1. How is an anxiety disorder different from just feeling anxious or worried?
If you have an anxiety disorder, worry or fear becomes long-term and may get worse instead of better as time goes on. Doctors and older adults tend to view anxiety and fear as normal given the circumstances of aging. But developing an anxiety disorder late in life is not a normal part of aging.
Anxiety caused by stressful events like moving or losing a job is a normal part of life. But anxiety disorders are different. An anxiety disorder lasts a long time and can get worse if it is not treated.
2. How common are anxiety disorders among older adults?
Studies estimate that anxiety disorders affect between 3 and 14 percent of older adults in a given year. More women than men experience anxiety disorders. They tend to be less common among older adults than younger adults.
3. What other illnesses can coexist with an anxiety disorder?
In older adults, anxiety disorders often occur at the same time as depression, heart disease, diabetes, and other medical problems. In some cases, these other illnesses need to be treated before a person will respond to treatment for the anxiety disorder.
4. What are the different types of anxiety disorders?
Anxiety disorders are a collection of disorders that include generalized anxiety disorder (GAD), social phobia panic disorder, post-traumatic stress disorder (PTSD), obsessive- compulsive disorder (OCD), and specific phobias.
5. What is generalized anxiety disorder (GAD)?
In generalized anxiety disorder (GAD), a person becomes very worried about things like health, money, and family problems, even if everything is OK. A person may be very anxious about just getting through the day.
6. What is social phobia?
In social phobia a person fears being judged by others or of being embarrassed. This fear can get in the way of doing everyday things such as going to work, running errands or meeting with friends. People who have social phobia often know that they shouldn’t be so afraid, but they can’t control their fear.
7. What is panic disorder?
In panic disorder, a person has sudden, unexplained attacks of terror, and often feels his or her heart pounding. During a panic attack, a person feels a sense of unreality, a fear of impending doom, or a fear of losing control. Panic attacks can occur at any time.
8. What is post-traumatic stress disorder (PTSD)?
Post-traumatic stress disorder (PTSD) develops after undergoing a terrifying ordeal like an accident or an act of violence. A person who develops PTSD may have been the one who was harmed, or have a loved one who was harmed, or have witnessed a harmful event.
9. What is obsessive-compulsive disorder (OCD)?
People with obsessive-compulsive disorder (OCD) feel the uncontrollable need to check things over and over, or they may have certain thoughts or perform certain routines over and over. The thoughts and rituals of OCD cause distress and get in the way of daily life.
The repeated, upsetting thoughts of OCD are called obsessions. To try to control them, people with OCD repeat rituals or behaviors, which are called compulsions. People with OCD can’t control these thoughts and rituals.
10. What is a phobia?
A specific phobia is an intense, extreme fear of something that poses little or no actual danger. Some of the more common specific phobias involve closed-in places, heights, escalators, tunnels, highway driving, water, flying, dogs, and the sight of blood.
11. Which anxiety disorders are most and least common among older adults?
Although the research is limited, some studies have found that specific phobias and GAD are the most common anxiety disorders among older adults. OCD and PTSD appear to be the least common, but there is little research on the prevalence of these illnesses in older populations.
12. Does an anxiety disorder look different in an older adult compared to a young adult?
Sometimes, yes. Brain studies have shown that older adults tend to experience and process emotions differently than younger adults. They also have different concerns. For example, they may worry more about health and disability, and have fewer concerns about work, finances, and family compared to younger adults.
Anxiety disorders among older adults frequently occur at the same time as other illnesses such as depression, diabetes, heart disease, or a number of other medical illnesses. Problems with cognition (thinking) and changes in life circumstances can also complicate matters.
13. Is it difficult to diagnose an anxiety disorder in older adults?
Because anxiety disorders may look different in older adults compared to younger adults, they can be difficult to detect and diagnose. Doctors can have difficulty distinguishing between anxiety caused by adapting to difficult life changes, and a true anxiety disorder. For example, if you fell and broke a hip, you may be justifiably fearful of going out for a while. But that would not mean you have developed an anxiety disorder.
Also, older adults may express their anxiety with a doctor differently than younger adults. For example, they may express anxiety in physical terms such as feeling dizzy or shaky, while younger adults may express it in more psychological terms.
Older adults may also have more difficulty answering complex screening questionnaires if they have diminished cognitive abilities or memory problems.
Sometimes the physical symptoms of other illnesses can get mixed up with the symptoms of anxiety, making it difficult to determine if a person has a true anxiety disorder. For instance, a person with heart disease sometimes has chest pain, which can also be a symptom of a panic disorder.
Muscle tightness, feeling very tense all the time, and difficulty sleeping can also be symptoms of a physical illness or an anxiety disorder, or both, complicating diagnosis. As a result of these complications, doctors may miss the anxiety disorder.
