Anxiety in Older Adults: Signs, Treatments, & Ways to Cope

Seniors frequently experience anxiety. Symptoms can include excessive worrying and fears regarding real or imagined health problems or events. Anxiety may affect 10-20% of older adults, although it often goes undiagnosed.¹ Therapy offers information to understand the causes of anxiety and can help in developing coping skills, with a goal of alleviating symptoms. Medication can also help reduce symptom severity.

Signs of Anxiety in Older Adults

Older adults may not be aware of their anxiety due to memory or cognitive impairments. Seniors  mask symptoms out of fear others will intervene in ways they don’t want. Other reasons their anxiety may not be apparent may include the loss of friends or family, a decrease in mobility, and more isolation.²

These scenarios make it more imperative to be aware of common signs of anxiety:³

• Increased self medication with alcohol or medication
• Irrational thoughts like  “I am going crazy” or “I know I am going to die”
• Restlessness
• Irritability
• Memory deficits
• Obsessive thoughts
• Headaches/stomach aches
• Muscle tightness
• Irrational and excessive worry or fear
• Checking and rechecking for safety
• Avoiding routine activities
• Avoiding social situations
• Racing heart
• Shallow breathing, trembling, nausea, sweating

Anxiety Often Goes Undiagnosed in Seniors

Diagnosing anxiety in seniors is challenging because other medical problems and complications from medication can mask or exacerbate their symptoms. Researchers describe the gap in diagnosing anxiety with older adults, stating that many anxious older adults are reluctant to seek treatment.⁴ They also advise senior anxiety disorders “impair function and quality of life and may increase risk for other serious medical problems such as depression, dementia (or psuedodementia), and heart disease.”⁴

Types of Anxiety Older Adults May Experience

The Institute on Aging reported that for seniors, “while anxiety doesn’t necessarily have a specific trigger, it often arises from or is exacerbated by specific environmental and situational factors.”⁶

These are the types of anxiety most frequently experienced by older adults:

1. Generalized Anxiety Disorder (GAD): The most common anxiety disorder, GAD is ongoing, exaggerated worry about life events or activities. It can happen after an acute illness or fall, or alternatively without any obvious trigger. These episodes can last for six months or longer.
2. Panic Disorder: Older adults can have repeated episodes of terror that last several minutes or more. They may fear medical problems like heart attacks or strokes even when they have not occurred. Symptoms include chest pain, dizziness, or weakness reinforcing irrational fears.
3. Post Traumatic Stress Disorder (PTSD): Many seniors have experienced traumatic events causing physical and emotional harm. Examples include military service, abuse or violence, falls, loss of loved ones. Flashbacks and nightmares can occur. Seniors may also go to great lengths to avoid reminders of their trauma. Other people with PTSD may be agitated, edgy or easy to startle.
4. Social Anxiety Disorder: Seniors may be self conscious of how they look to others because of  medical problems or if they need assistance in public settings. They may be embarrassed to be around others. This causes anxiety and sometimes refusal to be in social settings.

Do Many Older Adults Experience Anxiety and Depression Together?

A diagnosis of anxiety frequently comes in conjunction with another mental health diagnosis in older adults, like depression. Both these diagnoses can harm seniors’ ability to function. It also can negatively impact their quality of life. Experts at the Anxiety and Depression Association of America say that anxiety disorders in seniors are often correlated with a traumatic event, like a fall or an acute illness.²

The Geriatric Mental Health Foundation confirms, “for older adults, depression often goes along with anxiety, and both can be debilitating, reducing overall health and quality of life.”¹ There can be an overlap in symptoms that occur with depression and anxiety, complicating the diagnostic process. Similar symptoms that overlap include poor sleep, avoiding social situations, and excessive self medication. When anxiety and depression occur together, symptoms associated with them can become more severe.

What Are the Consequences of Untreated Anxiety in Older Adults?

Research has demonstrated that if anxiety in the elderly is left untreated, the consequences can be serious. Studies found that chronic anxiety can cause great harm to the physical and mental health of older adults. It can potentially lead to cancer, heart disease, and dementia.⁴ Untreated anxiety may also lead to greater stress and diminished cognitive capacity.

Family members are directly impacted if anxiety in seniors is not addressed. An older adult’s increased anxiety can spill onto caregivers and family, creating additional challenges. The potential for new medical problems evolving from untreated anxiety can cause seniors to be more incapacitated and dependent, increasing care needs. Additional isolation makes it harder to monitor senior well being. This means greater financial costs, time demands, and necessary additional caregiving support.

