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Anxiety: How Does It Affect Elderly Individuals?

Anxiety can affect individuals at any age in their lives. Many elderly individuals do not seek treatment for a variety of reasons. One of the main reasons is that they may not recognize they are having anxiety. Additionally, they may have experienced this emotion most of their lives. Others do not want to be started on any more medications than they are already on. There is evidence that anxiety disorders are common in older individuals: one in ten suffers from disorders such as generalized anxiety disorder, social anxiety disorder, panic disorder, and obsessive-compulsive disorder. These anxiety disorders can be very disabling, leading to poor physical health and lower quality of life. However, many seniors avoid seeking treatment for these disorders, because they feel that the anxiety is normal – “I’ve had it all my life, it’s a part of me” (University of Pittsburgh Medical Center, 2007).

Reasons for Anxiety
According to Cassidy and Rector (2008), late-life anxiety can often be “silent”—missed or difficult to diagnose as older adults tend to express psychological processes through physical problems instead of psychiatric problems or as a psychosomatic reaction, have multiple psychiatric, medical, and medication issues; and present anxiety differently than do younger patients. “Although anxiety disorders beginning in later life are uncommon, the symptoms of anxiety are quite common in older adults,” says George T. Grossberg, MD, professor and director of the division of geriatric psychiatry at Saint Louis University School of Medicine. “The main reason is that older adults are subjected to a variety of stresses and losses, any of which can cause or be accompanied by anxiety symptoms.” These stresses can include retirement, especially if it is sudden; loss or illness of a loved one; a decline in physical, cognitive, or emotional health; or financial concerns, explains Dr. Grossberg. Many older adults are also afraid of falling, being dependent on others, being left alone, and death” (Bhatia, 2012). Most of the time, elderly individuals will have depression with anxiety. Other times, they may have depression and no anxiety or anxiety without depression. Both depression and anxiety may be caused by what is going on in individuals’ lives.

Signs of Anxiety

The Geriatric Mental Health Foundation (2009) submits the following as sign and symptoms of anxiety: 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 and self-medication with alcohol or other central nervous system depressants.

Anxiety Disorders
Not every individual who suffers from anxiety has an anxiety disorder. Anxiety can be a perfectly normal way to respond to stress. According to the University of Pittsburg Medical Center (2007) “Anxiety is a normal response to certain situations and is useful in helping us to cope with problems and to manage threatening situations. Anxiety alerts us to threats and provides the physiological readiness needed for action. Anxiety may be very intense in certain situations yet still be considered normal. However, if it occurs when there is no threat and/or if its intensity is far higher than the situation warrants, it is likely to be a symptom of an anxiety disorder. Excess anxiety that occurs repeatedly and leads to distress and disablement is usually called an anxiety disorder. There are several different anxiety disorders.” The Geriatric Mental Health Foundation (2009) outlines the different anxiety disorders that can affect elderly individuals. They are as follows:

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.”

Treatments for Anxiety

Bhatia (2012) identifies that anxiety “left untreated, anxiety and anxiety disorders can lead to other problems, such as cognitive impairment, poor physical health, and a poor quality of life. So have your loved one examined by a primary care physician if you suspect that he or she has an anxiety disorder. Fortunately, there are a variety of treatments available if an anxiety disorder is diagnosed:

  • Psychotherapy or counseling. A mental health professional, such as a geriatric psychiatrist, psychologist, or social worker, can help determine what is causing the anxiety disorder and how to deal with its symptoms. “In many cases, a ‘behavioral’ approach, such as cognitive-behavior therapy, will give a person the tools to manage themselves,” says Stephen Read, MD, a geriatric psychiatrist and clinical professor at the University of California, Los Angeles.
  • Medication. While drugs won’t cure anxiety disorders, they can help control these disorders while your loved one is in therapy. The main medications used to treat anxiety disorders are antidepressants, anti-anxiety drugs, and beta-blockers. Antidepressants (specifically selective serotonin reuptake inhibitors or SSRIs) are preferred over anti-anxiety medication, as they are non-addicting and generally well-tolerated.
  • Stress reduction. Adopting stress management techniques, such as meditation, prayer, and deep breathing from the lower abdomen, can help lower anxiety. Yoga, progressive relaxation, and tai chi may also be beneficial, says Grossberg.
  • Getting better-quality sleep. A good night’s rest may also help. “Sleep disorders are of course rampant in those with anxiety, and improving sleep, which often requires medicine, will be a big help,” says Dr. Read.
  • Staying active. Activity of any kind such as physical or intellectual can ease anxiety symptoms. “Encouraging the use of routines, exercise and activity, and socialization may be useful. Relaxing activities and hobbies should be encouraged. Gardening, fishing, art, and music are particularly relaxing for some older adults,” says Grossberg.
  • Avoiding triggers. One should avoid things that can aggravate the symptoms of anxiety disorders, such as caffeine, smoking, over-the-counter cold medications, and alcohol.

Conclusion
In conclusion, obtaining treatment for anxiety disorders can really improve the quality of life of individuals who are suffering with anxiety. It is important for family member, friends and caregivers to be very supportive and use a calming voice when individuals are experiencing anxiety. Additionally, if you or someone you know is suffering from abnormal anxiety, it is important to seek professional assistance so that a diagnosis can be made and treatments started. Furthermore, although some anxiety is normal, if it continues it is important to understand that only a professional can determine if you are dealing with a disorder or not. Self diagnosing of determining your anxiety is normal can severely alter your life.

References:

Bhatia, J. (2012). Anxiety also affects the elderly: Older people experience anxiety and anxiety disorders, often because of age-related stressors. Here’s how caregivers can help them cope.
Retrieved: March 2, 2012 from:
http://www.everydayhealth.com/anxiety/anxiety-also-affects-elderly.aspx

Cassidy, K. & Rector, N. (2008). The silent geriatric giant: Anxiety disorders in late life. Retrieved:
March 2, 2012 from: http://www.medscape.com/viewarticle/579825

Geriatric Mental Health Foundation. (2009). Anxiety and older adults overcoming worry and fear.
Retrieved: March 2, 2012 from: http://www.gmhfonline.org/gmhf/consumer/factsheets/anxietyoldradult.html

University of Pittsburg Medical Center. (2007). Late life anxiety disorders: What you need to know.
Retrieved: March 2, 2012 from: http://www.wpic.pitt.edu/research/depr/anxiety.htm

Author: Pam Blau, Care Coordinator at Clinkscales Elder Law Practice, P.A.

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