How anxiety presents differently in older adults

Nazem Bassil, MD, Assistant Professor of Medicine/Geriatrics, Faculty of Medicine, Balamand University, St. George Hospital Medical Center, Beirut, Lebanon

Abdalraouf Ghandour, MD, Fellow, Division of Geriatric Medicine, University of Missouri, Columbia Columbia, MO

George T. Grossberg, MD, Samuel W. Fordyce Professor, Director of Geriatric Psychiatry, Department of Neurology and Psychiatry, St. Louis University School of Medicine, St. Louis, MO

Although anxiety disorders are common at all ages, there is a misconception that their prevalence drastically declines with age. For this reason anxiety disorders often are underdiagnosed and undertreated in geriatric patients, especially when the clinical presentation of these disorders in older patients differs from that seen in younger adults.

In older persons, anxiety symptoms often overlap with medical conditions such as hyperthyroidism and geriatric patients tend to express anxiety symptoms as medical or somatic problems such as pain rather than as psychological distress. As a result, older adults often seek treatment for depressive or anxiety symptoms from their primary care physician instead of a psychiatrist. Unfortunately, primary care physicians often miss psychiatric illness, including anxiety disorders, in geriatric patients.

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