Anxiety disorder in older adults Tier 3 Anxiety
Description: Anxiety disorder in older adults Tier 3 Anxiety disorder Anxiety, although experienced by most people, does not usually develop into an anxiety disorder. Transient anxiety is normal, however when anxiety starts to affect daily life this
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slide1. Anxiety disorder in older adults Tier 3<br>
slide2. Anxiety disorder Anxiety, although experienced by most people, does not usually develop into an anxiety disorder. Transient anxiety is normal, however when anxiety starts to affect daily life this indicates a problem.
Anxiety disorders are commonly unrecognised or undiagnosed and when anxiety disorders coexist with depression, the depressive episode may be recognised but the underlying anxiety disorder may be overlooked.
Depression and anxiety or anxiety disorders are commonly experienced together in some form, but can also be experienced alone. There are several terms used to describe the combination of depression and anxiety, including mixed anxiety and depressive disorder and depressive anxiety.<br>
slide3. Anxiety disorder in older adults Anxiety is one of the most common psychiatric disorders in the older population
About 1 in 5 older adults have anxiety disorder
Older adults in comparison to younger adults often report physical health symptoms
Most older adults with anxiety would have had anxiety symptoms when they were younger
There could be trigger events for anxiety presentations – falls, admission to hospital, recent bereavements and sudden loss<br>
slide4. Risk factors for Anxiety disorder in older adults Female
Low education attainment
Lower socio-economic status
Single or widowed
Poor physical health - self rated poor health included
Traumatic event (especially in childhood)
Neuroticism
Cognitive disorder
Presence of major illness in partner<br>
slide5. Types of anxiety disorder Generalised anxiety disorder
Phobias
Panic disorder
Obsessive compulsive disorder
Post traumatic stress disorder (see details in trauma slides)<br>
slide6. Description of types – part 1 Generalised anxiety disorder – generalised and persistent anxiety not restricted to any specific event
Phobias - anxiety evoked in certain well defined situations that are not currently dangerous. Examples include agoraphobia (fear of going out), social phobia, fear of falling
Panic disorder - recurrent attacks of severe anxiety not restricted to any particular situation or circumstances<br>
slide7. Description of types – part 2 Obsessive compulsive disorder - recurrent obsessional thoughts or compulsive acts
Post traumatic stress disorder - delayed or protracted response to a stressful situation of an exceptionally threatening nature<br>
slide8. Causes of anxiety There can be a number of causes for anxiety symptoms. Some of them are:
Depression
Anxiety can be a symptom of dementia
Medical illness
Medications
Alcohol and drug misuse<br>
slide9. Symptoms Restlessness and or agitation
Poor sleep
Poor appetite
Nervousness
Irritability
Tachycardia
Dry mouth
Nausea
Sweating
Muscle pains
Fatigue
Difficulty in sustaining attention and poor concentration
Inability to retain information<br>
slide10. Differences in symptoms in working age and older adults<br>
slide11. Assessment of anxiety Interview the person and the care giver
Older adults may underplay the symptoms such as avoiding going out due to fear of falls
Important to look for impact on functioning
Anxiety associated with dementia - assess cognition
Medical illness can present with anxiety symptoms
Physical health medications can make people anxious
Alcohol and drug use should always be asked about. People use it to manage anxiety but alcohol can worsen the anxiety symptoms<br>
slide12. Investigations Investigations including considering blood tests, thyroid function tests, blood sugar, ECG, blood calcium and potassium levels and sodium, kidney function tests, urine analysis and drug screening
Review medications – some medications such as Parkinson’s disease treatment can cause anxiety
Drug and alcohol use
Cognition<br>
slide13. Treatment Having a supportive caregiver can help
Do:
Talk in a neutral tone
Use very simple words and sentences. And speak slowly.
Give one instruction at a time
If asking for something, please give maximally two choices at a time
Sleep regularity can help with anxiety<br>
slide14. Treatment Consider interventions which include consideration of sleep, diet and exercise
Psychological therapy - relaxation therapy for GAD, systemic desensitisation for phobias, exposure and response prevention for OCD, EMDR ( Eye Movement Desensitisation Reprogramming) for PTSD
Cognitive therapy - CBT
Mindfulness<br>
slide15. Treatment Treatment of anxiety can include medications such as anti-depressant or antiepileptic medications
SSRI ( antidepressants) are the first line of treatment. When started on SSRI, monitor the patient for hyponatremia
Avoid using benzodiazepines if at all possible (increased risk of falls and cognitive decline)
Refer to the old age psychiatry team for assessment if you need to clarify diagnosis
Refer to the old age psychiatry team if the older adult is experiencing severe anxiety symptoms which do not settle<br>
slide16. Complications of GAD Complications of generalized anxiety disorder includes serious disability and impaired quality of life, impaired social and occupational functioning, increased risk of major depression, social anxiety disorder, and alcohol and drug misuse.
Physical health problems are more common in people with GAD. These include chronic pain syndromes, asthma or chronic obstructive pulmonary disease, and inflammatory bowel disease.
