Although complaints about anxiety are common among older persons, late-life anxiety disorders have been underestimated. Older persons tend to emphasize their physical complaints and are less likely to report psychiatric symptoms.[1] This article focuses on generalized anxiety disorder, which is characterized by chronic uncontrollable worry that interferes with functioning and is accompanied by restlessness and disturbed sleep.[2] However, it’s important to also consider conditions such as social anxiety disorder, specific phobias (e.g., fear of falling), panic disorders, and posttraumatic stress disorder.[3]

Prevalence of anxiety disorders in later life varies significantly based on different methodologies and may not fully capture the nature of anxiety in older people, especially among ethnic and racial minority groups. Overall, anxiety disorders are more common in later life than depression, with estimated rates ranging from 1.2% to 7.3% for 6- and 12-month prevalence respectively, and up to 11% for lifetime prevalence.[4] Using MSP billing data, anxiety codes account for only 0.6% of family practice and 1.5% of psychiatry billings for individuals 60 years of age and older, signaling that anxiety is not usually billed as a primary diagnosis for physician visits, possibly reflecting underdiagnosis or a secondary diagnosis.[5]

Physicians, especially frontline primary care providers, need to recognize the prevalence of anxiety, as many people go their entire lives normalizing it without seeking help. Treating anxiety can be life-changing, making it crucial for overall well-being. Physicians should be aware of red flags such as new panic attacks in older adults, which are less common later in life, and should rule out other medical causes that can cause or mimic anxiety (e.g., paroxysmal atrial fibrillation, hyperthyroidism, tumor).[6]

Anxiety disorders in older adults are associated with increased physical disability, poorer quality of life, higher use of health services, greater risk of depression, cognitive impairment, and dementia.[4] Older adult worries usually relate to later-life issues such as health care costs, loss of loved ones, retirement, caregiving responsibilities, and end-of-life planning.[4]

When nonmedication options are ineffective or not feasible, the first-selected pharmacotherapy is selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors. Despite the specific risks, which are higher in the elderly, like syndrome of inappropriate antidiuretic hormone secretion, falls, and bleeds, use of these medications, as well as pregabalin, can be beneficial in certain cases to improve quality of life and function. As per the classic geriatric adage, start low and go slow, but “go” is key, as medications need to be titrated to useful doses to be effective.[6] The risk-benefit ratio of benzodiazepine pharmacotherapy in elderly patients is not favorable.[7] Also, reduce dosage of or discontinue potentially anxiety-inducing medications while monitoring for suicidal ideation and symptom change.[7]

COVID-19 has disrupted the lives of many BC seniors with increased social isolation, contributing to anxiety. However, relying on social prescribing alone is insufficient to address this issue. Creating genuine social connections in the community is crucial to combat anxiety in seniors, but this falls beyond the scope of this article. The first step is recognizing and treating anxiety in seniors to help them thrive. National Seniors Day is 1 October! I encourage readers to share their strategies to combat seniors’ anxiety.
—Eileen M. Wong, MD, CCFP, FCFP
Council on Health Promotion Member

Acknowledgments

The author would like to thank Ms Karen Gilbert, occupational therapist, Providence Health Care, and Dr Paul Blackburn, geriatric psychiatrist, Vancouver Coastal Health, for providing resources and content for this article.

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This article is the opinion of the authors and not necessarily the Council on Health Promotion or Doctors of BC. This article has not been peer reviewed by the BCMJ Editorial Board.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

1.    Nagaratnam N, Nagaratnam K, Cheuk G. Anxiety and anxiety disorders in later life. In: Geriatric diseases: Evaluation and management. Nagaratnam N, Nagaratnam K, Cheuk G, editors. Cham, Switzerland: Springer; 2018. pp. 653-657.

2.    Munir S, Takov V. Generalized anxiety disorder. Treasure Island, FL: StatPearls Publishing; 2022. Accessed 27 July 2023. www.ncbi.nlm.nih.gov/books/NBK441870.

3.    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. 2022. Accessed 20 June 2023. https://doi.org/10.1176/appi.books.9780890425787.x05_Anxiety_Disorders [login required].

4.    Ramos K, Stanley MA. Anxiety disorders in late life. Psychiatr Clin North Am 2018;41:55-64.

5.    MSP. Claims files for FY 2022/2023 [internal document].

6.    Lenze EJ, Wetherell JL. A lifespan view of anxiety disorders. Dialogues Clin Neurosci 2011;13:381-399.

7.    Pary R, Sarai SK, Micchelli A, Lippmann S. Anxiety disorders in older patients. Prim Care Companion CNS Disord 2019;21:18nr02335.