Bringing the bedside to the bench, and then to the community: a prospectus for intervention research in late-life anxiety disorders

Abstract

Background: Anxiety disorders are highly prevalent in elderly persons, and they are associated with functional impairment, poorer quality of life, and adverse long-term consequences such as cognitive decline. Intervention research in late-life anxiety disorders (LLAD) lags behind where it ought to be. Research in cognitive neuroscience, aging, and stress intersects in LLAD and provides the opportunity to develop innovative interventions to prevent chronic anxiety and its consequences in this age group.

Methods: This paper evaluates gaps in the evidence base for treatment of LLAD and synthesizes recent research in cognitive neuroscience, basic behavioral science, stress, and aging.

Results: We examine three intervention issues in LLAD: (1) prevention; (2) acute treatment; and (3) pre-empting adverse consequences. We propose combining randomized controlled trials (RCTs) with mechanistic biobehavioral methodologies as an optimal approach for developing novel, optimized, and personalized treatments. Additionally, we examine three barriers in the field of LLAD research: (1) How do we measure anxiety?; (2) How do we raise awareness?; (3) How will we ensure our research is applicable to underserved populations (particularly minority groups)?

Conclusions: This prospectus outlines approaches for intervention research that can reduce the morbidity of LLAD.

Figure 1

The continuum of unanswered questions in late life anxiety disorders, from bench to bedside to community.

Figure 2

A potential design for preventive research in late-life anxiety disorders.

Figure 3

Neurobiological models of anxiety and resultant directions for personalized late-life anxiety treatment.

Figure 4

Late life anxiety as accelerated aging: adverse consequences and treatment options.