Anxiety Disorders Anxiety Disorders

in the Elderly in the Elderly

Janel Gauthier, Ph. D.

Recommended treatment modalities Among older people (65 years of age and older), many worry about their health,
family, financial situation and mortality. These worries are even more likely to
Research shows that anxiety disorders in the elderly are treatable. Medication arise when they feel that their physical and mental capacities are diminishing
and behavioral or cognitive psychotherapy are the recommended treatment and that they are loosing their autonomy. This is considered as normal anxiety.
modalities. They can be used alone or in association. However, sometimes anxiety is so intense that it causes significant impairment
In the case of medication, antidepressants (in in the persons daily functioning and becomes an important source of distress.
Medication and behavioral This kind of anxiety is not normal and it is called an anxiety disorder.
or cognitive psychotherapy are
particular selective serotonin reuptake
the recommended inhibitors or SSRIs and serotonin and norepi- Prevalence of anxiety disorders in the elderly is
nephrine reuptake inhibitors or SNRIs) are This kind of anxiety is not
treatment modalities. high. Current research shows that between 5.5 and normal and it is called
considered as the first line treatment for the 10% of seniors are suffering from an anxiety disor- an anxiety disorder.
majority of anxiety disorders. This medication class includes notably fluoxetine, der. Their prevalence is even higher in persons
sertraline, paroxetine, citalopram and venlafaxine. Antidepressants have general- living in institutions like a retirement home. Among them, women are twice as
ly to be taken for several weeks before their therapeutic effects are noticed. likely to suffer from an anxiety disorder as men. Anxiety disorders are at least
Anxiolytics, especially benzodiazepines like lorazepam and alprazolam, have the two times more frequent than depression in the elderly.
advantage of calming anxiety more effectively than antidepressants in the short-
The most common anxiety disorders in this age group are specific phobia, agora-
term. However, it is highly recommended to limit their use in the elderly to small
phobia, generalized anxiety disorder and social anxiety disorder. Obsessive-com-
doses during short periods of time, not exceeding six months. In fact, these med-
pulsive disorder, panic disorder and post-traumatic stress disorder are the less
ications can provoke or worsen memory problems, balance problems that can
frequent.
cause falls and psychomotor problems that can impair driving and cause road
accidents. A person with an anxiety disorder not properly treated is at risk of developing
another anxiety disorder or depression. It is thus important that older persons
As for psychotherapy, cognitive-behavioral therapy (CBT) is the preferred treat-
consult a health professional as soon as possible if
ment. It is a form of therapy that involves notably cognitive restructuring (a stra- Anxiety disorders are at least
they think that they are suffering from an anxiety
tegy consisting in questioning the thoughts that generate anxiety, in order to two times more frequent than
disorder. A variety of treatments are available to
replace them with more realistic and less catastrophic thoughts) and exposure (a depression in the elderly.
help them.
strategy consisting in the gradual and systematic confrontation of anxiety-pro-
voking objects or situations,in order to desensitize the person in face of anxiety). Ginny is 79 years old and she has been a widow for two years. She lives
Psychotherapy may take several weeks or months. alone in an apartment since her husband died. A few months ago, she fell
In the case of medication, and fractured her hip stepping out the door of her apartment. She was hos-
In the treatment of anxiety, it is important to reduce
antidepressants are considered pitalized and operated on. She is now able to walk. However, her doctor
and, if possible, eliminate all substances that stimu-
as the first line treatment referred her to an anxiety disorders clinic, because he found that she had
late the nervous system, because they can increase
for the majority developed various fears. For example, when she is by herself, she is afraid
anxiety. For example, caffeine is a stimulant that of anxiety disorders. to feel faint or of having vertigo and lose her balance. She very rarely goes
should be avoided coffee, tea, chocolate and many
out by herself. One of her daughters accompanies her when she goes out
soft drinks contain caffeine. Certain over-the-counter medications (e.g., cold
shopping. She describes herself as always having been nervous and wor-
medications) and certain herbal products contain caffeine or other stimulants
ried. However, her nervousness has worsened since the death of her hus-
(e.g., ephedrine).
band. She worries about the future and has difficulty falling asleep
Alcohol should also be avoided. Even though it seems to bring relieve, which is at because of her concerns. In addition, after hearing recently on the news
best only transitory, it will affect the sleep and well-being of the person in the

