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Anxiety
and Older Adults
Overcoming Worry and Fear
Feeling anxious or nervous
is a common emotion for people of all ages and a normal
reaction to stress.
Feeling anxious can help us handle problems and strange
situations, and even avoid danger. It is normal to
feel anxious about illnesses, new social interactions,
and frightening events. But when one feels anxious
often and the anxiety is overwhelming and affects
daily tasks, social life, and relationships, it
may be an
illness.
Anxiety is a common illness among older adults,
affecting as many as 10-20 percent of the older population,
though it is often undiagnosed. Phobia—when
an individual is fearful of certain things, places
or events—is
the most typical type of anxiety. Among adults, anxiety
is the most common mental health problem for women,
and the second most common for men, after substance
abuse.
Older adults with anxiety disorders often go
untreated for a number of reasons. Older adults
often do not
recognize or acknowledge their symptoms. When they
do, they may be reluctant to discuss their feelings
with their physicians. Some older adults may not
seek treatment because they have suffered symptoms
of anxiety
for most of their lives and believe the feelings
are normal. Both patients and physicians may miss
a diagnosis
of anxiety because of other medical conditions
and prescription drug use, or particular situations
that
the patient is coping with. For example, the anxiety
suffered by a recently widowed patient may be more
than normal grieving. Complicated or chronic grief
is often accompanied by persistent anxiety and
grieving spouses may avoid reminders of the deceased.
Untreated anxiety can lead to cognitive impairment,
disability, poor physical health, and a poor
quality of life. Fortunately, anxiety is treatable
with
prescription drugs and therapy. WHAT IS ANXIETY?
An anxiety disorder causes feelings of fear, worry,
apprehension, or dread that are excessive or disproportional
to the problems or situations that are feared. There
are several types of anxiety disorders.
Specific phobias.
A specific phobia is an intense, irrational fear of
a place, thing or event that actually
poses little or no threat. Some common specific phobias
are heights, escalators, tunnels, highway driving,
closed-in spaces, flying, and spiders. Agoraphobia
is a fear of public places, leaving one’s home,
or being alone. Phobias more common to older adults
include fear of death, disaster to family, and dental
procedures. Facing, or thinking about, these situations
or things can bring on severe anxiety or a panic attack
(chest pain, heart palpitations, shortness of breath,
dizziness, or nausea).
Social phobia (also called
social anxiety disorder). Social phobia is when an individual
feels overwhelmingly
anxious and self-conscious in everyday social situations.
An older adult might feel intense, persistent, and
chronic fear of being judged by others and of doing
things that will cause embarrassment. Some older
persons suffer a social phobia because they are embarrassed
about being unable to remember names or are ashamed
of their appearance due to illness. A social anxiety
disorder makes it hard to make and keep friends.
Some
with social phobia can be around others, but are
anxious beforehand, very uncomfortable throughout the
encounter,
and, afterwards, worry how they were judged. Physical
symptoms can include blushing, heavy sweating, trembling,
nausea, and difficulty talking.
Generalized anxiety
disorder (GAD). Those with GAD suffer constant worries,
and there may be nothing
or little to cause these worries. Those with GAD
are overly
concerned about health issues, money, family problems,
or possible disaster. Those with GAD usually understand
that they worry more than necessary. Older adults
with GAD have difficulty relaxing, sleeping and
concentrating, and startle easily. Symptoms include
fatigue, chest
pains, headaches, muscle tension, muscle aches,
difficulty swallowing, trembling, twitching, irritability,
sweating,
nausea, lightheadedness, having to go to the bathroom
frequently, feeling out of breath, and hot flashes.
Post-traumatic
stress disorder (PTSD). PTSD develops after a traumatic
event that involved physical
harm or the threat of physical harm to the individual,
a loved one, or even strangers. PTSD can result
from
traumatic incidents, such as a mugging, rape,
abuse, car accidents, or natural disasters such as
floods
or earthquakes, in addition to resulting from
experiences of war. Symptoms may emerge months or years
after
the
event. Some older adults may relive a trauma
30 years or more after an event due to feeling helpless
because
of a new disability (for example, being confined
to a wheel chair) or specific triggers that revive
old
memories (for example, news coverage of current
wars).
A person with PTSD may startle easily,
be emotionally numb with people with whom they were
once close,
have difficulty feeling affection, and lose
interest in
things they once enjoyed. Those suffering PTSD
may be irritable, aggressive or violent. A
person with
PTSD can experience flashbacks, in which vivid
thoughts of the trauma occur during the day
or in nightmares
during sleep. During a flashback, a person
may believe the traumatic event is happening again.
