Your anxiety might originally spring from a specific cause, like a bad fall you had. It’s when that fear of falling, even without any immediate danger, stays present that you have GAD. It’s this kind of anxiety that leaves many older adults housebound.
Other anxiety disorders include phobias, seemingly unreasonable fears (like terror of elevators), and panic attacks, in which you feel a sudden, uncontrolled terror. Panic attacks often come with physical symptoms, like shortness of breath and heart palpitations.
Recognizing the stressors
“Older adults face many of what I call ‘lifestyle adjustments.’ These adjustments include retiring, moving to a new environment, loss of family or friends, multiple medical conditions, and/or financial worries,” says Roberta Feldhausen, A.P.R.N.-P.M.H., Erickson Health’s director of mental health services. “They are also caring for many more people—their grandchildren, their adult children, and even still caring for parents,” Carpio adds.
Experts agree that it’s never too late to start fighting anxiety. The first step is proper diagnosis, usually through your primary care physician (PCP). “You have to be sure your jumpiness is truly from anxiety, and not from a physical problem like hypothyroidism,” Kennedy says. The latter leads to mental and physical sluggishness, due to under-production of a thyroid hormone.
Getting a diagnosis
“Primary care doctors really have to look for anxiety. That means taking time with our patients, getting a complete history, finding out what’s going on in their lives,” says Leslie Rigali, D.O., Erickson Health medical director at Brooksby Village, an Erickson-built and -managed community in Peabody, Mass.
“Another problem regarding anxiety in older adults is many of them are seeing multiple doctors, and each doctor may be getting a different part of the story,” Carpio says. Erickson Health professionals consult weekly and that makes it more likely for someone to have noticed if “Mrs. Smith” seems to be anxious in some way.
The old-fashioned treatment option
Drugs used to be the one recognized treatment for fighting anxiety. Medications can help, but finding the right one, in the right dose, takes patience. “In a lot of ways, nothing beats the old class of drugs called benzodiazepines, like Valium. However, in older adults, these can slow thinking and reflexes,” says Kennedy. “Some of these drugs tend to be sedating, causing balance problems. If you take them before bedtime and have to get up during the night, you’re more likely to fall,” Rigali says. Kennedy’s first choice with older patients is antidepressants, a group called SSRIs (selective serotonin reuptake inhibitors), like Prozac and Zoloft.
More than pills alone
“Medication is effective, but it’s combining medicine with lifestyle and attitude changes that conquers anxiety,” Feldhausen says.
“Anxiety is very responsive to behavioral changes, like learning relaxation techniques,” Schiavone says.
“We teach breathing exercises; thought stopping (recognizing the anxious thought and stopping it); keeping a journal; and replacing negative with positive thoughts,” Carpio says. “Maintain a regular sleep/wake cycle. Find some form of physical activity to keep your mind off anxious thoughts,” Kennedy adds. “Both caffeine and nicotine produce anxiety and both can be difficult to give up,” Schiavone says. “You have to believe in the long-term benefits.”
Finding help
“The number of older adults with mental health issues is growing, so we need a new culture of care providing the right mental health support for them,” says Kennedy.
Feldhausen points to advanced practice psychiatric nurses. “They combine both counseling skills (like social workers) and health skills (like nurses),” she says..
To find your best counselor, Feldhausen says, “I’d start with a referral from your PCP, preferably to someone with geriatric mental health skills.” She also recommends checking with your local mental health association or department of aging.