Objectives. Mental health (MH) is increasingly conceptualized, according to the dual-factor model (DFM), as the coexistence of well-being and ill-being rather than simply the absence of illness. However, this model has seldom been applied to aging populations. This study aims to move beyond deficit-based models of aging by examining the DFM in older adulthood using indicators of well-being and ill-being. In addition, we examined the profiles’ invariance across age cohorts, their sociodemographic correlates, and validated them against clinical diagnoses of mental illnesses. Methods. We used a sample of 44,528 participants aged 46 to 92 years from the baseline (Time 0) and first follow-up (Time 1) waves of the Canadian Longitudinal Study on Aging. Validated measures of well-being (life satisfaction and social support) and ill-being (depression and loneliness) served as the MH variables at T1. We conducted Latent Profile Analysis and assessed measurement invariance to identify distinct MH profiles and their stability across age cohorts. We then used multinomial logistic regression to examine sociodemographic correlates (T0) of the profiles and their relationships with clinical diagnoses of MH disorders. Results. Five distinct, age-invariant profiles emerged, each characterized by different levels of well-being and ill-being. The most adaptive profiles accounted for over 80% of the sample across age groups. Among the clinical diagnoses, mood disorder showed the largest effect across profiles. Discussion. The results are consistent with Keyes' (2002) conceptualization of the DFM. Our findings underscore the importance of focusing on MH and highlight the protective role of well-being in the aging population.

Insomnia and anxiety are highly prevalent and often comorbid in older adults. Although cognitive behavioural therapy is the first-line treatment for insomnia, few interventions simultaneously address both conditions. Furthermore, access remains limited by provider availability and high costs. To address these gaps, we developed an online CBT programme for insomnia and anxiety (eCBT+). This randomised controlled trial aimed to assess the usability and acceptability of the eCBT+ programme and evaluate its efficacy in older adults with insomnia. Eighty older adults with insomnia were randomised to the eCBT+ intervention (n = 38) or a waitlist (WL) control condition (n = 42). Platform usability and programme acceptability were assessed post-intervention using the System Usability Scale (SUS) questionnaire and the extended Technology Acceptance Model questionnaire. Insomnia and anxiety symptoms were evaluated with the Insomnia Severity Index (ISI) and Geriatric Anxiety Inventory (GAI) respectively, along with sleep-diary-derived sleep efficiency, at baseline and follow-up. Linear mixed models with an intention-to-treat approach assessed the Group*Time interaction. The platform was considered user-friendly (SUS = 69.94%). Perceived ease of use, perceived usefulness and result demonstrability were the main contributors to acceptability. The eCBT+ group showed reduced ISI and GAI and increased sleep efficiency, from baseline to follow-up, compared to the WL group (Ps < .001). The eCBT+ programme was user-friendly and its use was acceptable in older adults with insomnia. The programme improved sleep efficiency and reduced insomnia and anxiety symptoms, demonstrating the efficacy of our eCBT+ intervention. Web-based tools offer a promising approach to promote sleep and mental health among older adults (https://www.isrctn.com/ISRCTN15338211).

OBJECTIVES:Generalized anxiety disorder (GAD) is one of the most common anxiety disorders among older adults, and its impact on functioning is well-documented. Because its core cognitive and somatic symptoms overlap with age-related changes and comorbidities, GAD can be difficult to diagnose. Highlighting observable behaviours is essential, as they help detect an under-recognized disorder and distinguish anxiety from other conditions. Some researchers suggest that identifying anxiety-related behaviors in older adults and comparing them to those of younger adults may improve GAD recognition in later life. METHODS:This study compared anxiety-related behaviors in 321 older adults (M = 67.25 years) with those of adults aged 25 to 45 (M = 33.28 years, n = 273) and examined whether associations between behaviors and GAD symptoms differed across age. RESULTS:Older adults were more likely to engage in overplanning and checking and less likely to engage in reassurance-seeking compared to younger adults. Although older adults exhibited fewer anxiety-related behaviors, associations with GAD symptoms were similar across groups. All behaviors were related to GAD symptoms in older adults and predicted them. CONCLUSION:These results suggest that anxiety-related behaviors literature applies to older adults and highlights specific behavioral manifestations, clarifying GAD profile in this population.

