Panic Attacks in the Elderly: Causes, Getting Help, & 8 Ways to Cope

Signs of Panic Attacks in Seniors

A panic attack must include at least four of the following symptoms: accelerated heart rate, shortness of breath, chest pain, choking sensations, hot and cold flashes, sweating, trembling, nausea, depersonalization, fear of dying, going crazy, or losing control.¹ Sometimes they can be triggered, or they may just occur without an identifiable cause.

Many of these symptoms are associated with medical conditions that come with aging, like heart problems, respiratory illnesses, and menopause. There is heightened awareness of mortality as people grow older. Seniors may have greater anxiety regarding loneliness or having perceived life-threatening medical problems. The earlier a panic attack is identified, the better the treatment outcome. The more often panic attacks occur, the greater the fear of more panic attacks, creating an unhealthy cycle. This unhealthy pattern can develop into a panic disorder.

Panic attacks are closely aligned with fears of known or unknown origin. Panic attacks often feel like they last a long time, but in reality, they usually last from a few minutes to 20 minutes. They can happen during the day or may occur as nocturnal panic attacks. Panic attacks while driving can create a frightening scenario, as well as during other situations when people feel vulnerable. Feelings of vulnerability also tend to increase with age. Management can become challenging as more medical, emotional, or cognitive issues develop.

Symptoms of Panic Attacks in the Elderly

It can be difficult to discriminate between medical conditions and panic attacks in the elderly. For example, seniors have a higher possibility of experiencing balance issues or shortness of breath. Researchers explain that seniors “may present with panic symptoms, such as shortness of breath, dizziness, or trembling, that overlap with age-related medical conditions.²

Seniors who experience panic attacks may benefit from medications to help stabilize their symptoms. Buspirone is the most effective medication for seniors. Medication management is more complicated with seniors, not only due to their slower metabolism but also because people with cognitive issues may not be able to take medications as directed. The elderly may be more sensitive to medication side effects and finding the right dosage can be challenging because of existing medical issues. Older patients find it more difficult to achieve a therapeutic dosage over a long duration of time.

Some symptoms of a panic attack that might be more prevalent in the elderly include:

• Chest pain: This could be a dull ache or a sharp persistent pain. It can include tightness in the chest area and may feel like a heart attack.
• Shortness of breath: A person may be unable to catch their breath or feel out of breath doing limited physical activity. It can also include a tightness in the chest area.
• Dizziness: A person feels faint, has trouble maintaining balance, and feels weakness in their legs.
• Racing heart: A person feels like their heart is beating extremely fast.
• Nausea: When the body is under extreme stress, adrenaline floods the digestive system causing disruption in enzymes, which can result in nausea.
• Terror: Panic attacks can feel terrifying. When symptoms like chest pain or dizziness occur, terror and anxiety increase.
• Sweating profusely: Anxiety activates sweat glands, leading to excessive sweating.

Causes of Panic Attacks in the Elderly

Experts on anxiety with seniors report “Ten to 20 percent of older patients experience clinically important symptoms of anxiety.” ³ Anxiety in seniors can be influenced by environmental factors. Reduced vision, hearing, and cognition can be complicating factors that elevate anxiety, can cause disorientation, and lead to panic attacks.

Life event factors that coexist with aging can contribute to panic attacks including:

• Reduced financial resources
• Grief from the loss of loved ones
• Change of environment, like moving to assisted living or a nursing home
• Reduction or loss of mobility
• Loss of independence
• Failing health
• Increased isolation
• Fears of becoming a burden to loved ones
• A pre-existing history of anxiety or panic attacks

Risk Factors for Panic Attacks in the Elderly

In a large study done with post-menopausal women ages 50-79, researchers concluded panic attacks were “relatively common” and “seem to be associated with stressful life events, medical co-morbidity, and functional impairment.” ⁴ These risk factors outlined in the study could apply to aging men and women. Co-morbidity means having two diseases at the same time.

As people age, it is more common for people to be diagnosed with conditions like chronic obstructive pulmonary disease (COPD), diabetes, depression, and high blood pressure. Getting regular checkups with your physician who can prescribe treatments can help in stopping the progression of these illnesses. It can also help determine the difference between a medical problem and a panic attack.

Another diagnosis that can come with aging is dementia such as Alzheimer’s disease. These diagnoses include symptoms of cognitive and memory decline. They can create fear, uncertainty, and anxiety that can turn into panic attacks. If seniors have limited support networks and no additional resources, symptoms can evolve into more serious problems that could heighten the risk of panic attacks.

Health Concerns for Seniors Experiencing Panic Attacks

Experts on panic attacks with the elderly have concluded there is a relationship between existing medical problems and heightened incidences of anxiety. They report “higher rates of anxiety disorders among older adults who experience a variety of physical health conditions.” ⁵

Panic attacks do not cause heart attacks regardless of age and you cannot die from a panic attack. Heart attacks are caused by blockage of blood vessels leading to the heart. Panic attacks can cause extreme discomfort and fear of dying. Ongoing stress and perpetual anxiety left untreated can negatively impact quality of life and can shorten life expectancy. High stress releases a hormone called cortisol. The release of too much cortisol can negatively affect the immune system and can contribute to high blood pressure and cardiovascular diseases.

