The clinical characteristics of panic disorder in the elderly: a retrospective study.
BACKGROUND: Community-based studies of the elderly have observed pathologic levels of anxiety to be common but find low rates of DSM-III-R anxiety disorders. Our clinical experience was that panic disorder may be more common than previously acknowledged. Our goals were to determine the prevalence, clinical characteristics, and possible factors that may facilitate a late-onset of panic disorder. METHOD: The clinical records of 540 patients aged 60 years or more were reviewed. DSM-III-R panic disorder was identified in 51 subjects. Demographic information, current medical illness, and family history were extracted from their records. Rating scale measures of anxiety, depression, phobias, and cognition were available. For comparison, subjects were divided into an early group who experienced onset of panic disorder at age 59 years or earlier and a late group who experienced onset at age 60 years or later. RESULTS: The overall prevalence of panic disorder was 9.4% and late-onset panic was 5.7%. The late-onset group experienced more shortness of breath (p = .05) during panic attacks and were more likely to have medical disorders like chronic obstructive pulmonary disease, vertigo, and Parkinson's disease. The early-onset subjects were more socially phobic (p = .008) and more depressed. CONCLUSION: Panic disorder can have onset in late life. Its phenomenology is similar in most respects to that described in young adults. Factors contributing to onset include stress, medical illness, and central nervous system disease.