Late Life Generalized Anxiety Disorder

Anxiety disorders have historically been thought of as problems of childhood and early adulthood. However, the prevalence of anxiety disorders among older adults ranges from 10% to 20%, making this class of disorders more prevalent than other common late-life psychiatric problems such as dementia or depression.

Late-Life Onset

The onset of generalized anxiety disorder (GAD) specifically can occur at any point in the life cycle, though the average age of onset is 31 years old. Of all anxiety disorders, however, GAD stands as the most common in late-life with estimates in the older adult age group ranging from 1% to 7%.

Its prevalence in older adults may in part be reflective of the tenacity of GAD. Young adults who struggle with generalized anxiety can experience a recurrence of symptoms in the middle and later stages of life. The new onset of GAD among older adults is often related to co-existing depression.

The diagnosis of GAD in late life can be complicated by several factors:

• Older adults may present their symptoms differently than younger people. They may articulate the physical symptoms of anxiety more readily than psychological symptoms.
• The presence of medical illness (the odds of which increase with age) is a known risk factor for anxiety disorders.
• Older adults are more likely than younger adults to be taking multiple medications. Because physical symptoms of anxiety may overlap with medication side effects, it’s helpful to pay attention to the triggers and time course of physical symptoms as they relate to medication schedules or changes versus other potential stressors.

Why GAD Is Under-Treated in Older Adults

GAD is, unfortunately, under-treated in older adults. Inadequate diagnosis is one reason for this, but another is lack of access or ability to seek out treatment. Among older adults living with this disorder, it is estimated that only approximately one-quarter seek out professional help for their symptoms.

Screening for anxiety is one way to improve the identification, diagnosis, and treatment of GAD in older adult populations. Women of all ages are twice as likely to experience symptoms of anxiety disorders such as GAD. As such, a group of women's preventative healthcare professionals recommends that all women should be screened for anxiety conditions during routine healthcare exams.

Diagnosis

The first step in a diagnostic evaluation can involve speaking with a current physician—either a primary care physician or a clinician involved in the treatment of an existing medical illness. Diagnosis usually involves taking a medical history, a physical exam, and sometimes lab tests to rule out any medical conditions that might be contributing to or mimicking anxiety symptoms.

A doctor will also ask questions about the nature, duration, and severity of anxiety symptoms in order to help determine if these feelings represent normal worry or an anxiety disorder. A referral for a comprehensive evaluation with a mental health provider may follow.

Treatment

The treatments available for GAD in younger adults, which include medication and psychotherapy, have not been studied as comprehensively in randomized controlled trials of older adults.

Medication

Antidepressants, often SSRIs, are often prescribed to treat the symptoms of generalized anxiety disorder. Findings from medication studies for anxiety disorders completed in mixed-age adult samples and the existing trials in older adults generally do support the use of medications for anxiety in late life individuals.

Psychotherapy

There is also evidence that the psychotherapy approach used to good effect in the treatment of GAD in children and young adults, cognitive behavioral therapy (CBT), is similarly beneficial to older adults.

Modifications and enhancements to CBT—for example, using large-print educational materials and delivering the treatment in a group format—show promise for even more benefit for this age group. To address barriers to treatment including mobility and access, guided self-help approaches derived from CBT principles are also under study.