This article was downloaded by: ["Queen's University Libraries, Kingston"]

On: 28 August 2014, At: 00:54

Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer
House, 37-41 Mortimer Street, London W1T 3JH, UK

Aging & Mental Health

Publication details, including instructions for authors and subscription information:
http://www.tandfonline.com/loi/camh20

Age differences in the presentation of anxiety

a
G. A. Brenes PhD
a
Department of Psychiatry and Behavioral Medicine , Wake Forest University School of
Medicine , Winston-Salem, North Carolina, USA
Published online: 18 Jan 2007.

To cite this article: G. A. Brenes PhD (2006) Age differences in the presentation of anxiety, Aging & Mental Health, 10:3,
298-302, DOI: 10.1080/13607860500409898

To link to this article: http://dx.doi.org/10.1080/13607860500409898

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained
in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no
representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of
the Content. Any opinions and views expressed in this publication are the opinions and views of the authors,
and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied
upon and should be independently verified with primary sources of information. Taylor and Francis shall
not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other
liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or
arising out of the use of the Content.
This article may be used for research, teaching, and private study purposes. Any substantial or systematic
reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any
form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://
www.tandfonline.com/page/terms-and-conditions
 Aging & Mental Health, May 2006; 10(3): 298–302

ORIGINAL ARTICLE

Age differences in the presentation of anxiety

G. A. BRENES

Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem,
North Carolina, USA

(Received 26 May 2005; accepted 4 August 2005)

Downloaded by ["Queen's University Libraries, Kingston"] at 00:54 28 August 2014

Abstract
The research on anxiety and age has produced inconsistent findings. One reason for this may be that the manifestation of
anxiety symptoms is age-related. The purpose of this study was to determine if there are age-related differences in the
presentation of affective, cognitive, and somatic symptoms of anxiety. Primary care patients ranging in age from 19–87 years
completed three self-report measures of anxiety. Results indicate that older adults report less worry than younger adults.
There were no age differences in the report of somatic and affective symptoms. Thus, worry appears to play a less prominent
role in the presentation of anxiety in older adults. These findings suggest that older adults do experience anxiety differently
than younger adults.

Introduction
Anxiety is a significant problem for older adults.
Anxiety disorders are twice as prevalent as affective
disorders and 4–8 times more prevalent than major
depressive episodes among older adults (Regier,
Narrow, & Rae, 1988; Weissman et al., 1985).
Rates for anxiety symptoms are even higher.
Community studies have found that 10–24% of
older adults experience significant symptoms of
anxiety (Flint, 1994; Forsell & Winblad, 1998;
Fuentes & Cox, 1997; Sheikh, 1992), and 40% of
older medical patients have symptoms of anxiety
(Magni, Schifiano, DeDominics, & Belloni, 1998).
Further, the proportion of older adults who use
benzodiazepines underscores the importance of
anxiety in this population (Wang, Bohn, Glynn,
Mogun, & Avorn, 2001).
One way to conceptualize anxiety is through the
use of cognitive behavioral models. These models
posit that there are three components of anxiety:
affective, cognitive, and somatic symptoms. Affective
symptoms refer to the emotional feelings associated
with anxiety, such as feeling anxious or nervous. The
cognitive symptoms of anxiety reflect the thoughts
and worries associated with anxiety, such as having
difficulty controlling worry. Somatic symptoms of
anxiety refer to the physiological sensations asso-
ciated with anxiety, such as a racing heart or sweaty
palms. Of the non-pharmacological treatments for
anxiety, those based on cognitive behavioral models
are the most commonly studied and efficacious
(Chambless & Ollendick, 2001). These treatments
seek to change somatic symptoms and thought
patterns, thereby significantly reducing anxiety
(Barlow, 2002; Borkovec, Alcaine & Behar, 2004;
Craske, Barlow & O’Leary, 1992).
Cognitive-behavioral conceptualizations of symp-
toms have proven useful in the study of age
differences in depressive symptoms (Goldberg,
Breckenridge & Sheikh, 2003). Unfortunately,
there is little research on late-life anxiety and a full
understanding is necessary in order to provide the
best treatment. The small literature that does exist
is mixed: some studies have found that anxiety
symptoms are related to age (Morin et al., 1999;
Wetherell & Arean, 1997), while other studies have
found no such relationship (Fuentes & Cox, 2000).
This inconsistency may be due to the measure used
to assess anxiety, as different measures assess
different components of anxiety.
The specific symptoms measured by a scale are
important because anxiety may present more fre-
quently as somatic symptoms among older adults
(McDonald, 1973; Sallis & Lichstein, 1982;
Turnbull, 1989). In fact, Schaub and Linden
(2000) found that somatic comorbidity was
common among older adults. Moreover, older
adults may not attribute symptoms of anxiety to an
anxiety problem (Small, 1997), instead

