Objectives: The prevalence of generalized anxiety disorder (GAD) is supposed to decrease with age. Reasons suggested include that emotional control increases and that anxiety and worry are expressed differently in older adults. The aim of this study was to examine how the expression of anxiety and worry changes with age and how this influences diagnoses in current classification systems.
Method: Semistructured psychiatric examinations were performed in population-based samples of 70- (n = 562), 75- (n = 770), 79/80- (n = 603), and 85-year-olds (n = 433). Individuals with dementia were excluded. GAD was diagnosed according to DSM-5 (DSM5 GAD) and ICD-10 (ICD10 GAD) criteria. Individual symptoms were assessed according to severity and frequency. Functioning was measured with Global Assessment of Functioning (GAF).
Results: The prevalence of clinical anxiety, autonomic arousal, muscle tension, and irritability decreased with age, while that of worry and fatigue increased. Concentration difficulties and sleep disturbances remained stable. The prevalence of ICD10 GAD tended to decrease, while that of DSM5 GAD did not change with age. Core symptoms and diagnoses of GAD were related to lower GAF scores. However, in those with autonomic arousal and ICD10 GAD, GAF scores increased with age.
Conclusions: The prevalence of ICD10 GAD tended to decrease with increasing age while the prevalence of DSM5 GAD remained stable. This difference was partly due to a decreased frequency of severe anxiety and autonomic arousal symptoms, and that worries increased, suggesting changes in the expression of GAD with increasing age.
Keywords: DSM-5; ICD-10; anxiety; classification; elderly; epidemiology; generalized anxiety disorder; worry.
© 2018 John Wiley & Sons, Ltd.