4 1
Anxiety Disorders Anxiety Disorders
in the Elderly in the Elderly

about old people having been attacked and robbed, she worries about her tigo or feeling unsteady or faint, numbness or tingling, chills or hot flashes, rest-
security. She keeps her blinds closed and checks to see if her door is locked lessness or over-alertness or feeling of being at the end of ones rope, difficulty
several times a day. She feels more and more isolated and alone. At certain concentrating or memory gaps, irritability, tiredness or sleep disturbances.
times, she asks God to come and get her. She is being treated with a form It is difficult to identify the presence of an anxiety
of psychotherapy known as cognitive-behavioral therapy. In less than disorder in the elderly, because it often takes the Criteria that clearly differentiate
eight weeks, her symptoms have diminished considerably and her level of anxiety disorders in the young
form of a physical complaint that masks an under- do not always differentiate
functioning is now comparable to what it was before her accident. lying disorder. This represents a challenge for at them well in older persons.
least three reasons. To begin with, there is an
What causes anxiety disorders in the elderly ? important overlapping between symptoms related to an anxiety problem and
The causes of anxiety disorders in the elderly are numerous. Those who develop those caused by physical health problems (e.g., hyperthyroidism, cardiovascular
an anxiety disorder are often persons who suffered from such a disorder when disorders) or by other mental health problems (e.g., dementia) that tend to occur
they where younger. On the other hand, some subjects present an anxiety disor- with aging. Secondly, the medication consumption increases with age and cer-
der for the first time at an old age. Certain older persons are biologically predis- tain drugs have side effects that mimic anxious symptoms. Thirdly, the fact that
posed to develop an anxiety disorder because of diagnostic criteria for anxiety disorders are based on studies conducted among
their heredity. Neurobiological changes occurring Elements provoking anxiety in young adults, that thus excluded the elderly. Criteria that clearly differentiate
with age can also make them more vulnerable to an- seniors are the losses sustained anxiety disorders in the young do not always differentiate them well in older per-
naturally during the aging sons.
xiety. Elements provoking anxiety in seniors are the
process and the thoughts of
losses sustained naturally during the aging process danger and vulnerability
(e.g., loss of a loved one, of health, of intellectual Types of anxiety disorders
associated with these losses.
capacity, of autonomy) and the thoughts of danger Diagnoses of anxiety disorders vary according to what causes the anxiety. In the
and vulnerability associated with these losses. The losses do not have to be real case of generalized anxiety disorder, anxiety is related to fear of uncertainty
to cause anxiety, suffice that they are apprehended. The more the elderly have worries are excessive and concern various events or activities. In social anxiety
doubts about their capacities to adapt to these losses, the more they are at risk disorder, anxiety is generated by the fear of appearing ill-at-ease or of being
of becoming anxious and developing an anxiety problem. ridiculed in public. In agoraphobia, anxiety is caused by the fear of having a panic
attack in places or situations where it would be difficult or embarrassing to seek
Principal symptoms and characteristics help being alone outside the house, in a bus or on a train, in a crowd or in a wai-
of anxiety disorders ting line. In specific phobia, anxiety is linked to the fear of a specific object or
situation flying, having an injection or seeing blood. In the obsessive-compul-
Anxiety disorders are characterized by a persistent and intense fear of objects, sive disorder, the object of anxiety is related to the consequences of intrusive
persons, situations or events that disrupt considerably the persons usual activi- and inappropriate thoughts the subject fears to lose control if he is not able to
ties. Exposure to what is feared almost systematically generates anxiety that can eliminate these thoughts. In panic disorder, anxiety arises from the fear of what
take the form of a panic attack. The object of apprehension is avoided or faced could happen during a panic attack like a heart attack. In post-traumatic stress
with intense anxiety and great distress. Experiencing these fears brings about disorder, the object of anxiety is related to all the stimuli associated with the
important suffering. traumatic event, including thoughts, feelings and memories.
Anxious symptoms are numerous and varied. An anxious person can present one
or more of the following symptoms: palpitations, muscular tension, feeling out
of breath or of being suffocated,chest pain,nausea or abdominal discomfort,ver-

