Last Updated: April 4, 2013
By Jeannette Franks, PhD
We all experience anxiety. After all, worrying about the future
is part of being human and helps us plan ahead and make better
decisions. Some anxiety is normal and even productive. However,
when anxiety becomes disruptive and disabling to a person's life,
it is considered an unhealthy psychiatric disorder.
As many as one quarter of all people experience anxiety to an
unhealthy extent, and older people can be at particular risk.
Seniors may experience more troublesome anxiety than other age
groups for several reasons: they experience more losses, suffer
from more pain and chronic conditions, are often on multiple
medications that might exacerbate anxiety, and have confounding
ailments such as
Alzheimer's disease or
Some experts suggest that in general anxiety is equally
prevalent in all adult age groups but perhaps is less often
reported by seniors, and not as accurately diagnosed and treated as
in younger people. A large study published in theAmerican Journal
of Psychiatry(1998, A. Beekman) found that 10 percent of adults 55
to 85 years of age had elderly anxiety disorders-the same
prevalence as for other age groups.
Don't Dismiss Excessive Worrying Out of Hand
Sally had mid-stage Alzheimer's disease and was living alone in
her own home, near her daughter June, who looked in on her
frequently and helped manage the groceries, cooking,
transportation, and such. Neither wanted to live with the other,
and since Sally still had much intact long-term memory, she was
able to manage quite well in her beloved home that she still knew
The mother started complaining that the house next door had been
invaded by aliens. Odd lights and noises disturbed her sleep and
filled her with a feeling of dread. The daughter, familiar with the
neighborhood, asked around, and sure enough, the family across the
street had thought there was something odd going on. June contacted
the police, who had also had some reports about the house. The
police watched it more closely and eventually raided the house and
closed down a methamphetamine lab.
Sally had been right! Indeed bad things were happening next door
and once the house was closed down, her anxiety abated. So if your
loved one seems unduly anxious, don't be too quick to discount
their fears as "all in their head." Perhaps there is a real reason
behind their anxiety.
Major Types of Elderly Anxiety Disorders in Older People
- Acute stress disorder: Anxiety and behavioral
disturbances that develop within the first month after exposure to
an extreme trauma.
- Post-traumatic stress disorder (PTSD):
Symptoms of acute stress disorder that persist for more than one
- Panic attacks: A sudden, unpredictable,
intense, illogical fear and dread.
- Social anxiety: A preoccupation with how a
person is viewed by others.
- Generalized anxiety disorder (GAD): A pattern
of excessive worrying over simple, everyday occurrences and
- Phobias: Irrational fear of situations such as
heights, or fear of objects, such as snakes.
- Obsessive-compulsive disorder (OCD): A pattern
of intrusive thoughts that assault the mind and produce extreme
anxiety that can only be mitigated by an action, such as hand
washing in a ritualistic way.
The latter two are perhaps less common in older people, because
they can and often are successfully treated in youth or middle age.
Few long-term studies track elderly anxiety disorders, so there is
little information on how these problems vary with age.
It is important to recognize that anxiety disorders are not
because of some moral weakness or lack of character, but a genuine
biochemical disturbance. There also appears to be a genetic
predisposition. A recent study of identical twins found that if one
twin had a generalized anxiety disorder, there was a 50 percent
chance that the other twin would as well.
Acute and Post-Traumatic Stress Disorder (PTSD)
Rebecca's mother screamed frantically when the aides in the nursing home tried
to give her a shower. Regardless of how kind, gentle, or persuasive
the caregiver was, she began yelling and sobbing hysterically when
brought to the bright, white, shower room, where the aide attempted
to remove her clothes.
The social worker spent an hour talking to the woman and
determined that she had been raped in the high school gym shower
room as a teenager. The staff changed the bathing routine to a
quiet, homey room with a bath tub and soft lights and music.
Bathing was no longer a battle.
Acute stress disorder develops within the first month after
exposure to an extreme trauma. Symptoms include: repeatedly
experiencing the trauma in images, thoughts, dreams, or flashbacks;
extreme distress when exposed to cues that remind the person of the
trauma; avoidance of reminders of the trauma; a numbing of
emotions; and symptoms of agitation, arousal,
insomnia, anger, irritability, and inability to
When these symptoms persist for longer than a month, the anxiety
is diagnosed as PTSD.
Often the elderly did not receive therapy for traumatic events
such as rape, abuse, torture, or war. Until a trigger such as the
shower situation or dementia-which can disinhibit protective
behaviors-these older people have never expressed their emotional
pain and horror.
The woman in the dementia
care unit screaming may be a Holocaust survivor. The man who
panics at the sight of the Asian face of his well-meaning caregiver
may have been a prisoner of war. They may be re-experiencing
horrifying events in their mind's eye over and over again.
