Treating Anxiety Disorder in the Elderly

Average life expectancy keeps crawling upward. Unfortunately, the healthcare system isn’t advancing as rapidly as the population of elderly adults, and many seniors, especially those living in rural areas, are falling through the cracks.

One in five older adults suffers from a mental disorder, but unfortunately many don’t have access to mental health providers. A study published August 5 in JAMA Psychiatry may provide a solution. Research shows that cognitive behavioral therapy delivered by telephone is effective in treating anxiety disorder in the elderly.

sad old seniorAn Overreliance on Drug Therapy

Dr. Eric J Lenze of Washington University School of Medicine in St. Louis expresses concern that we may be overmedicating when treating anxiety disorder in the elderly when we should be employing safer cognitive therapies. He explains:

“The drugs that many older adults receive, particularly benzodiazepines for anxiety, can cause cognitive impairments and motor problems. But seniors who are anxious or have insomnia are receiving a skyrocketing number of prescriptions for these drugs, particularly in rural America. That’s a recipe for disaster because giving seniors benzodiazepines can contribute to serious and expensive consequences, such as broken hips, an acceleration in dementia and a general decline in an older person’s ability to function.”

Researchers at Wake Forest School of Medicine may have discovered a solution. Adults 60 years and older were randomized into two groups. The first group consisted of 70 seniors who received at least 9 and as much as 11 cognitive behavioral therapy (CBT) sessions over the telephone. Clinicians provided recognition of anxiety symptoms, relaxation, cognitive restructuring, the use of coping statements, problem solving, worry control, behavioral activation, exposure therapy, and relapse prevention, with optional chapters on sleep and pain.

The second group consisted of 71 seniors who received 10 sessions of nondirective supportive therapy (NST) over the telephone. Clinicians provided a supportive ear for patients to share and discuss their feelings, but no coping suggestions or solutions were provided.

Researchers measured anxiety, self-reported worry, and mood at the start of the study, and then two months and four months after the study. Results showed that after four months patients who received CBT over the phone had significantly decreased worry and depressive symptoms, as well as improved mood. Reported benefits matched those other patients experienced in previous, in-person CBT studies.

Hopefully, more mental health providers will take their cue from this study and provide cognitive behavioral therapy by phone for anxiety sufferers they are unable to treat in person.