OBJECTIVES:The Worry and Anxiety Questionnaire (WAQ) was initially developed to provide a rapid and efficient assessment of all the symptoms and diagnostic criteria for generalized anxiety disorder (GAD). Given that few instruments have been validated for evaluating GAD in older adults, the WAQ-being brief and assessing each component of GAD separately-may offer a valuable measure for this population. The present study examines its psychometric properties in older adults. METHOD:A total of 495 participants aged 60-90 years took part in the study. The sample included 141 individuals diagnosed with clinical or subclinical GAD through a clinician-administered structured interview and 354 individuals from the general population. All participants completed the WAQ and additional assessment instruments. RESULTS:A two-factor structure with good fit indices was identified for the WAQ. It demonstrated excellent internal consistency (ω = 0.96) and good convergent validity with other measures of GAD and related symptoms (r = 0.82). It also showed excellent sensitivity (95.8%) and adequate specificity (76.1%) for identifying probable GAD. CONCLUSION:These results support the robust psychometric properties of the WAQ in older adults. Beyond assessing the severity of GAD symptoms, the WAQ represents a valuable tool to facilitate diagnosis in this population.

OBJECTIVES:Symptoms of anxiety and anxiety disorders negatively impact the quality of life of older adults. Physical activity is a potentially accessible intervention with other health benefits and minimal risk, yet its impact on anxiety in older adults is unclear. DESIGN:Systematic review and meta-analysis. SETTING:Included databases were MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO and CINHAL were searched from inception to June 23, 2023. PARTICIPANTS, INTERVENTIONS, MEASUREMENTS:We included randomized controlled trials of older adults who reported anxiety symptoms or disorders at baseline, that compared physical activity interventions with a non-physical activity comparator. All steps were done in duplicate, and certainty of evidence was with Grading of Recommendations, Assessment, Development, and Evaluations. Random effects meta-analyses were performed. RESULTS:10,763 citations were reviewed, 13 studies were included in meta-analyses. At baseline, participants self-reported low to moderate levels of anxiety and different levels of fitness. In the meta-analysis, the physical activity intervention had a medium effect in decreasing the severity of anxiety symptoms compared to the control (standardized mean differences (SMD) - 0.66; 95 % Confidence Interval (CI) - 0.89, - 0.43). Subgroup analyses indicated reductions in symptom severity when only assessing the effects of in-person interventions (SMD: - 0.59; 95 %CI: - 0.79, - 0.38), studies of participants without pre-existing diseases (SMD: - 0.74; 95 % CI: - 0.99, - 0.50), resistance training (SMD: - 0.76; 95 % CI: - 1.15, - 0.38) and aerobic exercise (SMD: - 0.82; 95 % CI: - 1.15, - 0.49). Studies had small sample sizes and high risk of bias. CONCLUSIONS:Physical activity reduces symptoms of anxiety in older adults and is an acceptable and promising intervention to incorporate into care planning.

The psychobiological response to stress is known to be a key factor affecting health at any age, but especially in older adults. It involves the hypothalamic-pituitary-adrenal (HPA) axis, a hormonal circuit whose product is the activation of cortisol. We sought to explore the relationships leading to resilience to stress, as exemplified by the model of aging, stress, and resilience, in a sample of older adults at risk for mental health problems. Specifically, we examined the concurrent effects of individual age-related determinants, social support, and coping style on the cortisol awakening response (CAR), the cortisol area under the curve (AUC) with respect to ground, and the rate of change of cortisol from the awakening peak to bedtime. Our results showed an association between life impairment and health problems on the three indicators of HPA disturbance. An higher AUC was also observed in older age and in individuals reporting more major life events. Less use of avoidance coping was also associated with greater levels of CAR and AUC. Although significant, the measured determinant explained only a small part of the total interindividual variability in our three cortisol indices. Other factors, such as same-day stressors especially in older populations at risk for psychological distress, should be considered in future studies.

