I recently had the privilege to give a lecture on anxiety disorders in older age. Partly because I published a recent book covering depression in elderhood and partly because I see anxiety playing such a huge role in my patient populations, this topic intrigued me.

Long story short, it’s very prevalent. It’s the terrifying elephant in the room, and both the high rates and the types of anxiety disorders that are showing up in older patients are not what one would expect.

Even with my background as a geropsychologist, the trend in current anxiety disorders flabbergasted me.

…..

First, let’s talk about anxiety (otherwise known as “nerves,” depending on where you grew up):

Anxiety is a nervous system response to perceived stress. It has physiological components, including elevated heart rate, shortness of breath, and a tense feeling in joints and muscles. It allows the body to act quickly in response to danger, jump-starting chemical reactions that allow for fast reaction times and powerful movements — our ancestors would not have hung around long enough for any of us to exist if it weren’t for anxiety.

Anxiety also has strong cognitive components. When we perceive stress or danger, the mind hustles at the speed of light to find solutions that will keep the body safe. Racing thoughts and worrying about the future are common mental indicators of anxiety, and they are highly adaptive.

Anxiety is a normal and healthy part of the human experience, no matter one’s age or station in life.

The problem comes when, as with all parts of the human experience, we get too much of a good thing. When anxiety starts to impair functioning — or, get in the way of living a satisfactory life — psychologists begin to think in terms of a disorder. Some common signs that anxiety has swelled into the breadth of functional impairment include:

• Overestimating the present level of danger.


• Underestimating one’s ability to cope with the current danger.


• Avoiding situations that trigger anxious feelings.

One can imagine that a particularly scary situation, such as a car accident or becoming trapped in an elevator, can increase one’s perception of danger — a kind of shock out of blissful ignorance. Avoiding situations that remind us of fear or anxiety will thereby be inherently rewarding, as this allows us to escape from the unpleasant feeling.

Indeed, there are countless things in this world that can catalyze a physiological and cognitive anxiety response, such as:

1. Stressful experiences in the past (e.g., a critical parent)


2. Recent stressors (e.g., involuntary retirement)


3. A medication of substance reaction (e.g., an inhaler)


4. Physical symptoms/cues (e.g., COPD, heart arrhythmia)


5. Neurological changes (e.g., the possible side effect of a stroke)

Is it any surprise, then, that anxiety would pop up so frequently as we enter our golden years? Fear of injury, reliance on caretakers, loss of access to previous coping resources (like work), financial strain, and exposure to the deaths of close friends and family are all more common in our older years and are all contributors to anxiety.

Not only do we accrue more stressful life experiences as we age, but health concerns and the management of said concerns can also directly contribute to a feeling of panic and worry.

…..

So, what are the stats when it comes to older folks?

• 14–17 percent of those aged 65+ years currently have an anxiety disorder, while only one-third are being treated for it.


• The lifetime prevalence rate of having an anxiety disorder at some point is 31.1 percent, meaning about a third of older adults have or have had significant anxiety.


• Generalized Anxiety Disorder (GAD), or generalized worry or nervousness throughout different areas of life, is believed to be the most common anxiety disorder among older adults.

Specific anxiety disorders also have unique implications associated with older age.

Separation Anxiety: This is a debilitating fear concerning separation from home or important members of one’s life. Anyone who has raised a toddler can understand normal separation anxiety, yet it becomes pathological when it persists and interferes with daily tasks. Older individuals with this disorder may panic when left alone and fear that harm will come to children or spouses, who oftentimes are caregivers. There is strong evidence to suggest that this disorder occurs in greater numbers for older adults than it does in children.

Phobias: These are irrational fears that center around specific objects or situations, such as the fear of enclosed spaces (a.k.a., claustrophobia). For older adults, the phobias are more likely to center around fear of death, fear of disaster to family, and fear of dental procedures. Other phobic reactions can occur in response to fear of criticism connected to aging or fear that help will not be available when needed. Engaging with the phobic object or situation can even trigger a panic attack.

Post-Traumatic Stress Disorder: PTSD is defined by the lingering impact that a life-threatening event can have on an individual, including nightmares/flashbacks, avoidance/isolation, tense feelings around being overly vigilant of one’s surroundings, and negative moods. Life-threatening events can include motor vehicle accidents, sexual abuse, and experiences in active war zones.

Unique to older folks is the possibility for a phenomenon called “Late Onset Stress Symptomatology” (LOSS), which occurs when PTSD symptoms surface in later life, seemingly out of nowhere. What researchers have found is that individuals coped with life-threatening events in early adulthood through supportive marriages, throwing themselves into work, or (not recommended) prolonged alcohol abuse. When those coping strategies disappear, such as leaving work for retirement, the PTSD symptoms can no longer be held back and plague the individual.

Anxiety Disorders Due to Another Substance: This occurs when medications used to treat physiological conditions result in a side effect of anxiety. As we all age, our bodies also become less efficient at processing substances, meaning said substances can build up to unsafe levels. For example, the body is 33 percent slower at filtering out caffeine from the body in those aged 65 years and older compared to young adults, meaning the possibility of getting the caffeine jitters becomes very high. Medications commonly taken for medical concerns that can also induce anxiety include corticosteroids, thyroid medication, seizure drugs, asthma medication, and Levodopa for Parkinson’s Disease. The latter two medications are especially concerning clinically speaking, as individuals often reach for an inhaler when scared due to shortness of breath. Patients with Parkinson’s disease often advocate for higher and more frequent doses of Levodopa to control involuntary muscle movements, leading to a high possibility of taking too much and inducing anxiety.

Other Anxiety: Many other factors can contribute to problematic anxiety as we age. Anxiety is common among dementia patients who struggle to stay oriented. Hormone-related disorders, cardiovascular and respiratory disorders, and metabolism-related concerns can all contribute, as well. Combine this with disruptive changes, such as the need to enter into long-term care, and it begins to make sense that anxiety would be so common.

…..

That being said, I find myself wondering if it’s even fair to term these anxiety responses as “disorders.” In my view, anxiety can be a very realistic reaction to health changes and stressful circumstances at this stage of life.

Is it really paranoia if the CIA is listening to my phone calls?

Regardless of how one classifies it, a great deal can be accomplished to treat anxiety responses. Medications prescribed by a psychiatrist or psychiatric nurse practitioner who specializes in older populations can bring relief.

If that’s a hard pill to swallow, then talk therapy has been shown to be extremely effective. A skilled therapist can help bring initial relief in just a few sessions and lower symptoms to insignificant in 10–12 sessions. Psychologytoday.com is a great place to look within the United States, as it allows you to search for mental health providers who take your insurance.

What is clear to me from working with my clients is that aging comes with a great deal of resiliency and practice in coping with hardship. If anxiety is as common as the studies say, then I’m confident that it can be overcome.

A little bit of help never hurts.

…..

If you’re interested in exploring these ideas more, check out my first book available on Amazon: The Golden Rules of Retirement: A Psychologist’s Guide To Living Life to the Fullest, No Matter Your Financial Situation. Kindle and paperback editions are available now by going to the following link: https://www.amazon.com/Golden-Rules-Retirement

As well, check out my new book, The Golden Rules of Life Satisfaction: A Psychologist’s Guide to Living a Longer, More Satisfying Life No Matter Your Age!

And, stay tuned for details, including release date, upcoming sales, and future books in the Golden Rules series by visiting my website: lifecanbegolden.com/

-Lee Penn, PhD