Often older people with anxiety do not receive help. here’s why

CNN
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Anxiety is the most common psychological disorder among adults in the United States. In the elderly, it is associated with considerable distress as well as poor health, reduced quality of life and high rates of disability.

Yet when the U.S. Task Force on Preventive Services, an influential independent group of experts, suggested last year that adults be screened for anxiety, it left out one group – people over 65 years and older.

The main reason cited by the working group in draft recommendations published in September: “(C)urrent evidence is insufficient to assess the balance between the 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 not be reliable for older people. Screening involves evaluating people who do not have obvious symptoms of worrisome medical or psychological conditions.

“We recognize that many older people suffer from mental health issues like anxiety” and “we urgently call for more research,” said Lori Pbert, associate chief of the division of preventive and behavioral medicine at the University of Massachusetts Chan Medical School and former member of the task force that worked on the anxiety guidelines.

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

“I don’t see any harm in identifying anxiety in older people, especially because it doesn’t hurt and there are things we can do to reduce it,” said Dr Helen Lavretsky, professor of psychology at the University. ‘UCLA.

In a recent editorial of JAMA Psychiatry, Andreescu and Lavretsky noted that only about a third of older people with generalized anxiety disorder – intense and persistent worry about daily affairs – receive treatment. This is concerning, they said, given evidence of links between anxiety and stroke, heart failure, coronary heart disease, autoimmune diseases and neurodegenerative disorders such as dementia.

Other commonly undetected and untreated forms of anxiety 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 simmering disagreement over screening draws attention to the importance of anxiety later in life – a heightened concern during the Covid-19 pandemic, which has amplified stress and worry among older people. Here’s what you need to know.

From a book chapter published in 2020authored by Andreescu and a colleague, up to 15% of people age 65 and older who live outside nursing homes or other facilities have a diagnosable anxiety disorder.

Almost half have symptoms of anxiety – irritability, worry, restlessness, decreased concentration, trouble sleeping, fatigue, avoidance behaviors – which can be distressing but do not warrant a diagnosis, the study notes.

Most older people with anxiety struggle with this condition from early in life, but how it manifests can change over time. Specifically, older people tend to be more anxious about issues such as illness, loss of family and friends, retirement and cognitive decline, experts said. Only a fraction develop anxiety after reaching age 65.

Older adults often downplay symptoms of anxiety, thinking “this is how getting old” rather than “this is something I should do something about,” Andreescu said.

Additionally, they are more likely than younger adults to report “somatic” complaints – physical symptoms such as dizziness, fatigue, headache, chest pain, shortness of breath and gastrointestinal issues – which can be difficult to distinguish from underlying medical conditions, according to Gretchen Brenes, professor of gerontology and geriatric medicine at Wake Forest University School of Medicine.

Certain types of anxiety or anxious behaviors – including hoarding and fear of falling – are much more common in older people, but questionnaires designed to identify anxiety typically don’t ask about these issues, the report said. Dr. Jordan Karp, chair of psychiatry at the University of Arizona College of Medicine in Tucson.

When older adults voice their concerns, medical providers too often take them for granted, given the challenges of aging, said Dr. Eric Lenze, chief of psychiatry at Washington University School of Medicine in St. Louis and third author of the recent JAMA Psychiatry editorial. .

Simple questions can help determine if an older person should be assessed for their anxiety, he and other experts have suggested: Do you have recurring worries that are hard to control? Do you have trouble sleeping? Have you felt more irritable, stressed or nervous? Do you have trouble concentrating or thinking? Do you avoid things that you normally like to do because you are absorbed 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,” he told me. “Also, I tended to dwell on things that happened in the past and get upset.”

Psychotherapy — particularly cognitive behavioral therapy, which helps people cope with lingering negative thoughts — is generally considered the first line of treatment for anxiety in older adults. In a review of the evidence for the task force, researchers noted that this type of therapy helps reduce anxiety in older people seen in primary care settings.

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

Because mental health practitioners, especially those who specialize in geriatric mental health, are extremely hard to find, primary care physicians often recommend medications for anxiety relief.

Two categories 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, said the experts.

Benzodiazepines, a class of sedating drugs such as Valium, Ativan, Xanax, and Klonopin, are frequently prescribed to older adults, but should be avoided. The American Geriatrics Society has warned healthcare providers not to use them in the elderly, except when other therapies have failed, because they are addictive and greatly increase the risk of hip fractures, falls and injuries. other accidents, as well as short-term cognitive impairment.