When to Seek Help for Senior Anxiety

Seniors need help when the degree and frequency of anxiety, stress, and tension creates isolation, medical problems, or excessive fear. This creates an inability to engage in daily life activities and socialization. The onset of these symptoms and the resulting limitations signals that outside professional medical consultation is warranted.

Transitions can be triggering for seniors, resulting in heightened anxiety. Examples are moving to a new place, removal of a familiar support system, or the onset of a new medical condition. If there is a change in environment, additional support is appropriate. It’s helpful to monitor an older adult in these circumstances to ensure there is no decline in their cognition, behavior, or ability to function.

Treatment of Anxiety in Older Adults

If you’re aware of increased anxiety in an elder loved one, contact their doctor as soon as possible and have a geriatric evaluation. Confirm that anxiety is present and what other mental health or medical conditions might be occurring as well. There are different effective treatment options to help older adults manage anxiety. Counseling and medications are important tools in the management of anxiety. If there is severe dementia or cognitive impairment, counseling therapies may not be as effective.

Therapy

Psychotherapy may be the best initial treatment option because seniors are at higher risk to have side effects from medications. A research study found that 46% of older patients with anxiety (including generalized anxiety disorder, but not restricted to this diagnosis) experienced a relief of symptoms with Cognitive Behavioral Therapy, compared with 14% of controls.⁷ There has also been successful reduction of symptoms using only psychotherapy, or psychotherapy with a lower dose of medication.

The preferred therapy methods used to treat anxious seniors includes:

1. Cognitive Behavioral Therapy (CBT): A short-term therapy to help people change negative patterns of thinking and feeling.
2. Problem Solving Therapy: Helps patients use new techniques to solve problems from stressors to help enhance the quality of their life.
3. Reminiscence Therapy: Talk therapy to help people remember times from their past that offer positive, pleasant memories.
4. Desensitization Therapy: This treatment is to help patients identify situations that trigger anxiety. It helps them face these situations in a safe environment using learned skills of anxiety reduction and management.

Intended Treatment Outcome and Timeline

All these psychotherapies are short-term, meaning eight to twelve sessions. Counselors offer support, adaptive techniques, and insights about the causes of anxiety. Anxiety treatment offers a combination of coping and relaxation skills. Therapy helps patients recognize anxiety symptoms and teaches them how to manage them before they escalate.

All these treatment methods share similar goals. While all of these therapy techniques include verbal aspects, they also typically include education and support through helping someone develop tools to manage their anxiety. These may include progressive muscle relaxation, tools for sleeping better, and deep breathing.⁸

Lifestyle Changes

Adjusting environments and lifestyle are powerful treatment tools in working with the elderly. Examples include regular exercise, getting enough sleep, eating well, and also socialization. Gerontological researchers describe the benefits of these interventions: “These activities provide some stimulation and interaction with the environment, give a sense of control and reduce overall anxiety.”⁹

Medications

Medications may not be the first treatment used with seniors. Most older adults take multiple medications, and there are concerns about how the medications may interact. Anxiety medications can have more significant side effects with an elderly population. Because of these concerns, it is recommended that anti anxiety medications be prescribed by your primary care medical doctor or physicians with geriatric expertise. Primary care physicians will have the most complete information regarding medical history and current medications. If a psychiatrist is recommended, share the patient ‘s medical history, current medications and dosage, so the psychiatrist has a good understanding of patient history.

One of the most frequently used anti-anxiety medications is buspirone (Buspar). It is recommended for older adults for treating anxiety as it also has fewer side effects. Buspar is less likely to negatively interact with other medications.

Does Medicare Cover Anxiety Treatment?

Medicare Part A or hospital insurance covers the costs for inpatient mental health treatment in a psychiatric or general services hospital. This includes nursing care, medication, lab work, therapy, and other therapy for treatment.

Medicare Part B is for outpatient services. There is coverage for mental health diagnoses like anxiety. Patients must be seen by a properly licensed and certified mental health practitioner. Talk to your mental health practitioner about fees, because Medicare reimbursement may not cover everything. Medicare coverage includes ten mental health sessions annually. The National Council on Aging sponsors a website giving information regarding Medicare coverage.

