Objective: To examine the impact of late-life generalized anxiety disorder (GAD) on health-related quality of life. Method: We compared quality of life in 75 treatment-seeking older adults with GAD, 39 of whom had psychiatric comorbidity, with 32 older adults without psychiatric illness. We examined predictors of quality of life in these samples. We also compared data from the GAD patients to published norms from a large national sample of older adults with chronic medical conditions or major depression. Results: Older GAD patients reported worse health-related quality of life across most domains than asymptomatic older individuals. There were no differences in quality of life between GAD patients with and without psychiatric comorbidity, and comorbidity did not predict quality of life in multivariate regression analyses. Presence of GAD or symptoms of anxiety or depression were significantly related to impairment in every domain of quality of life. Comparisons with national norms suggest that older GAD patients report overall worse quality of life than individuals with recent acute myocardial infarction or type II diabetes, and are comparable in quality of life to individuals with major depression. Conclusion: Results suggest that late-life GAD is associated with substantial impairment in quality of life, and these findings cannot be explained by psychiatric comorbidity.
Current diagnostic criteria for generalized anxiety disorder (GAD) include at least six months of excessive, hard to control worry more days than not, along with at least three of the following associated symptoms: restlessness, sleep disturbance, fatigue, muscle tension, irritability, and impaired concentration (American Psychiatric Association, 1994). Existing evidence, although limited, suggests that GAD as defined by DSM criteria exists in late life and is similar in presentation to what is observed in younger adults (Beck et al., 1996 and Wetherell et al., 2003). For example, features that distinguish older adults with GAD from both normal older adults and older adults with subsyndromal anxiety symptoms include frequency and uncontrollability of worry, muscle tension, and sleep disturbance, along with distress or impairment (Wetherell et al., 2003).
Although some have questioned the severity and functional impact of GAD (Akiskal, 1998), evidence is mounting that individuals with GAD experience increased disability and poorer mental health and well-being relative to individuals with no psychiatric illness (Blazer et al., 1991, Hunt et al., 2002, Jones et al., 2001 and Wittchen et al., 1994). Several investigators have found that GAD comorbid with another disorder such as major depression is associated with increased functional impairment relative to that associated with either GAD or major depression alone (Judd et al., 1998, Kessler et al., 1999 and Wittchen et al., 2000). Although the results of small investigations have suggested that the disability associated with pure GAD is less than that associated with other disorders (Olfson et al., 1997 and Schonfeld et al., 1997), studies in larger and more representative samples have indicated that the level of disability associated with GAD alone is greater than or equal to that associated with other disorders such as major depression (Kessler et al., 1999, Massion et al., 1993 and Ormel et al., 1994). These studies, however, did not focus on older adults, for whom comorbid medical illness and associated disability may cloud the evaluation of functional impairment associated with GAD.
