Gail Gilman, Family Life Consultant, M.Ed., C.F.C.S. and Professor Emeritus, University of Minnesota
There are many experiences in aging that contribute to feeling anxious. Older adults have normal concerns over health issues, finances, housing, relationships, and many other things, at a time in life when they are experiencing multiple changes and significant emotional losses. Older adults may not use the word “anxiety,” but may discuss worries, fears, concerns, and being nervous or high strung. Anxiety becomes an issue when it begins to be overwhelming and significantly interferes with daily functioning. Older adults with anxiety disorders find it very difficult to control the worry. They may experience obsessive thoughts and the need to repeat certain behaviors to be comfortable. They may experience difficulty sleeping, worrying in the dark of the night, and may have recurrent nightmares. There can be a sense of restlessness, energy that is going nowhere, a racing of the thoughts in their mind.
Anxiety disorders are probably underestimated in older adults and are difficult to diagnose. Many older adults report problems with the physical “symptoms” of anxiety rather than the psychological. It is essential to rule out other physical causes and then to address the issues of an anxiety disorder. Anxiety disorders tend to run in families, and they may be able to describe other family members that were excessive worriers. Anxiety and depression often occur together in older adults. A focus on the anxiety symptoms may be an immediate need and then a shift may be necessary to focus on the issues that may be causing depression.
Anxiety presents with many physical symptoms: nausea, shakiness, irritable bowel, heart palpitations, shortness of breath, and muscle pain. The language used to describe anxiety is “I feel like I am going crazy”, or “I think I am going to die” or “Don’t leave me.”
There are many types of anxiety disorders. Generalized anxiety disorder is most common in older adults and can escalate into panic disorders, which can be very limiting. Obsessive-compulsive disorder may well be present but undiagnosed in persons residing in “garbage houses”, or in many older adults with “hoarding” issues. Social phobia may be present in many older adults who are incontinent. They begin to isolate themselves out of fear that they will have an “accident” and be embarrassed or scorned in social situations.
Being very anxious also puts an older person at risk of becoming dependent on alcohol or developing other substance abuse in attempts to control the anxiety. Alcohol will decrease the symptoms of anxiety, but often creates another whole set of problems.
Post traumatic stress disorder can be the result of events that elicits “old memories” of traumatic events: military combat, rape, and child abuse. Many older adults are “secret keepers” of the family alcoholism, past child abuse, or the effects natural disasters have had on them. In preparation for death many older adults need support to complete “unfinished business” that is causing great underlying anxiety.
Anytime an older adult says, “I have never told this to anyone,” be very prepared to listen closely to what comes next and to respond to issues that are revealed.
Anxiety in Family Caregivers
Family caregivers experience great stress over an extended period of time. Caregiver burden is often referred to. Many things seem to be out of control. Poor coping strategies increase the sense of loss of control and increase anxiety. Anxiety and depression often occur together. Caregivers of persons with dementia probably have increased risk of both depression and anxiety, due to the often unpredictable behaviors of the care receiver.
If you would like more information about “Anxiety in Aging” feel free to contact Gail Gilman, Family Life Consultant, M.Ed., C.F.C.S. and Emeritus University of Minnesota at waldn001@umn.edu. Be sure to watch for more Family Living Focus information in next week’s paper.