As we grow older, our ability to cope with life’s challenges grows with us. As toddlers, even the smallest problems can feel like the end of the world—as adults and seniors, we’re able to understand that things often aren’t so bad. However, having a higher tolerance for discomfort doesn’t necessarily make someone immune to hardship.
No matter how mentally strong they may be, age-related challenges and stressors can contribute to mental health issues in seniors. These challenges include serious illness, the death of a loved one, decreased physical mobility, and an overall loss of independence. Misuse of stimulants such as alcohol and nicotine can also contribute to this, and some prescription medications can also elevate anxiety risks—even when taken correctly.
According to the American Association for Geriatric Psychiatry, 10% to 20% of seniors are thought to struggle with anxiety disorders. This is likely a conservative estimate, given that many cases go unnoticed. Noticing warning signs and taking appropriate action is crucial no matter your age, but can become harder for older people, as they don’t want to feel like burdens or don’t believe that mental health is a serious issue. In this article, we have gathered advice on how to help your elderly loved ones if you believe they are struggling with anxiety.
Notice the signs
A certain level of anxiety is to be expected for anyone. However, when these anxieties become extreme, long lasting, and uncontrollable, other symptoms may start to appear.
The physical warning signs of Generalized Anxiety Disorder (GAD) include insomnia, decreased appetite, nausea, trembling, and sweating. Symptoms such as a racing heart rate, stomach pain, muscle tension, and headaches may also appear.
Aside from the physical symptoms, you should also watch out for changes in demeanor. Seniors may withdraw from activities they previously enjoyed, become easily alarmed, and become restless. They may also have trouble focusing or complain of experiencing intrusive thoughts.
Those with severe anxiety or panic disorders may also experience panic attacks. These can manifest as intense episodes of shortness of breath, chest pain, heart palpitations, lightheadedness, numbness, and / or chills. Many who have panic attacks describe feeling like they cannot take a full breath, and becoming dissociated and disconnected from their body and reality. Some may also feel like they are dying or having a heart attack.
In seniors, GAD is the most common form of severe anxiety, but some may experience social anxiety, phobias, or have Obsessive Compulsive Disorder (OCD). Social anxiety is characterized by an extreme fear of judgement in social situations, and can often manifest as loneliness, often due to withdrawing from social activities. Phobias are extreme, debilitating fears of a certain situation or object that does not pose a major threat. For seniors, common phobias include a fear of falls or getting sick, and may be caused by trauma from a prior accident or illness. In the case of OCD, seniors experience unwanted, intrusive compulsions to perform certain activities. This often takes the form of repeated counting or tapping, and may be done to prevent something bad from happening or to feel a sense of control.
Understand senior anxiety
As a child or caregiver of seniors, it can feel scary to notice these signs of anxiety. It can also be just as scary to notice some symptoms, but not know if they are signs of a mental or physical health issue. In the case of seniors these fears are especially common, as senior anxiety often manifests as a physical issue.
In an article by the Cable News Network (CNN), professor Gretchen Brenes—of Wake Forest University School of Medicine—commented that older patients tend to complain of physical symptoms more than younger patients. This tendency to focus on the physical effects of anxiety can create confusion as to whether the issue is mental, physical, or a combination of both. In addition, physical symptoms can be easy to write off as a natural part of aging, making getting a diagnosis challenging.
Along with asking about physical symptoms, experts recommend asking anxiety-specific questions to better understand a senior’s situation. Examples from Dr. Eric Lenze—of the Washington University School of Medicine—include:
- Do you have recurrent worries that are hard to control?
- Are you having trouble sleeping?
- Have you been feeling more irritable, stressed, or nervous?
- Are you avoiding things you normally like to do because you’re wrapped up in your worries?
Asking these targeted questions can help to narrow down the list of conditions your senior may be struggling with. At the very least, these questions may rule out physical illness and allow you and your loved one to focus on the mental side of their healthcare.
Talk about it
Mental health can be an uncomfortable topic for seniors and caregivers alike. However, after noticing warning signs of anxiety, the next step is to talk about it. If your senior seems receptive to the conversation, try expressing your concerns and introduce the possibility of an anxiety disorder. The goal here is not to overwhelm them with information, but rather to have an open conversation where both parties understand each other.
This can be made significantly easier by involving a trusted third party. If a senior has a family doctor who they know and trust, or a long-time friend who is a doctor, they can provide reassurance during these difficult conversations. Having that prior positive history with the doctor is especially important; their mutual trust will provide the foundation to support your conversations.
Once you have explained your concerns to each other, the next step for you and your senior is to create a treatment plan. Again, a doctor or therapist can be very helpful here. For example, after talking with a family doctor, they may recommend you seek the help of a therapist or write you a referral. Open and honest communication is the key to allowing both you and your loved one to understand—and agree on—the path forward.
Seek further help
Once you have made a plan, the next step is to follow it! While each senior’s situation is different, here are a few common treatments for anxiety.
1. Talk therapy
Also known as psychotherapy, counselling, or simply therapy, this method of treatment is centered on one-on-one conversations between the senior and a licensed counsellor. There are two main types of therapy: exposure therapy and cognitive behavioural therapy (CBT).
Exposure therapy works by gradually exposing patients to their fears and working to dismantle fear patterns. This is done through careful exposure to situations which cause them anxiety and can be done in real life, through their imagination, or through the creation of similar physical sensations.
CBT focuses on identifying and changing anxiety-inducing thought patterns alongside the creation of coping mechanisms. For example, a person with a panic disorder might focus on learning and understanding more about their panic attacks, in order to understand that they are temporary and not life-threatening.
