Understanding Geriatric Anxiety: A Case-Based Approach

Eric Lenze, MD

Associate Professor of Psychiatry, Department of Psychiatry
Washington University in St. Louis
St. Louis, MO

Generalized anxiety disorder (GAD) is common in older adults but often remains undiagnosed by clinicians. It is characterized by chronic, almost uncontrollable worry and anxiety. A case is described of a 71-year-old woman with a history of mild anxiety, whose condition worsened following development of chronic medical problems in her son and husband. Related symptoms included muscle tension, constipation, insomnia, and problems with GAD often have an exaggerated stress response. The decision was made to start medical treatment. Three studies to date have demonstrated the efficacy of selective serotonin reuptake inhibitors (SSRIs) in older adults with GAD. In this particular case, the patient had a partial response to SSRI treatment and the decision was then made to also start a course of 16 1-hour cognitive behavioral therapy (CBT) sessions. The patient’s anxiety decreased and her associated symptoms improved. She is currently maintained on SSRI therapy. While CBT general requires referral to a specialist, clinicians can readily become familiar with one component of this treatment, relaxation therapy. Clinicians can also refer patients to self-help books that are based on CBT principles.

References

Lenze EJ, Rollman BL, Shear MK, Dew MA, Pollock BG, Ciliberti C, Costantino M, Snyder S, Shi P, Spitznagel E, Andreescu C, Butters MA, Reynolds CF 3rd. Escitalopram for older adults with generalized anxiety disorder: a randomized controlled trial. JAMA. 2009;301(3):295-303.
Porensky EK, Dew MA, Karp JF, Skidmore E, Rollman BL, Shear MK, Lenze EJ. The burden of late-life generalized anxiety disorder: effects on disability, health-related quality of life, and healthcare utilization. Am J Geriatr Psychiatry. 2009;17(6):473-82.
Wolitzky-Taylor KB, Castriotta N, Lenze EJ, Stanley MA, Craske MG. Anxiety disorders in older adults: a comprehensive review. Depress Anxiety. 2010;27(2):190-211.

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