Anxiety In Elderly: Types, Symptoms, Causes & Ways To Manage 2023

It is estimated that the rate of anxiety disorders in older adults is as high as 20.8%,^[1] a number that closely mirrors the rates seen in all adults. The stressors differ at times, such as concerns about an illness, limited mobility, or recovery from falls. Regardless of the cause, the effects of anxiety can be isolating and potentially debilitating in their own right.

incidence of anxiety.^[2] Increasing awareness and improving our comfort level by actively discussing these concerns may go a long way toward improving access to appropriate help. It is crucial to remember that special care should be taken when helping older adults with anxiety,^[3] but available treatments can be safe and effective when used with appropriate care.

How Do You Treat Anxiety Disorders In Older Adults? 

Older adults process medications differently and can be more prone to side effects. Multiple medications are also more likely to be used to manage other conditions, raising the risk of drug interactions. Two key points when approaching assistance with anxiety are:

• Mental health services focused on non-pharmacy interventions should be considered first and can be very effective.
• Medications should be used at the lowest dose possible for the shortest amount of time. 

Types Of Anxiety In Older Adults

Improving our ability to help manage our own anxiety or to help a loved one or friend begins with the ability to talk about it openly, with compassion, and with an understanding of the kinds of support available. Gaining a better understanding of the kinds of anxiety individuals experience can be very helpful.

The Diagnostic and Statistical Manual of Mental Disorders has been updated to its fifth edition (referred to as DSM-5). Originally published in 1952, the manual has become a worldwide standard for defining mental health conditions. An accurate diagnosis allows for appropriately tailored therapy. Anxiety disorders are discussed in three categories within the DSM-5:

1. Excessive Worry Or Stress 

Generalized Anxiety Disorder (GAD)

GAD is the most commonly diagnosed form of anxiety. It is defined as consistent excessive anxiety or worry related to events in everyday life.

Post Traumatic Stress Disorder (PTSD)

PTSD is characterized by recurrent memories or “reliving” a traumatic event. This can lead to sudden outbursts, nightmares, and withdrawal from social situations, friends, and loved ones.

2. Fear

Panic Disorder

Panic attacks are associated with sudden feelings of intense fear and loss of control. There may not be a specific reason for these attacks, and the physical symptoms can be significant.

Specific Phobias

Many people are familiar with phobias as a fear of something specific, like a certain animal, heights, or open spaces. Social anxiety disorder is also described as social phobia. Feeling nervous in social situations can be normal, but avoidance of these situations leading to the disruption of relationships or responsibilities due to these anxious feelings may be worthy of further exploration.

Obsessive Compulsive Disorder (OCD)

Repetitive behaviors centered around the need for symmetry, fear of contamination (Excessive hand washing, for instance), and other preoccupations or compulsions such as hoarding can be potential signs of OCD.

Anxiety Symptoms In Older Adults

There can be some subtle differences in the signs and symptoms of anxiety in older adults when compared with younger or middle-aged individuals. These differences are primarily in severity, such as somewhat less severe physical symptoms of panic attacks, or a higher tendency toward avoidance of socializing and isolation.

Recognizing some of these signs and symptoms can allow a family member, friend, or acquaintance to offer support. Awareness of these symptoms also allows us to become more mindful of our own mental health. Symptoms of anxiety in the elderly can be most easily broken down into psychological and physical:

1. Psychological Symptoms 

• Difficulty sleeping. 
• Excessive worry or fear. 
• Withdrawal, or social isolation.

2. Physical Symptoms

• Heart palpitations; pounding or racing heart. 
• Chest pain
• Shortness of breath. 
• Shaking. 
• Sweating. 
• Unsteadiness on feet. 

Some of these symptoms can overlap with many other potential health conditions, such as restrictive airway disease (Asthma or COPD), cardiovascular disease, or may also be associated with cognitive disorders (Dementia, for instance). A doctor can help you determine or rule out other potential causes of symptoms and suggest a plan for treatment.

Causes Of Anxiety In Older Adults

Anxiety has the potential to be disregarded in older adults. This may be because of a variety of factors, ranging from the potential overlap of symptoms with other disorders to cultural aversions to seeking help. Risk factors with higher prevalence among older adults include:

• The loss of friends or loved ones.
• Traumatic experiences.
• Isolation, whether intentional or unintended (Due to mobility difficulty, for instance).
• Chronic pain.
• Managing disease.

