Anxiety and depression are common issues faced by older adults. Generalized anxiety disorder is the most prevalent form of anxiety seen in older adults. Symptoms of anxiety include excessive worry, restlessness, difficulty concentrating, irritability, and sleep disturbances. Depression symptoms include sadness, loss of interest, changes in appetite and sleep, fatigue, feelings of worthlessness, and suicidal thoughts. Both conditions can be caused by biological, psychological, and social factors. Treatment options include pharmacotherapy with SSRIs or SNRIs in lower doses, cognitive behavioral therapy, relaxation techniques, social involvement, and lifestyle changes like exercise. Risk of suicide is higher in older white males with psychiatric or substance abuse disorders and physical illness. Protective factors include social connections

1. Anxiety and Depression:Anxiety and Depression:
Am I singing the blues?Am I singing the blues?
Via Christi Health
Shiloh Jiwanlal BA, BSN, MSN, APRN, PMHCNS-BC

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Gray hair is a crown of
splendor!
Proverbs 16:31
IntroductionIntroduction

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• Protective
• If not protective what is it?
AnxietyAnxiety

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Fear: emotional response to real or perceived immediate
threat
Surges of autonomic arousal necessary - fight or flight
Anxiety: anticipation of future threat
Muscle tension, vigilance- preparation for future danger
and avoidance
Fear…………………..AnxietyFear…………………..Anxiety

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Statistics: Older adults ages 60 plus
2050 World Demographics: 2 billion
United States and Europe: Currently 1 in 5 persons
2050 – 1 in 3 persons
Anxiety Estimates: 19%
Depression: 7.7%
Who gets it?- AnxietyWho gets it?- Anxiety

6. Anxiety- Life Span-Anxiety- Life Span-
Neurodevelopmental DisordersNeurodevelopmental Disorders
Children- Phobias
Young Adults- Panic Disorders/Post Traumatic Disorder
Older Adults- Generalized Anxiety Disorders
Not counted: Fear Of Falling (FOF)- Fear and Avoidance- Agoraphobia
Older Adult onset- 11% women 2% men (over half new to Anxiety Disorders)
Biological, psychological and social variables
Chronic psychological distress- Cognitive impairment/decline
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• Excessive worry, anxiety
• Difficult to control the worry
• Restlessness or feeling keyed up or on edge
• Easily fatigues
• Difficulty concentrating, mind going blank
• Irritability
• Muscle tension
• Sleep disturbance
• Affecting daily living
(Worry and rumination – driving forces in late life mental disorders)
What does it look like?- AnxietyWhat does it look like?- Anxiety

8. DepressionDepression
A happy heart makes the face cheerful, but
heartache crushes the spirit.
Proverbs 15:13
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Mood and Interest
•Sad, empty, hopeless
•Less interest or pleasure
•Weight loss/gain
•Insomnia/hypersomnia
•Psychomotor agitation/retardation
•Fatigue or loss of energy
•Feelings of worthlessness, excessive or inappropriate guilt
•Diminished ability to think, concentrate, indecisiveness
•Recurrent thoughts of death, suicide
What is it?- DepressionWhat is it?- Depression

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-Temperamental
-Environmental
-Genetic
-First degree family members 2-4 fold higher
Who gets it?- DepressionWho gets it?- Depression

11. WisdomWisdom
Gracious words are a honeycomb, sweet to
the soul and healing to the bones.
Proverbs 16:24
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12. What can be done about them?
•Prevent
•Prepare
•Protect
•Build resilience
•Treatment support

13. PharmacotherapyPharmacotherapy
Risk: Benefit Ratio
Lower dose even increases the risk
Benzodiazepines- Short acting/short term
SSRIs and SNRIs
• Escitalopram
• Venlafaxine
• Duloxetine
• Citalopram
• Mirtazapine
(Gait impairment, bone loss, Impaired clotting, Hyponatremia)
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14. TreatmentTreatment
Cognitive Behavioral Therapy: Relaxation Training is the
most effective
• Psycho-education
• Problem-solving skills training
• Exposure and habituation to anxiety situations
• Sleep hygiene
• Bibliotherapy
• Guided self help- Here and Now (mindfulness)`
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15. TreatmentsTreatments
-Have a routine
-Exercise
-Rote activity- Knitting- Rocking Chair
-Social involvement
-Volunteer activity
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16. Suicide- Risk FactorsSuicide- Risk Factors
Older Adults- 45 per 100,000 per year
4 times the national overall per year
US population- 316.1 million
Risk Factors:
• White male
• Psychiatric and substance use disorders (71-97%)
• Mood disorders
• Ill health/functioning = Perceived meaning of illness
• Pain
• Impact on autonomy
• Living alone
• Physical inactivity
• Stressfull life events
• Loss of a spouse
• Loneliness
• Perceived burdensomeness/Thwarted belongingness
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17. Suicide- Protective FactorsSuicide- Protective Factors
• Social Connections (50% increase likelihood of survival)
• Hobbies
• Physical activity
• Having a confidante
• Belonging
• Sense of positive interactions
• Feeling cared for
• Spirituality
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18. Suicide PreventionSuicide Prevention
Suicide Hotline: 1-800-273-8255
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19. ConclusionConclusion
Light in a messenger’s eyes brings joy to
the heart, and good news gives health to
the bones.
Proverbs 15:30
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