Anxiety can be difficult to discuss no matter who you are. Far too many people don’t get the help they need, whether it’s because of the stigma or because they don’t realize they have a treatable problem. However, one group is disproportionately affected by the stigmatization of mental illness, and these individuals are far more likely to suffer from an undiagnosed anxiety disorder: older adults and the elderly.
Obstacles to Anxiety Treatment
Recently, an analysis by the Health and Social Care Information Centre found that women aged 60 and older were most likely to be hospitalized for anxiety in the UK, highlighting the fact that anxiety is still a problem for older adults, despite the once-held belief that anxiety disorders declined with age. Now, we’re starting to recognize that we don’t know as much about anxiety and older adults as we do about other conditions, like Alzheimer’s. There have not been many long-term studies of anxiety disorders in older adults, despite the fact that anxiety is just as prevalent in this age group as in the general population.
It’s thought that many older adults who struggle with anxiety actually had untreated anxiety in their younger years as well. Mental illness was even more stigmatized many years ago, so it makes sense that older age groups feel the impact more than their children and grandchildren. Many older individuals may lack the knowledge to identify anxiety symptoms, or may even believe such symptoms were normal, because they weren’t raised to discuss these things. Those who face cognitive problems have further difficulty taking the first step toward treatment, and overall, older adults are more likely to report physical ailments to their doctors than psychological issues.
Further complicating diagnosis is the fact that other aging-related issues may throw doctors and patients off. Medications can cause side effects similar to anxiety, and issues with memory, which are often associated with anxiety, can also be caused by advanced age or other problems like dementia.
How Anxiety Impacts Older Adults
The small numbers of older people seeking treatment for anxiety is why it was once thought that anxiety declines with age, but in fact, older adults face a range of triggers unique to their age group. Worries over physical health or chronic illness, the loss of loved ones, financial difficulty, loneliness, and decreased independence and mobility can all cause or exacerbate an anxiety disorder. Additionally, fear of falling is a very real concern that may become a serious trigger.
According to the Anxiety and Depression Association of America (ADAA), generalized anxiety disorder is the most common anxiety disorder among older adults. They also face PTSD and panic attacks at relatively high rates, as many individuals had traumas earlier in life for which they never received treatment, such as military combat, abuse or sexual assault. However, phobias and OCD are slightly less common because these disorders are most likely to have been addressed earlier in life.
Left untreated, anxiety in older adults can worsen cognitive impairment, memory, disability, and physical health. Additionally, depression and anxiety in older adults often occur alongside one another and can severely impact quality of life.
Help Is Possible at Any Age
Anxiety is a highly treatable condition, whether you’re 25 or 65. The ADAA recommends that older adults first seek help from their primary care physician, as it can be easier to confide in a doctor they already know and trust. From there, they can be referred to a mental health professional. The primary care doctor, the patient and his or her family, and the therapist should form a treatment team, as building trust and consensus among the group is extremely important to ensuring success.
The best treatment plans combine cognitive behavioral therapy, relaxation techniques, coping skills, and the support of loved ones. In some instances, medication may be prescribed, but older adults require smaller doses and even completely different kinds of medications than other age groups. For instance, benzodiazepines are rarely prescribed to older individuals, as the risk of cognitive impairment and falling usually outweighs the benefits of the medication.
If you suspect an older loved one is suffering from anxiety, The Geriatric Mental Health Foundation (GMHF) suggests talking with him about changes in his life. Some questions to ask:
- Has there been a change in activity or routine? Is he refusing routine activities or avoiding things he once enjoyed?
- Is he worrying about things often, or more than he used to?
- Have his drinking habits increased?
- Has there been a change in medication recently?
- Has he experienced an “off” mood – becoming overly emotional or lacking in emotion, or generally feeling “not right”?
Other signs of a possible anxiety disorder include a preoccupation with routine, social withdrawal, excessive safety concerns, hoarding/collecting, as well as other symptoms commonly associated with anxiety, such as poor quality sleep, racing heart, muscle tension, etc.
According to the GMHF, when talking to an older adult who has anxiety, it is important to remain calm and reassuring, and to acknowledge their fears and provide support without validating or enabling the anxiety. Remind your loved one that the origin of anxiety is often genetic or caused by a chemical imbalance, and that it is in no way a weakness or character defect.