In today’s final post on Overcoming Worry and Fear: Anxiety in Older Adults, I will discuss what leads to an anxiety disorder and some of the treatment options.

A number of things can contribute to an anxiety disorder:

• Extreme stress or trauma
• Bereavement and complicated or chronic grief
• Alcohol, caffeine, drugs (prescription, over-the-counter, and illegal)
• A family history of anxiety disorders
• Other medical or mental health illnesses or
• Neurodegenerative disorders (like Alzheimer’s or other dementias).

The stress and changes that sometimes go along with aging – poor health, memory problems, and losses, can cause an anxiety disorder.  Common fears about aging can lead to anxiety. Many older adults are afraid of falling, being unable to afford living expenses and medication, being victimized, being dependent on others, being left alone, and death.

Older adults and their families should be aware that health changes can also bring on anxiety. Anxiety disorders commonly occur along with other physical or mental illnesses, including alcohol or substance abuse, which may hide the symptoms or make them worse.

It’s also important to note that many older adults living with anxiety suffered an anxiety disorder (possibly undiagnosed and untreated when they were younger.

A stressful event, such as the death of a loved one, can cause a mild, brief anxiety, but anxiety that lasts at least six months can get worse if not treated.

Signs of an anxiety disorder include:

• Excessive worry or fear
• Refusing to do routine activities or being overly preoccupied with routine
• Avoiding social situations
• Overly concerned about safety
• Racing heart, shallow breathing, trembling, nausea, sweating
• Poor sleep
• Muscle tension, feeling weak and shaky
• Hoarding/collecting
• Depression
• Self-medication with alcohol or other central nervous system depressants

Treatment can involve medication, therapy, stress reduction, coping skills, and family or other social support.

A mental health care provider can determine what type of disorder or combination of disorders the patient has, and if any conditions, such as grief, depression, substance abuse, or dementia are present.

Those who have been treated before for an anxiety disorder should tell their provider about previous treatment.  If they received medication, they should indicate what was used, dosage, side effects, and whether the treatment was helpful.  IF the patient attended therapy sessions, he or she should describe the type, how many session they attended, and whether it was helpful.  Sometimes individuals must try several different treatments or combinations of treatments before they find the one that works best for them.

Medication will not cure anxiety disorders but will keep them under control while the person receives therapy. Medication must be prescribed by physicians. Often psychiatrists or geriatric psychiatrists, who can also offer therapy or work as a team with psychologists, social workers, or counselors who provide therapy.

The main medications used for anxiety disorders are antidepressants, anti-anxiety drugs, and beta-blockers, which control some of the physical symptoms.

Antidepressants:  Antidepressants are typically prescribed for most anxiety disorders. They work by altering the brain chemistry and symptoms usually start to fade after 4-6 weeks of treatment.

Anti-Anxiety Drugs: Anti-anxiety drugs, also called anxiolytics, are sometimes prescribed when a quick-acting and/or short-term medication is needed.

Beta-Blockers:  Beta-blockers can help relieve anxiety by preventing the physical symptoms that go along with certain anxiety disorders.

Therapy or psychotherapy involves talking with a trained mental health professional, such as a psychiatrist, social worker, or counselor, to discover what caused the anxiety disorder and how to deal with its symptoms.

Some of the other things a person can do to relieve anxiety include:

• Acknowledge worries and address any fears that can be handled
• Talk with a family, a friend or spiritual leader
• Adopt stress management techniques, meditation, prayer, and deep breathing from the lower abdomen
• Exercise
• Avoid things that can aggravate the symptoms of anxiety disorders:
• Caffeine (coffee, tea, soda, chocolate)
• Nicotine (smoking)
• Over-eating
• Over-the-counter cold medications
• Certain illegal drugs
• Certain herbal supplements
• Alcohol (while alcohol might initially help a person relax, it eventually interferes with sleep and overall wellness, and can even contribute to anxiety, depression, and dementia)
• Limit news of current events. It is important to stay current, but too much negative news can contribute to anxiety.
• Allow time for treatment to work

If you suspect an older adult you know might have a problem with anxiety, notice and ask about any changes in:

• Daily routines and activities. Is the person avoiding situations and activities he or she once enjoyed?
• Worries. Does he or she seem to worry excessively?
• Medication. Is he or she taking a new medication, either prescription or over-the-counter? Or has the dosage change for one of the medications?
  Is he or she drinking more alcoholic drinks than previously?
• Mood. Is the older adult tearful, lacking emotion, or “just doesn’t feel right.”

