Although many older adults experience anxiety, the condition is often overlooked by their providers, making it more difficult for them to be diagnosed and get appropriate treatment, Paula Span writes for the New York Times. To address this issue, some health experts are advocating for older Americans to be included in new recommendations for anxiety screenings.

Anxiety is often overlooked in adults

According to Span, anxiety is the most common mental health disorder and includes generalized anxiety disorder, social anxiety disorder, phobias, panic disorder, and post-traumatic stress disorder. Among older adults, a 2017 study found that over 17% had experienced an anxiety disorder over the last year.

The most common type of anxiety disorder among older adults is generalized anxiety disorder. "The most prominent symptom is severe, difficult-to-control worry," said Carmen Andreescu, a geriatric psychiatrist at the University of Pittsburgh School of Medicine.

"There's this continuing fear that something bad is going to happen," she added. "It can be all-consuming."

However, anxiety is often overlooked in older adults since their primary care doctors may not have the training to recognize mental health disorders, Span writes. Older adults may also present different symptoms of anxiety, such as insomnia or irritability, hoarding, a fear of falling, or physical discomforts like dizziness or muscle tension.

Some older patients are also reluctant to believe their problems may be psychological, which adds to underdiagnosis. "Some resent a label of 'anxious,'" Andreescu said. "They'd rather call it 'high stress,' something that doesn't indicate psychological weakness."

Although some people may believe some anxiety is normal as they age, it can have serious health consequences. So far, studies suggest that anxiety may be linked to increased risks of coronary heart disease, heart failure, stroke, and death.

Other research has also shown an association between anxiety and cognitive decline and dementia. Andreescu's neuroimaging studies have also found that "anxiety shrinks and ages the brain," she said.

There are effective treatments for anxiety, but since older adults require higher doses of antidepressants and may be taking multiple drugs, it can be difficult to find the right regimen.

"It's a bigger challenge to treat" older patients with anxiety, Andreescu said. "It's more complicated." However, she noted that, with time, "we do get it under control" and "[p]eople do respond to treatment."

Should anxiety screenings be recommended for older adults?

In September, the United States Preventive Services Task Force (USPSTF) released draft recommendations saying all adults ages 18 to 64, including those who are pregnant and postpartum, should be routinely screened for anxiety.

USPSTF gave the recommendation a "B" rating, suggesting that it would have a "moderate net benefit" for patients. However, for patients ages 65 and older, the task force gave anxiety screenings an "I" rating, meaning that there was insufficient evidence of potential benefits and harms.

According to Lori Pbert, a clinical psychologist and health behavior researcher at the University of Massachusetts Chan Medical School who served on the USPSTF panel, "evidence was lacking on the accuracy of screening tools and the benefits and harms of screening" when it came to older adults. Panel members also wanted more evidence that treatments were effective in this age group.

"It's a strong call for the clinical research that's needed," Pbert said. The task force's final recommendations are expected to be released later this year.

However, Andreescu and other health experts "politely but strongly disagree" with USPSTF's assessment on anxiety screenings for older adults, Span writes.

Eric Lenze, head of the psychiatry department at the Washington University School of Medicine in St. Louis, said that an "I" rating "makes people not look for or treat something that's already an undertreated condition."

"With a common disorder that causes a lot of impairment of quality of life and that has simple, inexpensive, straightforward kinds of treatment, I think screening is called for," he added. (Span, New York Times, 2/26)