Correspondence: Gretchen A. Brenes, PhD, Department of Psychiatry and Behavioral Medicine, Wake Forest University
School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157, USA. Tel: þ1 (336) 716 4551.
Fax: þ1 (336) 716 6830. E-mail: gbrenes@wfubmc.edu
ISSN 1360-7863 print/ISSN 1364-6915 online ß 2006 Taylor & Francis
DOI: 10.1080/13607860500409898

misattributing them to physical illness (Knauper &
Wittchen, 1994). Also, older adults may experience
the affective symptoms associated with anxiety
differently from younger adults. Lawton, Kleban
and Dean (1993) found that terms describing
anxiety were less salient for older adults. Further,
some research suggests that older adults worry less
(Babcock, Laguna, L.B., Laguna, K.D., & Urusky,
2000; Doucet, Ladouceur, Freeston, & Dugas,
1998; Powers, Wisocki, & Whitbourne, 1992).
Thus, existing research would suggest that when
older adults experience anxiety, they experience it
more somatically. Knowing which components are
most prominent in late-life anxiety would allow
clinicians to tailor treatments to elderly patients.
Downloaded by ["Queen's University Libraries, Kingston"] at 00:54 28 August 2014
This study seeks to explore the following
question: Do older and younger adults differ in
their self-reported symptoms of anxiety? Specific
hypotheses are:
1. Anxious older adults will report more somatic
symptoms of anxiety than anxious younger
adults.
2. Anxious older adults will report fewer affective
symptoms of anxiety than anxious younger
adults.
3. Anxious older adults will report fewer cognitive
symptoms of anxiety than anxious younger
adults.
Method
Participants
Participants were recruited from a large outpatient
academic internal medicine clinic. All participants
were 18 years of age and older. People who indicated
difficulty reading the questionnaire were offered
assistance by a research assistant.
Measures
Demographics. Participants were asked to indicate
their age in years, race, gender, years of education,
and marital status. They rated their health on
an 11-point Likert scale, ranging from 0 (poor
health) to 10 (excellent health).
Beck Anxiety Inventory (BAI; Beck, Epstein, Brown,
& Steer, 1988). The BAI consists of 21 items that
predominantly measure somatic symptoms (e.g.,
numbness or tingling, feeling hot) of anxiety.
Participants rate each item on a scale from 0 (not
at all) to 3 (severely). Responses to individual items
are then summed to create a total score, with higher
scores indicating greater anxiety. The reliability and
validity of the BAI has been established in samples
of older adults (Morin et al., 1999; Steer, Willman,
Kay, & Beck, 1994; Wetherell & Arean, 1997).
The internal consistency of the BAI in this sample
