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Generalized anxiety disorder (GAD) causes and risk factors

Key points

  • Generalized anxiety disorder is a chronic condition involving excessive, uncontrollable worry that disrupts daily life.
  • Causes include genetic predisposition, brain chemistry imbalances, medical conditions, and environmental stressors.
  • Risk factors include family history, female sex, chronic illness, trauma, and co-occurring depression or dementia.
  • Non-drug approaches like meditation, breathing exercises, and routine are effective and safer for older adults.
  • Medication (especially SSRIs) can help, but benzodiazepines should be used cautiously in older adults due to fall and cognitive risks.
  • Caregivers must also care for their own mental health—burnout is common and treatable.

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

Step-by-step

  1. Observe and document worry patterns over a week, noting triggers and duration, to help distinguish GAD from ordinary stress and inform the doctor.

  2. Schedule a comprehensive evaluation to rule out physical causes (thyroid, heart conditions, medication side effects) and request a referral to a mental health specialist.

  3. Try non-medication approaches first: meditation, deep breathing, gentle yoga, or guided relaxation recordings for five minutes daily.

  4. If medication is needed, ask about first-line SSRIs and avoid benzodiazepines for older adults due to fall and cognitive risks.

  5. Address co-occurring conditions (depression, insomnia, chronic pain) to reduce anxiety; use sleep hygiene or non-drug pain management.

  6. Create a low-stress daily routine with regular meals, gentle physical activity, and built-in rest breaks for predictability.

  7. Use grounding techniques during acute anxiety, such as naming five things you see, four you touch, three you hear, two you smell, and one you taste.

  8. Encourage social connection within the person's limits: short phone calls or quiet shared time with tea work well.

  9. Adapt communication for cognitive changes: use short, simple sentences, break tasks into single steps, and focus on emotional messages.

  10. Monitor for urgent warning signs: thoughts of self-harm, suicide, or sudden steep decline in function require emergency help.

What not to do

  • Do not dismiss anxiety as 'just nerves' or 'normal aging'; acknowledge it with empathy like 'I can see this is really hard for you right now.'

  • Do not rush to medication, especially benzodiazepines for older adults; weigh risks and benefits with a clinician.

  • Do not try to fix anxiety with advice or problem-solving; listen calmly and offer comfort instead.

  • Do not isolate the person or force social interaction; respect their limits and avoid overwhelming them.

Practical tools

  • Grounding Technique (5-4-3-2-1)

    During acute anxiety, guide the person to name five things they see, four things they can touch, three they hear, two they smell, and one they taste. This redirects focus to the present moment.

  • Relaxation Recordings

    Use short (5-minute) guided relaxation or breathing recordings designed for older adults to help reduce baseline anxiety.

Discuss with your clinician

Ask your doctor: 'Could my loved one's anxiety be caused or worsened by a medical condition like thyroid disease, heart problems, or a medication side effect?'

Ask the psychiatrist: 'What are the risks and benefits of starting an SSRI for GAD in an older adult? Are there any interactions with other medications they take?'

If benzodiazepines are suggested, ask: 'Are there safer alternatives? What is the risk of falls or cognitive decline with this medication?'

For a patient with dementia or Parkinson's, ask: 'How do we distinguish anxiety from symptoms of the neurological condition? What treatments are safest?'

If the person has thoughts of self-harm or suicide, seek emergency care immediately. Do not wait for a routine appointment.

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