When talking to an older adult who has an anxiety problem:

• Be calm and reassuring
• Acknowledge their fears but do not play along with them
• Be supportive without supporting their anxiety
• Encourage them to engage in social activities
• Offer assistance in getting them help from a physician or mental health professional

In today’s post on Depression Later in Life, I will focus on the fact that depression is treatable.

Most depressed elderly people can improve dramatically from treatment. In fact, there are highly effective treatments for depression in late life.  Some treatment prescribed by physicians include:

• Psychotherapy
• Antidepressant medications
• Electroconvulsive therapy (ECT)

Antidepressants work by increasing the level of neurotransmitters in the brain.  Neurotransmitters are the brain’s “messengers.” Many feelings, including pain and pleasure, are a result of the neurotransmitters’ function.  When the supply of neurotransmitters is imbalanced, depression may resul.

A frequent reason some people do not respond to antidepressant treatment is because they do not take the medication properly.  Missing doses or taking more that the prescribed amount of the medication compromises the effect of the antidepressant.  Similarly, stopping the medication too soon often results in a relapse of depression.  In fact, most patients who stop taking their medication before four to six months after recovery will experience a relapse of depression.

Usually, antidepressant medication is taken for a least six months to a year.  Typically, it takes four to twelve weeks to begin seeing results from antidepressant medication.  If after this period of time the depression does not subside, the patient should consult his or her physician.  Antidepressant drugs are not habit-forming or addictive. And because depression is often a recurrent illness, it usually is necessary to stay on the medication for six months after recovery to prevent new episodes of depression.

Electroconvulsive therapy (ECT) is a treatment that unnecessarily evokes fear in many people.  In reality, ECT is one of the most safe, fast-acting and effective treatments for severe depression.  It can be life saving.  ECT often is the best choice for the person who has a life-threatening depression that is not responding to antidepressant medication or for the person who cannot tolerate the medication.

After a thorough evaluation, a physician will determine the treatment best suited for a person’s depression.  The treatment of depression demands patience and perseverance fore patient and the physician.  Sometimes several different treatments must be tried before full recovery.  Each person has individual biological and psychological characteristics that require individualized care.

In tomorrow’s final post on Depression Later in Life, I will discuss caring for the depressed person.

This week I am featuring a four  part series on Depression in Late. Depression is not a natural part of aging and not just a passing mood.

Sadness associated with normal grief or eveyday “blues” is different from depression.  A dad or grieving person can continue to carry on with regular activities.  The depressed person suffers from symptoms trhatinterfere with his or her ability to function normally for a prolonged period of time.

Recognizing depression in the elderly is not always easy.  It is often difficult for the depressed older adult to describe how he or she is feeling.  In addition, the currently population of older Americans came of age at a time when depression was not understood to be a biological disorder and mental illness.  Therefore, some elderly fear being labeled “crazy”, or worry that their illness will be seen as a character weakness.

The depressed person or their family members may think that a change in mood or behavior is simply “a passing mood”, and the person should just “snap out of it”.  But someone suffering from depression cannot just “get over it”.

Depression is a medical illness that must be diagnosed and treated by trained professionals.  Untreated, depression may last months or even years.

