Generalized anxiety - what is it? and how common?

"Generalized anxiety" is just what it sounds like - pervasive, excessive worry that is difficult to control. In addition to worry, people may have other symptoms of anxiety - restlessness, being easily fatigued, problems concentrating, muscle tension, and sleep difficulty. Generalized anxiety is the most common type of anxiety diagnosed in older adults. It occurs in between 5% and 7% of older adults¹,², and is more common in elderly who live in nursing homes or other institutional settings.³

Although generalized anxiety is common among older adults, there is concern among health care providers that this public health problem is not being treated as often or as well as it could be. Researchers in this study advanced knowledge of generalized anxiety by doing two things:
(1) Identified ways that older adults are different from younger people in how they experience or express anxiety
(2) Looked at how well cognitive-behavior therapy (described below) helps older adults cope with generalized anxiety

Special considerations in older adults

Although generalized anxiety is diagnosed the same way in all adults, regardless of age, there seem to be differences in the way older adults experience it.

• Older adults worry about different things - in particular, they have more concerns about health compared to younger adults, who are generally more concerned about work-related issues
• Older adults describe their anxiety with words such as fret, compared to younger adults, who were raised in an era where more "psychological" words, such as worry or anxiety are common - as a result, older adults may be under-reporting their distress because they do not use "emotional" words to describe it
• Older adults have higher rates of other problems, such as depression, sleep disturbances, and health problems associated with advanced age, that overlap with generalized anxiety and may make it difficult to diagnosis their anxiety accurately
• Older adults tend to focus most on the physical symptoms of anxiety, so they usually seek treatment from their doctor or in another primary medical care setting - and they expect a medical diagnosis to explain their unpleasant physical sensations

Problems with traditional medication treatment

Because older adults usually seek treatment for anxiety in a medical setting, they are usually treated with medication. The most common drugs used for generalized anxiety are the benzodiazepines (which include drugs such as Valium and Xanax). These drugs have risks in elderly patients. Benzodiazepines can cause slowed thinking and physical movement, increasing the risk of falls and preventing the adult from driving. The drugs can interact with other medications in ways that can sometimes be dangerous. And individuals can become dependent on benzodiazepines.

Although use of these drugs is sometimes needed for quick or short-term relief of anxiety, they do not appear to be the best treatment for a longer-term problem like generalized anxiety. In order to move away from potentially risky drug treatments, researchers are starting to closely examine cognitive-behavior therapy, a non-medical treatment, to see if it is effective in relieving anxiety in older adults.

Treatment of anxiety with cognitive-behavior therapy

"Cognitive-behavioral" therapy, or CBT, is a type of treatment where patients learn to change their behaviors and beliefs in order to better cope with or relieve a particular problem. Whether done with younger or older adults, the basic elements are the same. In CBT for anxiety, the individual:

• Learns ways to relax the body
• Experiences anxiety-producing situations in safe, controlled "exposure" sessions to help develop tolerance for uncomfortable emotions and physical symptoms
• Adopts new beliefs about the physical symptoms of anxiety - and learns that the bodily sensations alone will not cause harm
• Develops "replacement" thoughts for the constant worry

Treatment time varies, but usually takes 1 or 2 hours weekly over 4 to 10 weeks. The cognitive-behavior skills can be learned in individual sessions or in a group format with other older adults. So far, research shows that patients have good results with either format.

Advantages of cognitive-behavior therapy over medication

Although using drug therapy to treat generalized anxiety may be necessary when rapid relief is required, there are advantages to using CBT rather than medications. First, as mentioned above, the drugs most commonly used to treat anxiety can cause negative side symptoms, such as drowsiness and slowed thinking.

And second, anxiety treated with medication tends to return after the drug treatment is stopped. Anxiety treated with CBT stays under control up to a year after treatment has stopped - and early research points to patients being able to manage anxiety for many years afterward by having annual "booster" sessions where cognitive-behavioral techniques are reviewed and updated.

In one treatment study, researchers found that cognitive-behavior therapy was used very effectively to help patients reduce or wean off medications. This was done under careful supervision by the physician in order to safely withdraw the patient from medications. Not only were patients able to reduce or stop drug treatments, but they showed significant reductions in their levels of anxiety that did not happen when using just medication alone.

Comment

This article made a breakthrough in terms of understanding the specific features and treatment needs of anxiety among older adults. It will be important to test these differences in future research, but the information is important now, and awareness of the differences between older and younger adults will help both medical and mental health providers watch for and treat anxiety in the elderly more effectively. It is also useful for family members to know about generalized anxiety in order to help the older members of the family think about their symptoms and ask for the most appropriate and best care.

Cognitive-behavioral treatment seems to be the overall best way to treat generalized anxiety in older adults. However, some people may prefer drug therapies or, in some situations, need medication for short-term relief of symptoms. For an overview of the safest and best medications for generalized anxiety, see the article entitled "Worried about worrying?" using the link below.