Depression is a commonly occurring mood disorder in the elderly. It is often closely linked to anxiety and panic attacks. Researchers describe shared psychological and social risk factors that contribute to anxiety later in life. These risk factors include “female gender, cognitive impairment, chronic health conditions, poor self-rated health, functional limitations, personality traits such as neuroticism and poor coping skills.” ⁶

Mental Health Diagnosis Related to Panic Attacks

Recognizing panic attacks can be tricky because they can be mistaken for mental or physical health problems. Some seniors may be afraid to tell loved ones about their symptoms out of fear of being talked into unwanted medical care. The elderly may be reluctant to learn the reason for these episodes not wanting to hear potentially bad health news. There can be many triggers for panic attacks. They are also associated with other diagnosed mental health disorders.

Here are some of the most common triggers for panic attacks in the elderly:

• Generalized anxiety disorder: Generalized anxiety disorder is persistent extreme uncontrollable anxiety without any known triggers.
• Post-traumatic stress disorder: Post-traumatic stress disorder (PTSD) People relive terror-filled emotions of a previous traumatic, often life-threatening event. Seniors can relive events that happened many years ago. This can be triggered in the elderly when a new disability makes them feel helpless.
• Panic disorders: A panic disorder is a type of anxiety disorder characterized by frequent panic attacks. It’s a hyper-reaction to life stressors that can be triggered or seemingly come from out of nowhere.
• Dementia: Caused by damage to connections in the brain creating loss of memory, cognitive impairment, and inability to problem solve or think clearly. It can happen to people in their sixties or older. With early onset dementia, people in their forties can be diagnosed. Seniors can have more frequent panic attacks because of these symptoms creating confusion and heightened anxiety.
• Alzheimer’s disease:  A type of dementia with similar symptoms to those diagnosed with dementia. These symptoms can cause panic attacks. One of the causes associated with Alzheimer’s disease is an abnormal amount of proteins causing plaque buildup around brain cells.
• Sundowner syndrome: Sundowner’s syndrome sometimes happens as people age. It occurs in the late afternoon or early evening and creates confusion and anxiety.

8 Ways Older Adults Can Cope With Panic Attacks

If a panic attack occurs when a loved one is present, they should remain calm and supportive. If the identified trigger is present, remove the senior immediately. Tell the senior to sit down, remain calm, close their eyes, and breathe slowly and deeply. Have them count slowly. This helps distract them and helps them feel like there is something they can do to help them regain control. Reassure them that this is a panic attack and will not last long and you will be there to help them through it.

Here are 8 ways older adults can cope with panic attacks:

1. Deep breathing: Deep breathing exercises are often recommended as a means of controlling panic attacks. It is something that is easily done by people of all ages. Taking slow, deep breaths allows more oxygen to enter the bloodstream reducing anxiety. It also connects with the parasympathetic nervous system enhancing relaxation.
2. Physical activity: Releases hormones called endorphins that stabilize mood and relax the body. Something simple like walking can help. For elderly individuals with limited mobility stretching or chair yoga is good. Consult doctors to get recommendations on exercise.
3. Cognitive Behavioral Therapy (CBT): (CBT) is often used to treat anxiety and panic attacks. This short-term treatment teaches ways to change harmful thought processes and behaviors that may contribute to anxious episodes and panic attacks.
4. Proper Nutrition: Eating a healthy diet is an effective way to manage brain and body health. For example, carbohydrates like those found in whole grains balance the hormone serotonin which helps stabilize mood.
5. Socialization: Isolation can increase anxiety and depression. It can occur more often for seniors with reduced mobility or limited transportation. Family and friends can set up regular visit times or facilitate opportunities for socialization when appropriate.
6. Substances and medications: Reduce or eliminate any use of alcohol or medications which can contribute to confusion, disorientation, and can promote anxiety.
7. Provide structure: People with memory issues, reduced cognition, or anxiety respond well to a predictable, structured routine. Sudden changes in daily routine schedules can create uncertainty causing anxiety and potential panic attacks.
8. Grounding Techniques: Used to help people be conscious of present surroundings using their 5 senses. For example: Acknowledge 5 things you see around you, Four things you can touch around you, including hearing, smell and taste while counting down from 5.

When to Get Professional Help for Panic Attacks As a Senior

In an elderly population, anxiety is frequently coupled with depression. These mental health disorders can be debilitating and can exacerbate existing medical problems. It’s important to note that memory loss can occur with increased anxiety or panic attacks. It can create safety concerns for seniors especially those that live alone and are not closely monitored on an ongoing basis.

Ageism can be a factor in getting proper treatment. Sometimes the elderly are denied proper health care or their complaints are not taken seriously. If panic attacks or ongoing severe anxiety are compromising safety or negatively impacting quality of life and relationships, it is time to seek professional help. Find a geriatrician who is a medical doctor specializing in working with seniors if there are unaddressed medical problems. Finding an online therapist may be a convenient option for addressing panic attacks, especially if you have mobility issues. Use an online therapist directory to choose a professional who works with older adults and has expertise with anxiety and panic disorders.

Final Thoughts

Seniors can experience significant life changes that can impact the quality and structure of their lives. Panic attacks in seniors are more often associated with a previous psychiatric history of anxiety or panic or medical conditions. Coping strategies and treatments are available to help seniors and their loved ones manage panic disorders resulting in a life that offers more satisfaction, safety, and support.