Anxiety Disorders

Anxiety Disorders

Anxiety is a normal response to stressful situations. Generally health community-dwelling older adults have developed excellent skills for coping with it. But anxiety becomes a problem when it prevents an individual from engaging in normal activity or diminishes ability to enjoy activities. Among adults over 65 years of age, 5.5 percent experience anxiety disorders, compared to 7.3 percent among younger adults (Stanley & Beck, 2000). Anxiety symptoms are more common in persons with other psychiatric or medical disorders. The rate of anxiety is approximately 11.7 percent among nursing home residents (Stanley & Beck) and as high as 38 percent among people with medical disorders such as Parkinson's disease and early dementia (Sadavoy & LeClair, 1997). It is very common for anxiety to accompany other psychiatric disorders, most notably depression.

Panic Attacks and Panic Disorders

Panic attacks are limited periods (usually several minutes) of intense fear that come on unexpectedly. These periods are accompanied by multiple symptoms, such as heart palpitations, sweating, shortness of breath, nausea, chest pain, dizziness, shakiness, or fear of losing control, going crazy, or dying. Some people experience panic attacks in response to certain situations, and some people experience them without any apparent trigger. Panic attacks may be part of the anxiety disorders described below. If an individual experiences recurrent, unexpected panic attacks in the absence of another anxiety disorder, they may have a panic disorder. Panic disorder is rare among older adults, however (Stanley & Beck, 2000). Treatment often includes a short-acting sedating medication called a benzodiazepine, such as lorazepam (Ativan) or alporazolam (Xanax), and cognitive behavioral psychotherapy.

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is commonly seen in clinical practice with older adults. The prevalence among community-residing older adults has been documented at 4.6 percent, although some speculate that rates are much higher (Stanley & Beck, 2000). As its name implies, people with GAD experience excessive worry or anxiety about multiple things, and it impairs their daily functioning, creating difficulty in controlling their worry. People with GAD experience at least three of the following symptoms: restlessness, problems concentrating, irritability, muscle tension, sleep problems, or premature fatigue. Sometimes the symptoms of GAD are directly due to a medical condition such as thyroid, cardiovascular, respiratory, metabolic, or neurological disorders. In such a case, an individual may be diagnosed with an anxiety disorder due to a general medical condition. Generalized anxiety treatment often includes a long-acting benzodiazepine, such as buspirone (Buspar), and cognitive behavioral psychotherapy.


Phobias are extreme fears of specific situations or objects. The most common phobia's is agoraphobia, which is the fear of being in placed from which it is not easy to escape. This phobia, which can develop later in life (Sadavoy & LeClair, 1997), makes it less likely that people will venture from their homes-some find it very difficult to leave home at all. Many people with agoraphobia also panic disorder. Another phobia is social phobia, which is extreme fear of social or performance situations in which the individual may feel embarrassed. Social phobia is often experienced as public speaking anxiety but may be as broad as fears of any social situation. Older adults tend to experience less social anxiety than do younger adults (Gretarsdottir, Woodruff-Borden, Meeks, & Depp, 2003). Other phobias are of animals, natural environments (e.g., heights, water), blood or needles, and certain situations (e.g., airplanes, enclosed spaces). Researchers estimate that 4.8 percent of older adults have a phobia (Stanley & Beck, 2000). Cognitive behavioral therapy has been found to be helpful in the treatment of phobias. Treatment focuses primarily on teaching relaxation techniques, and then exposing the individual to the feared object or situation while relaxed.

Obsessive-Compulsive Disorder

People with obsessive-compulsive disorder (OCD) have recurrent obsessions or compulsions that are severe enough to impair their daily functioning. Obsessions are persistent thoughts, ideas, or images that are anxiety-provoking and, at least initially, absurd to the individual experiencing them. Common examples of obsessions are contamination (e.g., being infected with germs), doubts (e.g., questioning if one left the stove on or locked the door), or a need to have things in a certain order. Compulsions are repeated behaviors (e.g., hand washing, repeating a word to prevent someone from getting hurt, checking locks, cleaning) that are intended to reduce anxiety, often about an obsession. One compulsion that may be a problem later in life is hoarding (e.g., saving newspapers, clothes or other objects).