was 0.93.
Age differences in anxiety 299
State-Trait Anxiety Inventory (STAI; Spielberger,
Gorsuch & Lushene, 1970). The STAI Trait scale
consists of 20 items that predominantly measure
affective and cognitive components of anxiety that
are more stable rather than situational. Participants
rate each item on a scale of 1 (almost never) to
4 (almost always). Responses are summed to create
a total score that can range from 20–80, with higher
scores indicating greater anxiety. Studies have found
that the STAI demonstrates good internal consis-
tency in samples of older adults ( ¼ 0.88–0.92;
Kabacoff, Segal, Hersen, & Van Hasselt, 1997;
Stanley, Beck & Zebb, 1996) as well as good test-
retest reliability (r ¼ 0.84; Stanley et al., 1996).
Support for construct validity comes from moderate
correlations with other measures of anxiety and
worry (Kabacoff et al., 1997; Stanley et al., 1996).
The internal consistency of the STAI in this sample
was 0.92.
Penn State Worry Questionnaire (PSWQ; Meyer,
Miller, Metzger, & Borkovec, 1990). The PSWQ is
a 16-item questionnaire that assesses the generality,
excessiveness, and uncontrollability of worry,
regardless of content. Individuals rate each item on
a Likert scale ranging from 1 (not at all true) to 5
(very true). Items are then summed to create a total
score, with higher scores indicating greater worry.
It has been validated in samples of older adults
(Beck, Stanley & Zebb, 1995). The internal
consistency of the PSWQ in this sample was 0.90.
Current anxiety status. Participants answered yes
or no to the following question: Over the last four
weeks, have you felt nervous, anxious, or on edge?
Procedures
All of the patients in the clinic were approached by
a research assistant in the waiting room and asked
to complete a short questionnaire. Participants were
told that participation in this study was voluntary.
Data was collected over a period of five months.
Results
A total of 279 individuals completed the question-
naire. Participants ranged in age from 19–87 years,
with an average age of 56.7 years (SD ¼ 15.5). The
majority of the sample was white (87.4%), well-
educated (M ¼ 14.3 years; SD ¼ 3.0), and married
(70.6%). Slightly more than two thirds of the sample
were women (68.9%). On a scale of 0–10, they rated
their health as relatively good (M ¼ 7.2, SD ¼ 2.2).
As seen in Table I, individuals who reported they
were anxious scored higher on the BAI (t [1, 277] ¼
6.08, p < 0.001), STAI (t [1, 277] ¼ 9.99, p < 0.001),
and PSWQ (t [1, 277] ¼ 8.83, p < 0.001) than
individuals who stated that they were not anxious.
Bivariate correlations between socio-demographic
 300 G. A. Brenes
Table I. Measures of anxiety. Table III. Multivariate correlates of anxiety.

