WK9DisRep
Jane,
So this student chose anxiety. Just write something quick. 2 paragraphs and 2 sources. Thanks!
Providing care to the elderly can be a challenge. The provider should use evidence-based practice to make decisions regarding treatment. This discussion will focus on treating anxiety in the elderly with FDA and off-label approved medication, non-pharmacological treatments, and clinical practice guidelines.
Interventions for Anxiety in the Elderly
Selective serotonin reuptake inhibitors (SSRI’s) and serotonin norepinephrine reuptake inhibitors (SNRI’s) are the preferred pharmacotherapy treatment for elderly patients with anxiety (Pary, Sarai, Sumner, & Lippmann, 2018, p. 331). Escitalopram (Lexapro) is an FDA-approved medication used to treat generalized anxiety disorder. Lexapro is known to be better tolerated and has fewer drug interactions. Low drug interaction is essential when treating the elderly as they are often prescribed numerous medications to treat medical problems.
Mirtazapine (Remeron) is used off-label for generalized anxiety disorder. Remeron is FDA-approved for major depressive disorder but has many other benefits, especially for the elderly. Remeron can be sedating, making it a good choice for those having trouble sleeping. It is also known to increase weight which is suitable for those who are underweight. Hyponatremia has been linked to Remeron use in the elderly (Grover, Shouan, Mehra, Chakrabarti, & Avasthi, 2018, p. 118). Clinicians should monitor sodium levels if they have elderly patients taking this medication.
Non-pharmacological treatments for treating anxiety in older adults is to focus on lifestyle changes. Subramanyam, Kedare, Singh, & Pinto (2018) recommend teaching about sleep hygiene, the importance of exercise, maintaining a healthy diet, and socialization (p. 376). Cognitive behavior therapy can also be a helpful treatment.
Risk Assessment and Treatment
After thoroughly assessing the client’s symptoms and comorbidities, the provider should select a treatment option that will be the least harmful and provide the best benefits. The Geriatric Anxiety Scale (GAS), Adult Manifest Anxiety Scale-elderly version (AMAS-E), and the Penn State Worry Questionnaire (PSWQ) are screening tools the provider can use to aid in diagnosis and monitor progress (Balsamo, Cataldi, Carlucci, & Fairfield, 2018, p. 575). Screening tools, along with patient-reported symptoms, should be the determining factor for treatment.
The benefits of Lexapro are that it is better tolerated compared to other drugs in its class, has fewer drug interactions, and it is safe for long-term use. Some of the risks are serotonin syndrome, increased risk of bleeding when combined with warfarin or non-steroidal anti-inflammatory drugs NSAIDs), and impaired effectiveness if given with NSAIDs.
Remeron's benefits are that it treats mood symptoms, has a sedative effect, and stimulates appetite. The risks are that it has antihistamine properties that cause dry mouth, constipation, dizziness, and confusion. Antihistamine's side effects could be dangerous for the elderly. Dizziness and sedation could increase the risk for falls.
Clinical Practice Guidelines
An assessment initiates treatment. Elderly persons are susceptible to metabolic changes and nutritional deficiencies. Subramanyam, Kedare, Singh, & Pinto (2018) recommend ruling out the anxiety's physical reasons (p. 374). Screening tools for anxiety can be helpful. The first-line medication choice is SSRI or SNRI. Benzodiazepines are typically avoided because of their side-effect profile. Pharmacological and non-pharmacological interventions are effective. For the elderly, Lexapro 10mg daily is recommended.
Conclusion
Treatment selection for elderly persons with anxiety should consider self-reported symptoms, screening tools, and comorbid conditions. The provider and patient should make a decision based on evidence-based practice and clinical practice guidelines. As in every situation, the patient should be made aware of potential risks and benefits and possible side effects, then together with the clinician, should select a treatment plan.
References
Balsamo, M., Cataldi, F., Carlucci, L., & Fairfield, B. (2018). Assessment of anxiety in older adults: A review of self-report measures. Clinical Interventions in Aging, 13, 573-593. doi:10.2147/cia.s114100
Grover, S., Shouan, A., Mehra, A., Chakrabarti, S., & Avasthi, A. (2018). Antidepressant-associated hyponatremia among the elderly: A retrospective study. Journal of Geriatric Mental Health, 5(2), 115-120. doi:10.4103/jgmh.jgmh_28_18
Pary, R., Sarai, S. K., Sumner, R., & Lippmann, S. (2018). Anxiety in geriatrics. Postgraduate Medicine, 131(5), 330-332. Retrieved from https://doi.org/10.1080/00325481.2019.1624583
Subramanyam, A. A., Kedare, J., Singh, O. P., & Pinto, C. (2018). Clinical practice guidelines for Geriatric Anxiety Disorders. Indian Journal of Psychiatry, 60(3), 371-382. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5840911/