An elderly woman sits quietly and stares off at the wall in front of her, her hands clutched tightly together. She’s there for a regular check-up, but how thorough will that check-up be? We have to wonder as do physicians who are awaiting a report being issued by the United States Preventive Services Task Force on late-life anxiety screening.
The preliminary report of this task force appears to lean toward screening of those over 65 as is done for adults with regard to depression. It should be noted that Medicare pays $25 for simple depression screening questionnaires completed in a medical office. The practice begs the question: why no payment for anxiety screenings?
Consider, for a moment, how major healthcare organizations have addressed the question of anxiety disorders in over-65-year-old patients.
Mild anxiety symptoms, according to the Centers for Disease Control and Prevention, steadily increase with age, from about 12% in adults 18 to 29 to 7% in adults 65 and over. The problem is that little research has addressed the incidence of serious anxiety disorders in the older-old population, even among the statistical data supplied by the World Health Organization there’s a gap. How many people in the US are living well beyond the age of 65 these days?
Over 54 million Americans, or roughly 16.5% of the total population, were 65 years of age or older, according to the U.S. Census Bureau. The population aged 65 and above increased by more than a third (34.2% or 13,787,044) over the past ten years and by 3.2% (1,688,924) between 2018 and 2019. Over 56 million Americans — or 16.9% of the country’s total population — were 65 or older in 2020.
The apparent lack of information on this age group is also noted in the National Institute of Mental Health reports, where there is statistical data lacking for those over 65. The lack of data on this age group is, again, noted in the Anxiety and Depression Association of America reports, which primarily show levels of anxiety and depression below the age of 65.
Information on anxiety disorders in general or on specific disorders can be found in other sources. For instance, according to Hopkins Medicine, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), panic disorder, and phobias affect roughly 18% of adults between the ages of 18 and 54 in a given year. Where’s the data on the over-65s? It’s missing.
According to the Anxiety and Depression Association of America (ADAA), social anxiety disorder affects 15 million adults, or 7.1% of the country’s population, whereas panic disorder affects 6 million adults or 2.7%. According to the Centers for Disease Control and Prevention (CDC), Americans aged 45 to 54 had the highest suicide rates in the United States in 2020.
Again, there is no data on the 65 and older individuals who may have committed suicide because of severe anxiety, loneliness, depression, and lack of medical care. Nevertheless, the ADAA statistics do not reveal how many of those people are above 65.
One concern raised by mental health organizations is that people over the age of 65 are less likely to report or seek treatment for depression or anxiety because they prefer to deal with these conditions on their own. This can be because of the stigma still associated with mental health services and treatment. But there is no scientific evidence for this idea; it’s just what most people think.
Although anxiety, in all of its manifestations, can be a serious threat to both mental and physical health, the healthcare sector currently does not. Not only is it unethical, but it could also be dangerous to say that common lifestyle changes cause those worries about the elderly.
Take into account the fact that as one ages, work options diminish. Being a medical consultant for the Social Security Administration, I was aware of the unwritten rule that if you are above 50, you are unemployable. How can someone who doesn’t have enough ways to make money, isn’t working, and is getting worse physically keep from getting nervous or having panic attacks? Anxiety is the outcome of their lack of control over any of this.
Shouldn’t healthcare professionals take a more proactive approach to finding and treating anxiety in their older patients? Indeed, 15-minute sessions don’t provide much time for a thorough examination of something about which the patient hasn’t complained. Should it remain that way forever?
Do we let down our elderly patients? For everything they’ve done for us, shouldn’t they be treated better?