Anxiety in Older Adults

Health Writer

Most people think of anxiety as a "young person's" illness - something that affects teens and young adults. Certainly, most people diagnosed with an anxiety disorder are between the ages of 15 and 40, but research shows that anxiety is also quite common in the elderly as well. A study published in the September 2009 issue of American Journal of Geriatric Psychiatry found that 7 percent of adults over the age of 65 years had an anxiety disorder.

Diagnosing Anxiety in the Elderly

Unfortunately, anxiety disorders are often missed in older adults. Physical health problems, such as high blood pressure, accelerated heart rates and difficulty breathing can all accompany anxiety but a doctor might instead associate these with cardiovascular disease or  chronic obstructive pulmonary disease  (COPD). Symptoms of anxiety also overlap with depression disorders; both can cause insomnia, decreased attention and irritability.

Besides other health conditions, many older adults are on medications for at least one condition. Some medications can increase agitation or cause anxiety symptoms. Doctors need to be aware of all medications you are taking as well as the side effects. Sometimes decreasing anxiety symptoms involves adjusting other medications.

Drs. Keri-Leigh Cassidy and Neil A. Rector, in the article, "The Silent Geriatric Giant: Anxiety Disorders in Late Life," suggest that a thorough health history is important to make an accurate diagnosis. Because anxiety disorders often show up early in life, it is possible that previous anxiety issues have been resolved but have now resurfaced. Many seniors, who did suffer with anxiety in their teens, might never have been diagnosed in the past but with time the anxiety lessened. When this happens, you might not associate feelings of anxiety when you were in your teens or twenties to how you are feeling now.

How Anxiety Symptoms Manifest in Older Adults

Generalized anxiety disorder (GAD) is the most common form of anxiety in older adults according to the  Anxiety and Depression Association of America, with symptoms including worry and rumination about physical illnesses, living alone and remaining independent. Panic disorder might follow a traumatic event, such as a serious illness, being a victim of a crime or falling. The fear of falling, especially in older adults who have already fallen, can lead to feelings of depression, lack of independence and can interfere with medical care.

Older adults can also develop certain phobias. Agoraphobia is the most common. This might occur after a traumatic event occurred, for example, an older adult who has been mugged might become fearful of leaving the house. Those with  obsessive compulsive disorder  might find their ruminations and obsessions changing - in many older adults thoughts begin to center around religion and sin.

Post-traumatic stress disorder  (PTSD) occurs after a traumatic event. This can happen in the young and the elderly. For the older adult, however, triggers from past events can bring about PTSD symptoms. Some older adults might have lived through horrible events, such as the Holocaust, World War II, sexual assault or child abuse that was never addressed as "trauma." News stories and current situations, such as grief or poor health can bring a flood of memories, causing the event to be relived and the anxiety surrounding it to resurface.

Dementia  can also contribute to anxiety. In the early stages of dementia, the feeling of losing memories can trigger panic. In addition, dementia can bring early, traumatic memories to the surface, causing the anxiety to resurface.

Treatment

Medications, such as  antidepressants  have been found to be helpful, however, experts warn that these medications should be started with very small doses and slowly increased as needed. Because older adults can metabolize medications differently, starting on a higher dose can cause additional medical problems.  Benzodiazepines  are not usually recommended for older adults because they can contribute to cognitive difficulties and falls.

Cognitive behavioral therapy (CBT) has also been found to be effective. In the past, any type of talk therapy has been ignored for older adults, however,  recent research  has shown that this type of therapy is effective and can reduce the use of benzodiazepines, which in turn can lower accidental falls and cognitive decline. Some CBT techniques might need to be modified to make it easier for older adults, such as increasing print size for handouts and using mnemonics to reinforce concepts.

For more information:

Anxiety in the Elderly

Four Medication Concerns for Elderly People with Anxiety

Medications that Can Cause or Worsen Anxiety

References:

"Finesse Required to Treat Anxiety in the Elderly," 2013, Terri D'Arrigo, ACP Internist, American College of Physicians

"The Silent Geriatric Giant: Anxiety Disorders in Late Life," 2008, Keri-Leigh Cassidy, M.D. and Neil A. Rector, Ph.D., Geriatrics and Aging, 11(3): 150-156