Older people with anxiety often do not get help. That’s why.

Sarah SmithMarch 10, 2023

Anxiety is the most common psychological disorder affecting adults in the US. In the elderly, it is associated with significant distress, as well as poor health, reduced quality of life, and increased rates of disability.

However, when the US Preventive Services Task Force, an independent and influential group of experts, proposed testing adults for anxiety last year, it left out one group: people aged 65 and over.

The main reason the task force cited in the draft guidelines published in September was that “available data are insufficient to assess the balance of benefits and harms of anxiety screening” in all older people. (Final recommendations are expected later this year.)

The Task Force noted that the questionnaires used for anxiety screening may not be reliable for older people. Screening involves evaluating people who do not have overt symptoms of troubling medical or psychological conditions.

“We recognize that many older adults experience mental health conditions such as anxiety,” and “we are urgently calling for more research,” said Laurie Pbert, deputy chief of the Division of Preventive and Behavioral Medicine at the University of Massachusetts Chan School of Medicine and a former task. a member of the squad who worked on the alert guidelines.

This “we don’t know enough yet” stance doesn’t sit well with some experts who study older people and treat them with anxiety. Dr. Carmen Andreescu, an associate professor of psychiatry at the University of Pittsburgh, called the target group’s position “baffling” because “it is well established that anxiety is not uncommon in the elderly and there are effective treatments.”

“I don’t see any danger in identifying anxiety in the elderly, especially because it’s not harmful and we can do something to reduce it,” said Dr. Helen Lavretsky, professor of psychology at UCLA.

In a recent JAMA Psychiatry editorial, Andreescu and Lavretsky noted that only about one-third of older adults with generalized anxiety disorder — intense, persistent worry about daily activities — receive treatment. This is worrisome, they say, given the evidence for links between anxiety and stroke, heart failure, coronary heart disease, autoimmune diseases, and neurodegenerative disorders such as dementia.

Other forms of anxiety that are usually undiagnosed and untreated in older adults include phobias (eg, fear of dogs), obsessive-compulsive disorder, panic disorder, social anxiety disorder (fear of being judged and judged by others), and post-traumatic stress disorder.

The smoldering controversy over screening is drawing attention to the significance of anxiety in later life — an anxiety that has increased during the COVID-19 pandemic that has heightened stress and anxiety among older people. Here’s what you should know.

Anxiety is widespread. According to a book chapter published in 2020, authored by Andreescu and a colleague, up to 15% of people aged 65 and older living outside nursing homes or other institutions have a diagnosable anxiety disorder.

The study notes that half of them have symptoms of anxiety — irritability, restlessness, restlessness, decreased concentration, sleep changes, fatigue, avoidance behavior — that may cause anxiety but do not warrant a diagnosis.

Most seniors have struggled with the condition with anxiety since the beginning of life, but the way it manifests can change over time. In particular, experts say older people tend to worry more about issues such as illness, loss of family and friends, retirement and cognitive decline. Only a small proportion develop anxiety after age 65.

Anxiety can be difficult to identify in the elderly. Older people often minimize anxiety symptoms by thinking “this is what aging is like” rather than “this is a problem that I have to do something about,” Andreescu said.

In addition, older people are more likely than younger people to report “somatic” complaints — physical symptoms such as dizziness, fatigue, headaches, chest pain, shortness of breath, and gastrointestinal problems — that, according to the study, are difficult to distinguish. from major diseases. Gretchen Brenes is Professor of Gerontology and Geriatric Medicine at Wake Forest University School of Medicine.

Certain types of anxiety or anxious behavior, such as hoarding and fear of falling, are much more common in older adults, but questionnaires designed to detect anxiety usually don’t ask these questions, said Dr. Jordan Karp, chair of the department of psychiatry at the Institute of Psychiatry. University of Arizona College of Medicine at Tucson.

When older adults express concerns, they are too often dismissed as the norm by healthcare professionals given the challenges of aging, says Dr. Eric Lenze, director of psychiatry at the Washington University School of Medicine in St. Louis and third author of a recent JAMA Psychiatry editorial. .

Simple questions can help determine whether an older adult needs to be tested for anxiety, he and other experts suggested: Do you have recurring worries that are hard to control? Are you having trouble sleeping? Did you feel more irritable, stressed or nervous? Do you have trouble concentrating or thinking? Are you avoiding the things you normally love to do because you’re mired in your worries?

Steven Snyder, 67, who lives in Zelienopole, Pennsylvania and was diagnosed with Generalized Anxiety Disorder in March 2019, would answer yes to many of these questions. “I’m a Type A person and I’m very worried about a lot of things – my family, my finances, my future,” he told me. “Besides, I tended to dwell on things that had happened in the past and it would all wind up.”

The treatment is effective. Psychotherapy — especially cognitive behavioral therapy, which helps people cope with persistent negative thoughts — is generally considered the first line of treatment for anxiety in older people. In a review of data for the target group, the researchers noted that this type of therapy helps to reduce anxiety in older adults seen in primary care settings.

Also recommended, Lenze noted, is relaxation therapy, which can include deep breathing exercises, massage or music therapy, yoga, and progressive muscle relaxation.

Since mental health professionals, especially those who specialize in the mental health of older adults, are extremely difficult to find, primary care physicians often recommend medication to relieve anxiety. Two categories of medications are commonly prescribed – antidepressants known as SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors), and both appear to help older people, experts say.

Elderly people are often prescribed, but should avoid, benzodiazepines, a class of sedatives such as Valium, Ativan, Xanax, and Klonopin. The American Geriatric Society has warned healthcare professionals not to use them in the elderly unless other treatments have failed, as they are addictive and greatly increase the risk of hip fractures, falls and other accidents, and short-term cognitive impairment.

We look forward to readers asking questions you would like answers to, challenges you face in your care, and advice you need as you work with the healthcare system. Visit khn.org/columnists to submit your queries or advice.

KHN (Kaiser Health News) is a national news service that produces in-depth journalism on health issues. Together with Policy Analysis and Polling, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is a charitable, non-profit organization providing health information to the nation.