Seniors with anxiety frequently don't get help. Here's why
Anxiety is the most common psychological disorder affecting adults in the U.S. In older people, it's associated with considerable distress as well as ill health, diminished quality of life, and elevated rates of disability.
Yet, when the U.S. Preventive Services Task Force, an independent, influential panel of experts, 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.
“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 doesn't 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
People aged 65and older don’t often get help with anxiety. in JAMA Psychiatry, Andreescu illness, and neurodegenerative and Lavretsky disorders noted that only about onethird such as dementia. of seniors with generalized Other forms of anxiety anxiety disorder commonly undetected and — intense, persistent worry untreated in seniors include about everyday matters — phobias (like a fear receive treatment. That's of dogs), obsessive-compulsive concerning, they said, disorder, panic disorder, considering evidence of social anxiety disorder links between anxiety and (a fear of being assessed stroke, heart failure, coronary and judged by others), and artery disease, autoimmune post-traumatic stress disorder. 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's what you should know.
Anxiety is common. According to a book chapter published in 2020, authored by Andreescu and a colleague, up to 15% 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 don't 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.