BACKGROUND:Anxiety and its disorders are common in later life. Given the known risks of psychopharmacological treatments in older adults, clinical decision making for anxiety management should be guided by the strongest available evidence. This study aimed to comprehensively synthesise evidence on the pharmacological treatment of anxiety in older adults. METHODS:In this systematic review and meta-analysis, we searched MEDLINE, Cochrane Central, Embase, PsycINFO, and CINAHL from database inception to April 23, 2024, for randomised controlled trials on pharmacological treatments for anxiety in older adults (aged 60 years or older, mean age 65 years or older, or subgroup analyses meeting these criteria). Primary outcomes included reduction in anxiety symptoms, or treatment response, or remission. Standardised mean differences (SMD) were calculated for continuous variables and absolute difference and risk ratio (RR) for dichotomous variables. The risk of bias was assessed using the Cochrane Risk of Bias tool, and the certainty of evidence rated using GRADE. People with lived experience were involved in conducting this research. This trial is registered with PROSPERO (CRD42023407837). FINDINGS:We identified 19 eligible studies, including 2336 participants, 1592 (68·15%) of whom were women and 722 (30·91%) men, and sex was not reported for the other 22 (0·94%) participants. Only eight of 19 studies reported on race or ethnicity, and study participants were predominantly White (1309 [91·6%] of 1428), and no studies reported outcomes related to gender. Antidepressants were more effective than placebo or waitlist control in reducing anxiety symptoms (SMD -1·19 [95% CI -1·80 to -0·58), with moderate certainty of evidence and substantial heterogeneity (I2 92·34%; p<0·0001). Antidepressants were also more effective than placebo or waitlist control in response or remission (RR 1·52 [95% CI 1·21 to 1·90]; absolute difference 146 per 1000 [95% CI 59 to 252]); with a low certainty of evidence and low heterogeneity (I2 8·09%; p=0·36). Planned subgroup analysis indicated selective serotonin reuptake inhibitors led to a greater reduction in anxiety symptoms (SMD -1·84 [95% CI -2·52 to -1·17]) compared with serotonin-norepinephrine reuptake inhibitors (SMD -0·46 [95% CI -0·65 to -0·27]), and there was no difference in response or remission. Benzodiazepines might reduce anxiety symptoms compared with placebo, but the evidence is very uncertain with high risk of bias. Meta-analyses for other drug classes for primary outcomes were not possible. INTERPRETATION:Antidepressants are more effective than placebo or waitlist for reducing anxiety symptoms, with evidence supporting their safety and tolerability in older adults. Evidence for the efficacy and safety of benzodiazepines is weak. These findings can guide evidence-based practice. FUNDING:Public Health Agency of Canada.

Introduction Anxiety is not a normal part of aging, and misconceptions about anxiety in older adults lead to it being underrecognized and undertreated. Anxiety has a negative impact on quality of life, increases disability and caregiver burden, and is a risk factor for depression and dementia. To address the need for up-to-date, comprehensive clinical guidelines aimed at the assessment, treatment, and prevention of anxiety in older adults, the Canadian Coalition for Seniors Mental Health (CCSMH) has led a guideline project which has engaged with older adults and caregivers, healthcare providers, and community organizations across Canada to produce guidelines and tools that establish best practices for the care of older people with anxiety. Methods The guideline development followed a rigorous process set out by the Guidelines International Network (GIN)-McMaster Guideline Development checklist, including systematic reviews and meta-analyses across priority areas, with certainty of evidence evaluated using the GRADE methodology, and Evidence to Decision Frameworks used to consolidate evidence on the interventions to establish the recommendations. Results The guideline contains a total of 32 recommendations across case-finding, assessment, and treatment. This presentation will provide an overview of the guidelines, with a focus on the treatment recommendations including non-pharmacological (CBT, Mindfulness, Exercise) and pharmacological interventions (antidepressants, buspirone, benzodiazepines, antipsychotics and gabapentinoids). The presentation will also include sharing of knowledge translation tools and other resources to support care. Conclusions Anxiety in older adults is a treatable mental health condition and there are many evidence-based interventions that are helpful. These guidelines are an important step in setting out best practices in the assessment and treatment of anxiety in older adults.

