Typical case: A 75-year-old woman, Li, presented to the clinic with frequent headaches, dizziness, chest tightness, and numbness in the limbs for 3 years. Her blood pressure was usually high. There was no obvious abnormality in blood biochemistry, cerebral hemogram suggested insufficient cerebral blood supply, ECG suggested slight myocardial ischemia, and CT and MRI of the head were normal. He was treated according to “cerebral insufficiency” and “coronary heart disease”, but there was no obvious effect. After repeated questioning of the medical history, it was found that Li Da Ma had lived separately from her children after her husband died 5 years ago and lived alone. The children are usually busy with work and rarely visit her. She gradually developed a sense of loss, nervousness and fear, insomnia (difficulty in falling asleep, easy to wake up, dreamy) and the aforementioned symptoms. This is a typical case of somatic illness with anxiety disorder. After 3 weeks of comprehensive treatment, including psychological counseling, family care and anti-anxiety medication, Li’s above-mentioned discomfort basically disappeared. Why do older people have anxiety disorders? In the clinic, we often encounter many elderly people with anxiety who deny that they suffer from anxiety. Some of them are living in good conditions and some of their children are very filial. So how do they develop anxiety disorders? Geriatric anxiety disorder is a common psychological disorder in the elderly and is usually caused by a combination of factors. First of all, when people grow old, their physiological and psychological conditions change, and their personality gradually develops in the direction of self-centeredness, stubbornness, sentimentality and loneliness. Secondly, as people grow old, certain acute and chronic illnesses and pains will follow, and anxiety, tension and fear will easily appear. Usually, anxiety in old age often coexists with physical diseases, and the two are causal to each other, forming a vicious circle, making physical symptoms more prominent, thus often ignoring the existence of “anxiety”. Again, family factors, such as financial and property problems, respect for the elderly, health problems, neighborhood relations and emergencies, if not handled properly, can also easily make the elderly fall into a quagmire of anxiety. Finally, social environment factors, such as the sense of loss after retirement, dissatisfaction with the trampling of social morality, etc. What are the characteristics of geriatric anxiety disorder? Due to the special physiological and psychological conditions of the elderly, geriatric anxiety disorders usually have their special characteristics. 1. There are more obvious symptoms of autonomic dysfunction, such as insomnia, forgetfulness, etc. 2.Somatization symptoms are more prominent, such as headache, dizziness, chest tightness, wandering numbness or pins-and-needles pain sensation, etc. 3.Often coexist with physical diseases such as stroke and heart disease. How to let the elderly get rid of anxiety disorder? 1.Let the elderly fully understand anxiety disorders through community publicity and education Due to the lack of community publicity and education about mental illness, people have very limited knowledge about mental illness, and some even reject it from the inside. When first diagnosed by a doctor with a mental illness such as anxiety or depression, only a very small number of elderly people agree with the doctor’s diagnosis and cooperate with the treatment, while the majority of elderly patients deny that they suffer from anxiety or depression and go to multiple general hospitals repeatedly, which wastes a lot of medical resources. As a result of the patient’s inability to cooperate with the doctor, the condition is delayed and treatment is delayed. Community mental health promotion and education can make the elderly fully aware of mental illnesses, especially anxiety and depression, which are also among the common illnesses of the elderly. With the relevant knowledge, they can take less detours and can make the diseases be diagnosed and treated in time. 2.Integrate into the society and adapt to the changes of social environment Anxiety disorders may be a concomitant product of the progress of social civilization. With the progress of material and medical and health care civilization, the problem of population aging becomes more and more prominent, and the demand of the elderly for spiritual civilization becomes higher and higher. Society has progressed, the pace of work has increased, unemployment has increased, and family members lack care for the elderly because of work. There are also many other spin-offs of social civilization such as property or economic disputes, ethics and morals that are important factors in the formation of geriatric anxiety disorder. Social integration, such as timely adaptation to changes in the social environment through active outdoor life, attending senior college, joining senior clubs and other activities, can reduce the occurrence of anxiety and alleviate anxiety symptoms. 3.Good mindset and self-direction Undoubtedly, we all know that a healthy mindset is one of the most effective means to prevent and treat anxiety disorders, and it depends on how you can maintain a positive and healthy mindset. When anxiety comes, it is up to the patient to eliminate the early mild anxiety state. First, become aware of this anxiety in yourself, face it squarely, and don’t mask its existence with various other reasons that you think are reasonable. Second, build up confidence, adjust your mind, and eliminate anxiety in time by cultivating interests and the principle of shifting attention. When the attention is shifted to something new, the psychological generation of new experiences is likely to gradually expel and replace the original anxiety. 4.Medication The treatment of anxiety disorders usually requires the intervention of drugs in addition to psychological regulation. What are the commonly used anti-anxiety drugs? There is a wide range of anti-anxiety drugs, and their clinical effects do not differ much from each other, but there are individual differences. Commonly used drugs include tricyclics (amitriptyline, etc.), buspirone, haloperidol, melitrexin, SSRIs (fluoxetine, paroxetine, sertraline, citalopram, etc.), SNRIs (venlafaxine, etc.) and traditional Chinese medicine (Wu Ling capsule). Most anxiolytic drugs are slow to take effect clinically, taking about 1-2 weeks for the clinical effects to appear gradually. What should I pay attention to when choosing anxiolytic drugs? To take into account the special psychology of elderly anxiety patients, the following points should be noted in the use of medication: 1. drug side effects: the physiological function of the elderly is gradually declining, the gastric mucosa is atrophied, oral medication is relatively easy to have adverse reactions, especially gastrointestinal reactions. 2, medication compliance: most patients with anxiety disorders often do not cooperate well with treatment in the early stages, most of them pay attention to every detail of the drug instructions, paying special attention to the study of side effects, and their medication compliance is poor. 3, regional health care characteristics: domestic elderly people like to choose proprietary Chinese medicine with few side effects for health care. Therefore, the use of drugs for the elderly should be based on the principle of “safety first and efficacy second”. High safety, good compliance, precise efficacy of proprietary Chinese medicine anti-anxiety drugs (Wu Ling capsule) can be the first choice for this type of patients. In the early stage of treatment, the combination of Chinese and Western medicine, such as Wu Ling capsule combined with flupirtine melitrexin, can make up for the slow effect of Chinese medicine. Antidepressants such as sertraline or escitalopram can also be the first choice for geriatric anxiety disorder, but should be used with caution in patients with severe heart disease or epilepsy!