(CNN)Anxiety is the most common psychological disorder affecting adults in the United States. In older people, it's associated with considerable distress as well as ill health, diminished quality of life and elevated rates of disability.
Yet when the US Preventive Services Task Force, an independent, influential panel of experts, suggested last year that adults be screened for anxiety, it left out one group — people 65 and older.
The major reason the task force cited in draft recommendations issued in September: "(T)he current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety" in all older adults. (Final recommendations are expected later this year.)
The task force noted that questionnaires used to screen for anxiety may be unreliable for older adults. Screening entails evaluating people who don't have obvious symptoms of worrisome medical or psychological conditions.
"We recognize that many older adults experience mental health conditions like anxiety," and "we are calling urgently for more research," said Lori Pbert, associate chief of the preventive and behavioral medicine division at the University of Massachusetts Chan Medical School and a former task force member who worked on the anxiety recommendations.
This "we don't know enough yet" stance doesn't sit well with some experts who study and treat older people with anxiety. Dr. Carmen Andreescu, an associate professor of psychiatry at the University of Pittsburgh, called the task force's position baffling because "it's well-established that anxiety isn't uncommon in older adults and effective treatments exist."
"I cannot think of any danger in identifying anxiety in older adults, especially because doing so has no harm and we can do things to reduce it," said Dr. Helen Lavretsky, a psychology professor at UCLA.
Physicians often recommend medications to ease anxiety when mental health care can be hard to find.
In a recent editorial in JAMA Psychiatry, Andreescu and Lavretsky noted that only about one-third of seniors with generalized anxiety disorder — intense, persistent worry about everyday matters — receive treatment. That's concerning, they said, considering evidence of links between anxiety and stroke, heart failure, coronary artery disease, autoimmune illness and neurodegenerative disorders such as dementia.
Other forms of anxiety commonly undetected and untreated in older adults include phobias (such as a fear of dogs), obsessive-compulsive disorder, panic disorder, social anxiety disorder (a fear of being assessed and judged by others) and post-traumatic stress disorder.
The smoldering disagreement over screening calls attention to the significance of anxiety in later life — a concern heightened during the Covid-19 pandemic, which magnified stress and worry among older people. Here's what you should know.
Anxiety is common
According to a book chapter published in 2020, authored by Andreescu and a colleague, up to 15% of people 65 and older who live outside nursing homes or other facilities have a diagnosable anxiety condition.