Table of Contents
Introduction
Over the many years that psychology has been developed, little amount of research has been conducted to ascertain the concept of anxiety in late life. As Gonçalves and Byrne (2011) write, it is only recently that clinical practice and the scientific community expanded to incorporate the concept of anxiety. Among the reasons that the authors stated is the limited and rare presentation of older adults with anxiety to the clinical setting, a factor that has led clinicians and scientists alike to assume that anxiety disorders are nor prevalent in late life. Despite this, the recent epidemiological studies have indicated that anxiety disorders among older adults are increasing, with reports by Salaz, Gutierrez and Dykeman (2016) indicating that anxiety disorders prevalence rates outweigh those of depression as a disorder among the older adults. The estimates rates provide in this report, though variant in methodological and conceptual aspects, illustrate that anxiety disorders are among the leading developmental psychology disorders that affect older adults. Therefore, this research paper attains its course from the above outline, where it will analyze Generalized Anxiety Disorder (GAD). This research aims at disseminating information about Generalized Anxiety Disorder among the older adults, as well as analyzing the factors behind the rare implementation of the available evidence-based treatments for this disorder.
Literature review
As stated in the introductory part of this study, anxiety disorders have been subject to intensified research, more so with the increasing prevalence of such disorders among the older adult population. Generalized Anxiety Disorder, as Eroglu, Annagur and Icbay (2012) narrate, is a disabling and prevalent disorder that is defined through tension, persistent worrying and symptoms of anxiety. Across the cross-sectional studies pertaining anxiety disorders, it has been established that GAD is the most frequent psychological disorder in primary care, with Landreville, Gosselin, Grenier, Hudon and Lorrain (2015) noting that approximately 25% of the primary care patients diagnosed with anxiety complain and exhibit symptoms of GAD.
In light of the establishment of the prevalence of this anxiety disorder, Wetherell, Gatz and Craske (2014) conducted a study to analyze the course and treatment of psychological disorders among the older adults. In this study, the researchers documented that the treatment of GAD, just like other anxiety disorders, is behind that of conditions linked with depression such as Alzheimer’s disease. Even more, a separate study by Gonçalves and Byrne (2012) indicated that doctors believed that anxiety disorders decreased along with age, a theoretical assumption which has since been quashed by the increasing physical complains of people encountering GAD in late stages of life.
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While at it, Mohlman, Price and Vietri (2013) defined older adults as the population aged above 65 years. While making this definition, the scholars explained that anxiety is relatively common among the older adults just as much as it is among the younger people. This observation supported the argument by Salaz, Gutierrez and Dykeman (2016), whose study revealed that anxiety disorder was even more prevalent among older adults as opposed to the younger populations.
Among the anxiety disorders to which the older adults are exposed to, GAD is most common, based on the research findings by Gonçalves and Byrne (2012). This anxiety disorder is popular among this population mainly because the older adults are at high risk of acute illnesses and traumatic events such as falls, which are risk factors of the GAD. A look at the other anxiety disorders discussed by the authors indicate that the prevalence of panic disorder, obsessive-compulsive disorder, chondriasis and agoraphobia are equally as prevalent among the older adults as they are among the general populations. What’s more, certain anxiety disorders have been found to be less prevalent among the older adult population.
Therefore, majority of the studies conducted on anxiety disorders among the older adults have been anchored on the statistics that GAD is the most prevalent form of anxiety disorder that manifests in late life. For instance, in the study by Wetherell, Gatz and Craske (2014), GAD was found to manifest through somatic and psychological complaints such as autonomic arousal, irritability, fatigue, concentration challenges, sleeping difficulties and persistent restlessness. In addition, Gaudreau, Landreville, Carmichael, Champagne and Camateros (2015) explained that GAD among the older adults has been classified as a chronic condition, as it affected patients for periods as long as 12 years.
Since the introduction of GAD in the DSM in 1980, Eroglu, Annagur and Icbay (2012) write that there have been several randomized trials and meta-analyses that have depicted the extent to which pharmacotherapy can be used to manage and eventually treat GAD. Besides, the study illustrated that psychological treatments have since been used by patients and clinicians, as this has proven to have better intervention outcomes. In light of the considerable growth of literature on the topic of GAD among older adults, this research conducts a new study to ascertain the different types of treatment.
Purpose of the research
To begin with, this study aims at examining the etiology of Generalized Anxiety Disorder as a developmental psychology problem to which the older adults are exposed. This will guide the study into defining the symptoms of GAD and the risk factors linked to the disorder among the target population discussed in the study. The above factors will set a research platform, which would critique the efficacy of the available methods of managing and treating GAD among the older populations. This will include a cross-sectional analysis of the possible effects, both long term and short term, of discussed methods of treatment. This research is important because it adds more value and depth onto the available wealth of knowledge and information about the methods of treating GAD, and the possible effects of such methods of treatment on the long-term physical health and psychological wellness of those diagnosed with GAD in late life.
Research questions
- What is the etiology of Generalized Anxiety Disorder (GAD)
- What are the signs and symptoms that dictate the clinical presentation of GAD among older adults?
- Who is at high risk of acquiring GAD?
- What are the methods of managing and treating GAD among older adults?
- Do these methods of treatment have any short or long term effects?