Anxious Not anxious Total sample BAI STAI PSWQ

Measure (n ¼ 145) (n ¼ 134) (N ¼ 279)
Variable  p  p  p
BAI 10.98 (11.06) 4.32 (6.45) 7.80 (9.70)
STAI 40.48 (10.58) 29.76 (6.77) 35.35 (10.41) Age
0.05 0.33
0.09 0.10
0.20 0.001
PSWQ 44.54 (11.87) 33.70 (8.15) 39.32 (11.56) Race
0.06 0.26
0.06 0.33
0.23 <0.001
Gender
0.09 0.08 0.02 0.73 0.12 0.03
Education
0.16 0.004
0.29 <0.001
0.20 0.001
Health
0.46 0.00
0.29 <0.001
0.17 0.004

Table II. Bivariate correlates of anxiety.

BAI STAI PSWQ

STAI 0.56** Table IV. Multivariate analyses of age differences in

PSWQ 0.49** 0.73** presentation of anxiety.
Downloaded by ["Queen's University Libraries, Kingston"] at 00:54 28 August 2014

Age
0.03
0.07
0.16*

Race
0.01 0.01
0.16* BAI STAI PSWQ
Gender 0.16* 0.10 0.17*
Education
0.24**
0.33**
0.23** Variable  p  p  p
Marital status 0.11 0.08 0.01
Step 1
Health
0.48**
0.32**
0.18*
Age
0.03 0.57
0.05 0.36
0.16 0.002
*p  0.01; ** p < 0.001. Race
0.03 0.53 0.001 0.99
0.18 0.001
Gender 0.07 0.18
0.03 0.57 0.08 0.13
Education
0.15 0.006
0.27 <0.001
0.18 0.001
Health 0.42 <0.001
0.20 <0.001
0.09 0.10
Anxiety status
0.23 <0.001
0.46 <0.001
0.40 <0.001
Step 2
characteristics and the anxiety measures are pre- Age 
0.04 0.88 0.18 0.47 0.51 0.05
sented in Table II. There is a significant correlation Anxiety status
between age and PSWQ, with older adults reporting
less worry (r ¼
0.16, p ¼ 0.007). The BAI scores
were significantly associated with gender (r ¼ 0.16,
p ¼ 0.007), education (r ¼
0.24, p < 0.001), and
health (r ¼
0.48, p < 0.001). Female gender, less The age by anxiety status interaction was exam-
education, and poorer health were associated with ined in the second step. Again, there was no
higher scores on the BAI. The STAI was signifi- significant age by anxiety status interaction for
cantly associated with education (r ¼
0.33, BAI (F [1, 261] ¼ 0.02, p < 0.88) and STAI
p < 0.001) and health (r ¼
0.32, p < 0.001). Again, (F [1, 261] ¼ 0.53, p ¼ 0.47) scores. The interaction
lower education and poorer health were associated between age and anxiety status was significant for
with higher scores on the STAI. Finally, race PSWQ (F [1, 261] ¼ 3.87, p ¼ 0.05). Older adults
(r ¼
0.16, p ¼ 0.01), gender (r ¼ 0.17, p ¼ 0.004), who indicated that they had been anxious during the
education (r ¼
0.23, p < 0.001), and health last four weeks scored more highly on the PSWQ
(r ¼
0.18, p ¼ 0.003) were associated with the than younger adults and non-anxious older adults.
PSWQ. White race, female gender, less education,
and poorer health were associated with higher scores
on the PSWQ. Discussion
In order to determine if age has a significant
relationship with anxiety that is independent of other The objective of this study was to examine age
socio-demographic characteristics, a series of three differences in self-reported affective, cognitive, and
regression analyses were conducted. Age, race, somatic components of anxiety. In bivariate ana-
gender, education, and health status were entered lyses, age was associated only with worry. No age
as predictors of BAI, STAI, and PSWQ scores. As differences were found on measures of affective or
seen in Table III, age was not significantly related somatic symptoms. Controlling for race, gender,
to BAI or STAI scores (ps > 0.05). However, age education, and health status did not change the
remained significantly related to PSWQ scores results. Thus, age appears to be inversely associated
( ¼
20, p  0.001).
Finally, in order to determine if there are age
differences in the presentation of anxiety, another
series of multiple regression analyses were conducted
(see Table IV). Socio-demographic characteristics
(age, race, gender, education, and health status)
and current anxiety status were entered in Step 1.
with worry and unrelated to somatic and affective
symptoms of anxiety.
Two other studies have found differences in BAI
scores by age. Wetherell and Arean (1997) surveyed
primary care patients and found that BAI score and
age were inversely related. However, their sample
was less educated and more ethnically diverse than