Obsessive-compulsive
disorder (OCD). While OCD is not common
among older adults, some
older
people do suffer
from persistent, upsetting thoughts that
they control by performing certain rituals, such
as repeatedly
checking things, touching things in a particular
order, or counting
things. Some common fears include possible
violence and harm to loved ones. Some with
OCD are preoccupied
with order and symmetry; others accumulate
or hoard unneeded items.
Panic disorder. Those
with panic disorder have sudden attacks of terror,
and usually
a pounding
heart,
chest pain, sweatiness, weakness, faintness,
dizziness, or
nausea. Panic attacks can occur at any
time, even during sleep. An attack usually peaks
within 10
minutes, but
some symptoms may last much longer. Panic
disorder is not common among older adults,
however,
an older adult with the disorder may refuse
to be
left alone.
An older person experiencing a panic attack
may think he or she is having a heart attack
or stroke.
WHY SHOULD AN OLDER ADULT BE CONCERNED ABOUT ANXIETY?
For older adults, depression often goes along with
anxiety, and both can be debilitating, reducing overall
health and quality of life. It is important to know
the signs of both anxiety and depression and to talk
with a physician about any concerns. Anxiety is also
strongly linked to memory. Anxiety can interfere with
memory, and significant anxiety can contribute to amnesia
or flashbacks of a traumatic event.
WHAT LEADS TO ANXIETY DISORDER?
A number of things can contribute to an anxiety disorder:
- Extreme stress or trauma
- Bereavement and complicated or chronic grief
- Alcohol, caffeine, drugs (prescription, over-the-counter,
and illegal)
- A family history of anxiety disorders
- Other medical or mental illnesses or
-
Neurodegenerative disorders (like Alzheimer’s
or other dementias).
The stresses and
changes that sometimes go along with aging—poor
health, memory problems, and losses—can
cause an anxiety disorder. Common fears
about aging can lead to anxiety. Many older adults
are afraid of
falling, being unable to afford living
expenses
and medication, being victimized, being
dependent on others,
being left alone, and death.
Older adults
and their families should be aware that health changes
can also
bring on anxiety.
Anxiety
disorders commonly occur along with
other physical or mental
illnesses, including alcohol or substance
abuse, which may hide the symptoms
or make them worse.
It’s also
important to note that many older adults
living with anxiety
suffered an anxiety
disorder (possibly
undiagnosed and untreated) when they
were younger.
A stressful event, such
as the death of a loved one, can cause a mild, brief
anxiety,
but anxiety
that
lasts at least six months can get
worse if
not treated. SIGNS OF ANXIETY DISORDER
- Excessive worry or fear
- Refusing to do routine activities or being overly
preoccupied with routine
- Avoiding social situations
- Overly concerned about safety
- Racing heart, shallow breathing, trembling, nausea,
sweating
- Poor sleep
- Muscle tension, feeling weak and shaky
- Hoarding/collecting
- Depression
- Self-medication with alcohol or other central nervous
system depressants
DEPRESSION AND ANXIETY
In older adults, anxiety and depression often occur
together. It is important for older adults to tell
their physicians if they are experiencing symptoms
of either.
SYMPTOMS OF DEPRESSION usually last more than two
weeks:
- Disturbed sleep (sleeping too much or too
little)
- Changes in appetite (weight loss or gain)
- Physical aches and pains
- Lack of energy or motivation
- Irritability and intolerance
- Loss of interest or pleasure
- Feelings of worthlessness or guilt
- Difficulties with concentration or decision-making
- Noticeable restlessness or slow movement
- Recurring thoughts of death or suicide
- Changed sex drive
^ Back to top
WHO CAN HELP?
Older adults who think they may be suffering from
anxiety should share their concerns with their primary
care physicians. A physician can help determine if
the symptoms are due to an anxiety disorder, a medical
condition, or both. If the physician diagnoses an anxiety
disorder, the next step is to see a mental health care
professional. Both patient and provider should work
as a team to make a plan to treat the anxiety disorder.
WHAT ARE THE TREATMENT OPTIONS?
Treatment can involve medication, therapy, stress
reduction, coping skills, and family or other social
support.
A mental health care provider can determine
what type of disorder or combination of disorders
the patient
has, and if any other conditions, such as grief,
depression, substance abuse, or dementia, are present.
Those
who have been treated before for an anxiety disorder
should tell their provider about previous
treatment.
