Anxiety is a common psychiatric disorder affecting individuals at any age, but can be more devastating to those of advanced age, particularly older adults diagnosed with dementia. Anxiety and dementia together can significantly reduce a person’s quality of life and make quality care more complicated to provide. The two disorders are also associated with a higher likelihood of placement into a senior care center.
Clinical Complexity
Clinically, it becomes difficult for skilled and seasoned healthcare professionals to assess age-related psychiatric and neuropsychiatric conditions due to so many confounding factors. Symptoms of many disorders overlap one another, such as anxiety and depression or agitation, and some may mask physiological or medical problems like diabetes or heart disease. Making matters more complicated are the many possible side effects of medications. Therefore, assessing anxiety within a pool of psychiatric, behavioral, cognitive and physical conditions is daunting to say the least.
Further Complications
Older adults who have cognitive impairment due to dementia-related disorders and anxiety tend to exhibit higher levels of psychological distress, which in turn can affect their activities of daily living. Many psychotropic medications can further decrease the individual’s ability to function leading to greater decline in quality of life. Experts report that psychological interventions have been somewhat successful for those who have both dementia and depression, but treatment for dementia and anxiety don’t seem to work as well.
What’s the Problem with Anxiety?
Because it’s difficult to assess accurately for anxiety among individuals who are cognitively impaired, it goes unnoticed and untreated, which can lead to further decline and complex behaviors. As the individual experiences more deterioration in cognition and function, providing care becomes increasingly challenging. There are still no robust scales or tools to assess anxiety in older adults. Many professionals rely on self-report, which may be inaccurate due to cognitive impairment. Others turn to family members for information, but this method has its limitations.
How Can These Conditions Be Managed?
The first line of intervention should always be non-pharmacological. Once psychosocial and other methods have been exhausted, and quality of life is diminishing, medications may be considered. According to the literature, music therapy seems to have some value in reducing distressing behaviors and feelings of anxiety among older adults. Activity therapy shows some promising outcomes as well, and involves engaging the older adult in meaningful and pleasurable activities. Exercise and pain management also seem to help manage symptoms of anxiety.
Final Thoughts on Dementia and Anxiety: What’s the Connection?
Cognitive decline due to a dementia-related disorder accompanied by anxiety appear to be fairly common among older adults, and especially those living in senior care communities. Accurately assessing anxiety is complicated by numerous physical, psychiatric, cognitive and behavioral comorbid conditions. When anxiety is unrecognized, it goes untreated and the individual may experience a downward spiral in health and quality of life. Until better interventions come along, attention, care and support can help to reduce anxiety and improve quality of life.