Anxiety is frequently considered a normal part of getting old. Along with becoming more frail, getting more aches and pains and starting to lose a few brain cells, anxiety is up there with stuff old people just ‘get’. Could this affect their chances of treatment? Well the reality is that it probably depends on a number of factors, such as the known susceptibility of the elderly to the side effects of medication. It may also be the case that anxiety is hard to spot as older people often appear anxious or depressed in relation to one or more physical ailments. Finally we return to the opening statement about what is often considered normal in the elderly and the possibility that caregivers simply overlook the option of treating anxiety because of this.
The issue of medication side effects would seem to suggest that more emphasis could be given to psychological therapies. In fact very few studies are available to indicate the benefits, or otherwise, of psychological treatments for anxiety in the elderly. In principle there is every reason to suppose that seniors would respond as positively as the rest of the population. What few studies exist do lend support. For example, case studies indicate that psychotherapy can be effective up to and including the early stages of dementia (Johnson, 1991).
Older people tend to have a poorer outcome when diagnosed with Generalized Anxiety Disorder (GAD). This may of course be due to the fact that the elderly often receive a poorer level of care, but it may be that the extent of GAD in the elderly is simply misunderstood and under-diagnosed. Studies by Eric J Lenze, MD, assistant professor of psychiatry at the University of Pittsburgh, states that GAD is the most common mental disorder in the elderly. In fact the incidence of GAD affects roughly 7 per cent of the elderly population. As such, this is more than double the recognized levels of depression in the elderly - although anxiety and depression are commonly associated.
Recognising Anxiety in the Elderly
The Anxiety Disorders Association of America, provide useful guidelines to help in the identification of anxiety. They suggest that careful phrasing of questions can help, for example:
- 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?
Both medication and psychological therapies can be used to help alleviate levels of anxiety, although it remains the case that clinical research on their effectiveness remains limited. We require a better understanding of the nature of anxiety and anxiety disorders in the elderly. Reducing anxiety in the elderly may have a number of benefits beyond the obvious, including better recovery rates following, for example, falls, heart attacks or strokes. With our limited knowledge it seems clear there is plenty of scope for psychologists and clinicians to learn more.
Anxiety in the Elderly. Retrieved September 13, 2007, from Anxiety Disorders Association of America Web site: http://www.adaa.org/GettingHelp/AnxietyDisorders/Elderly.asp
Johnson, F.A. (1991). Psychotherapy of the elderly anxious patient. In C. Salzman & B. Lebowitz (eds), Anxiety in the elderly: Treatment and research (pp.215-248). /new York: Springer.
Warner, Jennifer (2006,05,26). Anxiety Often Missed in Elderly. Retrieved September 13, 2007, from WebMD Web site: http://www.webmd.com/anxiety-panic/guide/20061101/anxiety
Jerry Kennard, Ph.D., is a chartered psychologist and associate fellow of the British Psychological Society. Jerry’s clinical background is in mental health and, most recently, higher education. He is the author of various self-help books and is co-founder of positivityguides.net.