A Longitudinal Analysis of Disparities of Anxiety Among U.S. Older Adults with Chronic Conditions within Different Age Groups

Background: In 2016, 38% of U.S. older adults aged 65 and older had at least one chronic condition, 47% had 2-3 chronic conditions, and 15% had four or more chronic conditions. Anxiety is one of the most common mental disorders among older adults who suffer from chronic conditions. This study aims to understand the disparities of anxiety of older adults with chronic conditions among different age groups, and explore the risk and protective factors associated with anxiety.

Methods: This study applied the latest rounds (round 5 to round 9) of the National Health and Aging Trends Study to analyze the risk and protective factors associated with anxiety. In total, 3,541 older adults who were sample persons, had at least one chronic condition, and participated in all 5 rounds were included in the present study. The Transactional Theory of Stress and Coping model was utilized to select predictors. Descriptive analysis was conducted for all predictors, and generalized estimating equations was applied to explore and identify the risk and protective factors.

Results: Participants who were 90+ (e^b= .672, P= .043) years old were less likely to have anxiety. Male participants (e^b= .591, P< .001) were less likely to have anxiety. Those who were married or partnered (e^b= 1.292, P= .007) were more likely to have anxiety. Those who were Black (e^b= 1.278, P= .011) and Hispanic (e^b= 2.152, P< .001) were more likely to have anxiety. Participants who had annual income of $50,000 to $99,999 (e^b= .733, P= .017) were less likely to have anxiety. Participants who reported good (e^b= 1.563, P= .019), fair (e^b= 2.056, P< .001), and poor (e^b= 2.936, P< .001) self-rated health were more likely to have anxiety. Participants who had more chronic conditions (e^b= 1.215, P< .001) were more likely to have anxiety, but those who had better cognitive capacity (e^b= .958, P< .001) were less likely to have anxiety. Participants who had more negative feelings (e^b= 1.570, P< .001), worse self-realization (e^b= 1.119, P< .001), and worse self-efficacy and resilience (e^b= 1.138, P< .001) were more likely to have anxiety. Participants who attended more social activities (e^b= .891, P= .001) were less likely to have anxiety. Participants who had more technological devices (e^b= .845, P< .001) were less likely to have anxiety. Anxiety did not change over time.

Conclusion: The findings of this study call for efficient chronic condition management to provide early screening, assessment, and diagnosis. Recommendations from healthcare providers, and proper education of healthy lifestyle and the dissemination of related information can make a difference in helping older adults gain better physical and mental health to prevent them from suffering anxiety. Moreover, the findings of this study urge the design and development of user-friendly technology devices, mobile apps, and older adult-centered smart emergency warning systems. Joint efforts involving policymakers, healthcare practitioners, researchers, and social workers are needed to develop new and creative mental health programs and interventions to help minimize the impacts of anxiety by exploring ways to make the anxiety decline over time.