2 3
Anxiety Disorders Anxiety Disorders
in the Elderly in the Elderly

about old people having been attacked and robbed, she worries about her tigo or feeling unsteady or faint, numbness or tingling, chills or hot flashes, rest-
security. She keeps her blinds closed and checks to see if her door is locked lessness or over-alertness or feeling of being at the end of ones rope, difficulty
several times a day. She feels more and more isolated and alone. At certain concentrating or memory gaps, irritability, tiredness or sleep disturbances.
times, she asks God to come and get her. She is being treated with a form It is difficult to identify the presence of an anxiety
of psychotherapy known as cognitive-behavioral therapy. In less than disorder in the elderly, because it often takes the Criteria that clearly differentiate
eight weeks, her symptoms have diminished considerably and her level of anxiety disorders in the young
form of a physical complaint that masks an under- do not always differentiate
functioning is now comparable to what it was before her accident. lying disorder. This represents a challenge for at them well in older persons.
least three reasons. To begin with, there is an
What causes anxiety disorders in the elderly ? important overlapping between symptoms related to an anxiety problem and
The causes of anxiety disorders in the elderly are numerous. Those who develop those caused by physical health problems (e.g., hyperthyroidism, cardiovascular
an anxiety disorder are often persons who suffered from such a disorder when disorders) or by other mental health problems (e.g., dementia) that tend to occur
they where younger. On the other hand, some subjects present an anxiety disor- with aging. Secondly, the medication consumption increases with age and cer-
der for the first time at an old age. Certain older persons are biologically predis- tain drugs have side effects that mimic anxious symptoms. Thirdly, the fact that
posed to develop an anxiety disorder because of diagnostic criteria for anxiety disorders are based on studies conducted among
their heredity. Neurobiological changes occurring Elements provoking anxiety in young adults, that thus excluded the elderly. Criteria that clearly differentiate
with age can also make them more vulnerable to an- seniors are the losses sustained anxiety disorders in the young do not always differentiate them well in older per-
naturally during the aging sons.
xiety. Elements provoking anxiety in seniors are the
process and the thoughts of
losses sustained naturally during the aging process danger and vulnerability
(e.g., loss of a loved one, of health, of intellectual Types of anxiety disorders
associated with these losses.
capacity, of autonomy) and the thoughts of danger Diagnoses of anxiety disorders vary according to what causes the anxiety. In the
and vulnerability associated with these losses. The losses do not have to be real case of generalized anxiety disorder, anxiety is related to fear of uncertainty
to cause anxiety, suffice that they are apprehended. The more the elderly have worries are excessive and concern various events or activities. In social anxiety
doubts about their capacities to adapt to these losses, the more they are at risk disorder, anxiety is generated by the fear of appearing ill-at-ease or of being
of becoming anxious and developing an anxiety problem. ridiculed in public. In agoraphobia, anxiety is caused by the fear of having a panic
attack in places or situations where it would be difficult or embarrassing to seek
Principal symptoms and characteristics help being alone outside the house, in a bus or on a train, in a crowd or in a wai-
of anxiety disorders ting line. In specific phobia, anxiety is linked to the fear of a specific object or
situation flying, having an injection or seeing blood. In the obsessive-compul-
Anxiety disorders are characterized by a persistent and intense fear of objects, sive disorder, the object of anxiety is related to the consequences of intrusive
persons, situations or events that disrupt considerably the persons usual activi- and inappropriate thoughts the subject fears to lose control if he is not able to
ties. Exposure to what is feared almost systematically generates anxiety that can eliminate these thoughts. In panic disorder, anxiety arises from the fear of what
take the form of a panic attack. The object of apprehension is avoided or faced could happen during a panic attack like a heart attack. In post-traumatic stress
with intense anxiety and great distress. Experiencing these fears brings about disorder, the object of anxiety is related to all the stimuli associated with the
important suffering. traumatic event, including thoughts, feelings and memories.
Anxious symptoms are numerous and varied. An anxious person can present one
or more of the following symptoms: palpitations, muscular tension, feeling out
of breath or of being suffocated,chest pain,nausea or abdominal discomfort,ver-

2 3
Anxiety Disorders Anxiety Disorders
in the Elderly in the Elderly
Janel Gauthier, Ph. D.

