Generalized Anxiety Disorder in Elderly

Generalized anxiety disorder is a disorder in which the patient has excessive anxiety and worry about a number of events or activities. The patient has a hard time controlling their worry and to keep worrisome thoughts from interfering with attention of the task at hand (American Psychiatric Association. 2013).

Treatment of GAD

            An FDA-approved drug that is used to treat an older adult with anxiety is Buspirone. Buspirone treats GAD as well as anxiety that is involved in medical conditions. It is an anxiolytic drug with a decreased side-effect profile. Buspirone is typically used as a second line agent behind SSRIs (Wilson et. al, 2020). With an older adult the starting dose should be 7.5mg twice daily and titrated for an optimal dosage (Schneider et. al, 2020). An example of a drug that can be used on an older adult that is off-label for generalized anxiety disorder would be propranolol. Propranolol is a non-selective beta-blocker that is currently used to treat anxiety. It is not currently approved by FDA for anxiety but has become one of the first line choices for providers to treat anxiety disorders (Alshehri et. al, 2020).  Propranolol is used in elderly to also treat peripheral symptoms of anxiety such as tachycardia and sweating (Alshehri et. al, 2020).  A nonpharmacological treatment for general anxiety disorder in an older adult is music therapy. Music therapy has shown to help increase social skills, cognitive abilities and causing undeniable improvement in geriatrics with depressive or anxiety disorders (Domínguez-Lloria et.al, 2020).

Risk Assessment

            A risk assessment for elderly with anxiety, Geriatric Anxiety Scale is a 30-item assessment. This assessment is a self-report assessment that assess, screens, and quantifies the severity of anxiety symptoms in the elderly population (Segal et. al, 2019). The older adult is asked to rate their symptoms during the last week from 0 being no anxiety to 3 meaning all the time. The total score for this assessment is based on the first 25 items. The score ranges from 0-75, with the higher scores rating more anxiety present. The additional 5 questions are added to the assessment to try to identify the areas of anxiety (Segal et. al, 2019).

            The benefit-risk assessment is an assessment that FDA uses as a foundation to review human drugs. This assessment includes participating in a meeting to gather stakeholder input, publishing a draft guidance on benefit-risk assessment for new drugs and biologics, continuing to revise relevant manuals and policies and procedures and standard operating procedures. The Benefit-risk integrated assessment also includes analysis of condition, current treatment options, benefit and risk and risk management (FDA,2018). Using an FDA approved medication helps because the FDA research to have safe medication. The benefits of off-label drug use is that it can be beneficial, especially if you have exhausted all of your treatment options, but it can be risky to use off-label drugs because it can increase the risk of a lawsuit and expose a patient to risky ineffective treatments.

Clinical Practice Guidelines

            Treating a geriatric patient with anxiety, we should follow the clinical guidelines. These clinical guidelines are there to provide the attending provider a ready reckoner to identify anxiety disorder, assess them, treat and manager side effects of medications among elder individuals (Subramanyam, et. al, 2018). The clinical guidelines include the classificatory systems of anxiety disorders, the differences in clinical presentation of anxiety disorders among the elderly patients, a comprehensive assessment, risk factors for anxiety disorders, specific presentations of various anxiety disorders, and medical conditions in the elderly which may be mistaken for anxiety disorders (Subramanyam, et. al, 2018). It is important that we use a risk assessment when we are diagnosing an elderly patient with an anxiety disorder. Other guidelines include using nonpharmacological treatments as first line treatment. These can include lifestyle modification, behavior therapy, cognitive therapy, and mindfulness. It is also important guideline when prescribing a pharmacological management to choose first line drugs such as SSRIs. It is important as a prescriber that you start low and go slow. You as the provider should also be aware of the side effects and how to manage them (Subramanyam, et. al, 2018). These clinical guidelines helps me to decide the drug I chose

References

Alshehri, Mohammed & Eltahir, Mahmoud. (2020). Common Drugs with Effective Off-Label Uses. 32. 25-33. 10.9734/JPRI/2020/v32i1030490.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Domínguez-Lloria, S., Ojea, M. J. G., & Pino-Juste, M. (2019). Efficiency of Music Therapy as a Non-pharmacological Treatment for the Elderly. International Journal of Health, Wellness & Society9(3).

FDA. (2018). BENEFIT-RISK ASSESSMENT IN DRUG REGULATORY DECISION-MAKING.

Schneider, R. B., Auinger, P., Tarolli, C. G., Iourinets, J., Gil-Díaz, M. C., & Richard, I. H. (2020). A trial of buspirone for anxiety in Parkinson’s disease: Safety and tolerability. Parkinsonism & Related Disorders81, 69-74.

Segal, D. L., Granier, K. L., Pifer, M. A., & Stone, L. E. (2019). Geriatric Anxiety Scale. Encyclopedia of Gerontology and Population Aging. Basingstoke: Springer Nature. https://doi. org/10.1007/978-3-319-69892-2_1103-1.

Subramanyam, A. A., Kedare, J., Singh, O. P., & Pinto, C. (2018). Clinical practice guidelines for geriatric anxiety disorders. Indian journal of psychiatry60(Suppl 3), S371.

Wilson, T. K., & Tripp, J. (2020). Buspirone. StatPearls [Internet].

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