How to Get Help for Anxiety in Older Adults

If anxiety appears to be present in older adults the first step is to see their physician. The doctor will identify any medical conditions that may be causing anxiety symptoms. You can get a referral for a gerontologist, a doctor with expertise working with the elderly. Referrals can come from doctors, friends, or other family members. Local Area Aging offices or hospitals may also have referral information for finding geriatric physicians. You can go to the Geriatric Mental Health Foundation to help you find a psychiatrist.

It is good to have someone who has frequently observed the patient attend these appointments. This ensures the doctor has accurate information for the assessment. Seniors are not always straightforward when they self-report, sometimes because of cognitive or memory deficits or denial regarding their level of functioning.

How to Get Help for a Loved One

If a senior loved one is experiencing anxiety they are feeling helpless and afraid. They need  reassurance that help is available and they are not alone. Recognize that your older loved one’s fears and anxiety are very real to them, and try to accept rather than challenge or minimize them. If it appears counseling is necessary, an online directory can be a great place to start to find a therapist who specializes in older adult mental health.

Reasons for a loved one’s anxiety need to be identified if possible so that appropriate steps can be taken. For example, if there are fears about a medical condition, connecting a loved one with a doctor will help diminish anxiety. If they are worried about what is going on in the world, reducing their time watching TV or listening to the radio can alleviate their anxiety. These simple acts can reduce additional caregiving needs for loved ones.
Untreated anxiety may cause additional stress for loved ones. If it is possible to have friends or  family spend more time with seniors, do it to reduce their time alone. Respite time is very critical to the wellbeing of family members. Look into local senior or adult day programs that might provide socialization opportunities. If the senior is reluctant or unable to leave home, there are  home companion programs.

When you’re uncertain about what to do or what programs are available, consult a geriatric care manager—a licensed clinician with expertise in working with the elderly. They can offer assessments and advice about available elder care options. They also can connect older adults with local resources and support family members.

Talking to an Older Adult About Their Mental Health

When talking to an older loved one about their anxiety and other related mental health problems, remember to stay calm and collaborative. Show your concern, but be sure not to judge them when they share their fears or concerns.

When approaching an older loved one about their mental health, there are key concepts to remember:

• Think of it as a collaboration rather than a confrontation
• Let them know you love them and are concerned about their health
• Help them understand what they are experiencing is not unusual and they are not alone
• Do not judge what they say even if you disagree with it
• Ask them about their biggest fears and wishes regarding their future
• Offer assurance that you want to do what you can to help them maintain as healthy, safe, and independent a lifestyle as possible

There are several questions you can raise to understand how realistic older adults are regarding their abilities and where they may be struggling:

• What specific things do they believe they need help with?
• If they express concerns, ask how you can help them make their environment feel more safe?
• How do they perceive they are doing mentally, emotionally and physically?
• Do they have any anxiety regarding their mental and physical well being?
• Would they be open to getting medical or mental health professional help for their anxiety?
• Is there someone they would want to work with?
• If not can they identify someone they trust to make a referral?

9 Ways to Help an Older Adult Reduce Anxiety

There are many things that can be done for seniors to help reduce their anxiety. You don’t need to be a mental health professional to do them, but many of these tips are great strategies to implement alongside professional treatment.

Here are nine recommendations to help reduce anxiety in an older adult:

1. Remain Connected to Your Loved One

Isolation can be intertwined with anxiety. If possible, spend more time with them. If you cannot do this, arrange for companionship through a relative, friend, neighbor, or a home care program. Check out local senior or adult day programs. Use technology like Facetime or Zoom or the telephone to maintain contact if face to face visitation is not possible. Reinforce the message that they are not alone.

2. Encourage Them to Make Healthy Lifestyle Changes to Reduce Their Anxiety

Reinforce maintaining a healthy diet and low impact exercise. If you can, participate with them. Try fun things for exercise like taking a walk or playing music or dancing. Teach them (or learn together!) deep breathing, yoga, or meditation exercises to manage anxiety.

3. Actively Listen to Them Sharing Their Fears & Concerns

Do this without judgement. Don’t minimize their feelings. Let them know it’s normal to have anxiety and that you understand. Reinforce the idea that you want to do what you can to help them cope with these fears so they can feel better.

4. Help Them Connect With Professionals

If anxiety continues to diminish their health and functionality, you can intercede with information regarding healthcare providers. Offer to connect them with healthcare professionals that can address their fears and anxiety. If possible, attend the appointments with them.

5. Take Note of When the Anxiety Is the Worst

For example, some seniors have Sundowners Syndrome, where they get more confused and anxious at night. Be cognizant of this and have a plan in place so extra support is available at times of higher anxiety.