Objectives Our objective was to assess the effect of cognitive-behavioral therapy for insomnia (CBTi) on subjective and objective sleep quality (including sleep spindles) and cognition during a sedative-hypnotics withdrawal program in older adults with insomnia disorder. Methods We performed a two-arm randomized controlled trial (RCT) of a sedative-hypnotic withdrawal plan alone (WPo group) or combined with CBTi (WP + CBTi group) in 47 older adults with insomnia disorder over a sixteen-week period. Our primary outcomes were change in self-reported insomnia severity (Insomnia Severity Index (ISI)), sleep efficiency (SE) from sleep diaries, and change in SE and spindle density from polysomnographic (PSG) recordings collected at baseline and at post-intervention (16 weeks). Secondary outcomes included other sleep changes from PSG, actigraphy and sleep diaries, sleep and mood questionnaires and neuropsychological assessments (manual dexterity, attention/concentration, verbal inhibition, visuo-spatial abilities). Results The withdrawal program was effective in achieving discontinuation and reducing insomnia severity, with similar success with and without CBTi. The combined intervention additionally improved subjective sleep quality and prevented the decrease in subjective sleep duration induced by sedative-hypnotic discontinuation. Neither intervention significantly impacted objective sleep architecture or cognitive performance. Furthermore, reduction in sleep spindle density was observed with combined CBTi and withdrawal, but not with withdrawal alone. Conclusions Both withdrawal alone and sedative-hypnotic withdrawal combined with CBTi effectively facilitated discontinuation and reduced insomnia severity, with the combined intervention further enhancing subjective sleep quality and preserving sleep duration. Although neither approach significantly impacted objective sleep architecture or cognitive performance, the potential reduction in sleep spindle density linked to the combined intervention warrants further investigation.

Insomnia and anxiety are highly prevalent and often comorbid in older adults. Although cognitive-behavioural therapy is the first-line treatment for insomnia, few interventions simultaneously address both conditions. Furthermore, access remains limited by provider availability and high costs. To address these gaps, we developed an online CBT program for insomnia and anxiety (eCBT+). This randomized controlled trial aimed to assess the usability and acceptability of the eCBT+ program and evaluate its efficacy in older adults with insomnia. Eighty older adults with insomnia were randomized to the eCBT+ intervention (n=38) or a waitlist (WL) control condition (n=42). Platform usability and program acceptability were assessed post-intervention using the System Usability Scale (SUS) questionnaire and the extended Technology Acceptance Model questionnaire. Insomnia and anxiety symptoms evaluated with the Insomnia Severity Index (ISI) and Geriatric Anxiety Inventory (GAI) respectively, along with sleep-diary sleep efficiency, were assessed at baseline and follow-up. Linear mixed models with an intention-to-treat approach assessed the Group*Time interaction. The platform was considered user-friendly (SUS=69.94%). Perceived ease of use, perceived usefulness, and result demonstrability were the main contributors to acceptability. The eCBT+ group showed reduced ISI and GAI and increased sleep efficiency, from baseline to follow-up, compared to the WL group (ps< .001). The eCBT+ program was user-friendly and its use was acceptable in older adults with insomnia. The program improved sleep efficiency and reduced insomnia and anxiety symptoms, demonstrating the efficacy of our eCBT+ intervention. Web-based tools offer a promising approach to promote sleep and mental health among older adults. (https://www.isrctn.com/[ISRCTN15338211][1]) ### Competing Interest Statement TDV received consultant and speakers fees from Eisai and Idorsia, consultant fees from Takeda, grant from Jazz Pharmaceuticals, consultant fees and grant from Paladin Labs, unrelated to the present study. ### Clinical Trial ISRCTN15338211 ### Funding Statement This research was funded by grants from the Center for Aging + Brain Health Innovation (CABHI), Bell Canada (Bell Cause pour la cause), and the Research Center of the Institut Universitaire de Geriatrie de Montreal (CRIUGM). MR has been supported by the Fonds de Recherche du Quebec Nature et Technologies (FRQNT) and fellowships from Concordia University. KG has been funded by grad students awards from the CIHR and local university awards (Concordia University, Universite de Montreal). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study protocol was approved by the Research Ethics Committee on Aging Neuroimaging of the Centre Integre Universitaire de Sante et de Services Sociaux du Centre-Sud-de-l'Ile-de-Montreal and all participants signed an electronic consent form. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data can be made available upon reasonable request to the corresponding authors (MR and TDV). [1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN15338211

