Imagine that you are about to give a speech before an audience of 500 people. In the last few minutes before your address, you begin to feel nervous, your heart starts to pound, and your palms get sweaty. (You now have something in common with Daisy’s reactions.) These feelings, common even to veteran speakers, are similar to those experienced by people with anxiety disorders: a group of conditions that are based on fear or uneasiness.

Anxiety disorders include problems such as feelings of severe anxiety for no apparent reason, phobias with regard to specific things or places, and obsessive-compulsive disorders, in which thoughts or actions are repeatedly performed (Beck & Averill, 2004; Mohlman et al., 2004). Although anxiety disorders occur in adults of all ages, they are particularly common in older adults due to loss of health, relocation stress, isolation, fear of losing independence, and many other reasons. Anxiety disorders are diagnosed in approximately 17% of older men and 21% of older women (Fitzwater,

2008) . The reasons for this gender difference are unknown.

Symptoms and Diagnosis of Anxiety Disorders.

Common to all the anxiety disorders are physical changes that interfere with social functioning, per­sonal relationships, or work. These physical changes include dry mouth, sweating, dizziness, upset stom­ach, diarrhea, insomnia, hyperventilation, chest pain, choking, frequent urination, headaches, and a sensation of a lump in the throat (Beck & Averill,

2004) . These symptoms occur in adults of all ages, but they are particularly common in older adults because of loss of health, relocation stress, isola­tion, fear of losing control over their lives, or guilt resulting from feelings of hostility toward family and friends.

An important issue concerning anxiety disorders in older adults is that anxiety may be an appropriate response to the situation. For example, helplessness anxiety such as Daisy is experiencing is generated by a potential or actual loss of control or mastery (Verwoerdt, 1981). In addition, a series of severe negative life experiences may result in a person’s reaching the breaking point and appearing highly anxious. Many older adults who show symptoms of anxiety disorder have underlying health problems that may be responsible for the symptoms. In all cases the anxious behavior should be investigated first as an appropriate response that may not war­rant medical intervention. The important point is to evaluate the older adult’s behavior in context.

These issues make it difficult to diagnose anxi­ety disorders, especially in older adults (Beck & Averill, 2004; Fitzwater, 2008; Mohlman et al.,

2004) . The problem is that there usually is nothing specific that a person can point to as the specific trigger or cause. In addition, anxiety in older adults often accompanies an underlying physical disorder or illness. These secondary causes of anxi­ety must be disentangled from the anxiety symp­toms so that each may be dealt with appropriately. In short, the trick is to distinguish between the “worried” and the well. Wetherell, Le Roux, and Gatz (2003) report that the key features of late – life anxiety disorder are distress and impairment, frequency and uncontrollability of worry, muscle tension, and sleep disturbance.

Treating Anxiety Disorders. Anxiety disorders can be treated with medication and psychotherapy (Beck & Averill, 2004). The most commonly used medications are benzodiazepine (e. g., Valium and Librium), SSRIs (Paxil, among others), buspirone, and beta-blockers. Though moderately effective, these drugs must be monitored very carefully in older adults because the amount needed to treat the disorder is very low and the potential for side effects is great. For older adults, the clear treatment of choice is psychotherapy, especially relaxation therapy (Beck & Averill, 2004). Although ben­zodiazepines are effective with adults of all ages, they must be used very carefully with older adults.

Effective dosage levels are lower in older adults, and the potential for side effects is much greater. Most important, these drugs can cause decreased cognitive functioning, which may be mistaken for early dementia. In general, the benzodiazepines may cause drowsiness, loss of coordination, head­aches, and lower energy levels. Moreover, because of the potential for addiction, the long-term use of these drugs should be avoided.

In most cases the treatment of choice for anxi­ety disorders is psychotherapy. A broad range of approaches is effective with adults of all ages (Niederehe & Schneider, 1998). These include relax­ation training, substituting rational for irrational thoughts, and gradual exposure to images or real situations that generate anxiety. Relaxation therapy is especially effective, is easily learned, and pres­ents a technique that is useful in many situations (e. g., falling asleep at night). The advantage of these psychotherapeutic techniques is that they usually involve only a few sessions, have high rates of suc­cess, and offer clients procedures that they can take with them.