Identifying and Treating Anxiety in Seniors
Anxiety occurs in older Americans with surprising frequency. Some reports estimate between 10 and 20% of seniors have generalized anxiety. This number could be even higher, as many often deny having psychological issues when asked by their doctors, focusing more on the physical symptoms anxiety can cause.
In a recent article, Hany Abdelaal, President of VNSNY Choice Health Plans, describes late-life anxiety this way. “It’s a pattern familiar to many of us with aging parents: the overwhelming worry or constant nervousness over day-to-day tasks, from taking medications to parking the car. Left untreated, this anxiety-related agitation in the elderly can disrupt sleep and eating, exacerbate chronic medical conditions, and ultimately contribute to a downward spiral of fear and isolation.”
As his article explains, older adults may have anxiety or worry about physical health (illness, changes in vision or hearing), cognitive difficulties, finances, and changes in life status (widowhood, care-giving responsibilities, retirement). They may feel anxious about keeping medications straight (sometimes to the point of giving up and stopping them altogether), not having enough groceries in the house, driving, and falling.
Anxiety is often accompanied by symptoms that mimic physical illness and may include muscle tension or pain, GI symptoms, shortness of breath, and heart palpitations. Symptoms can also include sleeplessness, an inability to concentrate, irritability, and lack of focus. As a result, complaints are often more about these physical symptoms than the anxiety causing them.
The good news is that anxiety can be treated. Stress can be reduced with social support, communication, education and, if needed, counseling and medication.
Social Support: When there is no one around to provide support or an alternate point of view, anxiety can cause irrational fears to grow. It’s critical to have a support system of family, friends and neighbors who can provide social contact by telephone, email and personal visits. Religious organizations can provide community and a place to visit regularly; most have visitation for those who are homebound. Senior centers can also provide social support.
Communication and Education: Living with chronic medical conditions and managing multiple medications can often trigger anxiety in elderly people, especially if they do not fully understand their situation. Medications should be routinely evaluated and, if possible, reduced. Patients need to understand what they are taking and why, what the desired effect is, and possible side effects. A caregiver or family member should accompany an older person to each doctor’s visit, prepared to ask questions and take notes. A family member can also “join” the appointment via Facetime or speaker phone. Upon request, the doctor’s office can provide a written care plan and prescribed medications at the end of each appointment.
Counseling and Medication: Many anxiety sufferers can benefit from psychological counseling in which they learn to reframe thoughts and behaviors, and challenge their irrational fears. Stress management techniques may be helpful. There are also a number of medications that can help reduce anxiety symptoms. Before adding another medication to what may be an already stressful multi-drug program, a doctor should fully evaluate the patient’s overall situation, reducing or streamlining medications where possible. That said, the addition of one of these medications can make a major difference in the life and outlook of an older person suffering from anxiety.