Seniors frequently suffer from anxiety disorders, but a powerful panel is likely to advise against systematic screening. Several specialists have different opinions.

Why Don't Doctors Check for Anxiety in Older Americans?

Seniors frequently suffer from anxiety disorders, but a powerful panel is likely to advise against systematic screening. Several specialists have different opinions.

Mike Tilton, Susan Tilton's husband, was in fact in good health. But after learning that a friend's spouse had terminal cancer, she started to fear that Mike might pass away soon as well.

Ms. Tilton, a 72-year-old Clayton, Missouri resident, claimed that she would "lie down and start thinking about it" at night. How would I react? How would I react? She had trouble sleeping and struggled through the next day as she considered life without her husband, whom she had married when she was 17 and he was 18.

She admitted that it was difficult to stop worrying. "How would I manage on my own? How would I use the house?

Ms. Tilton had previously been seeing a therapist and taking antidepressants, but she stopped when her doctor retired. She didn't fully understand that her anxiety was itself a diagnosable condition when, in late 2021, she went to see Dr. Eric Lenze, chief of the psychiatry division at the Washington University School of Medicine in St. Louis, for assistance with a separate health issue.

I just assumed that worrying was just the way things were, she added. "I think I've got it ever since I was young. It was how I normally thought, to me.

Many older folks have empathy. The most prevalent mental health condition is anxiety; according to a 2017 survey of older persons in six nations, more than 17% had an anxiety disorder in the previous year.

Seniors are most likely to suffer from generalised anxiety disorder, according to Ms. Tilton's diagnosis. Dr. Carmen Andreescu, a geriatric psychiatrist at the University of Pittsburgh School of Medicine and the author of a recent editorial on late-life anxiety in JAMA Psychiatry, stated that strong, difficult-to-control worry is the most noticeable sign.

There is a persistent worry that something negative may occur, she continued. That may consume all of your time.

Social anxiety disorder, phobias, panic disorder, and post-traumatic stress disorder are examples of other types of anxiety. Depression and anxiety co-occur frequently, making diagnosis and therapy more challenging. All adult age groups had an increase in anxiety and despair as a result of the coronavirus pandemic, of course.

A draught suggestion from the United States Preventative Services Task Force, an independent expert council that evaluates research on preventive interventions, has recently raised awareness of anxiety.

The panel recommended that adults between the ages of 18 and 64, including those who are expecting or recently gave birth, have an anxiety screening. It gave this suggestion a "B" grade, denoting that it had "moderate net benefit." Testing patients who may be having a certain health problem but do not yet have symptoms or cause concern is known as screening.

Nonetheless, the task committee gave seniors 65 and over a "I" rating, indicating that there was inadequate proof of both advantages and dangers.

Lori Pbert, a clinical psychologist and health behaviour researcher at the University of Massachusetts Chan Medical School who served on the panel, said of the procedure, "It's a really scientifically rigorous process."

"Evidence was inadequate on the accuracy of screening methods and the advantages and hazards of screening," she said, referring to older persons. The team also desired further proof of the efficacy of the treatments.

It's a powerful plea for the required clinical study, according to Dr. Pbert. Later this year, the task force will release its final proposal.

Dr. Andreescu and the editorial's other authors, including Dr. Lenze, respectfully disagree but strongly do. According to Dr. Lenze, a rating of "I" "makes people not look for or treat something that is already an undertreated condition."

"I think screening is called for with a common condition that produces a lot of quality of life impairment and that has easy, inexpensive, uncomplicated types of treatments," he continued.

Regardless of the task force's eventual decision, the discussion of anxiety among older persons brings to light a common yet sometimes disregarded mental health issue. The majority of these cases "go under the radar," according to Dr. Andreescu.

That may be indicative of how anxiety symptoms might vary among older patients, whose primary care physicians frequently lack the training to identify mental health illnesses. Seniors may acquire a fear of falling, engage in hoarding, or complain of physical discomforts as muscle tension, a choking sensation, dizziness, or shakiness. They may also experience acute stress, insomnia, or irritability.

However older patients' unwillingness to attribute their symptoms to psychological difficulties also contributes to underdiagnosis. Some people dislike the term "anxious," according to Dr. Andreescu. "They'd like to refer to it as 'high stress,' which doesn't suggest psychological fragility."

Also, because ageing carries real risks for anxiety and sadness, such as falls and bereavement, some people might regard anxiety as commonplace, like Ms. Tilton did.

Yet there are terrible repercussions. Our bodies' and brains' health are affected, according to Dr. Andreescu. Research have shown a link between cardiovascular disease and anxiety, with significantly higher risks of coronary heart disease, heart failure, stroke, and mortality. People who experience increased anxiety are also more likely to abuse drugs or alcohol.

Also, research repeatedly demonstrates a connection between anxiety and dementia and cognitive decline. According to Dr. Andreescu's neuroimaging research, "worry actually causes the brain to age and shrink," she added.

And it makes people's daily life worse. Jim Wright, a businessman from Pittsburgh who took part in Dr. Andreescu's study, said he experienced "a lot of sleepless nights."

Mr. Wright, 60, who also has developed difficult-to-control hypertension, said, "I'll wake up at 2 a.m. and lie there worrying about every crazy thing you can think of.

Another research participant, 81-year-old John Modell, a retired history professor in Pittsburgh, concerns about memory loss, getting lost on neighbor hood walks, and getting stuck in airports while travelling. Mr. Modell, whose father passed away from Alzheimer's disease, remarked, "I'm aware of being anxious 20 or 50 times a day." His ailments have prevented him from travelling and have limited his social activities; he believes they also had a part in the divorce.

Neither man has ever sought anxiety treatment. Mr. Wright remarked, "I've learned to deal with it. However, antidepressants known as selective serotonin reuptake inhibitors, such as Prozac, Lexapro, and Zoloft, can be used to alleviate anxiety when paired with specific types of cognitive behavioural therapy.

(Long-term usage is not advised for benzodiazepines and related medications, which many seniors use for momentary relief from insomnia and anxiety. Dr. Lenze stated that "the risks of confusion and falls are well-known." They are also habit-forming drugs. They're more difficult to stop.

Doctors start cautiously because older patients require larger antidepressant doses and are usually already taking numerous drugs. Treatment  of older nervous people "is a tougher issue," according to Dr. Andreescu. "It's more difficult,"

According to her, the medications can take weeks longer to provide relief than in younger individuals, which could cause patients to quit taking them because they feel like they aren't working. Moreover, older patients may relapse and need a different treatment plan.

But with time, Dr. Andreescu assured, "we do bring it under control." Treatment works on some people.

For instance, Ms. Tilton claimed to have regained her composure. Dr. Lenze raised her duloxetine (marketed as Cymbalta) dosage and added mirtazapine to it (Remeron). She declared, "I'm feeling great right now.

A special pleasure: better sleep. She said, "I can lay down on the bed and pass off in a second. It's truly a delight.