the current sample. In this study BAI scores were
related to race and education, and this may explain
the difference between the findings. Similarly, Morin
et al., (1999) found a trend for significance in the
relationship between age and BAI scores (p < 0.07).
Their sample was well-educated but they present
no information about the race or ethnicity of their
participants. The STAI results of this study are
similar to those of Fuentes and Cox (2000) who also
found no age differences in STAI scores. Lastly, the
finding that age is associated with decreased worry is
consistent with other reports that older adults worry
less than younger adults (Babcock et al., 2000;
Doucet et al., 1998; Powers et al., 1992).
Bivariate and multivariate analyses also indicated
Downloaded by ["Queen's University Libraries, Kingston"] at 00:54 28 August 2014
lower education and poorer health were associated
with all three types of anxiety symptoms. Lower
socioeconomic status, which includes lower educa-
tional achievement, is associated with increased rates
of anxiety disorders, possibly due to the association
between uncertainty and lack of security that are
characteristic of lower socioeconomic status and
anxiety (Kessler et al., 1994; Regier, Narrow & Rae,
1990). The relationship between anxiety and health
may be due to overlapping symptoms between health
problems and anxiety. Alternatively, health problems
may predispose people to increased anxiety or vice
versa. Furthermore, gender was associated with
increased anxiety as assessed by the BAI and
PSWQ. This too is consistent with other research
that has found increased rates of both anxiety and
depression for women (Beekman et al., 1998;
Fuentes & Cox, 2000; Morin et al., 1999); hormonal
differences and differences in life events have been
proposed as possible explanations for this relation-
ship (Howell, Brawman-Mintzer, Monnier, &
Yonkers, 2001). Finally, whites reported greater
levels of worry that other racial or ethnic groups.
Few studies have examined racial differences in
anxiety among older adults. A recent study found no
relationship between race and anxiety symptoms
among older adults (Mehta et al., 2003). However,
they did not assess symptoms of worry. Thus, the
current finding that whites worry more needs to be
replicated before it can be interpreted.
This study also examined whether anxious older
adults tend to present with more somatic symptoms,
fewer affective symptoms, and fewer cognitive
symptoms. In order to do this, we examined whether
older adults who said they were anxious differed
from younger anxious adults by testing the signifi-
cance of the interaction between anxiety status and
age. This interaction was not significant in the
analyses of the BAI and STAI scores, indicating
that older anxious adults do not significantly differ
from younger anxious adults on these two measures
of somatic and affective symptoms. However the
interaction between age and anxiety status was
significant in the analysis of the PSWQ scores.
Anxious older adults reported less worry than
Age differences in anxiety 301
anxious younger adults. The results of these analyses
suggest that anxious older adults do not differ with
respect to their presentation of affective and somatic
symptoms of anxiety, but that they do present with
less worry symptoms than younger adults. Why do
the PSWQ and the STAI have different relationships
with age, given that they both assess cognitive
symptoms of anxiety? The PSWQ strictly assesses
worry, both the intensity and ability to control it.
Although the STAI does include a question about
worry, it measures more general cognitive aspects of
anxiety, including the ease of making decisions and
the presence of disturbing thoughts. This suggests
that the age differences lie in the specific cognitive
symptom of worry.
Worry appears to play a less prominent role in the
symptom presentation of anxiety in older adults than
affective and somatic symptoms. This is of impor-
tance in primary care settings where there is growing
interest in screening for psychiatric disorders. When
screening older adults in a general medical setting,
measures that focus on affective and somatic
symptoms of anxiety are recommended. Use of
measures specific to worry may underestimate
anxiety symptoms in older adults and lead to
under-recognition of significant anxiety symptoms.
One limitation of this study is that the sample is
predominantly white and well-educated, limiting
