
240–243, 241
Seizures, in assessment of anxiety or depression in older adults,
110
Selective attention, anxiety and,
58–59
Selective serotonin reuptake inhibitors (SSRIs),
191, 231, 235
Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial,
234
Sertraline, for treatment of late-life depression,
236
Severity of Dependence Scale (SDS),
161, 117
Sexual activity, adverse effects of antidepressants on,
232–233
Sexual identity, in assessment of latelife depression,
124–125. See also Gender; LGBTQ+ older adults
Sexual minorities,
3, 9
late-life anxiety and,
66
SHAFT (mnemonic for instrumental activities of daily living),
18
Short Michigan Alcohol Screening Test—Geriatric Version (SMASTG),
117, 161
Shuganjieyu,
257, 259
Silent Generation,
310. See also LGBTQ+ older adults
Sleep apnea
in assessment of anxiety or depression in older adults,
112, 115
treatment,
240
Sleep disorders, as comorbidity of late-life depression,
39–40
SLUMS
. See Saint Louis University Mental Status examination
SMAST-G
. See Short Michigan Alcohol Screening Test—Geriatric Version
Social anxiety disorder (social phobia)
clinical features,
68
clinical presentation,
78
Social isolation
as contributor to late-life depression,
10
depression in Alzheimer’s disease and,
24
language barriers and,
11
as risk factor for anxiety,
58
as risk factor for suicide,
186, 187, 194, 270, 319
Social support, in assessment of latelife depression,
122–123
Socioeconomic status,
161–162
in assessment of late-life depression,
123
association with late-life depression,
10
Somatic symptom disorder,
96
Somatization, as comorbidity of anxiety,
95–96
Spaced retrieval,
220–221
Specific phobia
case example of,
76–77
characterization of,
76
clinical features,
68
clinical presentation,
76
fear of falling,
76, 77, 88–89
risk factors for fear of falling,
77, 97
Spirituality
. See alsoReligion
in assessment of late-life depression,
124–127, 126–127, 311–313
definition of,
311
late-life anxiety and,
59–60
late-life depression and,
11–12
SPRC
. See Suicide Prevention Resource Center
SSRIs
. See Selective serotonin reuptake inhibitors
STAI
. See State-Trait Anxiety Inventory
Stanford Ethnogeriatrics Curriculum,
165
STAR*D
. See Sequenced Treatment Alternatives to Relieve Depression trial
State-Trait Anxiety Inventory (STAI),
143
Steroids
association with late-life depression,
9
as factor in late-life depression and anxiety,
120
St. John’s wort,
257, 258
STOP-BANG questionnaire,
115
STOPP/START
. See Screening Tool of Older Persons’ Prescriptions and Screening Tool to Alert to Right Treatment
Stress
association with late-life depression,
8, 10
biopsychosocial-spiritual framework and,
128
minority stress,
125–126
social determinants of health and,
323
stress hormone regulation,
58, 91
stress threshold model,
93
Stressors
aging-related,
9
bipolar depression and,
246
cultural factors,
11, 59
in assessment of late-life depression,
123
bereavement,
27
financial,
123, 161–162, 186
psychosocial,
6, 187
risk factors for anxiety disorders,
58, 60, 61
as risk factor for suicide,
319
Stroke
association with anxiety,
63, 88, 113
CADASIL and,
112, 114
late-life depression and,
3, 8, 29, 32, 108, 113
psychotherapy for patients with,
217, 226
Structured Clinical Interview for DSM Disorders (SCID),
150
Subdural hematoma, in assessment of anxiety or depression in older adults,
109
Substance Abuse and Mental Health Services Administration (SAMHSA),
185, 197
Substance/medication-induced anxiety disorder, clinical features of,
68
Substance use disorders
anxiety and,
56, 95, 97
in assessment of anxiety or depression,
115–116
late-life depression and,
33, 36–38
OCD and,
95
as risk factor for suicide,
270, 319
severity of in older adults,
116
in treatment of anxiety or depression,
273
Subsyndromal anxiety,
66, 69
Subsyndromal depression,
26, 226
Subthreshold anxiety,
66, 69
Subthreshold depression,
26
Suicide
attempts as consequence of anxiety,
87–88, 179
as consequence of late-life depression,
30, 31
ideation,
135, 180–181
legal and ethical considerations,
203–206
involuntary commitment,
203–204
suicide at the end of life,
204–206
monitoring and addressing suicide risk determining appropriate level of care,
271–272
developing a suicide safety plan,
272
estimating risk,
270
implementing interventions to reduce risk,
272–273
interviewing the patient,
271
reducing access to means of suicide,
