Anxiety in Older Adults - It's Not Just Grey Hair and Wrinkles We Worry About
When we hear anxiety and aging in the same breath, we often think of the fears related to the physical aspect of aging; losing your independence, a decline in balance and ability, and changes to your physical appearance such as greying hair, wrinkled skin and age spots. When aging anxiety is thought of in this way, the experience of anxiousness becomes normalized; isn’t this something we all worry about? In some respects, yes, it is normal to worry about the changes you will face as you age, thanks to the constant reminders from advertising and popular media that the process of aging should be fought with cosmetics, vitamins, and a healthy lifestyle. However, it must be realized that anxiety is not a normal part of the aging process as greying hair and wrinkled skin are. It should not be expected that as we age we have to deal with anxiety on top of the changes we are already facing with our physical bodies, our environment or our cognitive abilities.
Generalized Anxiety Disorder, or GAD, is the most common anxiety disorder that older adults face, and some older adults have reported that they have been feeling symptoms of GAD for over 20 years before addressing it to their doctor by ways of navigating the aging process (Clifford et al., 2015). Another commonly observed anxiety disorder within older adults is the Fear of Falling, or FOF, which has been observed to be related to GAD (Payette et al., 2017). When interacting with older adults, safety and ensuring proper protocol to address a fall is a common discussion. Families and friends will suggest a fall detection device to protect their loved one in case of an emergency, which is something that can help reduce the anxiety and fear around falls. However, providing your anxious loved one with a fall detection device does not cure their anxiety, especially if they have been masking their GAD symptoms for most of their adult life. Especially when individuals have been doing so for many years, they will dismiss the anxiety they feel as normal, or “solved” when provided with a partial solution or extra support. This cannot be the norm if you want your loved ones to age comfortably. Vigilance is critical in this time of life to take the extra few minutes to discuss exactly what causes feelings of worry or anxiety. This may help you realize that the fears your loved one is experiencing are far more severe than what is considered “normal”.
Having these discussions with your loved one can be far more effective than bringing them to the doctor for a psychiatric assessment, as the prevalence of anxiety in older adults is often under-estimated as a result of the diagnostic tools and criteria required to receive a GAD diagnosis (Chong et al., 2020). This is because anxiety commonly manifests earlier on in life, and therefore some healthcare providers believe that diagnosing GAD in late life is pointless as it is too late to address, or that further research on this subject is irrelevant as individuals age and their habitual thinking becomes less malleable (Chong et al., 2020). Why do we think this way about our loved ones? We have evidence that anxiety can speed up the onset of dementia symptoms (Chong et al., 2020), so why are we now choosing to ignore anxiety in our loved ones, or pathologize the changes to one’s physical body rather than address the equally real and debilitating changes to one’s mental state?
Take this as a sign to have a conversation with your loved one not only about how they are doing physically, but how they are feeling mentally. This can provide insight into the mindset of your loved one and may help you in addressing their mental health needs just as well as you try to address their physical needs. Anxiety is not a normal part of aging, and in a transitional phase of an older adult's life, such as transferring to a retirement community or introducing caregivers into the home, feelings of anxiety can be exacerbated. Now is the time to address these symptoms so your loved one can continue to age comfortably, resiliently, and with dignity.
By Alyssa Pereira
Chong, T. W. H., Lautenschlager, N. T., Anstey, K. J., & Bryant, C. (2020). Anxiety disorders in late life-Why are we not more worried? International Journal of Geriatric Psychiatry, 35(9), 955–961.
Clifford, K. M., Duncan, N. A., Heinrich, K., & Shaw, J. (2015). Update on Managing Generalized Anxiety Disorder in Older Adults. Journal of Gerontological Nursing, 41(4), 10–20.
Payette, M.-C., Bélanger, C., Benyebdri, F., Filiatrault, J., Bherer, L., Bertrand, J.-A., Nadeau, A., Bruneau, M.-A., Clerc, D., Saint-Martin, M., Cruz-Santiago, D., Ménard, C., Nguyen, P., Vu, T. T. M., Comte, F., Bobeuf, F., & Grenier, S. (2017). The Association between Generalized Anxiety Disorder, Subthreshold Anxiety Symptoms and Fear of Falling among Older Adults: Preliminary Results from a Pilot Study. Clinical Gerontologist, 40(3), 197–206.