Research methodology
This study adopts a qualitative research methodology, which implies that its findings are largely dependent on readings from peer reviewed journal articles relaying findings from studies that have been conducted earlier on the topic of GAD. Along the qualitative research methodology, several methods were used to identify the studies that are liable for possible inclusion in the research.
Procedure
To begin with, an in-depth search was conducted on the major bibliographical databases that are linked with the topic, including Pub Med, International Journal of Psychology, and Clinical Psychology Review among others. The searches used the key world Generalized Anxiety Disorder, with combinations of indicative term such as etiology, treatment, risk factors and older adults. Thereafter, the reference list was analyzed with respect to the theme of management and treatment of GAD. From these chosen articles, the primary studies were included.
Variables
This research coded diverse aspects of the studies included herein. The participants of this study, therefore, were determined based on the recruitment method, as only clinical samples from community specialized and primary care setting were allowed. The participants were also characterized by the target group of the study. Consequently, the research directed its emphasis on populations aged above 65 years. Similarly, the methods of intervention and number of sessions were used to determine the sample size and diversity of the treatment methods applicable in the study.
Participants
Of the 10 studies included, a total of 1016 patients participated: 630 with psychotherapy conditions, 303 in control conditions, 51 in pharmacotherapy conditions and the remaining in the combined conditions of pharmacotherapy and psychotherapy. The recruitments, as mentioned in the section above were from clinical samples and community referrals.
Measures
The measurements collected for this research were based on the confidence intervals of the studies involved. Thereafter, a subgroup analyses was conducted to establish the risk factors, signs and symptoms of GAD. For the treatment results, the study retrieved its measurements from the results of the broad categories of the categories, including cognitive behavioral therapy and non cognitive behavioral psychotherapy.
Majority of the studies used in this research used small sample sizes, which made it difficult to generalize the findings of the research. Therefore, adjustments were made to establish the effect sizes of such as the self report anxiety measures, depression measures and the instruments used by clinicians to measure anxiety. In addition, the research acknowledges that misdiagnosis between depression and GAD has been a major cause of high level of comorbidity among the target group, a factor that validated the inclusion of depression measures in the study.
Discussion
Etiology
Across the studies, it was established that anxiety is a common symptom for many mental health conditions other than GAD. However, GAD was distinguished as different from these conditions through the causative factors that were linked to its manifestation. In this study, majority of the older adults diagnosed with GAD had a history of prolonged exposure to stressful situations. Looking at the older adults in the community care facilities, it was evidenced that majority of them had a family history of anxiety, which is linked to stressful situations such as domestic and social instability that trickles down the lineage. Moreover, interviews with physicians indicated an increased saturation of tobacco and caffeine among many of the GAD patients. This worsens the probability of anxiety among the older adults.
Signs and symptoms
As Mohlman, Price and Vietri (2013) elaborate; the clinical presentation of GAD cannot be ruled solely on the basis of anxiety. Therefore, this research classified the signs and symptoms of GAD among older adults into psychological, behavioral, physical and social. Panic, irritability, negative cognitions and excessive fear were the psychological symptoms of GAD, while the behavioral symptoms were sleeping disturbances, restlessness ad loss of appetite. Older adults with GAD displayed physical symptoms such as shaking, rapid heartbeat, and sweating, gastrointestinal distress and muscle tension. Socially, the GAD patients appeared withdrawn and sought isolation away from people.
Risk factors
In their research, Landreville, Gosselin, Grenier, Hudon and Lorrain (2015) established that the prevalence of GAD is higher among women than it is in men. In this study, approximately 63% of the sample size was made up of women, with many men suffering this disorder having a history of psychological trauma and poor coping strategies of the increased exposure to stressful activities. In addition, majority of the older female adults who are unmarried or widowed were found to be at high risk of attaining GAD. Certain communities are also at high risk of acquiring GAD, as illustrated in the research findings. These communities are those that have a history of economic discrimination, which minimizes their ability to access healthy foods, which translates to nutritional deficiencies that increase the risk of GAD. Besides, the ethnic minorities are not spared by the environments that expose older adults to heightened risk of acquiring GAD, such as unhealthy and stressful working environments.
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The most appropriate methods of treating GAD
This research classified the methods of treating GAD into psychotherapy and pharmacotherapy. Psychotherapy, as defined by Kendall, Cape, Chan and Taylor (2011), is the use of cognitive and behavioral methods to treat a psychological condition, while pharmacotherapy is the use of medications. The effect sizes of anxiety-focused psychotherapies against the active control conditions were higher than medications. Based on this study, diagnosis and treatment of GAD is more effective when started by a primary care physician. Kishita and Laidlaw (2017) opined that many older adults are more comfortable when talking to factors with which they have an affinity. This is the basis of psychotherapy as the successful intervention for GAD, as majority of the respondents argued that they accepted treatment due to the trust they had with their primary care physicians. Even more, pharmacotherapy was found to be less effective, as many older adults asserted their lack of adherence to the dosages of the anti-anxiety drugs prescribed by the physicians (Gaudreau, Landreville, Carmichael, Champagne and Camateros, 2015). However, the most satisfied older adults were those that combined either type of therapy, as they managed to encounter the effects of the disorder through medication.
Limitations of the design
In as much as this study includes a cross-sectional analysis of the treatment of GAD, it fails in analyzing the best measures for preventing the exposure of older adults to GAD. Consequently, this sets the tone for recommendations for future research to establish the best methods for preventing the exposure of older adults to the risk factors of GAD.
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