ELDER CONSIDERATIONS
Anxiety that starts for the first time in late life is frequently
associated with another condition such as depression, dementia, physical
illness, or medication toxicity or with-drawal. Phobias, particularly
agoraphobia, and GAD are the most common late-life anxiety disorders. Most
people with late-onset agoraphobia attribute the start of the dis-order to the
abrupt onset of a physical illness or as a response to a traumatic event such
as a fall or mugging. Late-onset GAD is usually associated with depression.
Though less common, panic attacks can occur in later life and are often related
to depression or a physical illness such as cardiovascular, gastrointestinal,
or chronic pul-monary diseases. Ruminative thoughts are common in late-life
depression and can take the form of obsessions such as contamination fears,
pathologic doubt, or fear of harming others. The treatment of choice for
anxiety disor-ders in the elderly is selective serotonin reuptake inhibi-tor
(SSRI) antidepressants. Initial treatment involves doses lower than the usual
starting doses for adults to ensure the elderly client can tolerate the
medication: if started on too high a dose, SSRIs can exacerbate anxiety
symptoms in elderly clients (Sakauye, 2008).
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