Title: Clinical effectiveness of interventions for treatment-resistant anxiety in older people; a systematic review Produced by

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Abstract (488 words)
Objectives

Clinical effectiveness of interventions for treatment-resistant anxiety in older people; a systematic review

HTA REPORT

This report was commissioned by the NIHR HTA Programme as project number 13/39

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Title: Clinical effectiveness of interventions for treatment-resistant anxiety in older people; a systematic review

Produced by:	BMJ Technology Assessment Group (BMJ-TAG)
Authors:	Samantha Barton, Senior Health Technology Assessment Analyst, BMJ Technology Assessment Group, London Charlotta Karner, Health Technology Assessment Analyst Lead, BMJ Technology Assessment Group, London Fatima Salih, Health Economist, BMJ Technology Assessment Group, London David S. Baldwin, Professor of Psychiatry, Faculty of Medicine, University of Southampton, Southampton Steven J. Edwards, Head of Clinical and Economic Evidence, BMJ Technology Assessment Group, London
Correspondence to:	Samantha Barton, Senior Health Technology Assessment Analyst, BMJ Technology Assessment Group, Clinical Improvement Division, BMA House, Tavistock Square, London, WC1H 9JP. email: samantha.barton@bmj.com
Date completed:	20/12/2013

Source of funding: This report was commissioned by the NIHR HTA Programme as project number 13/39
Declared competing interests of the authors:

David Baldwin has received honoraria for educational presentations from H. Lundbeck A/S; has acted as a paid consultant to Eli Lilly, GlaxoSmithKline, Grunenthal, Lundbeck, Pfizer, Pierre Fabre and Servier; currently holds research grants (on behalf of his employer) from H. Lundbeck A/S and Pfizer; and has accepted paid speaking engagements in industry-supported satellite symposia or other meetings hosted by Eli Lilly, GlaxoSmithKline, Lundbeck, Pfizer, Pierre Fabre and Servier.

Acknowledgements:

We would like to thank Dr Bart Sheehan (Consultant in Psychological Medicine) and Dr Philip Wilkinson (Consultant Psychiatrist) for providing feedback on the report.

Rider on responsibility for report

The views expressed in this report are those of the authors and not necessarily those of the NIHR HTA Programme. Any errors are the responsibility of the authors.

This report should be referenced as follows: Barton S, Karner C, Salih F, Baldwin DS, Edwards SJ. Clinical effectiveness of interventions for treatment-resistant anxiety in older people; a systematic review. BMJ-TAG, 2013.
Contributions of authors:

Samantha Barton	Provided overall project management, designed and carried out literature searches for the systematic review, assessed full publications for inclusion, wrote the report, and contributed to the editing of the report
Charlotta Karner	Assessed abstracts and titles for inclusion, assessed full publications for inclusion, and contributed to the editing of the report
Fatima Salih	Assessed abstracts and titles for inclusion, and contributed to the editing of the report
David S. Baldwin	Provided clinical input into the design of the literature search, advised on clinical matters, and contributed to the editing of the report
Steven J. Edwards	Contributed to the editing of the report and was overall director of the project and guarantor of the report

All authors read and commented on draft versions of the report

Abstract (488 words)

Background

Anxiety and related disorders include generalised anxiety disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, and phobic disorders (an intense fear of an object or situation). The disorders share psychological and physical symptoms of anxiety but each disorder has its own set of characteristic symptoms. Anxiety disorders can be difficult to recognise, particularly in older people (those aged over 65 years). Older people tend to be more reluctant to discuss mental health issues and there is the perception that older people are generally more worried than younger adults. It is estimated that between 3 and 14 out of every 100 older people has an anxiety disorder. Despite treatment, some people will continue to have symptoms of anxiety. People are generally considered to be ‘resistant’ or ‘refractory’ to treatment if they have an inadequate response or do not respond to their first treatment. Older adults with an anxiety disorder find it difficult to manage their day-to-day lives, and are at an increased risk of comorbid depression, falls, physical and functional disability, and loneliness.

Objectives

To evaluate the effectiveness of pharmacological, psychological and alternative therapies in older adults with an anxiety disorder that has not responded, or has responded inadequately, to treatment.

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