OBJECTIVE: The authors review the evaluation and treatment of anxiety symptoms in elderly patients, with particular emphasis on elderly patients with chronic medical illness. METHODS: A computer search for articles addressing anxiety symptoms in patients sixty-five and older was supplemented by the authors' clinical experience and knowledge of other literature and textbooks relevant to the topic. RESULTS: Ten to 20 percent of older patients experience clinically significant symptoms of anxiety. Anxiety complaints may represent the physiological consequence of treatable medical illness, the result of psychiatric illness, or an exaggerated or normal response to life events. Both psychopharmacologic and nonpharmacologic treatments can be effective in relieving symptoms. CONCLUSIONS: Careful differential diagnosis is an essential preliminary step to successful treatment. Non-pharmacologic interventions (behavioral treatments, in particular) may be effective for many patients. Consideration of both the benefits and the risks of medication management is recommended, as elderly patients are especially vulnerable to side effects.