Untreated depression can:

• Lead to disability
• Worsen symptoms of other illnesses
• Lead to premature death
• Result in suicide

When it is properly diagnosed and treated, more than 80 percent of those suffering from depression recover and return to their normal lives.  The most common symptoms of late-life depression include:

• Persistent sadness (lasting two weeks or more)
• Feeling slowed down
• Excessive worries about finances and health problems
• Frequent tearfulness
• Feeling worthless or helpless
• Weight changes
• Pacing and fidgeting
• Difficulty sleeping
• Difficulty concentrating
• Physical symptoms such as pain or gastrointestinal problems

One important signe of depression is when people withdraw from their regular social activities. Rather than explaining their symptoms as a medical illness, often depressed persons will give different explanations such as “It’s too much trouble,” “I don’t feel well enough,” or “I don’t have the energy.”

For the same reasons, they often neglect their personal appearance, or may begin cooking and eating less.  Like many illnesses, there are varying levels and types of depression.  A person may not feel”sad” about anything, buy may exhibit symptoms such as difficulty sleeping, weight loss, or physical pain with no apparent explanation.  This person still may be clinically depressed. Those same symptoms also may be a sign of another problem – only a doctor can make the correct diagnosis.

Tomorrow, I will feature Part Two of this series on Depression in Late Life.

Alzheimer’s and Halloween have something in common- they are both scary! For an Alzheimer’s patient Halloween can be disruptive, increase anxiety and agitation as well as be very confusing.

Children constantly ringing the doorbell, strange decorations, confusing costumes and ghostly creaking sounds which contribute to the spirit of the holiday can frighten the patient . This doesn’t mean you can’t celebrate, but you might want to reevaluate the ritual to see it with Alzheimer’s eyes.

Here are some tips for a fun Halloween:

Prepare for the celebration by discussing your plans with the Alzheimer’s patient and describing the holiday dynamics like trick or treaters. For example, show your loved one a decoration and ask, “Do you like this decoration?” If he or she says, “This frightens me,” then respect this perception. Don’t try to talk him or her out of it. Most patients will be okay with pumpkins and cats; however, witches and ghosts might be unnerving.

• Keep furniture in its place. Consequently, your loved one will not become confused or even worse, bump into things and fall. Alzheimer’s affects balance and perception. Watch out for low-lying candles! It’s always easier to prevent than to treat.
• Avoid rigging up strange sounds like ghostly laughter or creaking doors because they bombard people with too much stimuli.
• Let neighbors know that candy will be placed outside the door, (the honor system), so that children will not keep ringing the doorbell and frightening your loved one. Or put up a note on the door with instructions for trick or treaters. However, if your loved one is adequately prepared and looks forward to the children at your doorstep by all means let them come in and strut their stuff!
• Know your loved one’s dietary restrictions, especially if he or she is diabetic. If you keep Halloween candy in a nearby bowl, you might be surprised that much of it will be missing. Those candy corns can give anyone a sugar rush! Instead place some healthy, colorful treats like cut-up apples with cinnamon or berry/yogurt parfaits. Bake your own pumpkin pie using wholesome ingredients as you follow a lighter recipe.

Halloween can be tweaked and personalized to communicate a meaningful updated ritual. Both you and your loved one will enjoy the current anticipation as you tap into a positive memory of past celebrations. Make decorations together to maximize the occasion. Art therapy provides positive stimulation and creative self-expression. And while you are coloring and pasting, play music in the background, preferably from your loved one’s time period, for happiness synergy.

Thanks to Debbie Mandel for this great article!

I found this story on PBS today and wanted to share it.  Susan Dentzer reports on early onset Alzheimer’s, a degenerative brain disease, and how a forum organized by those suffering from the diagnosis has proven an effective means of coping.
JIM LEHRER: Finally tonight, dealing with Alzheimer’s disease at an earlier age. Susan Dentzer reports for our Health Unit, a partnership with the Robert Wood Johnson Foundation.

RICHARD BOZANICH: This is just really rough.

