Evidence-based guideline. Detection and assessment of late-life anxiety

Marianne Smith, University of Iowa
T. Ingram
V. Brighton

Abstract

Anxiety is common among older adults but is underdiagnosed and undertreated (Kroenke et al., 2007; Sadavoy & LeClair, 1997), leading to unnecessary suffering for the anxious older person. The most important first steps in facilitating appropriate treatment involve recognition of anxiety and unrealistic and excessive worry, and understanding that older adults may worry about real-life problems. In addition, nurses and other health care providers have many opportunities to observe physical and psychological symptoms that accompany anxious mood and worry, such as restlessness, fidgeting, irritability, and difficulty concentrating. Presence of one or more risk factor for anxiety (e.g., physical illness, recent psychosocial stress, depressed mood, cognitive impairment, somatic complaints for which no cause can be identified, select personal characteristics) should trigger assessment. Use of the full anxiety guideline (Smith et al., 2008) increases the probability that anxiety is accurately identified and quantified in a way that guides decision making. Referral for comprehensive assessment of anxiety and related symptoms is essential to determine diagnoses and, in turn, initiate therapeutic interventions and treatment to restore function and comfort. Just as for other health-related factors (e.g., vital signs, weight), ongoing monitoring of individuals at risk is essential to ensure optimal outcomes for anxious older adults.