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Symptoms | Worried Seniors: The Stress of Elder . . .
Worried Seniors: The Stress of Elderly Anxiety
Aunt Audrey was always a worried woman. As she aged, her anxiety completely overtook her. She was famous in the family for her exclamation, in the midst of a huge family reunion, "I'm so worried! Things have been going so well...I just know something awful is going to happen!" At least she was there. As her anxiety worsened, she never attended another.
Anxiety is something everyone experiences from time to time. For most people, their anxiety is related to something concrete and passes when the event is past. When there is no apparent reason for "nervousness," and it becomes chronic, it is particularly hard for both the anxious person and those around her to live with.
Anxiety in the elderly is demonstrated by a variety of symptoms. We all know an older person who has an attack of "nerves" at the drop of every hat. Some hyper-anxious people experience tremors, blurred vision, diarrhea, shortness of breath, and even chest pain. "Not feeling well" and staying in bed to avoid an anxiety provoking event is common.
While psychiatric experts break anxiety disorders into several sub-groups (generalized anxiety disorder, post-traumatic stress disorder, obsessive-compulsive disorder, etc. etc.) most of our elders are not receiving the kind of psychiatric help which might differentiate. They are more likely to be seen by their internal medicine physician and possibly several other medical specialists. Primary care doctors are most likely to diagnose "generalized anxiety disorder," if they make a diagnosis at all.
People with generalized anxiety disorder(GAD) live each day consumed with heightened worry, even when there doesn't seem to be anything obvious to worry about. At times, just the thought of having to get out of bed to face another anxious day creates more anxiety. They worry about everything from family to finances to running out of toilet paper. They find it difficult, if not impossible, to make decisions.
"A person with generalized anxiety disorder spends, on average, about 40 hours a week worrying, so it's almost like having a full-time job," says Eric J. Lenze, M.D., a geriatric psychiatrist at Washington University School of Medicine in St. Louis. "They worry about very real things, but the inability to put those worries out of their minds makes the condition disabling."
If left untreated, generalized anxiety disorder may lead to depression and a serious decline in quality of life for an affected senior. It can also seriously affect the lives of immediate family members and other caregivers.
Until recently, older people with anxiety disorders were treated primarily with sedative drugs. Sedatives, of course, are "depressants." While sedatives may have camouflaged the symptoms of anxiety, they also caused other serious problems, including increased falls, confusion and memory loss.
Most seniors still equate psychiatry with "being crazy." They tend to be very resistant to seeking psychiatric treatment for anxiety. Primary care doctors are generally comfortable with trying a serotonin reuptake inhibitor, better known as an antidepressant. More than half of the patients treated for anxiety with an antidepressant found their anxiety "much improved" after 12 weeks of daily use, so it's definitely worth a trial.
If you can get your anxious elder to give cognitive behavioral therapy a try, it can also be very effective for seniors who don't also have dementia. The rub is getting an anxious senior to accept the need for therapy and then to get them out of the house to try it. Neither will be easy.
As a family member/caregiver, what else can you do for an over-anxious senior?
For the sake of everyone's mental health...
• Make sure the doctor knows how badly anxiety is affecting your elder and ask for help;
• To the best of your ability, reward your elder with praise when she accomplishes something that was difficult and anxiety-provoking. Do your best to ignore anxious behavior.
• Anxious people are often overwhelmed by choices. Practice offering a selection of only two options whenever you can. This tip applies to such mundane things as what to have for lunch, or whether to choose assisted living facility A or B. You do the narrowing down before offering options.
• Avoid telling your anxious senior about potentially stressful appointments, such as medical/dental appointments or meetings with attorneys, until just before it is time to go. The less time available to ruminate about all the awful things that might happen, the better. If you don't live with your elder, simply arrive early enough to get them dressed and in the car with as little dialogue as possible.
• Accept that a hyper-anxious senior will often not follow through on promises to do something. If something is important and your elder is dithering, it is often easier to simply do it yourself, or hire it done. Maddening? Yes. More efficient and less stressful in the long run? Also yes. Make sure that your anxious senior pays for any services you have to bring in.
• Use your caller ID and voicemail to screen obsessive calls. Let your elder know that you will return her calls at a specific time each day (or each week, or whatever works for you). You can always listen to make sure there's no real emergency.
Knowing when to accept overanxious behavior and when to push for independence can be a real challenge. You will often have to use trial and error and your own common sense to differentiate between real emergencies and anxiety symptoms.