Anxiety in the Elderly (Geriatric Anxiety)
Anxiety in the Elderly (Geriatric Anxiety): Overview
Anxiety is common in older adults, though often under recognized. It may occur on its own or coexist with depression or medical illnesses. Persistent anxiety can reduce quality of life, increase disability, and worsen outcomes in chronic diseases.
Prevalence & Recognition
- Prevalence: Affects ~10–20% of older adults; higher in those with medical conditions or living in long-term care.
- Under diagnosed: May be mis-attributed to aging, personality, or physical illness.
- Presentation: Often more somatic (e.g., palpitations, GI distress) and less verbalized fear/worry than in younger adults.
Common Anxiety Disorders in Older Adults
- Generalized Anxiety Disorder (GAD) – most common; chronic worry, restlessness, muscle tension.
- Panic Disorder – less common but may be mistaken for cardiac issues.
- Phobias – e.g., fear of falling or being alone.
- Post-Traumatic Stress Disorder (PTSD) – may resurface from earlier trauma.
- Obsessive-Compulsive Disorder (OCD) – may emerge or persist into old age.
Risk Factors
- Chronic medical illness (e.g., COPD, cardiovascular disease)
- Cognitive decline or mild dementia
- Loss of spouse or close relationships
- Social isolation or major life changes (retirement, relocation)
- History of anxiety or mood disorders
- Substance use (including caffeine or alcohol)
Symptoms
- Excessive worry, even about routine matters
- Muscle tension, fatigue
- Irritability or restlessness
- Sleep problems
- Poor concentration
- Physical symptoms: dizziness, GI upset, shortness of breath, palpitations
Diagnosis
- Screening Tools:
- GAD-7
- Geriatric Anxiety Inventory (GAI)
- Hamilton Anxiety Rating Scale (HAM-A)
- Important to rule out medical causes (e.g., thyroid disorders, arrhythmias, medication side effects).
Treatment Options
1. Psychotherapy
- Cognitive Behavioral Therapy (CBT) – evidence-based, first-line treatment
- Mindfulness-based therapy
- Supportive or interpersonal therapy
2. Medications
- SSRIs (e.g., sertraline, escitalopram): preferred first-line
- SNRIs (e.g., duloxetine): especially with comorbid pain
- Avoid benzodiazepines due to fall risk, sedation, cognitive effects
3. Other Therapies
- Exercise (especially aerobic activity)
- Meditation or relaxation techniques
- Sleep hygiene
- Social support and engagement programs
Complications of Untreated Anxiety
- Impaired functioning and independence
- Increased risk of falls
- Poor medication adherence
- Higher rates of healthcare use
- Worsening of comorbid depression or dementia
Management Tips in Primary Care
- Address sensory deficits (hearing/vision)
- Review medications for anxiety triggers (e.g., bronchodilators, steroids)
- Use simple, clear communication
- Monitor for suicidal thoughts, especially with comorbid depression
Get the help you need at Vitality Medical Clinic in Spring Texas
serving the woodlands and spring areas
Megan Mohsin, PMHNP
