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Late Life Anxiety Disorders: What you need to know.

Our center is currently conducting a study, "Relief from anxiety in older adults", that tests the efficacy of a medication (Lexapro) for the relief of anxiety symptoms.  If you are aged 60 or older and think you may have trouble with worry or anxiety, call us at (412)-246-6249.

These are people describing their experiences with anxiety disorders. There is evidence that these disorders are common in older individuals: one in ten suffers from disorders such as generalized anxiety disorder, social anxiety disorder, panic disorder, and obsessive-compulsive disorder. These anxiety disorders can be very disabling, leading to poor physical health and lower quality of life. However, many seniors avoid seeking treatment for these disorders, because they feel that the anxiety is normal – "I’ve had it all my life, it’s a part of me."

What is an anxiety disorder?

Anxiety is a normal part of life, and it occurs in seniors too.  Older adults worry about health, family, finances, and their mortality.  Elderly persons react with fear or panic when danger is imminent, as are their younger counterparts.  Anxiety is a normal response to certain situations and is useful in helping us to cope with problems and to manage threatening situations.  Anxiety alerts us to threats and provides the physiological readiness needed for action.  Anxiety may be very intense in certain situations yet still be considered normal.  However, if it occurs when there is no threat and/or if its intensity is far higher than the situation warrants, it is likely to be a symptom of an anxiety disorder.  Excess anxiety that occurs repeatedly and leads to distress and disablement is usually called an anxiety disorder.

Are anxiety disorders common in older people? 

Yes; according to some studies, one in ten older people suffers from an anxiety disorder. 

What kind of anxiety disorders do older people get? 

There are many kinds of anxiety disorders.  One common disorder is generalized anxiety disorder, in which a person has constant distressing worries that the person finds difficult to control. Up to seven percent of elderly are afflicted by this condition at any time, which tends to be chronic (either constant throughout life or waxing and waning). Few people with this condition ever seek treatment for it. It is typical for elderly with Generalized Anxiety Disorder to have many physical symptoms, such as fatigue, chest pains, and headaches, so they often seek care from primary care and specialty doctors for these physical symptoms, receiving unnecessary medical workups and medications without ever realizing the psychological basis for their problems.

Another kind of anxiety disorder is phobias -- in this case, a person has a severe and excessive fear of a place, thing, or event.  A severe type of phobia is agoraphobia, in which a person is afraid to be in public places and may even be afraid to leave their house or to be alone.  Other phobias include "specific" phobias (such as fear of spiders or closed places) and social phobia (also called social anxiety disorder).

Panic disorder is marked by recurrent panic attacks -- these are sudden-onset, short-lived (less than 30 minutes) attacks of extreme anxiety and fear, accompanied by chest pain, shortness of breath, nausea, and/or other physical symptoms.  Older people with panic attacks often think they are having a heart attack or stroke, and they may go to an emergency room for these complaints.

Post-traumatic stress disorder can occur after a severe trauma such as an assault or life-threatening accident; symptoms can start months or years after the event and include reliving the experience (through thoughts or nightmares), emotional numbing, and hypervigilance  (increased startle, irritability, insomnia).  Little is known about this disorder in older persons, despite the numbers of elderly veterans who may have it.

Are anxiety disorders in older people treatable? 

The main types of treatment for anxiety disorders, medications and psychotherapy, are not well-proven specifically for older people, so currently treatment of late-life anxiety is directed by studies in younger adults.  

Medications that are proven to work for anxiety disorders include antidepressants, especially the serotonin reuptake inhibitors such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), or citalopram (Celexa); side effects include sexual dysfunction, nausea, sleep problems, fatigue, diarrhea, and nervousness -- usually short-lived.  Another treatment shown to be effective for older people, with similar side effects, is buspirone (BuSpar).

The class of medications known as benzodiazepines (such as diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax), and others) is effective for short-term relief of anxiety.  However, these medications are associated with fatigue, memory impairment, and impaired gait leading to falls, as well as impaired motor function making it more difficult to drive.  These side effects may be especially problematic in elderly persons.  For this reason, it is recommended that, in general, use of benzodiazepines be limited to short periods (weeks to a few months) and that the long-acting medications such as Valium be avoided.  That said, many elderly (and younger) individuals who take such medications chronically have few or no problems with them.

Psychotherapy effective for anxiety disorders includes cognitive-behavioral therapy, exposure therapy, and interpersonal therapy; these therapies have been little-studied in elderly persons with anxiety disorders but may be helpful.

How can I get help for an anxiety disorder? 

It can be helpful to see a mental health professional. For example, the Late-Life Depression Evaluation and Treatment Center can provide evaluations for anxiety, and it also can help with referrals in the community outside of the center.

Another place to start can often be your family doctor.  He or she will also be able to help you locate a mental health professional in your area.  A referral to a private psychiatrist, psychologist or social worker can be found through their respective professional organizations such as the American Psychiatric Association, the American Psychological Association and the National Association of Social Workers. Many communities also have geriatric assessment centers, such as the Benedum Geriatric Clinic in the Oakland section of Pittsburgh (412-692-4200).

You can get a referral to a geriatric psychiatrist in the U.S. or Canada through the American Association for Geriatric Psychiatry, by calling (301) 654-7850 x100 or by emailing main@aagponline.org.

Can medications make me anxious?

There are medications that can add to anxiety, especially ones that contain stimulants or caffeine. In addition coffee, tea, soda, and chocolate contain caffeine which can add to anxiety. Many cold medications, including over the counter and "herbal" preparations, have caffeine and/or ephedrine.  Always check with your doctor and pharmacy about interactions between prescribed medications and over the counter preparations.

Does drinking alcohol help anxiety?

While alcohol appears to "take the edge off" of anxiety , in the long run it interferes with sleep and overall wellness. Further, it can add to anxiety, depression and even dementia.  As little as two drinks per day can be problematic in older people, who are more susceptible to the adverse effects of alcohol.

How can I get treated?

Currently our center is not recruiting new patients for our anxiety study.  If you have a medical insurance card, you can get a referral through your insurance company:  look on the back of your card for "mental health" or "behavioral" information to call.  Also, you can talk to your family doctor about treatment or a referral.

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