SUSAN DENTZER, NewsHour Health Correspondent: Richard Bozanich and Jay Smith spent months planning and preparing. On the big day here in Los Angeles, Bill Bridgwater flew in from Colorado. James Smith and his wife, Juanita, came from Minnesota. And Carol Kirsch and her hud, Howard, drove in from ther aging baby boomers present, you might have thought this gathering was about prepring for retirement, launching a second career,acation home. But iasn’t.

FORUM SPEAKER: This is the largest gathering of people with dementia in one room in our country.

SUSAN DENTZER: In fact, what was billed as the Early Memory Loss Forum was one of the nation’s first-ever gatherings of baby boomers with early-onset Alzheimer’s disease, organized and led by these Alzheimer’s sufferers themselves.

Bozanich, who’s 49, welcomed the crowd on behalf of himself and co-organizer, Jay Smith.

RICHARD BOZANICH: Our motto has always been that this day was by and for persons with early memory loss. So for those of you who are traveling the same road as the two of us, this day is for you.

SUSAN DENTZER: It isn’t known how many Americans have the early-onset form of Alzheimer’s, but estimates range anywhere from 250,000 to 500,000. The cause isn’t fully understood, either, although several genetic mutations are implicated in some cases.

Meanwhile, it’s estimated that 5.1 million Americans now suffer from all forms of the disease, including the type that typically hits people 65 and older. With the population aging, the number of sufferers with all forms of Alzheimer’s could more than triple over the next 40 years.

We wanted to know more about what it’s like to be struck by Alzheimer’s in the prime of life, so we sat down for a conversation with this group, all suffering from early-onset Alzheimer’s. All have worked with the National Alzheimer’s Association and are among the nation’s most vocal spokespersons for the urgency of fighting the disease.

This diagnosis came along when you all were at the peak of your careers and the peak of your capabilities.

BILL BRIDGWATER: Prior to the onset of my Alzheimer’s at age 48, I was an information technology executive, and I had held senior-level positions at numerous multibillion-dollar companies.

RICHARD BOZANICH: I was managing editor of Daily Variety, which is an entertainment trade publication.

JAMES SMITH: I was an information technology director for a Fortune 100 company, a global company. I referred to it as our charmed little life, because everything just seemed to be firing on all cylinders.

Developing strange symptoms

SUSAN DENTZER: Each described how these seemingly charmed lives were suddenly interrupted by a bizarre range of symptoms, as Alzheimer’s, a degenerative brain disease, progressively killed neurons in different parts of the brain.As they lunched at the conference, they recalled how they’d sometimes exhibit the classic signs of memory loss, but often the symptoms were altogether different. Work colleagues were among the first to notice.

JAMES SMITH: People would ask me, they would say, “Well, why weren’t you at the meeting?” And I said, “Well, there was no meeting that I’m aware of.” And they said, “Well, you called the meeting. You should be aware of it.”

BILL BRIDGWATER: One of the things that was just driving me to distraction was insomnia. I could not sleep at night. I would get up and do 50 push-ups, 50 sit-ups, 50 leg kicks with each leg, and do everything I could to just drain myself. I laugh and tell people that I didn’t get much sleep, but I was in the best shape of my life.

CHUCK JACKSON: My arm would be sitting here and suddenly it would just shoot up and hit me in the head almost. And my legs would kick.

RICHARD BOZANICH: I was just bumping into walls and bumping into partitions. And, you know, you see a wall in front of you, and the obvious thing is to either go left or right, and I would just walk straight into the wall as if it weren’t there.

Conflicting diagnoses

SUSAN DENTZER: The group told us about dozens of visits to doctors who handed out conflicting diagnoses. Jay Smith, a successful architect who is not related to James Smith, had helped design courts and other facilities for California’s justice system.JAY SMITH, Alzheimer’s Sufferer: I thought I had a brain tumor, so I went to the neurologist, and I didn’t have a brain tumor. He said he thought I had a benign condition called migraine that doesn’t always cause headaches.

JAMES SMITH: For me, the initial diagnosis was depression. Then they shifted over and thought, well, maybe it’s a movement disorder, like MS or something like that. And for a while, they were thinking it might be Huntington’s disease.