14. What should I do if I think I have an anxiety disorder?
If you think you have an anxiety disorder, the first person you should see is your family doctor. A physician can determine whether the symptoms that alarm you are due to an anxiety disorder, another medical condition, or both.
If an anxiety disorder is diagnosed, the next step is usually seeing a mental health professional. The practitioners who are most helpful with anxiety disorders are those who have training in cognitive behavioral therapy and/or behavioral therapy, and who are open to using medication if it is needed.
You should feel comfortable talking with the mental health professional you choose. If you do not, you should seek help elsewhere. Once you find a mental health professional with whom you are comfortable, the two of you should work as a team and make a plan to treat your anxiety disorder together.
15. What increases my risk for developing an anxiety disorder?
Some factors that appear to be associated with an increased risk for an anxiety disorder in late life include being female; having several chronic medical conditions; being single, divorced or separated; and having less education.
Experiencing stressful life events, being physically limited in daily activities, and having had difficult childhood experiences also increase a person’s risk for developing an anxiety disorder.
Having depression also increases a person’s risk for an anxiety disorder in all age groups, although it is not clear whether the depression or anxiety usually comes first. Other medical problems such as stomach or digestive problems, hyperthyroidism, heart disease, respiratory problems, Parkinson’s disease, balance problems, and diabetes also are associated with anxiety.
16. What are the symptoms of generalized anxiety disorder (GAD)?
People with GAD often worry about everything, even if there is no reason to worry. They can’t control their worries and can’t relax. They may be easily startled, and have trouble falling or staying asleep.
They may also have physical symptoms such as feeling tired, having headaches and muscle aches, having a hard time concentrating, trembling or twitching, sweating, having hot flashes, and having to go to the bathroom a lot. They may also be irritable.
17. What are the symptoms of social phobia?
People with social phobia are very anxious about being with other people. They feel very self-conscious around other people, have a hard time talking to others, and worry about being embarrassed.
They may worry for days or weeks before an event where they will meet other people. They may have a hard time making friends, and may isolate themselves. They may also have physical symptoms such as blushing, heavy sweating, trembling, and nausea.
18. What are the symptoms of panic disorder?
People with panic disorder experience marked attacks of fear. During an attack, they may sweat a lot, feel weak or faint, or feel dizzy. They may feel flush or chilled, and their hands may tingle or feel numb. They may also feel nauseous, have chest pain, or have difficulty breathing.
People with panic disorder also sometimes fear they are having a heart attack, losing their minds, or are about to die. They can’t predict when an attack will occur, so they often worry intensely in between episodes and dread the next attack, causing even more anxiety.
19. What are the symptoms of post-traumatic stress disorder (PTSD)?
People with post-traumatic stress disorder (PTSD) constantly re-live the trauma they experienced while awake, and in nightmares while asleep. These are called flashbacks and may include images, sounds, smells, or feelings. They may be triggered by ordinary events, such as a door slamming or a car backfiring.
People with PTSD may startle easily, become emotionally distant especially with loved ones, lose interest in things they once enjoyed, be irritable, become aggressive, or even become violent. They may avoid situations that remind them of the traumatic incident. People with PTSD often have depression, too.
20. What are the symptoms of obsessive-compulsive disorder (OCD)?
People with obsessive-compulsive disorder (OCD) have repeated and unwanted thoughts or images about things such as fear of germs, dirt, or intruders; violent or sexual acts; hurting loved ones; or being overly tidy.
They conduct the same rituals over and over, such as washing hands, locking and unlocking doors, counting, keeping unneeded items, or repeating the same actions again and again. They do not get pleasure from these rituals, but performing the rituals may give them brief relief from the anxiety the thoughts cause.
People with OCD have these thoughts and do these rituals for at least an hour, often longer, on most days. People with OCD can’t stop the thoughts or rituals, so they sometimes miss work or meetings with friends.
21. What are the symptoms of a specific phobia?
People with a specific phobia have an irrational, extreme fear of a particular thing. Although they may realize the fear is irrational, they often find that facing, or even thinking about facing, the feared object or situation brings on a panic attack or severe anxiety.
22. How are anxiety disorders typically treated?
Most disorders can be treated with medication or psychotherapy. For some, a combination of medication and psychotherapy may be the best treatment approach.
23. What are the most common types of antidepressants used to treat anxiety disorders?
Antidepressants are increasingly recommended to treat anxiety disorders in older adults. They are most commonly prescribed to treat generalized anxiety disorder (GAD) and panic disorder.
The newest and most popular types of antidepressant medications are called selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). SSRIs include fluoxetine (Prozac), citalopram (Celexa), and several others. SNRIs include venlafaxine (Effexor) and duloxetine (Cymbalta).
