Generalized Anxiety Disorder is Common in Older Adults
While scientists aren’t entirely sure why some people are more prone to GAD than others, part of the risk is genetic, says Simon Sherry, an associate professor of psychology and neuroscience at Dalhousie University in Halifax. The condition also often coincides with other illnesses, such as depression, and women are twice as likely as men to be affected, according to Sherry.
As anxiety disorders go, GAD is one of the most common, especially in older adults. Studies suggest it affects somewhere between three and 10 per cent of people, says Julie Wetherell, a psychologist at VA San Diego Healthcare System and professor of psychiatry at the University of California, San Diego who focuses much of her research on psychological treatments for GAD in elderly patients. “GAD is more common in seniors than social-anxiety disorder, panic disorder, post-traumatic stress disorder and major depression.”
It also manifests a little differently in people who are 55 and older. Wetherell says they tend to worry less about work and more about personal health and family issues. “Sometimes people have a lifelong history of anxiety that they’ve coped with through distraction or workaholism,” she says. “The pervasiveness of the worry becomes apparent when they’re no longer working or once they’re unable to engage in previous coping strategies.”
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Generalized Anxiety Disorder is Difficult to Diagnose
Anxiety symptoms are associated with several health issues, which can make diagnosis difficult. Conditions that can cause—or mimic—anxiety include coronary artery disease, chronic obstructive pulmonary disease, dehydration and hyperthyroidism. “It’s possible to have both a medical condition and anxiety, so when a medical condition is diagnosed, anxiety may remain untreated,” Wetherell says. Anxiety-like symptoms can be caused by medications, including blood pressure pills, hormones, steroids, antidepressants and over-the-counter drugs that contain caffeine, like some cough syrups and decongestants.
GAD sufferers rarely turn to psychologists and will instead often see a medical doctor about their physical symptoms. In some cases, professionals brush off both physical and psychological concerns. “Many people think that worry isn’t a legitimate mental health complaint since everybody frets,” Robichaud says. She’s seen patients who endured symptoms for 15 years before seeking help. Older adults tend to downplay problems with anxiety. GAD sufferers often get accustomed to their extreme patterns of thinking, Sherry says. “If worry is your normal, you may not appreciate the extent to which you’re living in distress,” he says. “But while GAD is common, costly and impairing, it’s also highly treatable, which is why it’s important to seek help.”
Medication Can Have Serious Side Effects
It took two years of treatment before Folk was symptom-free. “While I had reasonable moments during the 12 years I was ill, most of the time was horrible,” he says. “My anxiety disorder felt like a nightmare I couldn’t wake up from.”
Folk’s psychologist taught him that he could react physically, even when he wasn’t aware that he was anxious, and explained why he wasn’t able to calm himself down. “It was helpful for me to know what was going on in my body,” Folk says. “Then it took a year of stress reduction and daily self-reflection strategies to help me learn not to react to life with fear.”
His success in overcoming GAD eventually led him to found anxietycentre.com, a site that offers information and counselling by mental health professionals to those grappling with the condition. The guidance provided on the site is based on cognitive behavioural therapy, which is the gold standard in treating anxiety disorders. CBT teaches patients to change their unhealthy patterns of thinking and behaviour in order to help them function normally. “I worked hard at overcoming my fear of anxiety and panic attacks and, over time, my symptoms subsided,” Folk says. He’s been symptom-free since 1985.
While some medications can help treat anxiety, they come with serious side effects, such as sedation, cognitive impairment (over long-term use) and even the development of a tolerance, which can lead to addiction. Wetherell often recommends a non-pharmaceutical approach rooted in relaxation and meditation.
“Our research team is currently using Mindfulness-Based Stress Reduction, which has no side effects,” she says. (MBSR techniques include mindful breathing and mental body scans to increase awareness of physical sensations.) “We found that MBSR reduces cortisol, a stress hormone that damages the hippocampus and frontal lobe of the brain, so it may have beneficial effects on memory and thinking, as well as on anxiety.”
Wetherell says there are videos on YouTube that lead people through body scans (which coach participants in bringing awareness to each part of the body sequentially) and other mindfulness techniques. “I encourage people to practise daily so they can use relaxation techniques when they’re anxious,” she says.
Other studies support Wetherell’s findings. In January, researchers from the Georgetown University Medical Center in Washington, D.C., published a study showing that GAD patients had fewer hormonal and immunological stress markers in their blood after taking an MBSR class for eight weeks. An important aspect of mindfulness is to learn to zero in on present-moment experience, says Robichaud. “For GAD patients, worries involve thoughts about negative events that might occur in the future, so being able to focus on the present can be beneficial.”
To remain present, Christine Purdon, professor in the department of psychology at the University of Waterloo, suggests patients be aware of the tenses they’re thinking in. “I ask them, ‘Is your mind in the future? Does it need to be there?’” Purdon shows people how to recognize that whatever they’re worrying about is neither imminent nor realistic. The goal, she says, is also to help people realize when they’re underestimating their ability to cope and overestimating the demands of their environment.
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