Anxiety

Anxiety is intense nervousness or worrying that interferes with the ability to function.

Nervousness or worrying is a normal response to a threat or to stress. Everyone experiences nervousness or worrying occasionally. But anxiety is intense nervousness or worrying. Anxiety may develop for no apparent reason. Anxiety can occur with many physical disorders, or it can be a side effect of certain drugs. Anxiety may also be a symptom of an anxiety disorder that requires treatment. Anxiety disorders often are chronic, but the symptoms fluctuate. Therefore, the person may be calm at times and overwhelmingly nervous at other times. Anxiety disorders can interfere greatly with an older person's quality of life and ability to perform daily activities.

Anxiety disorders are common in older people. Many anxious older people have had anxiety disorders earlier in their lives, whereas others develop an anxiety disorder for the first time during old age.

The most common anxiety disorder in older people is generalized anxiety disorder. People with this disorder have at least 6 months of almost daily nervousness and worry about activities or events. Generalized anxiety disorder affects at least 1 out of every 30 older people. Women are more likely than men to experience generalized anxiety disorder.

Other anxiety disorders, including obsessive-compulsive disorder and phobic disorders, are also quite common among older people. Posttraumatic stress disorder and panic disorder are much less common among older people.

For additional detail on this topic, see What Are Obsessive-Compulsive Disorder, Phobic Disorders, Post-Traumatic Stress Disorder, and Panic Disorder?.

Causes

The cause of anxiety is usually not determined. However, anxiety can be caused by a variety of physical disorders, such as hyperthyroidism, chronic obstructive pulmonary disease (COPD), and heart failure. Impaired memory and thinking (cognitive impairment), whether it develops suddenly and lasts for a limited period (for example, delirium) or develops gradually and progresses (for example, dementia), is often accompanied by anxiety symptoms. Anxiety can also be a side effect of several drugs taken for physical disorders, including thyroid hormone replacement drugs, corticosteroids, and certain drugs used to treat some lung problems (beta-adrenergic agonists). Drinking excessive amounts of beverages containing caffeine, such as coffee, tea, and certain sodas, can also contribute to anxiety.

The exact cause of anxiety disorders is unclear. Both temporary stressors and ongoing, persistent daily hassles contribute to development of anxiety disorders in some people. Anxiety disorders often develop in people with other mental health disorders, such as a depressive or psychotic disorder. Some experts think that imbalances of certain substances that carry messages between nerves (neurotransmitters) in the brain play an important role.

Symptoms and Diagnosis

Anxiety can develop gradually and continue to worsen. In some, the symptoms occur more suddenly and wax and wane. Symptoms range in intensity from barely noticeable worrying and jitteriness to complete fear or panic.

People with generalized anxiety disorder may feel worried almost all of the time, although brief respites of calmness can occur. Nervousness and worrying often worsen during stressful situations. The focus of the worries among older people is often health, safety, or money. This focus often shifts from one topic to another over time. Difficulty falling and staying asleep (insomnia) is common among people with generalized anxiety disorder. Nervousness and worrying may be accompanied at any time by restlessness, fatigue, difficulty concentrating, irritability, and a sense of increased muscle tension.

Symptoms in people with obsessive-compulsive disorder, phobic disorders, and posttraumatic stress disorder tend to fluctuate and consist mainly of nervousness and worrying. People with panic disorder develop a surge of anxiety that lasts for only a few minutes or hours (panic attacks).

The diagnosis of an anxiety disorder is based largely on symptoms. The ability to tolerate anxiety varies, and determining what constitutes abnormal anxiety can be difficult.

Treatment

When a physical disorder or a drug is thought to be causing or contributing to anxiety, treating the disorder or reducing or stopping the offending drug may relieve the anxiety. If a person is consuming an excessive amount of caffeinated beverages, reducing or eliminating caffeine from the diet may help. However, other treatment is usually needed for anxiety disorders.

Most people with anxiety disorders respond best to a combination of drug therapy and counseling (psychotherapy).

Drug therapy: Several types of drugs are used to treat anxiety disorders. They are similar in effectiveness but differ by the side effects they can cause.

Certain drugs used to treat depression (antidepressants) are used to treat anxiety. These antidepressants are helpful not only in people who have both anxiety and depression, but also in people who do not have depression. The antidepressants used are usually selective serotonin reuptake inhibitors (SSRIs), such as sertraline and paroxetine, or antidepressants that are similar to SSRIs, including venlafaxine and mirtazapine. Antidepressants usually must be taken for a few weeks before they help control anxiety. For this reason, faster-acting drugs, such as benzodiazepines, may be taken along with an antidepressant until the antidepressant takes effect. The benzodiazepine can then be discontinued.

Benzodiazepines are also used to treat anxiety. They begin to work very quickly after they are taken. Thus, they can be used for brief periods when they are most needed to control symptoms. For some older people, however, they are best used regularly. Their use for periods longer than several months is not recommended because of the risk of side effects. Lorazepam, oxazepam, and temazepam are three drugs that may be safer for older people. Older, long-acting benzodiazepines, such as diazepam, chlordiazepoxide, and flurazepam, are best avoided in older people because they cause more side effects. Still, all benzodiazepines, even the safer ones, may cause confusion, poor concentration, sleepiness, and unsteadiness while walking.

Buspirone is another drug used in treatment. In most cases, this drug takes 2 to 4 weeks to take effect. Buspirone has few side effects. However, this drug is not as effective in people who have previously taken benzodiazepines.

Counseling: Counseling may focus on the root of anxiety. Often, however, counseling is not able to uncover a cause and instead focuses on helping the person learn new techniques for relaxation. Some counseling techniques make use of soothing music or visual images. People with anxiety disorders can also be taught to recognize triggers and stimuli that bring on episodes of worsened anxiety. Once the triggers or stimuli are recognized, people can learn new ways to cope and maintain control. Exposure therapy is sometimes used, especially for people with panic disorder and obsessive-compulsive disorder. Exposure therapy involves repeatedly exposing the person to a feared object or situation. This causes the person to experience the anxiety over and over until the feared object or situation loses its effect.