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May 27, 2018
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An epidemic of anxiety in the elderly

By: Julie Ann Soukoulis
February 16, 2018

There is much to learn about diagnosis and treatment of anxiety in older adults. Especially when it comes to how adult children can recognize if their aging parent has an anxiety problem.

Anxiety is as common in the old as in the young, although how and when it appears is distinctly different in older adults. Anxiety disorders in the elderly population are real and treatable. Just as the high incidence of depression that often comes with anxiety. Being a woman and having a less formal education have been proven to be major risk factors, as does having had anxiety earlier in life.

What “brings out” the anxiety are the stresses and vulnerabilities unique to the aging process such as:

Chronic physical problems

Cognitive impairment

Significant emotional losses

According to experts - late-life anxiety disorders have long been under-estimated. This is because older patients are less likely to report psychiatric symptoms, as well as being much more likely to emphasize their physical complaints. Some major epidemiological studies have excluded Generalized Anxiety Disorder, one of the most prevalent anxiety disorders in older adults, although the reasoning for this remains unclear.

How to recognize anxiety in an aging senior

Recognizing an anxiety disorder in an older person can pose several challenges. Aging brings with it a higher prevalence of certain medical conditions, along with very realistic concerns about physical problems, as well as higher use of prescription medications. 

This means that separating a medical condition from the physical symptoms of an anxiety disorder is more complicated in the older adult. Diagnosing anxiety in individuals with dementia can be especially difficult, too: agitation typical of dementia may be difficult to separate from anxiety.

Also, impaired memory may be interpreted as a sign of anxiety or dementia. Fear can become excessive albeit realistic, depending on the person’s situation. Anxiety and worry are simple to recognize. When your elder spends too much time fretting, reviewing negative scenarios or sitting quietly looking distressed, while wringing their hands, it may be time to discuss intervention and treatment.

Treatments for senior anxiety

In most cases, diagnosis and treatment should start with the primary care physician. Often older people feel more comfortable opening up to a doctor with whom they already have a relationship. Obviously, if they already trust their primary care physician, the chances are increased that they will accept treatment, or a referral to a mental health professional.

Medication and psychosocial therapies are used to treat anxiety in older persons, although clinical research on their effectiveness is still limited. Anti-depressants (specifically the selective serotonin reuptake inhibitors or SSRIs), rather than anti-anxiety medication (such as the benzodiazepines), are preferred medications for most anxiety disorders.

Cognitive Behavioral Therapy (CBT) is increasingly used to reduce anxiety in older adults. CBT may involve relaxation training, cognitive restructuring (replacing anxiety-producing thoughts with more realistic, less catastrophic ones) and exposure (systematic encounters with feared objects or situations). CBT can take up to several months and has no side effects.

Treating anxiety in the older patient successfully depends, in part, on a partnership between the patient, the family, and the doctor. Everyone needs to agree on what the problem is, while making a commitment to stick with treatment until the patient can return to normal functioning. Family members may need to advocate for the older person, ensuring that issues encountered during treatment—such as drug side effects—are dealt with promptly.

Diagnosing elder anxiety

Seniors are often reluctant to report psychiatric problems. To help identify anxiety it may be useful to phrase questions in the following way:

How to identify anxiety:

Have you been concerned about or fretted over a number of things?

Is there anything going on in your life that is causing you concern?

Do you find that you have a hard time putting things out of your mind?

How to identify how or when physical symptoms started:

What were you doing when you noticed the chest pain?

What were you thinking about when you felt your heart start to race?

When you can’t sleep, what is usually going through your head?

(This is an adaptation from Ariel J. Lang, Ph.D., and Murray B. Stein, M.D., “Anxiety Disorders: How to Recognize and Treat the Medical Symptoms of Emotional Illness,” Geriatrics. 2001 May; 56 (5): 24-27, 31-34.)

Are you worried about anxiety in your aging parent?

Talking to your elderly parent or loved one about any changes in their lives is one of the best ways to find out if there is a problem. Ask about any changes you notice in the following:

Daily routines and activities Is Grandma refusing to do previously routine activities or avoiding social situations she used to enjoy?

Worries. Does Dad seem to have more worries than before and do those worries seem out of proportion to reality (such as a real threat to his safety).

Medication. Has Mom recently started taking another medicine? Is she using more of a particular medication than before? Medication side effects (such as breathing problems, irregular heartbeat, or tremors) can simulate symptoms of anxiety. Also, an increased use of medication (or alcohol) may indicate an attempt to “self-medicate.”

Overall mood. Depression and anxiety often occur together. Tearfulness, apathy and a loss of interest in formerly enjoyable activities are possible signs of depression which can also be brought on by anxiety.

Information sources:

Anxiety Disorders Association of America Newsletter, New Thinking on Anxiety and Aging: Anxiety Disorders Common in the Elderly.

Resources that may help support you caring for an aging loved one can be found on www.caregiverstress.com orwww.helpforalzheimersfamilies.com ,  in addition Home Instead  recognizes the need for resources and support thus literally wrote a book you can buy on Amazon called : Confidence to Care. There is also a free downloadable app for both apple and android.

Julie Ann Soukoulis is the owner of Home Instead Senior care office in Rohnert Park, mother of two and passionate about healthy living at all ages. Having cared for her own two parents, she understands your struggles and aims, through her website, www.homeinstead.com/sonoma to educate and encourage seniors & caregivers. Have a caregiving or aging concern? She’s love to hear from you at 586-1516 anytime.