Reasoning with people who have these issues is not effective. Nor
is simply demanding that someone toughen up and "get over it."
Margaret, a 74-year old widow, volunteered twice a week at a
senior center a half-hour drive from her house, which she found
very satisfying. It kept her in touch with friends, gave her a
chance to contribute and feel productive, and she enjoyed the hot
lunch in a social atmosphere.
One day, while crossing the bridge over a large river between
her home and the senior center, she experienced a horrendous
feeling of dread. Her heart pounded and her hands began to shake.
She thought perhaps she was having a heart attack.
As soon as she got over the bridge she pulled over, sweating and
weak. After a few moments, the feeling passed.
She drove herself to an urgent care clinic and the doctor there
could find nothing wrong. She met with her primary care physician a
few days later-he assured her that she was fine. The next week,
driving over the high bridge, she didn't experience another attack,
but felt nervous and worried that it would happen again.
She tracked down the social worker at the senior center and
described the experience. The social worker asked, "Do you think
that it might have been a panic attack?" After discussing what
comprised a panic attack, they agreed that one had occurred.
Margaret drove home, comforted by the diagnosis and the
knowledge that not only might it never occur again, but if it did
it would quickly pass. She never had another panic attack.
It is normal to feel panic at a terrifying event such as an
earthquake or car crash. But people with a panic disorder may
experience horrific terror with no discernable trigger or cause.
For some minutes they experience intense and overpowering feelings
of fear that leave the sufferers helpless. Physical symptoms may
include fainting, dizziness, heart palpitations, sweating, and or
A panic attack can come once in a person's lifetime or
frequently. Attacks can begin at any age and are twice as common in
women. There is a genetic pre-disposition. If one identical twin
has this disorder, there is a more than 80 percent chance that the
How to help someone who is having a panic attack
- If you know the person's relaxation methods, do them
- Be calm and gentle
- Go together to a safe, quiet place where he or she can sit or
- Help the person slow down breathing by slowly inhaling and
- Use imagery such as, "We are lying in the warm shade of a
beautiful, tropical beach listening to the gentle murmur of the
- For some people the gentle contact of hand holding or an
embrace can be reassuring
Learning relaxation techniques through yoga, meditation, prayer,
or bio-feedback can be very helpful in preventing future panic
Generalized anxiety disorder (GAD)
GAD is common-as many as 5 percent of the population experiences
this disorder during their lifetime. There appears to be a genetic
component. If one identical twin is diagnosed with GAD, the chances
are 50 percent that the other twin will too. However, in
non-identical twins, the chance is only 15 percent.
People with GAD tend to be pessimists who expect the worse, and
often interpret everyday mishaps as major disasters. Rather than
seeing the glass as half full; it must be half empty. Simple
setbacks such as a dented fender are exaggerated out of proportion
and cause the person far more pain than such minor events would
GAD is often a chronic condition, with negative events
exacerbating the disease. Perhaps half the people with GAD are
clinically depressed and there is a tendency to attempt to
self-medicate with overuse of alcohol, over-the-counter and illegal
drugs, and prescription medications. Most people with GAD know they
shouldn't worry so much, but are powerless to change their
Symptoms include tight muscles, back pain, or headaches for
which a physician can find no biological cause. People with GAD
often feel restless, on edge, and are easily startled. Chronic
anxiety can cause the body to feel tired, exhausted, or fatigued,
all of which are made worse by the insomnia associated with
Social anxiety disorder
Many of us feel uneasy meeting strangers or speaking in public.
But people with social anxiety disorder are so terrified of social
situations that they withdraw and refuse many social occasions.
This problem may be exacerbated in older people because of hearing
impairment, issues with incontinence, or embarrassment over using a
walker or wheelchair.
Social anxiety occurs in perhaps 10 to 20 percent of the
population and is the third most common psychiatric disorder, after
substance abuse and depression. It can cause an increased spiral of
isolation and inability to interact socially.
All of these elderly anxiety disorders usually respond well to a
combination of talk therapy and medication. While prescription
drugs should be used with caution in the elderly, and often at
lower doses, there are now some particularly effective medications
that a physician can prescribe such as Paxil®,
Prozac®, and Zoloft®. Numerous studies have
indicated that for a medication to be most effective, the patient
should also be meeting on a regular basis with a skilled counselor,
therapist, or social worker. Other treatments effective for some
people include meditation, biofeedback, massage, and
Jeannette Franks, PhD, is a passionate gerontologist who teaches
at University of Washington and Bastyr University; she is the
author of a book on assisted living and numerous