the generalizability of the findings. Indeed, level of
education was associated with all three measures of
anxiety. Furthermore, recruitment was limited to
one clinic rather than multiple sites. A second
limitation of this study is that participants reported
only low to moderate levels of anxiety. Nonetheless,
almost half of the sample described themselves as
anxious or nervous. Another limitation is the use
of one question to assess current anxiety status.
However, participants classified as anxious or non-
anxious differed significantly in the expected direc-
tions on all three measures of anxiety supporting
its validity. Only self-report measures of anxiety were
used; future research should incorporate both
clinical and physiological measures of anxiety.
This study found that older adults worry less than
younger adults. When age differences in the pre-
sentation of anxiety were examined more closely, we
continued to find that anxious older adults report
less worry than anxious younger adults. Contrary to
previous research (Lawton et al., 1993; Schaub &
Linden, 2000), no differences emerged with respect
to measures of affective or somatic symptoms. It is
commonly believed that older adults experience their
anxiety primarily through somatic symptoms, but
the results of this study suggest that anxious
older adults are no more likely to present with
somatic symptoms than anxious younger adults.
This study provides further evidence that older
adults do experience anxiety differently than younger
adults.
 302 G. A. Brenes
Acknowledgements
This research was supported by the Brooks Scholar
in Academic Medicine Award and National Institute
of Mental Health Grant MH65281. I would like to
thank Kate Johnston and Melissa Rawley for their
assistance with data collection.
References
Babcock, R. L., Laguna, L. B., Laguna, K. D., & Urusky, D. A.
(2000). Age differences in the experience of worry. Journal of
Mental Health and Aging, 6, 227–235.
Barlow, D. H. (2002). Anxiety and its disorders: The nature and
treatment of anxiety and panic (2nd ed.). New York: Guilford
Downloaded by ["Queen's University Libraries, Kingston"] at 00:54 28 August 2014
Press.
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An
inventory for measuring clinical anxiety: Psychometric proper-
ties. Journal of Consulting & Clinical Psychology, 56, 893–897.
Beck, J. G., Stanley, M. A., & Zebb, B. J. (1996). Characteristics
of Generalized Anxiety Disorder in older adults: A descriptive
study. Behavior Research and Therapy, 34, 225–234.
Beekman, A. T. F., Bremmer, M. A., Deeg, D. J. H., Van
Balkom, A. J. L. M., Smit, J. H., De Beurs, E., et al. (1998).
Anxiety disorders in later life: A report from the Longitudinal
Aging Study Amsterdam. International Journal of Geriatric
Psychiatry, 13, 717–726.
Borkovec, T. D., Alcaine, O. M., & Behar, E. (2004). Avoidance
theory of worry and Generalized Anxiety Disorder.
In R. G. Heimberg, C. L. Turk & D. S. Mennin (Eds),
Generalized Anxiety Disorder: Advances in research and practice.
New York: Guilford Press.
Chambless, D. L., & Ollendick, T. H. (2001). Empirically
supported psychological interventions: Controversies and
evidence. Annual Review of Psychology, 52, 685–716.
Craske, M. G., Barlow, D. H., & O’Leary, T. A. (1992). Mastery
of Your Anxiety and Panic (2nd ed.). Albany, NY: Graywind
Publications Inc.
Doucet, C., Ladouceur, R., Freeston, M. H., & Dugas, M. J.
(1998). Worry themes and the tendency to worry in older
adults. Canadian Journal of Aging, 17, 361–371.
Flint, A. J. (1994). Epidemiology and comorbidity of anxiety
disorders in the elderly. American Journal of Psychiatry, 151,
640–649.
Forsell, Y., & Winblad, B. (1998). Feelings of anxiety and
associated variables in a very elderly population. International
Journal of Geriatric Psychiatry, 13, 454–458.
Fuentes, K., & Cox, B. J. (1997). Prevalence of anxiety disorders
in elderly adults: A critical analysis. Journal of Behavior Therapy
and Experimental Psychiatry, 28, 269–279.
Fuentes, K., & Cox, B. (2000). Assessment of anxiety in older
adults: A community-based survey and comparison with
younger adults. Behaviour Research & Therapy, 38, 297–309.
Goldberg, J. H., Breckenridge, J. N., & Sheikh, J. I. (2003). Age
differences in symptoms of depression and anxiety: Examining
behavioral medicine outpatients. Journal of Behavioral Medicine,
26, 119–132.
Howell, H. B., Brawman-Mintzer, O., Monnier, J., & Yonkers,
