A systematic review of the association of anxiety with health care utilization and costs in people aged 65 years and older

Theoretical background: In older people, anxiety disorders are among the most prevalent mental disorders and a high proportion suffers from clinically relevant anxiety symptoms. Despite studies suggesting an association of anxiety with health care utilization (HCU) and a resulting economic burden to the health care system, we found no review systematically analyzing evidence on this association in older people. Objective: To analyze and synthesize evidence on the association of anxiety disorders and symptoms with HCU and costs in people aged 65 years and over in a systematic review. Methods: A systematic search of peer-reviewed literature was conducted in three electronic databases. Additional references were identified through reference lists of included studies. Inclusion criteria were: studies reporting the association of anxiety disorders or symptoms with HCU or costs, specifically in people aged 65 years and over, with observational study design, in German or English language. Findings were synthesized qualitatively and study quality was assessed. Results: N = 15 studies (HCU n = 10, costs n = 5) were included in the final synthesis. Overall, studies either reported significantly increased HCU in anxiety disorders compared to a healthy comparison group/according to degree of symptoms, or found no significant association between these variables. Total excess costs for anxiety disorders ranged from -116 to 19,003 $PPP per year. Limitations: Differences in methodology limited the comparability of included studies. Conclusion: Most studies suggest an increased economic burden due to anxiety in older people. Studies using standardized instruments are needed.