Mental Health

Anxiety and aging

January 21, 2008 11:06 AM EST

        Recently I had coffee with a friend who is worried about her 86-year-old mother, who lives in the Midwest. “Lately it seems like she’s worried about everything,” my friend told me. “She never used to be this way. Do you think she has an anxiety disorder?”

It’s possible. Anxiety disorders are the most common mental health disorders among older adults. Approximately 11% of people ages 55 and over suffer from some type of anxiety disorder. Although most anxiety disorders start in early adulthood, they tend to last well into the later years. In addition to enduring anxiety disorders from their youth, older adults become increasingly susceptible to anxiety caused by illness or a medication. That’s because both illness and the need for medication become more common with age.

Yet anxiety in older adults has received relatively little scientific attention. Most of what’s known comes from studies of young and middle-aged adults, but the findings on anxiety medications don’t all hold true for older people. Age-related changes in the absorption and metabolism of drugs tend to make drugs linger longer in the body, increasing the risk for harmful effects even at doses considered safe for younger people. In addition, older adults are more likely to be taking multiple medications for a variety of conditions, some of which may interact with anxiety medications.

January 21, 2008 11:06 AM EST

        Recently I had coffee with a friend who is worried about her 86-year-old mother, who lives in the Midwest. “Lately it seems like she’s worried about everything,” my friend told me. “She never used to be this way. Do you think she has an anxiety disorder?”

It’s possible. Anxiety disorders are the most common mental health disorders among older adults. Approximately 11% of people ages 55 and over suffer from some type of anxiety disorder. Although most anxiety disorders start in early adulthood, they tend to last well into the later years. In addition to enduring anxiety disorders from their youth, older adults become increasingly susceptible to anxiety caused by illness or a medication. That’s because both illness and the need for medication become more common with age.

Yet anxiety in older adults has received relatively little scientific attention. Most of what’s known comes from studies of young and middle-aged adults, but the findings on anxiety medications don’t all hold true for older people. Age-related changes in the absorption and metabolism of drugs tend to make drugs linger longer in the body, increasing the risk for harmful effects even at doses considered safe for younger people. In addition, older adults are more likely to be taking multiple medications for a variety of conditions, some of which may interact with anxiety medications.

Because of these medical realities and the greater risks to health, doctors often prescribe anti-anxiety drugs in lower doses or they recommend different therapies. Drugs known as benzodiazepines are used sparingly because some effects, such as sedation and impaired cognition, can be exaggerated. If benzodiazepines are used, the best choices are short-acting versions, such as lorazepam (Ativan), oxazepam (Serax), or temazepam (Restoril). These don’t linger in the body as long as long-acting ones such as diazepam (Valium), clonazepam (Klonopin), or chlordiazepoxide (Librium). In general, short-acting drugs cause less sedation and cognitive impairment, making them safer for people who need to drive.

An alternative, and a better choice for some individuals, is buspirone. It doesn’t cause sedation or cognitive impairment, and its pattern of drug interactions may be favorable depending on the other medications on a person’s prescription list. However, research on buspirone has been disappointing, with a number of studies finding it less effective than benzodiazepines in treating anxiety. And buspirone carries two other drawbacks: It takes several weeks to take effect, and it does not improve insomnia, a frequent complaint among older people with anxiety.

A third medication alternative is to try an antidepressant. Antidepressants are effective for many anxiety disorders, and may also help if depression is part of the picture. Like buspirone, they can take several weeks to work. Also, as with any medication, adverse effects and drug interactions need to be considered.

Preliminary studies have found that cognitive behavioral therapy is effective for older individuals with two types of anxiety disorders: panic disorder and social phobia. When used along with medication, cognitive-behavioral therapy may reduce the amount of time the drug is needed. For older people who can’t tolerate anti-anxiety medications, this form of therapy can be used by itself.

I shared some of this information with my friend. But I also offered to refer her mother to one of my colleagues in the Midwest. Only a formal evaluation will reveal whether her mother is really suffering from an anxiety disorder, and then provide information about how best to treat it.

Are you, or someone you know, older than 55 and suffering from an anxiety disorder? How is it being treated?

Dr. Michael Miller has been on staff of the Beth Israel Deaconess Medical Center, a large teaching hospital in Boston, for more than 25 years. He is also an Assistant Professor of Psychiatry at Harvard Medical School.

Anxiety and Phobias
Anxiety disorders-which include panic attacks, post-traumatic stress disorder, obsessive-compulsive disorder, and phobias-are among the most common mental illnesses, affecting about 23 million American adults. Thankfully, never before have there been so many therapies to help control anxiety. is a special report from Harvard Medical School that provides up-to-date information on these treatments, as well as information on the many types of anxiety disorders, their symptoms, causes, and getting a proper diagnosis.
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© 2008 by Michael C. Miller, M.D., Harvard Medical School

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