It’s a rather common joke that older people seem to worry about everything, and each new generation seem to vow that they will never be the same. However, as people grow older, we realise that the anxieties of ageing such as failing health, loneliness and stress, are very real.
For many elderly people, anxiety and stress seem to be part of the ageing process. It may be a symptom associated with many physical ailments, a realistic response to life circumstances such as the loss of a partner, or a sign of a mental health problem.
Whatever the cause, management and treatment of anxiety in the elderly are often complicated by such factors as diagnostic difficulties, the infirmities of age, and memory problems.
Although anxiety itself is common among the elderly, senior citizens appear less likely than younger people to suffer from specific anxiety disorders. When an older person does have one of the anxiety disorders, the disorder is usually developed earlier in life, typically in the late teens or twenties.
Simple phobia – anxiety caused by a specific object or circumstance such as fear of height, is one of the most common anxiety disorders for both young and old.
Agoraphobia, the fear of being in public places from which escape appears difficult, is the second most common anxiety disorder in the elderly. In extreme cases, people with agoraphobia may refuse to leave their homes.
Some researchers believe that traditional definitions of anxiety disorders are inappropriate for the elderly. They believe that older people react differently to stress and that the symptoms may also be different in the elderly. In addition, new situations such as living alone, failing health and issues of safety and security may trigger realistic anxiety among older citizens.
Experts agree that this is particularly true to South Africa, with its limited social safety infrastructure for the elderly, the high cost of medical care and the rising crime rate. All of these increase the vulnerability of the elderly, and so too their anxiety levels.
Dr Frans Korb says making an accurate diagnosis in the elderly person is more difficult. Many of the signs of an anxiety disorder are identical to the symptoms of physical illness. Some anxiety disorder symptoms may also be characteristics of old age or result from side effects of medication.
Shortness of breath, trembling, sleep problems and muscular aches may indicate the presence of an anxiety disorder. But these are also typical complications of old age, and possibly, depression.
Anxiety itself may be a symptom of a physical disease It occasionally arises as a side effect of medication – a special problem in the elderly as many older people require drugs for physical illnesses. Anxiety symptoms may also indicate depression, which is common among older people in response to declining health or the death of loved ones.
Local experts agree that anxiety disorders in the elderly are highly responsive to treatment, but only a small percentage of elderly patients seek help from a mental health professional.
June, a seventy-three year old lady who suffered for thirty-eight years without a proper diagnosis, urges other elderly anxiety patients to get help. “I gather some [other elderly people] feel that they are too old to get over it. You can get help. You don’t have to live a restricted life.” June sought help two years ago. “It turned my life around,” she said.
Reasons for the elderly not seeking help include:
· Many elderly people with mental health problems fail to recognise the nature of their difficulties and seek help for physical ailments instead. They attribute their problems to old age.
· The elderly tend to view mental health problems as an embarrassment. They are likely to blame themselves and feel ashamed of needing help.
· Misunderstanding mental health care causes many older people to fear institutionalisation if they seek help.
· Expensive medical cover in South Africa also discourages the elderly from seeking help.
· Medications have been proven to be effective in reducing or eliminating many of the symptoms of anxiety and anxiety disorders, but therapists make use of a unique set of considerations when prescribing drugs for elderly patients.
· Metabolism, kidney and liver function, and the workings of the central nervous system tend to become less efficient with age, rendering the elderly more sensitive to some of the medications used in the treatment of these disorders.
· Physicians need to consider the possible interaction of these drugs with one another, as well as other illnesses present or drug regimens being followed.
· Failing memory is another issue that has to be considered, as it may make it difficult for some older people to follow their prescribed dosage schedule.
Other treatment available to the elderly includes “exposure” therapy, where the patient is gradually exposed to the feared circumstance to demonstrate that it can be confronted without danger. But some experts argue that the level of arousal generated during this kind of therapy may overwhelm the elderly patient. Helping the elderly to learn ways of managing and controlling anxiety are suggested as alternatives. Relaxation techniques are also thought to be a key element of programmes that stress fear management.
Flexibility when devising a treatment regiment for the elderly patient is essential. The therapist may also need to be flexible regarding treatment locations as well, and it may be necessary to visit homes or hospital rooms to ensure that treatment is not interrupted by physical ailments.