Anxiety is the most common psychological
disorder affecting adults in the US. In older people, it is associated with
considerable distress as well as ill health, diminished quality of life, and
elevated rates of disability.
اضافة اعلان
Yet, when an independent,
influential panel of experts, the US Preventive Services Task Force, suggested
last year that adults be screened for anxiety, it left out one group — people
65 and older.
The major reason the task force
cited in draft recommendations issued in September: “the 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
entails evaluating people who don’t have obvious symptoms of worrisome medical
or psychological conditions.
‘More research’“We recognize that many older adults
experience mental health conditions like anxiety” and “we are calling urgently
for more research,” said Lori Pbert, associate chief of the preventive and
behavioral medicine division at the University of Massachusetts Chan Medical
School and a former task force member who worked on the anxiety
recommendations.
This “we don’t know enough yet”
stance does not sit well with some experts who study and treat seniors with
anxiety. Dr Carmen Andreescu, an associate professor of psychiatry at the
University of Pittsburgh, called the task force’s position “baffling” because
“it’s well established that anxiety isn’t uncommon in older adults and
effective treatments exist.”
“I cannot think of any danger in
identifying anxiety in older adults, especially because doing so has no harm
and we can do things to reduce it,” said Dr Helen Lavretsky, a psychology
professor at UCLA.
In a recent editorial in JAMA
Psychiatry, Andreescu and Lavretsky noted that only about one-third of seniors
with generalized anxiety disorder — intense, persistent worry about everyday
matters — receive treatment. That is concerning, they said, considering
evidence of links between anxiety and stroke, heart failure, coronary artery
disease, autoimmune illness, and neurodegenerative disorders such as dementia.
Other forms of anxiety commonly
undetected and untreated in seniors include phobias (like a fear of dogs),
obsessive-compulsive disorder, panic disorder, social anxiety disorder (a fear
of being assessed and judged by others), and post-traumatic stress disorder.
Also, seniors 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.
The smoldering disagreement over
screening calls attention to the significance of anxiety in later life — a
concern heightened during the COVID-19 pandemic, which magnified stress and
worry among seniors.
Here is what you should knowAnxiety is common. According to a
book chapter published in 2020, authored by Andreescu and a colleague, up to 15
percent of people 65 and older who live outside nursing homes or other
facilities have a diagnosable anxiety condition.
As many as half have symptoms of
anxiety — irritability, worry, restlessness, decreased concentration, sleep
changes, fatigue, avoidant behaviors — that can be distressing but do not
justify a diagnosis, the study noted.
Most seniors with anxiety have
struggled with this condition since earlier in life, but the way it manifests
may change over time. Specifically, older adults tend to be more anxious about
issues such as illness, the loss of family and friends, retirement, and
cognitive declines, experts said. Only a small fraction develop anxiety after
turning 65.
Anxiety can be difficult to identify
in older adults. Older adults often minimize symptoms of anxiety, thinking
“this is what getting older is like” rather than “this is a problem that I
should do something about,” Andreescu said.
Also, seniors 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 Gretchen Brenes, a professor of gerontology
and geriatric medicine at Wake Forest University School of Medicine.
Some types of anxiety or anxious
behaviors — notably, hoarding and fear of falling — are much more common in
older adults, but questionnaires meant to identify anxiety do not typically ask
about those issues, said Dr Jordan Karp, chair of psychiatry at the University
of Arizona College of Medicine in Tucson.
When older adults voice concerns,
medical providers too often dismiss them as normal, given the challenges of
aging, said Dr Eric Lenze, head of psychiatry at Washington University School
of Medicine in St. Louis and the third author of the recent JAMA Psychiatry
editorial.
Simple questions can help identify
whether an older adult needs to be evaluated for anxiety, he and other experts
suggested: Do you have recurrent worries that are hard to control? Are you
having trouble sleeping? Have you been feeling more irritable, stressed, or
nervous? Are you having trouble with concentration or thinking? Are you
avoiding things you normally like to do because you’re 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 queries. “I’m a Type A
personality and I worry a lot about a lot of things — my family, my finances,
the future,” he told me. “Also, I’ve tended to dwell on things that happened in
the past and get all worked up.”
Treatments are effective.
Psychotherapy — particularly cognitive behavioral therapy, which helps people
address persistent negative thoughts — is generally considered the first line
of anxiety treatment in older adults. In an evidence review for the task force,
researchers noted that this type of therapy helps reduce anxiety in seniors
seen in primary care settings.
Also recommended, Lenze noted, is
relaxation therapy, which can involve deep breathing exercises, massage or
music therapy, yoga, and progressive muscle relaxation.
Because mental health practitioners,
especially those who specialize in seniors’ mental health, are extremely
difficult to find, primary care physicians often recommend medications to ease
anxiety. Two categories of drugs — antidepressants known as SSRIs (selective
serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake
inhibitors) — are typically prescribed, and both appear to help to older
adults, experts said.
Frequently prescribed to older
adults, but to be avoided by them, are benzodiazepines, a class of sedating
medications such as Valium, Ativan, Xanax, and Klonopin. The American
Geriatrics Society has warned medical providers not to use these in older
adults, except when other therapies have failed, because they are addictive and
significantly increase the risk of hip fractures, falls, and other accidents,
and short-term cognitive impairments.
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