When life presents stressful situations, drastic changes, or unusual circumstances, it is normal to experience a sense of nervousness and anxiety. Feelings of anxiousness can help us avoid danger and serves a fundamental role in survival. But when these feelings begin to dominate the way a person thinks and feels in everyday situations, it can become debilitating, hindering the quality of life. As one grows older, the quality of life becomes a significant factor in well-being and longevity. According to mental health experts, more than 27 percent of older adults under the care of an aging service provider have symptoms of anxiety that may not amount to the diagnosis of a disorder, but significantly impact their functioning.
The anxiety that interferes with daily life is not normal during the process of aging and can lead to increased health problems. Statistics show that 3 percent to 14 percent of older Americans have a diagnosable anxiety disorder. As the aging population’s life span continues to increase, it is important to know the signs and symptoms of anxiety, methods in which it can be treated, and what loved ones can do to make the many transitions of aging manageable.
Anxiety in Older Adults
Anxiety can be defined as excessive and intrusive worry, fear, and feelings of dread that occur disproportionately to the situation being experienced. Physical symptoms of anxiety can present as panic attacks: rapid heartbeat, cold sweats, tremors, and hyperventilation. Panic attacks often mimic heart attacks, which can make the sufferer believe that they are in a life-threatening situation. Physical complications that co-occur with an anxiety attack can result in cardiovascular events if this condition is left untreated.
Whether an elderly adult has an anxiety disorder or is having difficulty coping with the process of aging, family members can sometimes feel as if there has been a drastic, sudden change in the behavior or personality of their loved ones. In these situations, the change may be attributable to one of the following types of anxiety:
- Generalized Anxiety Disorder: This form of anxiety presents a state of constant worry with little to no cause. Older adults with GAD have difficulty relaxing, sleeping, 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: Brought on by an event that posed physical harm or the threat of physical harm, PTSD presents in those who have suffered traumas in war zones, crimes, or are experiencing abuse in the present time that cause flashbacks to a similar traumatic moment. Some older adults with PTSD re-experience trauma from previous years due to specific triggers that can revive memories. Many who have PTSD often withdraw from socialization and internalize their pain as a method of self-protection.
- Panic Disorder: Panic disorder occurs as an instant attack of fear or terror that can render a person helpless from the combination of sudden physical and emotional distress. Older adults with panic disorder may believe that they are experiencing a life-threatening heart attack or stroke. Symptoms include chest pain, cold sweats, dizziness, and physical weakness. Panic attacks can occur during sleep or while the sufferer is awake.
- Social Anxiety Disorder: This disorder occurs when a person feels very anxious, self-conscious, and overwhelmed in private or public social situations like talking on the phone, running errands out in public, or during an activity or group event. When an older adult feels the effects of social anxiety disorder, he or she may wish to withdraw from activities that require any form of interaction.
What Causes Panic Attacks in the Elderly?
Loss of a Spouse
Companionship is an essential part of a fulfilling life. When a spouse dies, the loved one left behind loses more than a life partner. Family roles become redefined, daily routines are interrupted by the absence of a primary member. While life continues at the same hectic pace, a grieving spouse may feel less of a sense of purpose and drive. According to Knoxville, Tennessee gerontology psychiatrist Dr. Melanie Hunt, “When a person loses someone they have shared a life-long connection with, they feel as if a part of them has been amputated. This level of loss can cause psychological impacts that can greatly hinder physical health.” Loss of interest in normal activities, a decrease in appetite, and an increase of feelings of despair can cause an imbalance in brain function and trigger a panic response.
The bereaved may also feel a sense of fear, regret, or guilt from unfinished tasks or unmended fences. Additionally, research shows that how a loved one passes away poses another dimension in the grief of the widowed spouse. For example, if a spouse had a long battle with a terminal illness, the caretaking spouse may feel a sense of failure, as if there was not enough done to prevent the death from happening at the moment it occurred. Such thoughts can lead to mental and emotional obsessions, causing sleeplessness, anxiety, and panic.
The contemplation of one’s mortality is natural in the process of understanding death and dying. When one loses a partner during their golden years, such a loss can amplify the fear of one’s death. For some older adults, the loss of a spouse can result in stress-related cardiomyopathy, also known as “broken heart syndrome.”
When older adults experience age-related health issues, it is normal to experience feelings of fear and uncertainty. Some chronic medical conditions may cause anxiety and can be linked to risk factors in mental health. A person with comorbidity (one or more co-occurring health issues) can experience an increase in anxiety as other symptoms arise. Illness such as heart disease and other cardiovascular conditions, COPD, insomnia, thyroid disease, and diabetes can cause increased anxiety and leave patients feeling poorly, overall. Diseases that cause cognitive declines such as Parkinson’s Disease, Alzheimer’s, and dementia can also cause a patient to have panic attacks, disorientation, agitation, and distress.
