“With a common disorder that causes a lot of impairment of quality of life and that has simple, inexpensive, straightforward kinds of treatment, I think screening is called for,” he added.
Whatever the final task force recommendation, the discussion of anxiety in older people highlights a prevalent but often overlooked mental health concern. “A lot of these cases fly under the radar,” Dr. Andreescu said.
That may reflect the way symptoms of anxiety can differ among older people, whose primary care doctors often lack the training to recognize mental health disorders. In addition to severe worry, seniors often experience insomnia or irritability; they may develop a fear of falling, engage in hoarding or complain of physical discomforts like muscle tension, a choking sensation, dizziness or shakiness.
But underdiagnosis also stems from older patients’ reluctance to ascribe their problems to psychological issues. “Some resent a label of ‘anxious,’” Dr. Andreescu said. “They’d rather call it ‘high stress,’ something that doesn’t indicate psychological weakness.”
And since aging involves genuine sources of fear and distress, from falls to bereavement, people may see anxiety as normal, as Ms. Tilton did.
It has serious consequences, however. “It has an impact on the health of our brains and our bodies,” Dr. Andreescu said. Studies have demonstrated connections between anxiety and cardiovascular disease, with greatly increased risks of coronary heart disease, heart failure, stroke and death. Patients with higher anxiety levels are more likely to engage in substance abuse, too.
Research also consistently shows that anxiety is linked to cognitive decline and dementia. Dr. Andreescu’s neuroimaging studies have found that “anxiety actually shrinks and ages the brain,” she said.