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Source: Jorge Royan
Flutur Blog Author
Mallika Priya Khullar
2 years ago
Flutur effect
Flutur Blog Author
Mallika Priya Khullar
2 years ago

The Elephant in the Geriatric Room

What is GAD
Generalized Anxiety Disorder (GAD) is characterized by worry regarding a plethora of things. People with GAD tend to be excessively and persistently worried about issues like health or work and find it very hard to control these feelings. They may obsess more than necessary about actual events even when there is no apparent reason for concern. Sometimes just the thought of getting through the day produces anxiety.

People with GAD don’t know how to stop the cycle of worry and feel it is beyond their control. Their logical mind does inform them that the worry they feel is more than warranted but they are unable to come out of the cycle. At times, people can even struggle with physical symptoms such as stomach aches and headaches.

Although GAD is one of the most common types of mental illness affecting people ages 60 and older, it is often dismissed or overlooked, especially in a country such as ours.

Late-life anxiety disorders are twice as prevalent as dementia among adults aged 65 and more, and four to eight times more prevalent than major depressive disorders. Anxiety in the elderly causes significant impact on morbidity and mortality of older adults. GAD not increases the risk of physical disability, problems with memory, and reduced quality of life, they also increase the risk of death. And it seldom occurs alone. Most patients with GAD also have symptoms of other mental health problems, such as depression or substance abuse.
Treatment of GAD in the Elderly
Venlafaxine, the serotonin norepinephrine reuptake inhibitor, was equally effective at treating adults over age 60 suffering from anxiety disorders compared with younger adults, showed one study. Older adults who took the SSRI for eight months reported an overall improvement in symptoms and quality of life. There is also one meta-analysis of five controlled trials (136 subjects, 47 controls) that supports the use of the venlafaxine for treating late-life GAD. However one can’t assume the same drugs used to treat GAD in younger people will always work in the elderly.

Further research will be needed to determine the effects of these drugs particularly in the elderly. The standing research on pharmacological treatment of anxiety disorders in late life is limited, and guidelines are generally based solely on extrapolation from research with younger ages.

Benzodiazepines are frequently overprescribed for older individuals with anxiety, often with serious side effects in this age group including cognitive impairment, rebound withdrawal symptoms, dependence, incontinence, and falls leading to hip fractures and fall-related death.

The general principles for the use of medications for older adults are to start low and go slow but also aim high and treat long.
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