Background Receiving a diagnosis of a major neurocognitive disorder due to Alzheimer's disease (AD) brings with it the need to adjust to a new life situation. People with AD seek to (1) maintain emotionally positive goals in their current lives, and (2) use positive experiences from the past to create continuity in their lives, with the aim of maintaining their quality of life and gaining a sense of hope. Objective This research aims to explore the coping strategies and processes used following diagnosis. Method An exploratory qualitative design was implemented to study the different coping strategies used by ten people with AD , via semi-structured interviews. The transcribed data was subject to an interpretative phenomenological analysis. Results All participants experienced unpleasant emotions following their diagnosis. Their coping process following two different trajectories: (1) adaptive coping strategies to gain resilience and hope to maintain meaning in their current lives; (2) less adaptive coping strategies essentially resulting in the denial of the diagnosis and withdrawal from social life. Conclusions This research makes it possible to identify possible intervention paths adapted to an individual's needs to help them move towards adaptive coping strategies.

Treatments for generalized anxiety disorder (GAD) that circumvent the barriers to accessing mental health care in older adults are needed. The main goal of this multisite randomized controlled trial was to evaluate the efficacy of CBT-based self-help guided by a lay provider (LP) for generalized anxiety (i.e., threshold or subthreshold GAD) in older adults. Participants (≥ 60 years) were block randomized based on diagnosis to an experimental (n = 75) or wait-list control group (n = 75). Experimental group participants used a manual presenting CBT-based readings and exercises and received brief weekly support calls by LPs. Groups were similar in terms of sociodemographic characteristics and initially did not differ significantly on outcomes. At post-treatment, the experimental group showed greater improvement across both primary outcomes (i.e., worry tendency, p < .0001, Standardized mean difference [SMD] = -1.5971, and GAD severity, p < .0001, SMD = -1.1639) and most additional outcomes (e.g., targeted psychological vulnerabilities, depressive symptoms, sleep difficulties, and GAD diagnosis) with small to large effect sizes (SMD = -0.4358 to -1.5402). The experimental group also showed maintenance of treatment effects or other improvements at 6- and 12-month follow-up. Participants in the control group who completed the treatment after their waiting period also improved on worry tendency (SMD = -1.2477) and GAD severity (SMD = -0.8443) and most of the other variables (SMD = -0.3728 to -1.0154). Results demonstrate that self-help guided by a LP is effective for treating GAD in older adults and that the improvements are sustained after treatment.

