Anxiety Identification in Older People

Whether you are a family member or friend, it's a concern when you see an older person suffering from stress and anxiety. It's helpful to understand how to identify "anxiety", which is a physical condition with specific causes -- and solutions. The observer needs to understand this is a condition of "degrees".

Differentiating anxiety that is unrealistic, excessive, and life-altering from usual worry is often difficult in older adults. The type of worries and fears expressed by older adults are different than the worries and fears of younger people. For example, older adults are more likely to express worry about health and illness compared to younger people.

Given that older people worry about realistic problems—such as falling, losing hearing or eyesight, and becoming dependent on others—considerable effort is often needed to determine if the extent of worry interferes with daily function

The overlap between physical health problems in late life and anxiety is another important area to consider. Anxiety is observed to interact with physical illness in several important ways.

• Physical illness can directly cause anxiety related symptoms.
• Physical illness can trigger a reaction of anxiety, worry and/or fear.
• Somatic (physical) symptoms of anxiety are often the focus of older adults' complaints.
• Medications used to treat physical illness may cause anxiety-related symptoms.
• Circular problems, in which increased anxiety results in behaviors that contribute to worsening of physical health conditions, are common.

Any person aged 60 years and older who expresses worry or fear, and who is identified as being at risk due to circumstances such as physically ill, recent psychosocial stress, depressed, cognitively impaired, somatic complaints for which there are no identifiable causes, should be evaluated for anxiety. Common sources of worry and fear among older adults are noted below.

Worries and Fears in Older Adults

These worries and fears were commonly expressed by older adults, but not by younger ones, in research comparing the content of worries in younger and older people.

• Being unable to remember important things; mental decline
• Being physically disabled
• Inability to care for oneself
• Falling
• Losing eyesight or hearing
• Losing control of bodily functions
• Spouse/family becoming ill, having an accident
• Losing sight or hearing
• Being forced to live in a nursing home
• Being robbed or attacked
• Loss of ability to get around by oneself
• Death of family/friends
• Dependence on health care providers
• House being burgled/vandalized
• Being taken care of by strangers
• Feeling insecure
• Being a burden for loved ones
• Getting older
• Becoming ill/having an accident
• Dying

There are many different types of anxiety assessment scales. Because this guideline focuses on general anxiety detection (not diagnosis or detection of change related to treatment), four scales that are designed for screening anxiety. Each scale was designed to be used as a screening instrument to help clinicians identify the presence of anxiety.

• The Geriatric Anxiety Inventory (GAI)
• The Short Anxiety Screening Test (SAST)
• The Hospital Anxiety and Depression Scale (HADS)
• Rating Anxiety in Dementia (RAID)
• Mini-Mental State Exam (MMSE)

SOURCE: John A. Hartford Foundation's Center of Geriatric Nursing Excellence at the University of Iowa Gerontological Nursing Intervention Research Center, Research Translation and Dissemination Core.

MORE INFORMATION: National Guideline Clearinghouse™ (NGC) http://guideline.gov/content.aspx?id=13598