6. Encourage Distance Between Your Loved One & the Source of Anxiety

For example, if they are getting anxious about events in the news, advise them to stop listening to the news. If a person they know does or says things to reinforce their anxiety try to limit their time together.

7. Utilize Fun Distractions

Distraction is a great tool to combat anxiety. Recommend a fun project they can do or you can do together. Putting photographs in albums, sewing, reading books, doing puzzles, or making a musical playlist are ideas. Try to engage in activities you know they enjoy and that highlight their skills. This can strengthen your relationship and their self esteem.

8. Identify Sources of Anxiety

Consider what you can do to help. For example, if paying bills and finances create anxiety, offer to help. Go through the mail together, help create a budget.

9. Educate Yourself About Anxiety

What causes it, how do people display symptoms, what are the best treatment options. Share what you have learned with your loved one.

Senior Anxiety Statistics

This statistical information sheds more light on anxiety and its relationship with older adults.

Here are some significant statistics regarding anxiety in older adults:

• The commonest anxiety disorder seen in clinical practice is Generalized Anxiety Disorder (GAD), (7.3%), followed by phobias (3.1%), panic disorder (1%) and Obsessive Compulsive Disorder (0.6%)⁹
• Generalized Anxiety Disorder seldom occurs alone. Up to 90% of patients with this disorder also have symptoms of another mental health problem such as depression, dysthymia, bipolar disorder, or substance abuse.⁷
• Over their lifetimes, about 15% of those who survive past the age of 65 will have an anxiety disorder.⁸
• Anxiety, like depression, is among the most prevalent, mental health problems among older adults with almost half of older adults who are diagnosed with a major depression also meet the criteria for anxiety.¹⁰
• Hispanic adults age 50 or older were slightly more likely to report a lifetime diagnosis of an anxiety disorder compared to white, non Hispanic, black, non Hispanic, or other, Non Hispanic adults (14.5% compared to 12.6%, 11%, and 14.2% respectively)¹
• 10-20% of the older population have anxiety, though it is often undiagnosed. Phobia—when an individual is fearful of certain things, places, or events—is the most typical type of anxiety.¹

Tests, Quizzes, & Self-Assessment Tools for Anxiety in Seniors

There are numerous assessment tools available to determine if an anxiety diagnosis is present in a senior. All assessments should be reviewed by a trained healthcare professional to accurately interpret results.

These assessment tools fall into three categories:

1. Self Rated: The patient fills this assessment tool out. It is self reported.
2. Observer Rated: People who have observed the patient complete these assessments.
3. Assessment scales or tests administered by trained interviewers who are Mental Health Professionals.

The test most frequently used to assess anxiety in older adults is the Geriatric Anxiety Inventory. It has 20 Agree/Disagree items to assess the most frequent anxiety symptoms. The measurements of symptoms with this inventory are limited in order to minimize confusion between symptoms common to anxiety and general medical conditions.¹¹

Other tests and assessment tools that are often used include:

• Generalized Anxiety Diagnosis Questionnaire for DSM IV(GADQ-IV): a self report test.
• Penn State Worry Questionnaire (PSWQ): The most widely-used self report measurement tool. It has 16 questions measuring state of worry rating from 1-5 with 5 being “very typical of me.”
• Patient Health Questionnaire with GAD screening questions: 3 page primary care evaluation tool for people with mental health disorders. It is self administered by the patient and looks at Depression as well as anxiety.
• Generalized Anxiety Disorder Severity Scale (GADSS): This is given in an interview with a healthcare professional. It assesses the severity of generalized anxiety disorder.
• Beck Anxiety Inventory (BAI): A 21 item inventory that assesses levels of anxiety in patients. It can be administered by a trained healthcare professional or self reported.
• Overall Anxiety Severity and Impairment Scale (OASIS): A 5 question self report scale assessing severity and level of impairment from anxiety. Responses range from 0 (not at all) to 4 (constant anxiety)

Additional Resources for Anxiety in Older Adults

If you or an older loved one are dealing with anxiety, these resources may be helpful:

1. National Alliance for Mental Illness (NAMI): Provides Support for patients, family members, and caregivers. Also does, education, and provides resources. 1-800-950-6264.
2. Anxiety and Depression Association of America: Provides online support, education, resources.
3. Anxiety Support Groups: This site offers multiple peer support groups to help with issues around anxiety.