BackgroundSubjective cognitive decline (SCD) is linked to a more rapid progression to the development of mild cognitive impairment (MCI) or Alzheimer's disease (AD). SCD has been correlated with affective symptoms such as depression and anxiety. Recent research aimed to shed light on the relationship between these affective symptoms and how they might correlate to a more rapid progression to objective cognitive impairment. No studies have assessed the presence, type, and intensity of depressive and anxiety symptoms between SCD individuals who progressed versus those who did not.ObjectiveThis study aimed to establish whether there are differences between subclinical depressive and anxiety symptoms in terms of presence, type, and intensity of symptoms presented by individuals with SCD who progressed to an objective cognitive decline.MethodsThe recruited participants originated from the Consortium for the Early Identification of Alzheimer's Disease - Québec (CIMA-Q) cohort. They were assessed twice, with an interval of 4 years separating the evaluations. Anxiety symptoms were assessed using the Geriatric Anxiety Inventory (GAI) and depression symptoms using the Geriatric Depression Scale (GDS-30).ResultsThe presence, type and intensity of anxiety symptoms did not significantly distinguish the two groups. Only one type of hopelessness-related depressive symptom was significantly higher in SCD participants who had progressed to objective cognitive decline compared with those who had not.ConclusionsOur results suggest that it may be beneficial to target hopelessness in non-pharmacological interventions aimed at preventing the progression of people with SCD to MCI or AD.

Generalized anxiety disorder (GAD) is one of the most common anxiety disorders in older adults. Given the aging population, it is important to determine if there are age-related variations in the presentation of GAD in older adults. The present study examined the relationship between age and the clinical presentation of GAD in people aged 60 to 87 years (N = 109, M = 68.2). A structured diagnostic interview was conducted and participants completed measures of GAD severity, tendency to worry, behavioral manifestations of GAD, depression, and disability. Most of the analyses performed did not show a significant relationship between age and different indices of GAD presentation. A comparison of the youngest (≤67 years) and oldest (>67 years) participants, based on the median age of the sample, showed that the second group had significantly higher rates of comorbid anxiety disorders (60.8% vs 39.7%; χ² = 4.85, p = .03) and death-related worries (54.9% vs 34.5%; χ² = 4.44, p = .04). Conversely, the youngest group reported more work or school-related worries (60.5% vs 25.0%; χ² = 9.15, p = .002). Overall, the results show that the clinical presentation of GAD does not vary much according to age among older adults. However, the observed differences suggest that clinicians should take into account the presence of comorbid anxiety disorders and the sources of worries according to the age of their client.

INTRODUCTION:In a 5-year follow-up study, we investigated the enduring effects of cognitive training on older adults with mild cognitive impairment (MCI). METHODS:A randomized controlled single-blind trial involved 145 older adults with MCI, assigned to cognitive training (MEMO+), an active control psychosocial intervention, or a no-contact condition. Five-year effects were measured on immediate and delayed memory recall, the Montreal Cognitive Assessment screening test (MoCA), self-reported strategy use, and daily living difficulties. RESULTS:At follow-up, participants who received cognitive training showed a smaller decline in delayed memory and maintained MoCA scores, contrasting with greater declines in the control groups. Cognitive training participants outperformed controls in both delayed memory and MoCA scores at the 5-year time point. No significant group differences were observed in self-reported strategy use or difficulties in daily living. DISCUSSION:Cognitive training provides long-term benefits by mitigating memory decline and slowing clinical symptom progression in older adults with MCI. Highlights:Cognitive training reduced the 5-year memory decline of persons with MCI.Cognitive training also reduced decline on the Montreal Cognitive Assessment (MoCA).No intervention effect was found on strategy use or activities of daily living.

