By some estimates, as many as one in five older Americans suffer from some form of anxiety disorder. These can range from specific phobias (my irrational fear of dentists, for instance, is known as dentophobia) to full-on panic attacks, and they may contribute to a variety of chronic illnesses. So, I was struck the other day by a couple of recent studies showing the effectiveness of nonpharmaceutical remedies to these disorders. They seemed to offer some hope for those wallowing in worry.
Trouble is, most seniors will never receive treatment because they’ll never be diagnosed.
The United States Preventive Services Task Force (USPSTF) last year recommended that no one above the age of 64 be screened for anxiety disorders, arguing that current research offers insufficient data on its benefits for the Medicare set. The ruling leaves it up to older patients — notoriously reticent about discussing their mental health — to ask their physicians to test them for the condition. The ruling, Carmen Andreescu, MD, and two of her colleagues argue, was a missed opportunity.
“Anxiety represents a highly prevalent problem and a potentially modifiable risk factor for diseases of aging,” Andreescu, a geriatric psychiatrist at the University of Pittsburgh School of Medicine, writes in a 2023 JAMA Psychiatry editorial. “Opposite to the opinion expressed in the USPSTF, we do not anticipate any harm in recommending anxiety screening in older adults but consider this a great tool leading to prevention of mental and cognitive disorders of aging.”
Seniors contend with atypical anxiety issues — chronic worrying, a fear of falling, loneliness — and these are often manifested in physical disorders, making them more difficult to diagnose because we often minimize our symptoms. As a result, Andreescu notes, only about a third of older adults dealing with generalized anxiety disorder are ever treated. And that’s a problem, because plenty of research has shown a link between anxiety and a variety of aging-related diseases, including cardiovascular disease, cognitive disorders, and even autoimmune illnesses. One meta-analysis she cites found that study participants suffering from anxiety disorders were 45 percent more likely than their anxiety-free counterparts to descend into Alzheimer’s.
Physiologically, this may make some sense, she explains, because chronic anxiety tends to tax our cardiovascular, hypothalamic-pituitary-adrenal, and immune systems in a way that has been shown to cause neurological and cardiovascular trouble. “Just as depression has been identified as a major modifiable risk factor for diseases of aging, including Alzheimer’s disease, so to might anxiety disorders,” she writes.
Andreescu acknowledges concerns about the dangers of overprescribing benzodiazepine and other antianxiety drugs for older adults, but she points to alternative approaches, including selective serotonin reuptake inhibitors and cognitive behavioral therapy. And the two new studies I mentioned earlier suggest that other novel, nonpharmaceutical approaches may also be effective.
Brazilian researchers, reviewing more than 200 studies on the use of resistance training to mitigate the effects of depression and anxiety, concluded that its benefits were particularly significant among older adults.
“Epidemiological studies have shown that the decrease in muscle strength and mass that occurs naturally as we age may be associated with an increase in mental health problems, given the existence of various physiological mechanisms that bring about function and structural changes and that are controlled by the brain.”
That’s not surprising, notes lead study author Paolo Cunha, PhD, a postdoctoral fellow at the Albert Einstein Jewish-Brazilian Institute of Education and Research. “Epidemiological studies have shown that the decrease in muscle strength and mass that occurs naturally as we age may be associated with an increase in mental health problems, given the existence of various physiological mechanisms that bring about function and structural changes and that are controlled by the brain,” he says.
The study, published in the journal Psychiatry Research, found that a particular weight-training approach was most effective for anxious seniors. While researchers don’t recommend a specific exercise, they did find that performing three sets of six moves three times a week using free weights or machines was more productive than a body-weight routine.
“We don’t have statistics comparing the two kinds of training,” Cunha explains, “but the analysis showed that resistance training with weights and other gear is more effective in terms of improving the mental health of older people, largely because the intensity and volume of the exercises can be more precisely controlled.”
Meanwhile, a research team at the University of Florida is promoting a treatment approach for older adults dealing with anxiety issues that is, well, a bit more unconventional: transcranial direct-current stimulation (tDCS).
I suspect those with a morbid fear of electricity (electrophobia) did not sign up for this study, which involved sending a weak electrical current into the brains of participants via electrodes strategically planted on their heads. Nearly 400 seniors did volunteer, though, and half of them underwent 12 weeks of tDCS treatments along with cognitive training while the other half participated in the training but received a placebo version of tDCS.
After accounting for participants’ use of pharmaceuticals, researchers found that the seniors who received the tDCS treatments showed significant improvement in their anxiety levels when compared with the placebo group. The results, published in the journal Brain Stimulation, mirrored the outcomes of earlier trials involving brain stimulation to the prefrontal cortex, notes lead study author Hanna Hausman, MS, a PhD student in neuropsychology.
“Extensive research has demonstrated the efficacy of active stimulation to this area of the brain in reducing psychological symptoms in individuals with diagnosed psychiatric disorders,” Hausman explains. “It was an unexpected yet welcome surprise to witness similar effects in our sample of older adults without significant psychiatric histories, especially on a large scale. Demonstrating this therapeutic effect is important because even subclinical depression and anxiety symptoms in older adults are associated with adverse outcomes.”
The treatment approach, Hausman argues, is cost-effective, portable, and can be seamlessly integrated with other therapeutic approaches — which makes tDCS a lot like weight training (unless you’re an electrophobe). But neither approach holds much promise for anxious seniors unless clinical screening identifies their particular disorder. As Andreescu puts it in her JAMA editorial, “Older adults should not be denied the opportunity to benefit.”
