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How effective is cognitive behavioural therapy for managing anxiety and related disorders in older adults aged 55 and older?
Compared with minimal management, CBT may be more effective in reducing anxiety severity and the symptoms of worry and depression immediately after treatment. However, the lessening in anxiety severity may not be sustained, and at six months, there may be little or no difference between treatments.
There was not enough evidence to determine the effects of CBT on clinical recovery/improvement or whether CBT is more effective than other psychological therapies.
The results from this review suggest that the treatment of older adults with anxiety disorders can follow the clinical guidance for younger adults, while acknowledging circumstances and issues more common among older adults, such as hearing or vision problems and other physical comorbidities.
The majority of the evidence was of low certainty because studies were small and at risk of bias. Participants were aware of which treatment they were getting, and studies had issues with attrition, some of which was related to treatment preference or dissatisfaction with treatment.
Anxiety and related disorders are the most common mental disorders globally, with lifetime prevalence rates ranging from 17% in the EU to 29% in the US. In older adults, prevalence ranges from 6 to 12%.
These disorders are often undiagnosed and untreated in older adults due to ageism and a focus on physical health issues. Anxiety, if left untreated, is commonly associated with depression and physical health problems, such as increased risk of coronary heart disease and mortality.
CBT is the most researched psychological therapy for anxiety disorders in adults, and known to be effective in this population. However, it remains unclear whether these results apply to older adults.
Hendriks G-J, et al. Cognitive behavioural therapy and third-wave approaches for anxiety and related disorders in older people. Cochrane Database Syst Rev 2024;7:CD007674. This review contains 21 trials, which included 1234 people.
Pharmacist prescribers Linda Bryant and Leanne Te Karu discuss positive polypharmacy for heart failure. Current evidence shows the intensive implementation of four medications offers the greatest benefit to most patients with heart failure, with significant reductions in cardiovascular mortality, heart failure hospitalisations and all-cause mortality
