Late-life anxiety disorders

Meet the patient

A 74-year-old woman has been to ED four times in eight weeks with chest tightness. Three ECGs, two troponin sets and a CT coronary angiogram are all normal. The last discharge letter says non-cardiac chest pain, reassure.^[2][4]

She has not been on a bus since March. Her daughter now does the shopping. She phones her GP most weeks and apologises each time for wasting everyone's time.^[2][4]

Two questions decide this consultation. Is there a body problem still hiding in here? And why has nobody offered her a treatment that works? Older adults under-report emotion and lead with the chest, which is exactly how disabling anxiety gets discharged as reassurance.^[2][4]

Etymology worth one line in a viva: anxiety comes from Latin angere — to choke, to press tight — the same root as angina*. The word was built out of a chest symptom. When your 74-year-old leads with tightness rather than worry, she is using the older and more accurate vocabulary.*^[2][4]

References16ShowHide

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