If they received medication, they should indicate
what was used, dosage, side effects, and whether
the treatment
was helpful. If the patient attended therapy sessions,
he or she should describe the type, how many sessions,
and whether it was helpful. Sometimes individuals
must try several different treatments or combinations
of
treatments before they find the one that works
best for them. MEDICATION
Medication will not cure anxiety disorders but will
keep them under control while the person receives therapy.
Medication must be prescribed by physicians, often
psychiatrists or geriatric psychiatrists, who can also
offer therapy or work as a team with psychologists,
social workers, or counselors who provide therapy.
The
main medications used for anxiety disorders are antidepressants,
anti-anxiety drugs, and beta-blockers,
which control some of the physical symptoms.
Antidepressants: Antidepressants
are typically prescribed for most anxiety disorders.
They work by altering
the brain chemistry. Because symptoms usually start
to
fade after 4-6 weeks of antidepressants, it is
important to take them long enough for them to work.
Antidepressants
include selective serotonin reuptake inhibitors
(SSRIs), serotonin and norepinephrine reuptake inhibitors
(SNRIs), tricyclics, and monoamine oxidase inhibitors
(MAOIs).
Anti-anxiety drugs: Anti-anxiety drugs,
also called anxiolytics, are sometimes prescribed
when a quick-acting
and/or short-term medication is needed. Buspirone
is an anti-anxiety drug that has been shown to
be effective
for older adults. Benzodiazepines, another anti-anxiety
drug, are effective but should be prescribed
carefully to older adults because of risk of memory
impairment,
unsteadiness, and falls. When they are used,
benzodiazepines are usually prescribed for short periods
of time.
Some people experience withdrawal symptoms if
they stop
taking them abruptly instead of tapering off.
When taken regularly for a long time, benzodiazepines
can be addictive but typically are not.
Beta-blockers: Beta-blockers can help relieve anxiety by preventing
the physical symptoms that
go along
with certain anxiety disorders. TAKING MEDICATION
- Learn about the effects (for
example, when it should begin to help and
in what way) and side effects.
- Tell your doctor about any other drugs
(both prescription and over-the-counter),
herbal supplements, or alternative
therapies you are taking.
- Find out when and how the medication
should be stopped. Some cannot be stopped
abruptly and must be tapered
down under a doctor’s supervision.
- Some medications are only effective if
taken regularly.
THERAPY
Therapy or psychotherapy involves talking
with a trained mental health professional,
such as a psychiatrist,
psychologist, social worker, or counselor, to discover
what caused the anxiety disorder and how to deal with
its symptoms.
In cognitive-behavioral therapy, therapists
help people change the thinking patterns
that contribute to their
fears and the ways they react to anxiety-provoking
situations. A therapist can teach new coping and
relaxation skills and help resolve problems
that cause anxiety.
When a patient is ready to face his or her fears,
a therapist can teach exposure techniques
to desensitize
the patient to the situations that trigger anxious
feelings. Therapists also teach deep breathing and
other relaxation techniques to relieve anxiety. Behavioral
therapy is short-term therapy of 12 or fewer sessions. WHAT ELSE CAN A PERSON DO TO RELIEVE ANXIETY
- Acknowledge worries and address any fears that
can be handled (for example, if an individual is
worried about finances, a visit to a financial
planner may be helpful)
- Talk with family, a friend or spiritual leader
- Adopt stress management techniques, meditation,
prayer, and deep breathing from the lower abdomen
- Exercise
- Avoid things that can aggravate the symptoms
of anxiety disorders:
- Caffeine (coffee, tea, soda, chocolate)
- Nicotine (smoking)
- Over-eating
- Over-the-counter cold medications
- Certain illegal drugs
- Certain herbal supplements
- Alcohol (While alcohol might initially help
a person relax, it eventually interferes with
sleep and overall wellness, and can even contribute
to anxiety, depression, and dementia.)
- Limit news of current events. It is important
to stay current, but too much negative news can
contribute to anxiety.
- Allow time for treatment to work
^ Back to top
CONCERNED ABOUT AN OLDER FAMILY MEMBER OR FRIEND?
If you suspect an older adult you know might have
a problem with
anxiety, notice and ask about any changes in:
- Daily routines and activities. Is the person avoiding
situations and activities he or she once enjoyed?
- Worries. Does he or she seem to worry excessively?
- Medication. Is he or she taking a new medication,
either prescription or over-the-counter? Or has the
dosage changed for one of the medications?
- Is he or she drinking more alcoholic drinks than
previously?
- Mood. Is the older adult tearful, lacking emotion,
or “just doesn’t feel right.”
