Dementia

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

Elayne Forgie has been a professional geriatric care manager for over 20 years and was a founding Board Member of the Florida Geriatric Care Managers Association. She is the President/CEO of ElderCare at Home, Inc. and The Alzheimer's Care Resource Center. Information on this website or contained in this article is not intended to replace the medical advice of your doctor or health care provider.