Anxiety can be difficult to detect in elderly patients

This article originally appeared on KHN.

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

But when the U.S. Preventive Services Task Force, an influential independent panel of experts, recommended last year that adults be screened for anxiety, it left out one group — people 65 and older.

The main reason the task force cited in draft recommendations issued in September: “current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety” in all older adults. (Final recommendations are expected later this year.)

The task force noted that questionnaires used to screen for anxiety may be unreliable for older adults. Screening involves evaluating people who do not have obvious symptoms of worrisome medical or psychological conditions.

“We recognize that many older adults experience mental health conditions such as anxiety” and “we urgently call for more research,” said Lori Pbert, associate chief of preventive and behavioral medicine at the University of Massachusetts Chan School of Medicine and a former dean. member of the force who worked on the stress recommendations.

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

“I can’t think of any danger in identifying anxiety in older adults, especially since it doesn’t hurt and we can do things to reduce it,” said Dr. Helen Lavretsky, a professor of psychology at UCLA.

In a recent article in JAMA Psychiatry, Andreescu and Lavretsky noted that only about a third of older adults with generalized anxiety disorder—intense, persistent worry about everyday matters—receive treatment. That’s concerning, they said, given evidence of a link between stress and stroke, heart failure, coronary heart disease, autoimmune disease and neurodegenerative disorders such as dementia.

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

The subdued debate over screening draws attention to the importance of stress in later life – a concern that has intensified during the Covid-19 pandemic, which has increased anxiety and worry among older people. Here’s what you need to know.

Anxiety is common. According to a 2020 book chapter authored by Andreescu and a colleague, up to 15% of people age 65 and older living outside of nursing homes or other facilities have a diagnosable anxiety condition.

About half have anxiety symptoms — irritability, restlessness, restlessness, impaired concentration, sleep changes, fatigue, avoidance behaviors — that can be bothersome but don’t warrant a diagnosis, the study noted.

Most seniors with anxiety have struggled with this condition from earlier in life, but the way it manifests can change over time. In particular, older people tend to be more anxious about things like illness, loss of family and friends, retirement and cognitive decline, experts said. Only a small percentage develop anxiety after 65.

Anxiety can be difficult to detect in older adults. Older adults often minimize symptoms of anxiety, believing that “this is just getting old” instead of “this is a problem I need to do something about,” Andreescu said.

Also, older adults are more likely than younger adults to report “somatic” complaints — physical symptoms such as dizziness, fatigue, headaches, chest pain, shortness of breath and gastrointestinal problems — that can be difficult to distinguish from underlying medical conditions, according to with Gretchen Brenes, professor of gerontology and geriatric medicine at Wake Forest University School of Medicine.

Certain types of anxiety or anxious behaviors — notably, crowding and fear of falling — are much more common in older adults, but questionnaires designed to detect anxiety don’t typically ask about these issues, said Dr. Jordan Karp, president in psychiatry at the University of Arizona College of Medicine in Tucson.

When older adults express concerns, medical providers too often dismiss them as normal given the challenges of aging, said Dr. Eric Lenze, chief of psychiatry at Washington University School of Medicine in St. Louis and the third author of the recent JAMA Psychiatry article. .

Simple questions can help determine whether an older adult should be evaluated for anxiety, he and other experts suggested: Do you have recurring worries that are difficult to control? Do you have trouble sleeping? Have you been feeling more irritable, stressed or nervous? Do you have trouble concentrating or thinking? Do you avoid things you normally enjoy doing because you are wrapped up in your worries?

Stephen Snyder, 67, who lives in Zelienople, Pennsylvania and was diagnosed with generalized anxiety disorder in March 2019, would answer yes to many of these questions. “I’m a type A personality and I worry a lot about a lot of things – my family, my finances, the future,” she told me. “Also, I tend to focus on things that happened in the past and solve everything.”

Treatments are effective. Psychotherapy—particularly cognitive behavioral therapy, which helps people deal with persistent negative thoughts—is generally considered the first line of treatment for anxiety in older adults. In a task force review of evidence, researchers noted that this type of treatment helps 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.

Because 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 classes of drugs — antidepressants known as SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) — are commonly prescribed, and both seem to help older people, experts said.

Benzodiazepines, a class of sedatives such as Valium, Ativan, Xanax, and Klonopin, are often prescribed to, but should be avoided by, older adults. The American Geriatrics Society has warned doctors against using them in older adults unless other treatments have failed because they are addictive and significantly increase the risk of hip fractures, falls and other accidents, and short-term cognitive impairment.

KHN (Kaiser Health News) is a national newsroom that produces in-depth health journalism. Along with Policy Analysis and Polling, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization that provides health information to the nation.

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