The combination of medication-related side effects can cause disruptions in metabolism and heartbeat, bringing on a panic attack. For example, a person diagnosed with COPD may take a bronchodilator/inhaler. Common side effects for this medication are rapid heartbeat, nervousness, and high blood pressure. The onset of these types of side effects combined with pre-existing illness-related symptoms can cause excessive worry. Physical limitations as a person ages can leave one feeling chronic pain, which can cause an older person to fear movement and stimulate obsessive thoughts of being pain-free. This can lead to a snowball effect of physical, emotional, and mental instability. Additionally, older adults who have chronic pain are often at risk for the misuse of prescription medications; chemical dependency is a major risk factor for anxiety, sudden mood, and personality changes.
According to Mayo Clinic online, late-life depression affects about 6 million Americans, ages 65 and older with only 10 percent receiving treatment. Depression in the elderly is frequently confused with the effects of multiple illnesses and the medicines used to treat them.
Many factors can contribute to the onset of elderly depression. Both depression and anxiety can feed into mood swings, physical exhaustion, and a lack of interest in activities of daily living. Transitions from independent living to assisted living can also bring about depressive episodes. These changes in mood or behavior can be a result of a “mourning period” in which elderly people long for their independence, memory, and physical capacity.
Reflections on the past are common later in life; elderly adults may experience memories of repressed past traumas that may not have been addressed. This can cause disruptive emotional upheaval, feelings of regret, hopelessness, and fear of one’s mortality. The loss of a supportive community due to health restrictions can result in consistent disappointment. With a decline in physical abilities and loss of friends and family, feelings of fear can cause feelings of isolation. When older adults experience late-life depression it is oftentimes a cumulative or gradual change. The longer symptoms go untreated, the harder it will be for them to rehabilitate, increasing the risk of death.
When addressing the issue of anxiety in older adults, it is important to consider proper nutrition, hydration, and regular activity as part of a comprehensive treatment plan. Minor adjustments with small, measurable goals can make a large impact on the quality of life. It is time to consider medication when anxiety interferes with activities of daily living and general well-being despite lifestyle improvements. Consulting a loved one’s primary care physician is an effective first step. During the consultation, medication interactions could be evaluated. Common prescriptions for late-age anxiety or depression may include antidepressants, benzodiazepines, or beta-blockers.
It is important to monitor when the medication begins to work and its side effects. When discussing medication with a loved one’s doctor, it is important to note any herbal supplements that are also being taken in conjunction with the prescription medication. If a side effect appears to cause harm, notify the physician immediately. Some medications can not be abruptly stopped and may require a physician’s supervision to safely adjust to tolerable levels or slowly tapered down. Additionally, a doctor may refer her patient to a therapist while taking medication.
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Many forms of therapy target different physical, mental, and emotional challenges facing older adults. 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.
- Cognitive Behavioral Therapy: A therapist can assist someone to change thinking patterns that contribute to anxiety. This is an effective form of treatment for those who have been diagnosed with anxiety disorders.
- Group Therapy: A therapist can use different techniques that help the group work together to heal and find a sense of purpose in active listening. This is best for patients who thrive in a community environment.
- Bereavement Therapy: Also known as grief counseling, a therapist focuses on the trauma of loss for the older adult. Surviving family members are often encouraged to take part in this form of counseling to promote healthy communication about the complexity of the loss.
Family members are the frontlines of care and advocacy for older adults. When a loved one is making a transition from independent living to assisted living, regular visits from family members can offer a sense of continuity and security for their loved ones. Additionally, family members who keep regular visits can work alongside assisted living care professionals so that care plans can be customized and consistently enforced. Consistency in caretaking is an essential part of a successful transition in receiving a little extra help with daily activities. During visitation periods, family members can ensure the care of their loved ones by asking questions, actively listening, and monitoring any physical, emotional, or personality changes.
Intergenerational activity helps an elderly loved one play an active role in the lives of grand and great-grandchildren. Being able to interact with younger generations assists older adults in rediscovering a sense of purpose and motivation while warding off feelings of hopelessness, fear, and uncertainty.
Taking the time to celebrate even the smallest victories in the life of a loved one emphasizes a positive and supportive environment. Offering gratitude, kudos, and other forms of positive reinforcement can help change affect and enhance motivation. Celebrating each day of a family member’s life as if it is his last can create new traditions of peace, laughter, and joy lasting for generations.