Anxiety: spectrum from response to a crisis → adjustment disorder → major anxiety disorder.
Ensure anxiety not secondary to lack of information or poor symptom control, especially pain or dyspnea.
Delirium can present with anxiety-like symptoms.
Medications
Antidepressants
- see section on depression management for choice of antidepressant. Mirtazepine best choice for frail elders.
Benzodiazepines
- only use regularly for severe ongoing anxiety in those not responsive to antidepressants: clonazepam
- for acute short-acting anxiety/panic (temporary use until antidepressant onsets): lorazepam
- in frail older adults: methotrimeprazine better than benzodiazepine due to risk of delirium with benzos
Pregabalin or Gabapentin
useful for anxiety with neuropathic pain, insomnia. Many side effects in frail elders.
Other therapies
- supportive psychological and spiritual counselling
- discussing and providing information about disease-progression and the dying process may relieve specific anxieties
- avoid anxiety triggers
- music therapy