SUSAN DENTZER: Most of the group told us the correct diagnosis was only arrived at when they finally got a battery of neuropsychological tests and a PET scan of the brain.

But for Chuck Jackson, who most recently worked as a counselor to laid-off workers, the diagnosis was far easier.

CHUCK JACKSON: We’re one of those groups of families that have the highest rate or incidence of Alzheimer’s in their family. I watched my mother go through it when I was — I was 13 at the time. And when she died at the age of 50, I knew what was coming.

SUSAN DENTZER: In fact, out of his mother’s family of 14 children, 12 died of the disease, thanks to inherited mutation in a gene called PSEN2. Now Jackson and his older brother both have Alzheimer’s.

The group members told us that getting the diagnosis prompted a range of reactions.

JAY SMITH: It came as a shock, because I hadn’t thought about Alzheimer’s or memory loss up to that point, and relief to have an answer, “I can now focus on my life knowing what’s wrong.”

CAROL KIRSCH, Alzheimer’s Sufferer: I just refused to believe it. I just said, “No, this can’t be.” I knew enough about it that I was scared. I was scared.

SUSAN DENTZER: James Smith and his wife, Juanita, spoke at the conference about how they reacted after getting the diagnosis.

JAMES SMITH: We would just lay in bed together, and hold each other, and cry, and really not know — it felt like you were in a maze and all the doors just suddenly slammed shut. And there’s just no path that takes you anywhere. I remember it as being one of the — probably one of the darkest periods of our entire life.

I just read this incredible letter written by an Alzheimer’s patient to his family. It simply says it all.

Don’t wait until a crisis occurs!  For over 12 years ElderCare at Home has helped hundreds of families not only create a strong ElderCare Plan, but also stop a crisis from occurring in the first place!

You have a crisis? Do you have a plan in place?  Who will care for your loved one that suffers from Alzheimer’s disease or dementia?   If something happens to you tomorrow, what will happen to your loved one?

ElderCare at Home will help you create a plan that will identify the needs and issues involved in caring for your loved one, and will provide you with the information, resources, and direction needed to enhance their quality of life and yours!

JOIN us for a FREE webinar this Wednesday July 27th from 3-4pm , Alzheimer’s Disease & Crisis Prevention, presented by Elayne Forgie, CMC, will teach you different ways you can prevent a crisis from occurring in the first place.

This webinar is a must if you are a family caregiver, paid caregiver or a friend. To register for the webinar click here! 

July 13th, 2011 from 3:00p-4:00p

Register Today and mark your calendars. We have a lot of beneficial information to share with you. To Learn More about this Free webinar watch this short video with the host of the webinar Elayne Forgie.

Caring for someone who has Alzheimer’s disease can be overwhelming. This webinar will teach you how to recognize the signs of stress and depression; how to cope with these emotions and how to overcome the negative feelings. This webinar is a must if you are a family caregiver, paid caregiver or a friend to someone with Alzheimer’s disease.

To register for the free webinar, simply  follow the link below

Register Now!

https://www3.gotomeeting.com/register/307946662

Before you consider massaging peoplee with Alzheimer’s disease, you first have to learn enough about the disease to develop an understanding of the emotional problems you will face.

The best source of information is the relatively recent second edition of the Merck Manual of Geriatrics. It is written for physicians, mostly likely internists and general practitioners, some from foreign countries, in an effort to help those colleagues to somehow alleviate the tremendous nationwide dearth of geriatricians by presenting them with this fabulous textbook. I believe this is what makes the book so thorough, so lucid and so understandable, even for us lay-people.

This manual is a godsend for those of us fascinated by the tremendous variances you find among age cohorts, because it is true that there are typical 20-year-olds, but no typical 75-year-olds. Members of the latter group go all the way from mountaineer and long distance runner, to writer and piano virtuoso, to the helpless wheelchair occupant stuck in the hall of a nursing home. To read more, click here!