Research,
on both the course and treatment of anxiety in older adults, lags
behind that of other mental conditions, such as depression and Alzheimer's.
Until recently, anxiety disorders were believed to decline with
age. But now experts are beginning to recognize that aging and anxiety
are not mutually exclusive: anxiety is as common in the old as in
the young, although how and when it appears is distinctly different
in older adults.
Anxiety
disorders in the elderly population are real and treatable, just
as they are in younger people. Another commonality between old and
young is the high incidence of depression with anxiety. Depression
and anxiety go together in the elderly, as they do in the young,
with almost half of those with major depression also meeting the
criteria for anxiety and about one-quarter of those with anxiety
meeting criteria for major depression. As with younger persons,
being a woman and having less formal education are risk factors
for anxiety in older adults.
Most older
adults with an anxiety disorder had one when they were younger.
What "brings out" the anxiety are the stresses and vulnerabilities
unique to the aging process: chronic physical problems, cognitive
impairment and significant emotional losses.
Late-life
anxiety disorders have been underestimated for several reasons,
according to experts. For example, older patients are less likely
to report psychiatric symptoms and more likely to emphasize their
physical complaints, and some major epidemiological studies have
excluded Generalized Anxiety Disorder, one
of the most prevalent anxiety disorders in older adults.
Recognizing
Anxiety in the Aging
Recognizing an anxiety disorder in an older person poses several
challenges. Aging brings with it a higher prevalence of certain
medical conditions, realistic concern about physical problems, and
a higher use of prescription medications. As a result, separating
a medical condition from physical symptoms of an anxiety disorder
is more complicated in the older adult. Diagnosing anxiety in individuals
with dementia can be difficult, too: agitation typical of dementia
may be difficult to separate from anxiety; impaired memory may be
interpreted as a sign of anxiety or dementia, and fears may be excessive
or realistic depending on the person's situation.
Treatment
Diagnosis and treatment in most cases should start with the primary
care physician. Many older people feel more comfortable opening
up to a doctor with whom they already have a relationship. Also,
if they already trust their primary care physician, the chances
are increased that they will go along with treatment or a referral
to a mental health professional."
Both medication and psychosocial therapies are used to treat anxiety
in older persons, although clinical research on their effectiveness
is still limited. Anti-depressants (specifically the selective serotonin
reuptake inhibitors or SSRIs), rather than anti-anxiety medication
(such as the benzodiazepines), are the preferred medication for
most anxiety disorders. Cognitive Behavioral Therapy (CBT) is being
used increasingly to reduce anxiety in older adults. CBT may involve
relaxation training, cognitive restructuring (replacing anxiety-producing
thoughts with more realistic, less catastrophic ones) and exposure
(systematic encounters with feared objects or situations). CBT can
take up to several months and has no side effects.
Success
in treating anxiety in the older patient depends, in part, on a
partnership between the patient, the family and the doctor. Everyone
needs to agree on what the problem is and make a commitment to stick
with treatment until the patient can return to normal functioning.
Family members may need to advocate for the older person, ensuring
that issues encountered during treatment-such as drug side effects-are
dealt with promptly.
See "Guide
to Treatment"
Diagnosing
Anxiety in the Aging
Often the elderly are reluctant to report psychiatric problems.
To help identify anxiety it may be useful to phrase questions in
the following way:
To identify
anxiety:
- Have you been concerned
about or fretted over a number of things?
- Is there anything
going on in your life that is causing you concern?
- Do you find that
you have a hard time putting things out of your mind?
To identify
how and when physical symptoms began:
- What were you doing
when you noticed the chest pain?
- What were you thinking
about when you felt your heart start to race?
- When you can't sleep,
what is usually going through your head?
Adapted
from Ariel J. Lang, Ph.D., and Murray B. Stein, M.D., "Anxiety
Disorders: How to Recognize and Treat the Medical Symptoms of Emotional
Illness," Geriatrics. 2001 May; 56 (5): 24-27, 31-34.
Worried about an Aging Parent?
Talking to your elderly parent or loved one about any changes in
their lives is one of the best ways to find out if there is a problem.
Ask about any changes you notice in the following:
- Daily routines
and activities. Is Grandma refusing to do previously routine
activities or avoiding social situations she used to enjoy?
- Worries.
Does Dad seem to have more worries than before and do those
worries seem out of proportion to reality (such as a real threat
to his safety).
- Medication.
Has Mom recently started taking another medicine? Is she using
more of a particular medication than before? Medication side
effects (such as breathing problems, irregular heartbeat, or
tremors) can simulate symptoms of anxiety. Also, an increased
use of medication (or alcohol) may indicate an attempt to "self-medicate."
- Overall mood.
Depression and anxiety often occur together. Tearfulness, apathy,
and a loss of interest in formerly enjoyable activities are
possible signs of depression.
Take an Anxiety Disorders Self-Test for Family Members
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