Recommended treatment modalities Among older people (65 years of age and older), many worry about their health,
family, financial situation and mortality. These worries are even more likely to
Research shows that anxiety disorders in the elderly are treatable. Medication arise when they feel that their physical and mental capacities are diminishing
and behavioral or cognitive psychotherapy are the recommended treatment and that they are loosing their autonomy. This is considered as normal anxiety.
modalities. They can be used alone or in association. However, sometimes anxiety is so intense that it causes significant impairment
In the case of medication, antidepressants (in in the persons daily functioning and becomes an important source of distress.
Medication and behavioral This kind of anxiety is not normal and it is called an anxiety disorder.
or cognitive psychotherapy are
particular selective serotonin reuptake
the recommended inhibitors or SSRIs and serotonin and norepi- Prevalence of anxiety disorders in the elderly is
nephrine reuptake inhibitors or SNRIs) are This kind of anxiety is not
treatment modalities. high. Current research shows that between 5.5 and normal and it is called
considered as the first line treatment for the 10% of seniors are suffering from an anxiety disor- an anxiety disorder.
majority of anxiety disorders. This medication class includes notably fluoxetine, der. Their prevalence is even higher in persons
sertraline, paroxetine, citalopram and venlafaxine. Antidepressants have general- living in institutions like a retirement home. Among them, women are twice as
ly to be taken for several weeks before their therapeutic effects are noticed. likely to suffer from an anxiety disorder as men. Anxiety disorders are at least
Anxiolytics, especially benzodiazepines like lorazepam and alprazolam, have the two times more frequent than depression in the elderly.
advantage of calming anxiety more effectively than antidepressants in the short-
The most common anxiety disorders in this age group are specific phobia, agora-
term. However, it is highly recommended to limit their use in the elderly to small
phobia, generalized anxiety disorder and social anxiety disorder. Obsessive-com-
doses during short periods of time, not exceeding six months. In fact, these med-
pulsive disorder, panic disorder and post-traumatic stress disorder are the less
ications can provoke or worsen memory problems, balance problems that can
frequent.
cause falls and psychomotor problems that can impair driving and cause road
accidents. A person with an anxiety disorder not properly treated is at risk of developing
another anxiety disorder or depression. It is thus important that older persons
As for psychotherapy, cognitive-behavioral therapy (CBT) is the preferred treat-
consult a health professional as soon as possible if
ment. It is a form of therapy that involves notably cognitive restructuring (a stra- Anxiety disorders are at least
they think that they are suffering from an anxiety
tegy consisting in questioning the thoughts that generate anxiety, in order to two times more frequent than
disorder. A variety of treatments are available to
replace them with more realistic and less catastrophic thoughts) and exposure (a depression in the elderly.
help them.
strategy consisting in the gradual and systematic confrontation of anxiety-pro-
voking objects or situations,in order to desensitize the person in face of anxiety). Ginny is 79 years old and she has been a widow for two years. She lives
Psychotherapy may take several weeks or months. alone in an apartment since her husband died. A few months ago, she fell
In the case of medication, and fractured her hip stepping out the door of her apartment. She was hos-
In the treatment of anxiety, it is important to reduce
antidepressants are considered pitalized and operated on. She is now able to walk. However, her doctor
and, if possible, eliminate all substances that stimu-
as the first line treatment referred her to an anxiety disorders clinic, because he found that she had
late the nervous system, because they can increase
for the majority developed various fears. For example, when she is by herself, she is afraid
anxiety. For example, caffeine is a stimulant that of anxiety disorders. to feel faint or of having vertigo and lose her balance. She very rarely goes
should be avoided coffee, tea, chocolate and many
out by herself. One of her daughters accompanies her when she goes out
soft drinks contain caffeine. Certain over-the-counter medications (e.g., cold
shopping. She describes herself as always having been nervous and wor-
medications) and certain herbal products contain caffeine or other stimulants
ried. However, her nervousness has worsened since the death of her hus-
(e.g., ephedrine).
band. She worries about the future and has difficulty falling asleep
Alcohol should also be avoided. Even though it seems to bring relieve, which is at because of her concerns. In addition, after hearing recently on the news
best only transitory, it will affect the sleep and well-being of the person in the

