From the Guidelines
For an 88-year-old male experiencing uneasiness and anxiety without known triggers, I strongly recommend starting with non-pharmacological approaches, including regular physical activity, relaxation techniques, and establishing a consistent sleep schedule, before considering medication. When it comes to medication, the evidence from 1 suggests that anxiolytic drugs, such as buspirone, may be a suitable option.
- Buspirone is recommended for the management of anxiety and agitation, with an initial dosage of 5 mg twice daily and a maximum of 20 mg three times daily 1.
- It is essential to note that buspirone may take 2 to 4 weeks to become effective, and it is most useful in patients with mild to moderate agitation 1. Other options, such as benzodiazepines, are not recommended due to the risk of tolerance, addiction, depression, and cognitive impairment, particularly in elderly patients 1.
- The use of benzodiazepines, such as lorazepam, oxazepam, and temazepam, should be avoided if possible, especially in geriatric patients, due to the increased risk of falls, cognitive impairment, and dependence 1. It is crucial to monitor the patient closely for side effects, particularly orthostatic hypotension, cognitive changes, and drug interactions with existing medications.
- Age-related changes in drug metabolism necessitate starting at lower doses and titrating slowly in geriatric patients to minimize adverse effects while achieving symptom control. A follow-up appointment should be scheduled within 2 weeks to assess treatment response and adjust as needed.
From the FDA Drug Label
Sertraline is a prescription medicine used to treat depression It is also used to treat: Major Depressive Disorder (MDD) Obsessive Compulsive Disorder (OCD) Panic Disorder Posttraumatic Stress Disorder (PTSD) Social Anxiety Disorder Premenstrual Dysphoric Disorder (PMDD) Lorazepam Oral Concentrate is a prescription medicine used: to treat anxiety disorders for the short-term relief of the symptoms of anxiety or anxiety that can happen with symptoms of depression
For an 88-year-old male with anxiety and uneasiness without identifiable triggers, treatment options may include:
- Sertraline for anxiety disorders such as Social Anxiety Disorder or Panic Disorder, as it is used to treat these conditions 2
- Lorazepam for the short-term relief of anxiety symptoms 3 It is essential to consult a healthcare provider to determine the best course of treatment, considering the patient's age, medical history, and potential interactions with other medications.
From the Research
Treatment Options for Anxiety
- For an 88-year-old male with anxiety and uneasiness without identifiable triggers, treatment options may include selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioural therapy (CBT) 4, 5, 6.
- SSRIs, such as sertraline, have been shown to be effective in reducing anxiety symptoms in patients with generalized anxiety disorder (GAD) 4, 7.
- CBT is also a recommended treatment for anxiety disorders, including GAD and social anxiety disorder, and can be delivered in various formats, including in-person and online sessions 4, 5, 6.
- A study found that CBT combined with conventional treatment was effective in reducing symptoms of social anxiety disorder in patients who had not responded to SSRI treatment alone 5.
- Another study found that SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs) were effective in reducing symptoms of anxiety, obsessive-compulsive, and stress-related disorders, with minimal differences between medications concerning efficacy and acceptability 7.
Considerations for Older Adults
- Anxiety is a common mental health problem in older adults, with a prevalence of 14.5% in individuals aged 82 years and older 8.
- Older adults who experience loss, such as the death of a loved one, may be at increased risk of developing anxiety symptoms 8.
- Treatment of anxiety in older adults should take into account the individual's medical history, cognitive status, and social support network 8.
- A personalized treatment approach, considering the individual's preferences and needs, may be beneficial in managing anxiety symptoms in older adults 6.