Potential causes of anxiety could come from a wide variety of sources, and managing them can become overwhelming. When navigating difficult situations, compassion is key, whether with others or with ourselves. Effective treatment often begins with openly accepting help.

How To Manage Anxiety In Older Adults

1. Non-Pharmacological Approaches 

Prior to considering medications, it is recommended to consider lifestyle changes, mindfulness, and different forms of therapy. These can be very effective and will reduce potential medication burden.

Lifestyle 

Establishing a daily routine or form of structure can help provide a sense of control. Worry and fear lead to a loss of this sense of control. Exercising can be an excellent way to maintain strength, physical health, and mobility and can be an effective stress reliever. Exercise does not need to be strenuous to be helpful. Taking a walk, or stretching your upper body can be enough to improve a sense of well-being.

Mindfulness

Applying mindfulness as an intervention for anxiety refers to focusing on the present. There are several strategies for implementing this, focusing on senses such as taste, and smell, or being aware of and identifying present emotions. Often also approached with deep breathing techniques and forms of meditation, mindfulness allows you to regain control of your thoughts and your responses to external stimuli, regardless of how chaotic they may be.

Therapy

Cognitive Behavioral Therapy (CBT)

Primary care physicians often refer patients to individual sessions with therapists providing CBT. This form of therapy can be quite structured. Education is provided, negative thought patterns or behaviors are identified without judgment, and individualized solutions are proposed and worked on with feedback. 

Therapy options are becoming more accessible, even for those unable to travel to an office visit. Using telehealth visits, you can either establish a relationship with a new therapist using a service like Talkspace or do a remote visit with a therapist at a local clinic if they offer the service.

Social Groups

Specific topics of discussion or activities may be at the heart of individual groups such as book clubs, religious gatherings, or support groups, but the goal is essentially the same: connecting with others and developing a social support network. Supporting others can be as therapeutic and meaningful as the help you receive yourself.

There are a variety of alternative therapies available, including art therapy, music therapy, dance, yoga, and massage. You are very likely to find a form of therapy that can help you develop relaxation techniques.

2. Management Of Anxiety With Medications

The use of medications to relieve anxiety is commonplace, and there are established methods to provide support. Because many older adults managing anxiety disorders may also be managing other conditions and using other medications, it is important to ensure new medications are used safely. Side effects can occur at higher rates, so an important tenet is to use the lowest dose possible for the shortest amount of time to provide the support needed.

There are several commonly used classes of medications used to treat anxiety, and individual medications within those classes can have their own sets of advantages and disadvantages.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Escitalopram (Lexapro), and sertraline (Zoloft)^[4] are recommended for first-line treatment. These are considered better options than other medications within the class because they provide the best balance between a lower risk of daytime drowsiness and falls compared with insomnia.

If you are taking a blood thinner, a NSAID, or have a history of bleeding (from a stomach ulcer, for instance), these medications should be used with caution. Regular labs should also be drawn to ensure electrolytes remain in balance. With proper monitoring, many individuals are able to achieve a good balance with SSRIs.

Both SSRIs and SNRIs can take four to six weeks to take effect. It is important to use the medication on a daily basis over time to ensure it remains effective.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Venlafaxine (Effexor), Desvenlafaxine (Pristiq), and duloxetine (Cymbalta) are also commonly used for anxiety management. These medications do offer an additional benefit of support for conditions like fibromyalgia and nerve pain. They are associated with higher levels of daytime drowsiness and nausea, however.

Buspirone

Buspirone works on an intermediate time frame, taking about two weeks to reach full effect. The side effect profile is favorable overall, but some individuals do report restlessness or difficulty sleeping.

Mirtazapine

Mirtazapine is effective for anxiety management but has a strong anticholinergic effect. This effect increases dry mouth and constipation. Mirtazapine also acts as an effective appetite stimulant. Drowsiness is very common, and the medication is often taken at night. It can improve sleep, but morning grogginess should be monitored.

Benzodiazepines 

Benzodiazepines like alprazolam, clonazepam, or lorazepam are best used short-term, if at all. These medications are particularly helpful for panic attacks and do work quickly. Benzodiazepines also carry a risk of chemical dependence, memory impairment, drowsiness, and significant fall risk.

Each of these medications carries a potential risk of drug interactions. Your doctor or pharmacist can help you determine whether this would be a cause for concern.

Conclusion

Older adults with anxiety disorders have a variety of options for support. Different forms of therapy are recommended first and can be very effective. Regardless of whether medications are considered, it is very helpful to maintain a solid social support structure. Lower doses of medications should be used when possible to minimize side effects.