272
screening for suicidality,
270
resources
for clinicians,
208–209
for patients, families, and caregivers,
208
risk assessment,
132–135, 163, 184–190, 185
during COVID-19 pandemic,
186
factors in,
207
identifying risk factors,
185–186, 187188
means reduction,
194
National Strategy for Suicide Prevention,
199–200
psychiatric medications and other biological treatments,
190–192
psychosocial interventions,
194–195
psychotherapy,
192–194
public services for the health and well-being of older adults,
199
risk determination,
188–189, 189
risk reduction interventions,
189–190, 190
suicide inquiry,
186, 188
suicide safety planning,
195–197, 196
risk factors in older adults,
319
risk reduction,
177, 207
estimating risk level and determining appropriate interventions,
189
means of suicide in older adults,
272
model of screening for, assessing, and addressing suicidality in older adults,
182
scope,
178–181
screening for suicidality,
181–184, 182
role of screening,
182–183
screening tools,
183–184
strategies,
190
suicide rates for females,
178
suicide rates for males,
179
suicide rates by ethnicity and gender,
180
systems-level approaches to suicide risk reduction
collaborative care model,
198–199
overview,
198
in special populations,
200–203
dementia and suicide risk,
200–203
in long-term care settings,
203
suicide inquiry,
185, 186, 188
Suicide Assessment Five-Step Evaluation and Triage (SAFE-T),
109, 135, 166
Suicide Prevention Resource Center (SPRC),
200, 208, 280
Suicide Safety Plan,
209
Sunbox Company,
255
Supporting Seniors Receiving Treatment and Intervention (SUSTAIN),
265, 267–268, 269, 273
Surgeon General’s Report on Mental Health,
198
SUSTAIN
. See Supporting Seniors Receiving Treatment and Intervention
Suvorexant, for treatment of insomnia,
39, 240, 241
Tai chi,
258, 259
Tamoxifen, as factor in late-life depression and anxiety,
120
TBI
. See Traumatic brain injury
TCAs
. See Tricyclic antidepressants
TEAM
. See Telemedicine Enhanced Antidepressant Management
Telemedicine Enhanced Antidepressant Management (TEAM),
269
Telepsychiatry,
278
adoption during COVID-19,
269
for management of late-life depression and anxiety,
269–270
Temazepam, for treatment of insomnia,
241
Third-wave cognitive-behavioral therapies, for management of late-life depression and anxiety,
218, 223–224
Thyroid disorders, association with anxiety,
63
Thyrotoxicosis, in assessment of anxiety or depression in older adults,
110
TIP
. See Treatment Initiation Program
Trauma
in childhood,
323–324
as factor in assessment of late-life depression,
120–121
screening,
161
Traumatic brain injury (TBI), association with anxiety,
63
Trazodone, for treatment of insomnia,
242
Treatment Initiation Program (TIP),
216
Triazolam, for treatment of insomnia,
241
Tricyclic antidepressants (TCAs),
231
Tryptophan, for treatment of insomnia,
242
U.S. Centers for Medicare and Medicaid Services (CMS),
198
U.S. Health and Retirement Study (HRS),
327
U.S. Preventive Services Task Force (USPSTF),
182
USPSTF
. See U.S. Preventive Services Task Force
Valerian, for treatment of insomnia,
242
Valproate, for treatment of bipolar depression,
245
Vascular depression,
6, 24–25, 38, 108, 253
Venlafaxine XR, for treatment of latelife depression,
236
Vibrant Emotional Health,
197
VMAT-2 inhibitors, as factor in latelife depression and anxiety,
120
Vortioxetine,
231, 236
Well-being
public services for the health and well-being of older adults,
199
well-being therapy,
267
Wisconsin Card Sort Task performance,
221
Wisconsin Star Method,
127, 130, 130, 134160–161, 164
Women
menopause in later life,
8
PTSD in older women,
83
prevalence of anxiety and depression in,
163
religion and,
312
suicide rates for females by age group,
178
Yoga,
258, 260
Zaleplon, for treatment of insomnia,
39, 241
“Z-drugs,” for treatment of insomnia,
39, 241
Zero Suicide initiative,
200, 207, 209
Zolpidem, for treatment of insomnia,
39, 241
Zung Self-Rating Anxiety Scale (SAS),
313–314
Zung Self-Rating Depression Scale (SDS),
313

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Go to Late-Life Depression and Anxiety
Late-Life Depression and Anxiety
Pages: 343 - 364

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Published in print: 7 February 2022
Published online: 5 December 2024
© American Psychiatric Association Publishing

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