Got Anxiety? Looking at anxiety disorders with older adults
Mary B. Barmann, MFT
Until recently, anxiety disorders were believed to decline with age. Experts now recognize that aging and anxiety are not mutually exclusive — anxiety is equally common among the old and young.
Recognizing late-life anxiety disorders in older adults can be challenging. Termed “the silent geriatric giant,” undiagnosed late-life anxiety has a hugely negative impact on the life of the senior as well as the lives of the people around them.
Facts about Late-Life Anxiety Disorders
Research on the course of late-life anxiety disorders is underestimated and lags behind that of conditions such as Depression and Alzheimer’s for a number of reasons: Older people are less likely to report psychiatric symptoms, generally have developed strengths and coping skills resulting in fewer negative emotional reactions, are more tolerant of life’s ups and downs, and deal better with crises.
Some interesting facts about late-life anxiety:
7% of adults aged 65 and older have a diagnosable anxiety disorder.
15% of those past the age of 65 will have had an anxiety disorder.
Anxiety affects twice as many older adults as depression.
Risk factors: Being a woman, less formal education, chronic medical conditions, being unmarried, physical limitations, adverse childhood events, stressful life events.
8% to 71% of adults with Dementia have anxiety symptoms.
5% to 21% of adults with Dementia have an actual Anxiety Disorder.
40% of older adults with disabilities or chronic medical conditions report anxiety.
30% of older adults in primary care settings have generalized anxiety symptoms.
Only 14% of older adults with anxiety receive mental health services.
Recognizing Anxiety Disorders in Older Adults
This is tricky. Seniors are reluctant to report anxiety symptoms because they grew up when mental illness was stigmatized. Loss of friends and relatives, decreased mobility, and greater isolation create more stress and worry.
Aging produces higher rates of medical and physical conditions with symptoms similar to those of an anxiety disorder, a greater use of prescription medications with side effects, and mental and emotional changes related to cognitive impairment such as Dementia.
Because anxiety symptoms include agitation, headaches, back pain, or rapid heartbeat, separating neurological or medical conditions from symptoms of an anxiety disorder is challenging.
Seniors with true anxiety disorders experience more difficulties managing their day-to-day lives than seniors with normal worries, have greater risk of physical illness, falls, depression, disability, premature mortality, social isolation, and placement in institutions. The quality of their life is significantly worse than those of seniors without anxiety.
The Most Common Anxiety Disorder in Seniors
Generalized Anxiety Disorder accounts for 50% of late-life diagnosed anxiety disorders. GAD in seniors: The persistent presence of worry or tension, when there is little or no imminent cause. Worries are difficult to control and associated with routine daily events and activities, and traumatic events such as a fall or acute illness.
Frequent and uncomfortable physical symptoms are experienced. Such worries hamper the senior’s ability to get through the day. Anxiety lasts 6 or more months and negatively impacts and interferes with quality of life. Sleep difficulties worsen and daily activities are restricted. Because physical disorders such as cardiac conditions, respiratory problems, and unsteadiness become more prevalent with aging, the co-occurrence of anxiety disorders and physical diseases considerably raises the risk of poor physical outcomes. GAD in older adults often precedes an episode of depression, but may also activate depression.
What To Do When You Suspect Anxiety in Older Adults
Diagnosing late-life anxiety depends on a collaborative partnership between the aging adult, family, and the loved one’s doctor. How you approach the older adult makes a significant difference:
Talk to the aging adult: This is the first step to find out if there is a problem. Focus on changes in frequency, duration, or intensity you or others have noticed in the following areas: Daily routines/activities, worries, fears, medication, overall mood and behavior
Be thoughtful during discussions: Seniors are often reluctant to report psychiatric problems. Be caring and kind. The level of intensity of the interaction and how questions are phrased are important. Sample questions include:
Is there anything going on that is causing you concern?
Do you find that you have a hard time putting things out of your mind?
What were you doing when you noticed the chest pain?
When you can’t sleep, what is usually going through your head?
Include the primary physician: Continue diagnosis with the primary geriatric care physician. Older people feel comfortable opening up to a doctor with whom they already trust and like. Chances are increased that they will accept a referral to a mental health professional.
Anxiety disorders in the elderly are real. Older adults with anxiety disorders do not have to suffer. Correctly identifying this condition is the first proactive step to providing help.
Barry C. Barmann, Ph.D., is a Licensed Clinical Psychologist in Nevada and California. His wife, Mary B. Barmann, MFT, is a licensed Marriage and Family Therapist in California. Visit anxietytreatmentinclinevillage.com to learn more.
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