Health Panel: Adults Under 65 Should Be Screened for Anxiety

What about people 65 and older?

The screening recommendations exclude a large portion of the population — adults 65 and older. And while youth and younger adults have seen a notable increase in anxiety in recent years, older adults are not immune.

In fact, a recent survey conducted by AARP found that 61 percent of participants age 50 and older experienced some level of anxiety in the past year; 45 percent said they were bothered by anxiety. And a 2021 report from the University of Michigan’s National Poll on Healthy Aging found that 28 percent of adults ages 50 to 80 experienced worse anxiety or worry during the pandemic.

Even years before COVID-19 hit, nearly 1 in 10 adults age 60 and older had an anxiety disorder in the previous year, federal data shows.

“I see many older adults who are struggling with anxiety disorders and significant stress who would benefit from treatment. So I feel like this is a population where it’s very important to screen for anxiety,” Gerlach says.

For now, the advice from experts is to stay tuned. Screening recommendations for this age group could come in the near future. The USPSTF is holding off on making recommendations for people 65 and older now because there “just simply isn’t enough evidence” to show that the benefits of screening older adults outweigh any potential downsides, Hudak says.

One such risk is that older adults could be placed on medications that do more harm than good. For example, benzodiazepines are a common class of anti-anxiety medications (Xanax is one example). But in older adults, these drugs can cause side effects like impaired cognition and an increased risk of falls, the National Institutes of Health says. 

Another potential concern is that some symptoms of anxiety — take sleep disruption or pain, for example — are more common among older adults, and a screening tool could end up capturing people who have these symptoms for other reasons, not due to anxiety, and could funnel them down the wrong treatment path, Saltz explains.

USPSTF member Gbenga Ogedegbe, M.D., said said in a statement when the recommendations were first proposed, “In the absence of evidence, health care professionals should use their judgment based on individual patient circumstances when determining whether or not to screen.”

Meanwhile, the task force is recommending that all adults — including those 65 and older — continue to be routinely screened for depression.

Recognizing signs of anxiety

Of course, you don’t have to wait for your annual checkup to talk to your doctor about anxiety, especially if you start to notice symptoms. These might include a general sense of worry, panic or feeling like your mind is racing, Gerlach says. Irritability and inability to concentrate can also be warning signs, Saltz adds.

Anxiety often triggers physical symptoms too, notes Hudak, like heart palpitations or shortness of breath. People can also experience an upset stomach, tingling in their hands and fingers and difficulty sleeping. “So certainly, having new unexplained physical symptoms is at least a potential red flag for anxiety,” Hudak says. “And then the other issue is a change in functioning. If you find yourself not going out and being able to do the kinds of things you normally would like to do, that can be a sign of anxiety as well.”

One thing to note: Everyone experiences anxiety from time to time. It can creep up during a particularly stressful time in life and it can happen during ordinary moments. “If you didn’t have anxiety, you wouldn’t bother to look both ways before you crossed the street,” Hudak says. And this can make recognizing an anxiety disorder difficult. “When it becomes abnormal, it’s hard to point your finger and say, ‘Aha! This is excessive anxiety.’ ”

A telltale sign is just feeling “really bad,” depressed even, Hudak says.

Provider shortage could hamstring efforts 

Treatment options for anxiety disorders run the gamut, Gerlach says, and may involve seeing a mental health specialist or therapist who can teach you various tools and techniques to help manage your anxiety. Medications may also be prescribed.

However, some patients could find it difficult to get help right away. Experts argue that one potential downside of the new recommendation is the stress it could add to an already strapped system. (More than 150 million Americans currently live in areas where there’s a shortage of mental health professionals.) Even people who have access to providers may find themselves on long wait lists.

“We don’t have enough mental health professionals in this country now. And if you want to screen people and double the patient population — and there’s a lot of people out there who really, really need treatment — where are they going to go? It’s a real problem,” Hudak says.

Primary care physicians, who are also in short supply, can often help get anxiety treatments started, Gerlach says. But for people experiencing more severe symptoms, a referral to a behavioral health professional or psychiatrist may be best.

“It certainly is a concern that if we have a lot of people screening positive, we want to make sure that we have adequate resources to actually treat and provide the help that patients need,” Gerlach says.

Editor's note: This story, first published Sept. 22, 2022, has been updated to reflect the finalized recommendations.