Both exposure and cognitive behavioural therapy can be conducted in person or virtually, making this an accessible option for those with mobility issues or those who live in remote areas. Many senior therapy services will also accept insurance—especially online psychologists!
2. Medication
Modern medicine has provided us with many advances in medication. For those with anxiety disorders, serotonin reuptake inhibitors such as Prozac, Celexa, and Zoloft can make a world of a difference. These drugs work by lowering the rate at which serotonin—a neurotransmitter thought to regulate happiness, anxiety, and other emotions—is reabsorbed; this allows serotonin to continue to work its positive effects for longer.
Stronger drugs such as Xanax, Ativan, Klonopin, and Valium also exist and are often prescribed to younger patients, but are generally advised against for seniors. In a list accompanying an article by the Pharmacist’s Letter, Valium was listed as having negative side effects on older adults, including depression, confusion, and increased risk of falls. Xanax, Ativan, and Klonopin have also been linked to increased risk of hip fractures, falls, and short-term cognitive impairment by the American Geriatrics Society. As with any medication, it is important to consult a doctor before taking an anxiety suppressant. It is also very important to have regular checkups to monitor the drug’s effects and catch any side effects before they become problematic.
3. Mindfulness
Should a senior not be open to therapy or medication, an alternative course of action is to practice mindfulness. Mindfulness through meditation can be very helpful for a vast range of issues, from simple stress to complex trauma. In fact, mindfulness is often used alongside more traditional forms of therapy, like CBT. After reviewing 200 articles on the subject, the American Psychological Association found that mindfulness-based therapy was “especially effective for reducing stress, anxiety, and depression” in healthy people, and showed promising results in the treatment of both mental and physical health issues.
Yoga, a practice rooted in mindfulness, is another fantastic option—especially for seniors looking to remain active and mentally sharp. According to an article published on PubMed, yoga has been shown to have positive impacts on one’s balance, mobility, mental health, and the prevention of cognitive decline. Not only is this practice effective against anxiety, but it also results in an increase in physical capabilities. As mentioned earlier, loss of mobility and independence are known contributors to senior anxiety, so yoga combats this on multiple different levels!
For those of you caring for seniors who are against mental health treatment, framing this as an opportunity for physical exercise is a possible workaround in order to reap the benefits of this practice.
4. Lifestyle changes
Lifestyle and habits can contribute significantly to how someone feels throughout the day. While changing day-to-day habits cannot cure underlying anxiety disorders, it can help to reduce some of their effects. Substances such as caffeine, nicotine, alcohol, and other stimulants can heighten symptoms of anxiety, and so limiting these substances can make symptoms a bit more manageable. Additionally, consistently getting a solid amount of sleep—for seniors, this means 7 to 9 hours a night—has been proven to lessen anxiety. Consider suggesting these changes to your elderly loved ones; they can provide the leg up needed to begin successfully managing anxiety.
Understand stigma
Mental health continues to be one of the most stigmatized topics in healthcare. Despite what some may say, mental illnesses are not character defects or attention seeking behaviour, and can be caused by a vast range of things from genetics, to childhood trauma, to stress from one’s environment. Regardless of the reason, mental illnesses are health issues, just like broken bones and diseases; they should not be looked down upon.
For the older demographic, this stigma can be particularly hard to let go of and / or fight back against. According to a PubMed article, many elderly people “view mental illness as a sign of weakness” and thus do not admit to facing mental health issues—especially if they feel they may lose their independence by doing so. Unfortunately, this can also be exacerbated by healthcare providers’ unconscious biases; as society has painted a picture of older people being set in their ways and unwilling or unable to change, some may deem it “too late for psychiatric care to be administered”.
Because of the stigma surrounding it, when talking about mental health, it is important to consider your approach carefully. Listed below are a few tips to consider:
1. Educate yourself first
Our own biases, unconscious or otherwise, affect the way we talk about things. Taking the time to understand the facts of mental illness is the first step, as you want to be fully informed before talking to others. Educating yourself can also help you realize when you are being judgemental and make you aware of where you may need to change that thinking.
2. Choose your words
Words have connotations, both positive and negative. By choosing to focus on the positive side of things and being respectful and understanding, conversations about mental health can go from scary to hopeful. After all, a person’s mental illness doesn’t define who they are or who they can become. Try to avoid words like “crazy” or “unhinged” as these have very negative connotations. Instead, try using words like “uncomfortable” or “overwhelming” to describe symptoms and mental health conditions, and take care to remain positive and uplifting. Mental health is scary, but that doesn’t mean that change isn’t possible.
3. Involve a professional
As mentioned earlier, involving a trusted doctor or therapist can be beneficial in explaining mental health topics. Not only will their professional experience give a sense of credibility, but having a second opinion can put many seniors’ minds at ease. Some may be tempted to believe that anxiety, depression, and other mental illnesses are merely “newfangled” ideas, and having an expert opinion can help to reframe these thoughts.
Above all, make it clear to your elderly loved ones that they do not have to be living with severe anxiety, and take care to remind them that there are ways to help.
Final remarks
Throughout this article, we listed four main methods for you to help your elderly loved ones to combat severe anxiety: talk therapy, medication, mindfulness, and lifestyle changes. Every senior is different, and so not all of these will work for your situation. Try not to get discouraged by setbacks and instead view them as learning opportunities; each time something doesn’t work, you can move forward with a better understanding of what your senior’s needs are. The important thing is to continue to put in the effort to find something that works for them. By educating yourself, talking openly about mental health issues, and involving professionals when possible (or necessary), you can significantly increase your senior’s quality of life for years to come.
