Module 13c: Anxiety

Module 13c: Anxiety

Anxiety and Older Adults: Considerations

Evidence suggests that, for older adults:

  • 18% of older Canadians experience symptoms of anxiety or depression that they find difficult to cope with (Canadian Institute for Health Information, 2022)
  • 6% of older Canadians have a diagnosed anxiety disorder (Statistics Canada, 2021)
  • Generalized anxiety disorder (GAD) and phobias are the most common anxiety disorders (Grenier et al., 2019)

Explore the Canadian Guidelines for the Assessment and Treatment of Anxiety in Older Adults from the Canadian Coalition for Seniors’ Mental Health at: https://ccsmh.ca/areas-of-focus/anxiety/clinical-guidelines/

For Generalized Anxiety Disorder, in the DSM-V (Diagnostic and Statistical Manual 5th Ed.), the American Psychiatric Association note that four or more of the following symptoms (see list below) must be present more days than not for six months. At least one of the symptoms should be”excessive anxiety and worry”. Symptoms must cause clinically significant distress or impairment in social, occupational or other functional areas and not be better explained by another mental disorder, by physiological effects of a substance and/or by another medical condition.

Symptoms of Generalized Anxiety Disorder

  • Excessive anxiety and worry that the person finds difficulty to control
  • Restlessness, feeling keyed up or on edge
  • Easily fatigued
  • Difficulty concentrating or mind going blank
  • Irritability
  • Muscle tension
  • Sleep disturbance (difficulty falling asleep, staying asleep or restless unsatisfying sleep)

Who’s at Risk?

    • Depression
    • Female sex
    • Functional limitations
    • Insomnia
    • Chronic conditions: high blood pressure, COPD, cardiac disease, sleep disorders, Parkinson’s Disease, vision loss (Silva et al., 2022; Vink et al., 2008)
    • Frailty (Tan et al., 2023)
    • Cognitive impairment or decline
    • Pain
    • Polypharmacy
    • Poor health status
    • Pyschosocial stressors: living with low income, living in precarious housing, unmet care needs, ageism (Carden et al., 2022; Kang & Kim, 2022)
    • Anxiety related to fear of falling

    Protective Factors (Hwang et al., 2020; Pain et al., 2019)

    • Life satisfaction or described meaning of life
    • Positive affect
    • Positive attachments
    • Spirituality

    References

    • Canadian Institute for Health Information. (2023). How Canada Compares: Results from the Commonwealth Fund’s 2022 International Health Policy Survey of Primary Care Physicians in 10 Countries— Methodology Notes. https://www.cihi.ca/sites/default/files/document/ cmwf-2022-meth-notes-en.pdf
    • Carden, K. D., McDuffie, D. L., Murry, K., Bui, C., & Allen, R. S. (2022). Minority stress process among older Black Americans: The role of age, perceived discrimination, and anxiety. Aging & Mental Health, 26(4), 852–859. https://doi.org/10.1080/13607863.2021.1904380
    • Grenier, S., Payette, M.-C., Gunther, B., Askari, S., Desjardins, F. F., Raymond, B., & Berbiche, D. (2019). Association of age and gender with anxiety disorders in older adults: A systematic review and meta‐ analysis. International Journal of Geriatric Psychiatry, 34(3), 397–407. https://doi.org/10.1002/gps.5035
    • Hwang, Y., Massimo, L., & Hodgson, N. (2020). Modifiable factors associated with anxiety in persons with dementia: An integrative review. Geriatric Nursing, 41(6), 852–862. https://doi.org/10.1016/j.gerinurse.2020.06.003
    • Kang, H., & Kim, H. (2022). Ageism and Psychological WellBeing Among Older Adults: A Systematic Review. Gerontology and Geriatric Medicine, 8, 233372142210870. https://doi. org/10.1177/23337214221087023
    • Nelson, S. E., & Wilson, K. (2017). The mental health of Indigenous peoples in Canada: A critical review of research. Social Science & Medicine, 176, 93–112. https://doi.org/10.1016/j.socscimed.2017.01.021
    • Pachana, N., Byrne, G., Siddle, H., Koloski, N., Harley, E., & Arnold, E. (2007). Development and validation of the Geriatric Anxiety Inventory. International Psychogeriatrics, 19, 103-114. doi: 10.1017/S1041610206003504.
    • Pai, H.-C., Li, C.-C., Tsai, S.-M., & Pai, Y.-C. (2019). Association between illness representation and psychological distress in stroke patients: A systematic review and meta-analysis. International Journal of Nursing Studies, 94, 42–50.
    • Silva, S., Bártolo, A., Santos, I. M., Pereira, A., & Monteiro, S. (2022). Towards a Better Understanding of the Factors Associated with Distress in Elderly Cancer Patients: A Systematic Review. International Journal of Environmental Research and Public Health, 19(6), 3424. https://doi.org/10.3390/ijerph19063424
    • Statistics Canada. (2021). Table 13-10-0788-01 Chronic conditions among seniors aged 65 and older, Canadian Health Survey on Seniors. https://doi.org/10.25318/1310078801-eng
    • Tan, M., Bhanu, C., & Frost, R. (2023). The association between frailty and anxiety: A systematic review. International Journal of Geriatric Psychiatry, 38(5), e5918. https://doi.org/10.1002/gps.5918
    • Vink, D., Aartsen, M. J., & Schoevers, R. A. (2008). Risk factors for anxiety and depression in the elderly: A review. Journal of Affective Disorders, 106(1–2), 29–44. https://doi.org/10.1016/j.jad.2007.06.005

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