When talking with an older adult who has an
anxiety problem:
- Be calm and reassuring
- Acknowledge their fears but do not play along with
them
- Be supportive without supporting their anxiety
- Encourage them to engage in social activities
- Offer assistance in getting them help from a physician
or mental health professional
RESOURCES
American Psychiatric Association
1000 Wilson Boulevard, Suite 1825
Arlington, VA 22209-3901
Phone: (703) 907-7300
Website: www.psych.org
American Psychological Association
750 First Street, NE
Washington, DC 20002-4242
Phone: (800) 374-2721
Website: www.apa.org
Anxiety Disorders Association of
America
8730 Georgia Avenue, Suite 600
Silver Spring, MD 20910
Phone: (240) 485-1001
Website: www.adaa.org
National Association of Social
Workers
750 First Street, NE, Suite 700
Washington, DC 20002-4241
Phone: (202) 408-8600
Website: www.socialworkers.org
FIND A GERIATRIC PSYCHIATRIST
A geriatric psychiatrist
is a medical doctor with special training in the diagnosis
and treatment of mental
illnesses that may occur in older adults. These include,
but are not limited to, dementia, depression, anxiety,
alcohol and substance abuse/misuse, and late-life
schizophrenia. Geriatric psychiatrists can help their
patients navigate the health care system.
The Geriatric
Mental Health Foundation can provide the names of
geriatric psychiatrists. Visit www.GMHFonline.org
or call (301) 654-7850.
OLDER ADULTS & MENTAL HEALTH BROCHURE SERIES This publication is part of a series of brochures
published by the Geriatric Mental Health Foundation
to provide information about the mental health of the
elderly. Other GMHF brochures include:
- Sleeping Well As We Age: Insomnia is Not a Normal
Part of Aging
- Healthy Aging: Keeping Mentally Fit as You Age
- Substance Abuse and Misuse Among Older Adults
- A Guide to Mental Wellness in Older Age: Recognizing
and Overcoming Depression (A Depression Recovery
Toolkit)
- Depression in Late Life: Not a Natural Part of
Aging
- Depression in Late Life (in Spanish) - Depresión
Tardía: No Es Una Parte Natural Del Envejecimiento
- Coping with Depression and the Holidays
- Alzheimer’s Disease: Understanding the Most
Common Dementing Disorder
- Alzheimer’s Disease (in Spanish) - Enfermedad
de Alzheimer: Entendiendo Acerca de la Demencia Más
Común
- Caring for the Alzheimer’s Disease
Patient: How You Can Provide the Best Care and Maintain
Your
Own Well-Being
To view brochures online, visit www.GMHFonline.org/gmhf/consumer.
Order from the website or call (301) 654-7850.
REFERENCES
“Anxiety Disorders” by the National Institute
of Mental Health. 2007. NIH Publication No.
06-3879 Sakauye KM. Geriatric
Psychiatry Basics. New
York: WW Norton & Company; 2008.
“Anxiety Disorders in Older Adults” by the
Anxiety Disorders Association of America. Online
at www.adaa.org.
“Late Life Anxiety Disorders: What you need
to know.” By
the Late Life Depression Evaluation and Treatment
Center at the University of Pittsburgh Medical
Center. (www.wpic.pitt.edu/research/depr/anxiety.htm)
Mental
Health: A Report of the Surgeon General. Chapter
5. Older Adults and Mental Health.
1999.
This brochure
was funded by individual contributions
made in memory of Philip H. Sheridan. GERIATRIC MENTAL HEALTH FOUNDATION
The Geriatric Mental Health Foundation was established
by the American Association for Geriatric Psychiatry
to raise awareness of psychiatric and mental health
problems and issues affecting older adults, eliminate
the stigma of mental illness and treatment, promote
healthy aging strategies, and increase access to quality
mental health care for older adults.
To achieve this
vision, the Foundation’s mission
is to raise awareness of psychiatric and mental health
problems and issues affecting older adults. The Foundation
focuses on public education targeted to the health
care consumer and family caregiver about mental health
promotion, and illness prevention, and treatment. The
Foundation develops programs to enhance communication
and foster broad collaboration between the aging and
mental health research community, mental health care
providers, and the general public.
To learn more about
the Geriatric Mental Health Foundation, visit www.GMHFonline.org or call (301) 654-7850.
HELP SPREAD THE WORD
If this information has been helpful, consider helping
the Geriatric Mental Health Foundation reach more people--older
adults, their families and friends--by donating. Your
donation will help spread the word that mental illness
is not a normal part of aging and that help is available.
To donate, visit www.GMHFonline.org and select “How
to Contribute,” or call (301) 654-7850, ext.
100.
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