4 1
 Anxiety Disorders
in the Elderly

long run. Even taken in moderation (e.g., two drinks a day), alcohol can worsen
anxiety, depression and even dementia.
When older persons receive a medical prescription for anxiety, it is important
that they inform their doctor or pharmacist of all the medications or natural
Editorial products they are taking, because these products can interact negatively with
committee : the medication prescribed.
Denis Audet , Practical recommendations for persons
Family Physician
who have aging parents
Louis Blanchette,
ADAC/ACTA If you have an aging parent, and you think he is suffering from an anxiety pro-
blem, encourage him to talk to his doctor about the changes you have noticed in
Stphane Bouchard,
his life.Often,older people feel embarrassed to talk about their anxiety problems.
Psychologist
However, many will accept to confide in a doctor they trust. In addition, if they
Jean-Claude Cusson, trust their doctor, they are more likely to comply with an anxiety-relieving treat-
ATAQ ment or to accept referral to another health professional for evaluation and treat-
Martin Katzman, ment.
Psychiatrist Dr. Janel Gauthier, psychologist
Professor
Acknowledgement: Laval University

We would like to thank our

two FOUNDING PARTNERS: Useful resources
To learn more about anxiety disorders in the elderly, please consult:
ADAC/ACTA :
http://www.anxietycanada.ca/
Can older adults and the older have anxiety disorders? :
http://anxietybc.com/faq/older.html/
Late Life Anxiety Disorders: What you need to know :
http://www.wpic.pitt.edu/research/depr/anxiety.htm/
Anxiety Disorders Association of America: Anxiety in the Older :
http://www.adaa.org/AnxietyDisorderInfor/AnxietyOlder.cfm/
for their unrestricted
educational grant to Mood Disorders Society of Canada (Socit pour les troubles de lhumeur du Canada)
Rapport sur les maladies mentales (Chap. 4 : Troubles anxieux) :
financially support this http://www.mooddisorderscanada.ca/report/francais/chapter4/quesont.htm/
publication.
Association/Troubles Anxieux du Qubec(ATAQ) :
May 2005 http://www.ataq.org/

Cette brochure est aussi disponible en franais 5

 Anxiety Disorders
in the Elderly

long run. Even taken in moderation (e.g., two drinks a day), alcohol can worsen
anxiety, depression and even dementia.
When older persons receive a medical prescription for anxiety, it is important
that they inform their doctor or pharmacist of all the medications or natural
Editorial products they are taking, because these products can interact negatively with
committee : the medication prescribed.
Denis Audet , Practical recommendations for persons
Family Physician
who have aging parents
Louis Blanchette,
ADAC/ACTA If you have an aging parent, and you think he is suffering from an anxiety pro-
blem, encourage him to talk to his doctor about the changes you have noticed in
Stphane Bouchard,
his life.Often,older people feel embarrassed to talk about their anxiety problems.
Psychologist
However, many will accept to confide in a doctor they trust. In addition, if they
Jean-Claude Cusson, trust their doctor, they are more likely to comply with an anxiety-relieving treat-
ATAQ ment or to accept referral to another health professional for evaluation and treat-
Martin Katzman, ment.
Psychiatrist Dr. Janel Gauthier, psychologist
Professor
Acknowledgement: Laval University

We would like to thank our

two FOUNDING PARTNERS: Useful resources
To learn more about anxiety disorders in the elderly, please consult:
ADAC/ACTA :
http://www.anxietycanada.ca/
Can older adults and the older have anxiety disorders? :
http://anxietybc.com/faq/older.html/
Late Life Anxiety Disorders: What you need to know :
http://www.wpic.pitt.edu/research/depr/anxiety.htm/
Anxiety Disorders Association of America: Anxiety in the Older :
http://www.adaa.org/AnxietyDisorderInfor/AnxietyOlder.cfm/
for their unrestricted
educational grant to Mood Disorders Society of Canada (Socit pour les troubles de lhumeur du Canada)
Rapport sur les maladies mentales (Chap. 4 : Troubles anxieux) :
financially support this http://www.mooddisorderscanada.ca/report/francais/chapter4/quesont.htm/
publication.
Association/Troubles Anxieux du Qubec(ATAQ) :
May 2005 http://www.ataq.org/

Cette brochure est aussi disponible en franais 5