(Or perhaps how to help yourself when your senior has anxiety)
We live in a culture of anxiety. Don’t believe me? Ask Brene Brown. Ask Peter Attia. Ask Dr Daniel Amen. Ask anyone you know who is honest. If you're a caregiver, you may need to help your senior with anxiety. Because old age comes with plenty of reasons to feel stressed.
Anxiety is common in seniors over the age of 65. Estimates say that up to 20% of older adults struggle with anxiety. Almost 20% of all adults in the US struggle with anxiety. And think about all the people out there worrying but not telling their doctor. The actual numbers are likely much higher.
I see it all the time in my office and in my regular life. People recognize anxiety in their loved ones and want to help. But their loved one is not ready to admit they even have anxiety, let alone do something about it.
I know someone whose mother calls her anxiety Afib. When she is anxious she feels like she has a heart arrhythmia so she'll say her Afib is acting up. This is after they made sure she truly did not have an irregular heartbeat. But to her, Afib is not as scary or shameful as anxiety.
I imagine I will be anxious as I age. There is a lot to worry about! My own health and that of my loved ones. Will we have enough money to care for ourselves? Will we be lonely? What will be my downfall? Cancer, a freak accident, dementia? What if I fall and break something? Will my friends die before me? Will I lose my senses? It’s a lot to think about.
Anxiety symptoms
Seniors with anxiety are a lot like anyone, of any age with anxiety:
Sometimes they can’t sit still- very often they putter around the house, clean, organize.
They like to go over plans several times.
They might assume the worst- their minds head to the worst case scenario quickly.
They might be avoidant or dismissive when asked to talk about what is causing them to feel anxious.
They might have trouble falling asleep or wake up very early in the morning.
They might struggle with memory. Not all memory problems are dementia; anxiety is often the culprit
Physical symptoms like heart palpitations, sweating, or feeling hot are common
Hoarding or refusing to throw anything away
What can you do about it?
If your senior is anxious, the best thing to do is to talk about it. It might also be the hardest part of dealing with it. My mom used to lash out when she was anxious. Her very protective anxious mind would do or say anything to change the subject. These were some of our toughest conversations.
Anxiety loves to be in control and it will pull out all the stops to stick around.
The best place to start is to ask permission to share your thoughts. This very act may, in fact, cause anxiety in the receiver of the question. But it's the best way to establish that you're serious. This is not something you want to let them laugh off. It’s uncommon for people to say no to this question at the start. Try to choose your words carefully so that your senior doesn't get overwhelmed and shut down. Instead of saying, "I want to talk about your mental health," try asking them about their worries. "Worries" is a much less loaded word for the elderly. Remember, they are from a different era, and have different attitudes towards mental health.
Some conversation openers include:
“I’ve noticed you doing some things that make me think you might be worrying more. I’m hoping we could talk about it”
“I’ve noticed you are having a hard time sitting still or being quiet and I’d like to talk about it.”
If you have a senior who can't even say the word "feelings," let alone talk about them, a more direct approach might be best.
“Grandma you’re worrying a lot- more than is good for you”
If they get upset then it can be helpful to de-escalate. You can say something like, “look, anxiety stinks, I know, and there are things you can do about it so that’s why I brought it up. If I thought you looked like you were having a stroke I wouldn’t keep that to myself either!”
Partnering can help as well. Tell them you have had anxiety, too, which helps you notice the signs. You can do this even if you've never had anxiety; it's all about making them feel less alone. If you did some therapy or tried some medication you can share your experiences with them. Being vulnerable and open about your own experiences will go a long way in helping them open up about their own. Even if your senior is VERY resistant to help you might be planting the seed.
What next?
If your senior is open to exploring this more, congratulations! Seriously. Acknowledging a struggle is hard for everyone. If your senior has worked with a therapist in the past, start there. Their primary care doctor is also a good place to start. If your senior is ok with it, you can go with them to the appointment. You can also offer to reach out to the doctor beforehand over the patient portal or by leaving a phone message.
Reframing anxious behavior is another tool. Naming behaviors as a manifestation of anxiety is often appropriate. For example, you can say something like “I know you ask a lot of questions when you are nervous so how can I help you right now? I have time to devote to this so how can I be useful to you?” Alternatively, if they are struggling you could remind they have a choice. Say something like, “It doesn’t feel good to feel nervous- there is another way to do this and I wish you would consider it”
If your senior is open to talk therapy this is a great way to manage worries. Medications can be an option but not all are created equal. Some have dangerous side effects or interactions. Make sure to check with your seniors doctor before trying any medication. This includes old prescriptions of their medicine cabinet.
Your efforts may not work
If your senior shuts you down at least you can say you tried. Also, you can work on setting boundaries. Boundaries are not for other people, they are for you. They help you let people know what behaviors you are willing to tolerate. You can’t control what other people do and say but you can control how you respond. Set limits for how long and how often you're willing to listen or talk about their worries. Remember that worries are often annoyingly disguised as complaints. This is a skill that is not innate in most people and you will need to practice it. Setting a boundary can be scary. It can also be liberating. I like Nedra Tawwab’s book on this subject. Titled “Drama Free”, it provides concrete examples and practical tips. She has an accompanying workbook that I have used myself and found helpful. She also has a solid Instagram account if that is more up your alley.
You can always have hope and keep trying and it’s ok to abandon ship. You may have tried time and again to get them to see things your way. They may never be willing to address anxiety or change their behaviors. Accepting that things are not going to change can be half the battle. It can be a relief to stop trying to change something and focus on what you can - your own expectations.
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