Suicidal ideation and attempts are also more prevalent in people with GAD compared to the general population and this risk increases further in those who also suffer from major depression<br>
slide17. Resources MPC_07_01 Anxiety | MPC_07_01 Anxiety (mindedforfamilies.org.uk)
This is an easy to access website for older adults and their families which has good information on symptoms ,reasons and treatments for anxiety<br>
slide2. Anxiety disorder Anxiety, although experienced by most people, does not usually develop into an anxiety disorder. Transient anxiety is normal, however when anxiety starts to affect daily life this indicates a problem.
Anxiety disorders are commonly unrecognised or undiagnosed and when anxiety disorders coexist with depression, the depressive episode may be recognised but the underlying anxiety disorder may be overlooked.
Depression and anxiety or anxiety disorders are commonly experienced together in some form, but can also be experienced alone. There are several terms used to describe the combination of depression and anxiety, including mixed anxiety and depressive disorder and depressive anxiety.<br>
slide3. Anxiety disorder in older adults Anxiety is one of the most common psychiatric disorders in the older population
About 1 in 5 older adults have anxiety disorder
Older adults in comparison to younger adults often report physical health symptoms
Most older adults with anxiety would have had anxiety symptoms when they were younger
There could be trigger events for anxiety presentations – falls, admission to hospital, recent bereavements and sudden loss<br>
slide4. Risk factors for Anxiety disorder in older adults Female
Low education attainment
Lower socio-economic status
Single or widowed
Poor physical health - self rated poor health included
Traumatic event (especially in childhood)
Neuroticism
Cognitive disorder
Presence of major illness in partner<br>
slide5. Types of anxiety disorder Generalised anxiety disorder
Phobias
Panic disorder
Obsessive compulsive disorder
Post traumatic stress disorder (see details in trauma slides)<br>
slide6. Description of types – part 1 Generalised anxiety disorder – generalised and persistent anxiety not restricted to any specific event
Phobias - anxiety evoked in certain well defined situations that are not currently dangerous. Examples include agoraphobia (fear of going out), social phobia, fear of falling
Panic disorder - recurrent attacks of severe anxiety not restricted to any particular situation or circumstances<br>
slide7. Description of types – part 2 Obsessive compulsive disorder - recurrent obsessional thoughts or compulsive acts
Post traumatic stress disorder - delayed or protracted response to a stressful situation of an exceptionally threatening nature<br>
slide8. Causes of anxiety There can be a number of causes for anxiety symptoms. Some of them are:
Depression
Anxiety can be a symptom of dementia
Medical illness
Medications
Alcohol and drug misuse<br>
slide9. Symptoms Restlessness and or agitation
Poor sleep
Poor appetite
Nervousness
Irritability
Tachycardia
Dry mouth
Nausea
Sweating
Muscle pains
Fatigue
Difficulty in sustaining attention and poor concentration
Inability to retain information<br>
slide10. Differences in symptoms in working age and older adults<br>
slide11. Assessment of anxiety Interview the person and the care giver
Older adults may underplay the symptoms such as avoiding going out due to fear of falls
Important to look for impact on functioning
Anxiety associated with dementia - assess cognition
Medical illness can present with anxiety symptoms
Physical health medications can make people anxious
Alcohol and drug use should always be asked about. People use it to manage anxiety but alcohol can worsen the anxiety symptoms<br>
slide12. Investigations Investigations including considering blood tests, thyroid function tests, blood sugar, ECG, blood calcium and potassium levels and sodium, kidney function tests, urine analysis and drug screening
Review medications – some medications such as Parkinson’s disease treatment can cause anxiety
Drug and alcohol use
Cognition<br>
slide13. Treatment Having a supportive caregiver can help
Do:
Talk in a neutral tone
Use very simple words and sentences. And speak slowly.
Give one instruction at a time
If asking for something, please give maximally two choices at a time
Sleep regularity can help with anxiety<br>
slide14. Treatment Consider interventions which include consideration of sleep, diet and exercise
Psychological therapy - relaxation therapy for GAD, systemic desensitisation for phobias, exposure and response prevention for OCD, EMDR ( Eye Movement Desensitisation Reprogramming) for PTSD
Cognitive therapy - CBT
Mindfulness<br>
slide15. Treatment Treatment of anxiety can include medications such as anti-depressant or antiepileptic medications
SSRI ( antidepressants) are the first line of treatment. When started on SSRI, monitor the patient for hyponatremia
Avoid using benzodiazepines if at all possible (increased risk of falls and cognitive decline)
Refer to the old age psychiatry team for assessment if you need to clarify diagnosis
Refer to the old age psychiatry team if the older adult is experiencing severe anxiety symptoms which do not settle<br>
slide16. Complications of GAD Complications of generalized anxiety disorder includes serious disability and impaired quality of life, impaired social and occupational functioning, increased risk of major depression, social anxiety disorder, and alcohol and drug misuse.
Physical health problems are more common in people with GAD. These include chronic pain syndromes, asthma or chronic obstructive pulmonary disease, and inflammatory bowel disease.
Suicidal ideation and attempts are also more prevalent in people with GAD compared to the general population and this risk increases further in those who also suffer from major depression<br>
slide17. Resources MPC_07_01 Anxiety | MPC_07_01 Anxiety (mindedforfamilies.org.uk)
This is an easy to access website for older adults and their families which has good information on symptoms ,reasons and treatments for anxiety<br>