K. A. (2001). Generalized anxiety disorder in women.
Psychiatric Clinics of North America, 24, 165–178.
Kabacoff, R. I., Segal, D. L., Hersen, M., & Van Hasselt, V. B.
(1997). Psychometric properties and diagnostic utility of the
Beck Anxiety Inventory and the State-Trait Anxiety Inventory
with older adult psychiatric outpatients. Journal of Anxiety
Disorders, 11, 33–47.
Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B.,
Hughes, M., Eshleman, S., et al. (1994). Lifetime and 12-
month prevalence of DSM-III-R psychiatric disorders in the
United States: Results from the National Comorbidity Survey.
Archives of General Psychiatry, 51, 8–19.
Knauper, B., & Wittchen, H. U. (1994). Diagnosing major
depression in the elderly: Evidence for response bias in
standardized diagnostic interviews? Journal of Psychiatric
Research, 28, 147–164.
Lawton, M. P., Kleban, M. H., & Dean, J. (1993). Affect and age:
Cross-sectional comparisons of structure and prevalence.
Psychology & Aging, 8, 165–175.
Magni, G., Schifiano, F., DeDominics, M. G., & Belloni, G.
(1998). Psychological distress in geriatric and adult medical
in-patients. Archives of Gerontology and Geriatrics, 7, 151–161.
McDonald, C. (1973). An age-specific analysis of the neuroses.
British Journal of Psychiatry, 122, 477–480.
Mehta, K. M., Simonsick, E. M., Penninx, B. W., Schulz, R.,
Rubin, S. M., Satterfield, S., et al. (2003). Prevalence and
correlates of anxiety symptoms in well-functioning older adults:
Findings from the Health Aging and Body Composition Study.
Journal of the American Geriatrics Society, 51, 499–504.
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D.
(1990). Development and validation of the Penn State Worry
Questionnaire. Behavior Research and Therapy, 28, 487–495.
Morin, C. M., Landreville, P., Colecchi, C., McDonald, K.,
Stone, J., & Ling, W. (1999). The Beck Anxiety Inventory:
Psychometric properties with older adults. Journal of Clinical
Geropsychology, 5, 19–29.
Powers, C. B., Wisocki, P. A., & Whitbourne, S. K. (1992). Age
differences and correlates of worrying in young and elderly
adults. Gerontologist, 32, 82–88.
Regier, D. A., Boyd, J. H., Burke Jr, J. D., Rae, D. S., Myers, J.
K., Kramer, M., et al. (1988). One-month prevalence of
mental disorders in the United States. Based on five
Epidemiologic Catchment Area sites. Archives of General
Psychiatry, 45, 977–986.
Regier, D. A., Narrow, W. E., & Rae, D. S. (1990). The epidemio-
logy of anxiety disorders: The Epidemiologic Catchment Area
(ECA) experience. Psychiatric Research, 24, 3–14.
Sallis, J. F., & Lichstein, K. L. (1982). Analysis and management
of geriatric anxiety. International Journal of Aging and Human
Development, 15, 197–211.
Schaub, R. T., & Linden, M. (2000). Anxiety and anxiety
disorders in the old and very old–results from the Berlin Aging
Study (BASE). Comprehensive Psychiatry, 41, 48–54.
Sheikh, J. I. (1992). Anxiety and its disorders in old age.
In J. E. Birren, R. B. Sloane, G. D. Cohen, N. R. Hooyman,
B. D. Lebowitz, M. Wykie, et al. (Eds), Handbook of Mental
Health and Aging (pp. 409–432). San Diego: Academic Press.
Small, G. W. (1997). Recognizing and treating anxiety in the
elderly. Journal of Clinical Psychiatry, 58, 41–47.
Spielberger, C., Gorsuch, R., & Lushene, R. (1970). Manual for
the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting
Psychologists Press.
Stanley, M. A., Beck, J. G., & Zebb, B. J. (1996). Psychometric
properties of four anxiety measures in older adults. Behavior
Research and Therapy, 34, 827–838.
Steer, R. A., Willman, M., Kay, P. A., & Beck, A. T. (1994).
Differentiating elderly medical and psychiatric outpatients with
the Beck Anxiety Inventory. Assessment, 1, 345–351.
Turnbull, J. M. (1989). Anxiety and physical illness in the elderly.
Journal of Clinical Psychiatry, 50, 40–45.
Wang, P. S., Bohn, R. L., Glynn, R. J., Mogun, H., & Avorn, J.
(2001). Hazardous benzodiazepine regimens in the elderly:
Effects of half-life, dosage, and duration on risk of hip fracture.
American Journal of Psychiatry, 158, 892–898.
Weissman, M. M., Myers, J. K., Tischler, G. L., Holzer III, C. E.,
Leaf, P. J., Orvaschel, H., et al. (1985). Psychiatric disorders
(DSM-III) and cognitive impairment among the elderly in a U. S.
urban community. Acta Psychiatrica Scandinavia, 71, 366–379.
Wetherell, J. L., & Arean, P. A. (1997). Psychometric evaluation
of the Beck Anxiety Inventory with older medical patients.
Psychological Assessment, 9, 136–144.