Case One: Generalized Anxiety Disorder
Ethel, age seventy-one, has always been a nervous woman. When interviewed by a psychiatrist, she describes feeling worried about future events that might happen. She explains she has had these worries "for as long as I can remember." At times, she has bouts with fatigue, headaches, and muscle aches. She says that what bothers her most is her chronic insomnia, and she has taken many different medications for sleep throughout her life. "I take my sleeping pills and I do just fine," she says. However, her family doesn't agree. Her daughter is distressed by Ethel's constant need for reassurance: "When mom's really worried about something, she'll phone me ten to twenty times in a day. Sometimes she seems paralyzed by her worries." When asked about this, Ethel reveals that she does have difficulty controlling her worries and that she takes an extra sleeping pill in the daytime for "nerves."
Ethel has classic signs of generalized anxiety disorder, a condition marked by constant distressing worries that the person finds difficult to control. Up to 2 percent of elderly people are afflicted by this condition at any time, which tends to be chronic (either constant throughout life, as in Ethel's case, or waxing and waning). Few people with this condition ever seek treatment for it. It is typical for older adults with generalized anxiety disorder to have many physical symptoms, such as Ethel's fatigue and headaches, so they often seek care from primary-care and specialty doctors for these physical symptoms, receiving unnecessary medical workups and medications without ever realizing the psychological basis for their problems.
When underlying anxiety is recognized by a doctor, it is often treated with a medication in the class called benzodiazepines. Valium (diazepam) is a well-known example of this type of medication. Unfortunately, this is not necessarily the best treatment, as benzodiazepines have side effects such as memory impairment, slowed reaction time (for example, when driving), and impaired balance, compounding problems an elderly person might have already. If so, these side effects are potentially of serious concern. Other treatments known to be efficacious for generalized anxiety disorder in younger adults, such as certain types of antidepressant medications and psychotherapies such as cognitive-behavior therapy may be better choices. However, these treatments have not yet been proven efficacious in the elderly population, though there are many reports of them alleviating this condition. In Ethel's case, her primary-care physician eventually convinced her of the underlying anxiety basis behind her symptoms and the need for a different type of medication. She was willing to try this because she trusted him, and within weeks both she and her daughter were feeling much better. She understood that this treatment would probably be needed long-term.