OBJECTIVES:To examine how change in benzodiazepine (BZD) use is linked to changes in depressive symptoms intensity, worry intensity, and sleep quality over 16 months. METHOD:Data come from a larger randomised controlled trial (RCT) named the 'Programme d'Aide du Succès au SEvrage (PASSE-60+)' study (NCT02281175). Seventy-three participants age 60 years and older took part in a 4-month discontinuation programme and were assessed four times over 16 months. Change in BZD use was defined as the difference in reported mg/day between two assessments. Control variables were RCT discontinuation group; BZD use at T1; and either depressive symptoms, worry intensity, or sleep quality at T1. Hierarchical multiple regressions were used to analyse data. RESULTS:In the short term, right after the discontinuation programme, sleep quality worsened with lower BZD use. This link was no longer significant at the 3- and 12-month follow-up. In the long term, depressive symptoms lowered with lower BZD use. No change was found in worry intensity in relation to BZD use at all measurement times. CONCLUSION:Discontinuation may improve depressive symptoms. Our study also questions the long-term effectiveness of BZD use, since long-term discontinuation was not linked with change in worry intensity and sleep quality.

Objectives Few are the longitudinal studies on the changes in moderate or severe symptoms of anxiety or depression (MSS-ANXDEP) from before to during the COVID-19 pandemic in Canada. The aim was to study the change in MSS-ANXDEP and associated sociodemographic, economic, psychosocial, health behaviour and lifestyle, and clinical factors. Methods The current sample includes 59,997 adults aged ≥ 35 years participating in the 2018 and 2020 health surveys of the 5 established cohorts of the Canadian Partnership for Tomorrow’s Health (CanPath). MSS-ANXDEP was based on a cutoff score ≥ 10 on the 7-item Generalized Anxiety Disorder Scale and Patient Health Questionnaire (PHQ-8). Change in MSS-ANXDEP was categorized as follows: no MSS-ANXDEP, remitted, incident, and persistent. Multinomial regressions were used to study MSS-ANXDEP as a function of sociodemographic, economic, psychosocial, health behaviours and lifestyle, and clinical factors. Results Sociodemographic and economic (i.e. age, gender, cohort, race/ethnicity, lower income, decreased in income, work status, being an essential worker), lifestyle and health behaviours (i.e. smoking, cannabis and alcohol use, drinking more alcohol), psychosocial (i.e. provide help to others, information and instrumental support, and change in relationships with friends, family, and partner) and clinical factors (i.e. lifetime mental disorder and multimorbidity) were associated with remitted, incident, and persistent MSS-ANXDEP. Conclusion Health and socio-economic factors were associated with changes in symptoms of anxiety and depression during the pandemic, further increasing inequities in mental health needs. Public health campaigns on the importance of healthy behaviours should continue and health policies should reduce economic and social barriers to integrated substance use and mental health care.

Background Anxiety disorders are prevalent amongst older adults and negatively impact their quality-of-life and health. Anxiety disorders often go undetected or are misattributed to age-related changes. The aim of this systematic review of reviews, was to synthesize existing evidence on risk factors associated with anxiety in older adults to improve opportunities for early detection and intervention. Methods A rapid systematic review of reviews was performed. Studies were included if they were systematic reviews, specific to older adults, reported modifiable or non-modifiable factors associated with increased or decreased frequency of anxiety, and reported on anxiety disorders or symptoms of anxiety (including fear of falling). Results 27 papers met criteria for inclusion. A total of 77 unique risk and protective factors across demographic, health, environmental, and psychosocial domains were identified. Recurrently identified risk factors for anxiety included female sex, health (e.g., multimorbidity, sensory impairments), physical functions (e.g., impaired balance, history of falls), psychological factors (e.g., fear of falling, depression), social isolation, and sleep disturbances, whereas good physical health and balance confidence were protective. Conclusions This review reinforces the multifaceted and complex nature of anxiety in older adults. The results synthesized, highlight risk factors that should prompt detection of older adults for anxiety disorders and provide valuable insight for the development of tailored detection tools that better identify older adults at risk. Future research should address methodological limitations and include more diverse populations to improve opportunities for early detection and intervention in this vulnerable population.