Psychological symptoms

Symptoms of anxiety and depression occur to a greater or lesser extent in all of the neurotic disorders encountered in elderly patients. Depressive symptomatology in old age is described elsewhere (see Chapter.8.5.4). As far as anxiety is concerned, the focus of the worries and fears of elderly people is on those issues that are of general concern in this age group, such as physical illness, finances, crime, and the family. The range of phobias described by elderly people is broadly similar to those seen in younger adults,*1.) although some, such as the fear of falling, are more commonly seen in old age. Clinically significant anxieties and fears in elderly people are often dismissed as reasonable purely on grounds of age. In fact, it is issues such as physical frailty and the availability of social support that determine patient perception of vulnerability and risk, and these rather than age should be considered when deciding whether or not their concerns are reasonable.

The clinical features of obsessive-compulsive disorder in old age are similar to those seen in younger patients. Obsessional symptoms rarely appear for the first time after the age of 50 years, and in such cases the possibility of an organic cause such as dementia or a space-occupying lesion should be investigated. They may also form part of a primary affective disorder.

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