Anxiety Disorder

Everyone feels some degree of anxiety from time to time. We have all felt the racing heart, queasy stomach, or sweaty palms associated with an anxious feeling. But when this feeling becomes so intense and prolonged that it interferes with daily living, it is possible that an anxiety disorder could be the cause. Anxiety can be described as an ongoing feeling of worry, distress, fear, or a rising sense of dread that something is very wrong. Up to 14% of older adults meet the diagnostic criteria for an anxiety disorder. An even greater percentage of older adults have anxiety symptoms that significantly impact their functioning, quality of life and relationships even though they do not meet diagnostic criteria. Anxiety disorders are often unrecognized and untreated in older adults.

Risk factors specific to late-life anxiety include:

• Chronic medical conditions – especially chronic obstructive pulmonary disease (COPD), cardiovascular disease, thyroid disease and diabetes
• Perceived (self-reported) poor health
• Sleep disturbances
• Pain
• Side effects of medications, e.g., steroids, antidepressants, stimulants, inhalers
• Alcohol or drug (including prescription and over-the-counter) misuse or abuse
• Physical limitations in daily activities
• Stressful life events
• Traumatic or stressful childhood events
• Distress for physical or social changes
• Isolation and/or loneliness

Symptoms of anxiety may be directly related to a physical illness or the medications taken for an illness. For example, people with chronic heart disease have a higher than average rate of anxiety, and some prescribed heart medications have side effects of anxiety.

Symptoms of anxiety are common among people who are caregivers for ill or frail loved ones. The stress of the responsibility of caregiving as well as the caregiver’s health and support system are significant factors in the onset or worsening of an anxiety disorder. Generalized anxiety disorder is much more than the normal anxiety that people may experience day to day. It is constant and fills one’s day with worry and tension. People with generalized anxiety disorder may know that their feelings don’t make sense, but they cannot control or stop them. Symptoms may come without warning.

Symptoms of generalized anxiety disorder include:

• Expectation of disaster
• Worrying excessively about health, money, family, work, or problems
• Feeling overwhelmed by daily routines or tasks
• Inability to overcome concerns – concerns may intensify without reason
• Difficulty relaxing and easily startled, difficulty falling or staying asleep
• Difficulty concentrating or making decisions
• Physical symptoms such as fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, hot flashes, light-headedness, shortness of breath, nausea, frequent urination

Because symptoms of anxiety are often felt as physical discomfort, many older adults with anxiety disorders end up in doctor’s offices or emergency rooms with complaints of physical concerns such as chest pain, headaches, stomach problems, and frequent urination. They often experience substantial medical testing before an anxiety disorder is finally diagnosed whereas an anxiety screening or assessment would have been quicker, cheaper and less frightening. Anxiety is highly treatable and people shouldn’t wait for the symptoms to become disabling. Some people may not recognize symptoms of anxiety because they have lived with it for so long that the symptoms have become the person’s “normal” experience.

Anxiety symptoms might also be normalized if it is the culture of the family. For example, if a child grows up with a parent who exhibits traits of anxiety in the form of worrying and fretting all of the time, that child may consider that behavior to be normal. Feeling worried, overwhelmed and on edge can seem perfectly “in sync” in families where anxiety is a shared experience.