What does it look like?
Anxiety disorders tend to be chronic conditions with periodic mild exacerbations, rather than the discrete, and often dramatic, mood changes seen in unipolar depression and bipolar disorder.
Generalized anxiety disorder is the most commonly diagnosed anxiety condition in older adults. This is characterized by a variety of worries that are difficult to control, produce distress, and are often associated with physical symptoms. Most often patients describe muscle tension or GI upset. These patients often describe themselves as lifelong “worriers” or “worry warts.”
Posttraumatic stress disorder (PTSD) can exist throughout a person’s life or become amplified in old age. The role transitions, medical illnesses, and increased dependency associated with aging can cause anxiety to emerge around previous traumas.
Anxiety disorders have a tendency to co-occur with other psychiatric conditions. In older adults, it is important to screen for hoarding, obsessive-compulsive behavior, depression, and substance misuse. Alcohol and prescription medication misuse are the most prevalent in the elderly.
How do I screen for it?
The diagnosis is made with a clinical history that focuses on the temporal course of symptoms and focus of the anxiety. Screening and epidemiological instruments often have low sensitivity in older adults as a result of insight and recall issues.
The difficulty in diagnosing primary anxiety disorders is often differentiating these conditions from medical illnesses and medication use. Below are suggestions to aid in making this distinction.