5 - (OP17) Return of Fear in Late-life Anxiety: Age and Anxiety-related Differences in Fear Extinction and Retention in Younger and Older Adults

Age-related changes in psychophysiology, neurocircuitry, learning and memory may influence the development and treatment of anxiety in older adults, yet the fear learning mechanisms underpinning late-life anxiety remain poorly understood. This study examined age- and anxiety-related differences in fear acquisition, extinction and extinction retention in older and younger adults.

Participants (N= 144) were 73 older adults (65-86 years) with and without an anxiety disorder, and 71 younger adults (20-40 years) with and without an anxiety disorder. Participants completed a differential fear conditioning paradigm (fear acquisition, extinction and delayed extinction retention). Skin conductance response (SCR), subjective fear, and valance ratings were assessed.

There were no age-differences in contingency awareness. Older adults showed less subjective fear, negative valance and SCR than younger adults. All groups showed good differential fear conditioning and initial fear extinction, with only anxious older adults showing spontaneous recovery of fear at retention. Both anxious groups showed incomplete extinction of evaluative conditioning.

Reduced reactivity to fear-inducing stimuli in older adults may reduce the risk of developing anxiety disorders. However, late-life anxiety appears to involve distinct fear learning processes compared to younger adults. Spontaneous recovery of fear in anxious older (but not younger) adults suggests a deficit in the consolidation or retrieval of extinction learning in anxious older adults that may increase their risk for relapse. Results highlight the importance of addressing enduring negative beliefs that may contribute to maintenance of anxiety, in addition to fear. This study strengthens our understanding of the learning mechanisms underpinning late-life anxiety and offers insights for treatment optimisation.