The most common side effects of SSRIs and SNRIs include headache, nausea, insomnia or nervousness, agitation or a jittery feeling, and sexual problems. Often they are mild and temporary. However, any unusual reactions or side effects that interfere with normal functioning should be reported to a doctor immediately.
24. What other types of antidepressants can help anxiety disorders?
For some people, older classes of antidepressants such as tricyclics and monoamine oxidase inhibitors (MAOIs) may be a better choice.
People taking MAOIs must follow strict food and medicine guidelines to avoid potentially serious interactions. They must avoid substances that contain high levels of the chemical tyramine which is found in many cheeses, wines, and pickles and in some medications including decongestants.
MAOIs interact with tyramine in a way that may cause a sharp rise in blood pressure, possibly leading to a stroke. A doctor should give a patient taking an MAOI a complete list of foods, medicines, and substances to avoid.
25. How should antidepressants be taken?
For all types of antidepressants, patients must take regular doses for at least three to four weeks, sometimes longer, before they are likely to feel the full benefit. They should continue taking the medication for an amount of time specified by their doctor, even if they are feeling better, to prevent the anxiety from returning.
Stopping medication should be done only under a doctor’s supervision. An antidepressant needs to be gradually stopped to give the body time to adjust. Some people may need to stay on the medication for a long time.
For older adults who are already taking several medications for other conditions, it is important to talk with a doctor about any adverse drug interactions that may occur while taking antidepressants.
26. What types of anti-anxiety medications are used to treat anxiety disorders?
Benzodiazepines are a type of anti-anxiety medication sometimes used to treat anxiety disorders in older adults. Benzodiazepines include clonazepam (Klonopin), which is used for social phobia and generalized anxiety disorder (GAD); lorazepam (Ativan), which is used for panic disorder; and alprazolam (Xanax), which is used for panic disorder and GAD.
The most common side effects for benzodiazepines are drowsiness and dizziness. Other possible side effects include upset stomach, blurred vision, headache, confusion, grogginess, and nightmares. In older adults, they can also increase the risk for falling any may cause memory problems.
Buspirone (Buspar) is an anti-anxiety medication used to treat GAD. Unlike benzodiazepines, however, it takes at least two weeks for buspirone to begin working.
27. How should anti-anxiety medications be taken?
Benzodiazepines can be habit-forming, so they should be taken with caution. Also, they tend to stay in an older adult’s system longer than in younger adults, because older adults tend to have slower metabolisms. As a result, they can accumulate in the body faster than in younger adults. Therefore, benzodiazepines should only be used for a limited amount of time.
28. Will psychotherapy help me?
A type of psychotherapy called cognitive-behavioral therapy (CBT) is very useful in treating anxiety disorders. The cognitive part helps people change the thinking patterns that support their fears, and the behavioral part helps people change the way they react to anxiety-provoking situations.
29. How can cognitive behavioral therapy help with obsessive-compulsive disorder?
People with obsessive-compulsive disorder (OCD) who fear dirt and germs are encouraged to get their hands dirty and wait increasing amounts of time before washing them. The therapist helps the person cope with the anxiety that waiting produces. After the exercise has been repeated a number of times, the anxiety may lessen.
30. How can cognitive behavior therapy help with social phobia?
Cognitive behavioral therapy can help people with social phobia learn how to overcome the belief that others are always watching and judging them. When people are ready to confront their fears, they are shown how to use exposure techniques to desensitize themselves to situations that trigger their anxieties.
For example, people with social phobia may be encouraged to spend time in feared social situations and to make small social blunders and observe how people respond to them. Since the response is usually far less harsh than the person fears, the anxiety lessens.
31. How can cognitive behavioral therapy help with post-traumatic stress disorder (PTSD)?
People with post traumatic stress disorder (PTSD) may be helped by recalling their traumatic event in a safe environment, which helps reduce the fear it produces. Cognitive behavioral therapists also teach deep breathing and other types of exercises to relieve anxiety and encourage relaxation.
32. How is exposure-based behavioral therapy used?
Exposure-based behavioral therapy is used to treat specific phobias. The person gradually encounters the object or situation that is feared, perhaps at first only through pictures or tapes, then later face-to-face. Often the therapist will accompany the person to a feared situation to provide support and guidance.
33. What is being done to improve understanding and treatment of anxiety disorders in older adults?
The research on treating anxiety disorders in older adults lags behind other fields. Many studies of anxiety treatments limit their enrollment to participants younger than 65, thereby excluding older adults.
Among studies that do include older adults, results have suggested that cognitive behavioral therapy (CBT) may be less effective in older adults compared to younger adults. However, CBT may be more effective if it is modified to address the specific issues and limitations that are unique to older adults.
Doctors once believed that older adults did not develop anxiety disorders. They believed anxiety disorders were specific to younger people. Researchers are just now beginning to understand how anxiety disorders affect older adults. But much more research is needed.