Post Traumatic Stress Disorder

Post Traumatic stress disorder (PTSD) may develop after exposure to an extraordinarily stressful event, such as being threatened with death or personal harm, or witnessing the death or severe injury of someone else. This disorder was first recognized in the United States after the Vietnam War, and since that time, many military veterans and other trauma victims have been treated for it. Lifetime prevalence of PTSD in the general population of the United States ranges from 1 to 9.2 percent (Hidalgo & Davidson, 2000). Determining the prevalence of PTSD among older adults is difficult, however. Most studies have been done with war veterans, Holocaust survivors, and disaster victims and do not include other types of trauma survivors. Current estimates of prevalence of PTSD among older adults range from 3 percent to 56 percent, depending on the group studied, with highest rates for former prisoners of war.

PTSD involves recurrent thoughts about or images of the traumatic event, recurrent nightmares, feelings of reliving the even, or intense distress when reminded of the event. People with PTSD avoid thoughts about or people who were involved in the event, feel distant from others, have difficulty experiencing emotions, are very irritable, have trouble sleeping or concentrating, or are hyper-aware of their surrounds (fearing the event might sneak up on them again). These symptoms often get worse during stress, and some sufferers attempt to medicate themselves with alcohol or drugs. Older adults who have had traumatic events earlier in life tend to experience periods of symptoms intermittently over the course of their live (Hyer, Summers, Braswell & Boyd, 1995). Some older adults experience increased symptoms later in life (McLeod, 1994).

Treatment for PTSD often includes anti-anxiety medications, antidepressant medications, and psychotherapy to minimize the impact of the traumatic event on the individuals current life.

Treatment of Anxiety Disorders

Psychotherapy is effective in reducing symptoms of anxiety. Research has shown that helping an individual with anxiety to change thoughts in specific situations and thought patterns across situations (as in cognitive behavioral therapy) decreases the frequency and intensity of symptoms. Medications have also been found to be very helpful. Short-acting anti-anxiety medications, such as benzodiazepines (e.g., lorazepam [Ativan] and alprazolam [Xanax]) relieve symptoms of anxiety quickly, but do not last long and can be addictive. These medications can produce dangerous side effects in older adults, including cardiac and pulmonary problems, increased fall risk, and confusion. Long-acting medications, such as buspirone (Buspar) or diazepam (Valium), take longer to take effect but minimize symptoms for a longer period of time. These are not used as often due to potential side effects for older adults. Beta-blockers (such as propranolol [Inderal} or metoprolol [Lopressor]), which are typically used for cardiovascular problems, are often prescribed to treat severe physical symptoms of anxiety, such as tremors, pounding heart, muscle tension, and sweating. Beta-blockers are often given for use in a single situation that causes anxiety, such as public speaking or flying. Antidepressant medications are also prescribed for some people with anxiety disorders, particularly panic disorder and obsessive-compulsive disorder.

The above information was provided by the Socitety of Certified Senior Advisors (SCSA).

The following information was provided by Ryan Rivera

How to Tell the Difference Between a Panic Attack and a Heart Attack

As you age, there are certain concerns you always have to have about your health. Perhaps the most common is your heart, since heart issues are a common, inconvenient part of aging. But there are some issues that can affect you regardless of age, and in rare cases, these issues may make it more difficult to monitor your health the way you hope to.

Introduction to Panic Attacks

Anxiety disorders can hit you at any age, and panic attacks are perhaps the most problematic. Panic attacks are sudden, relatively unprompted feelings of intense fear, and the most common subject of this fear is your own health. Panic attack symptoms are so unusual, in fact, that many people end up in the hospital with a fear that they are having a heart attack. The symptoms can be very similar:

· Rapid, intense heartbeat.

· Light-headedness and a feeling of something being "seriously wrong."

· An intense need to sit down, and occasionally feeling very weak.

· Dizziness and problems with clear thinking.

In addition, panic attacks can provide an intense fear that you are in the process of dying, and may create physical symptoms as a result of the placebo effect (for example, experiencing chest pains because you believe that you're suffering from something that creates chest pains).

What makes panic attacks an even greater problem for the aging community is that panic attacks are largely triggered by paying too much attention to your health. You're told to monitor your health regularly, but if you suffer from panic attacks, this type of over-attention to your health can actually trigger more panic attacks, as any time something feels even remotely out of place it can cascade into something far more pronounced.

Responding to a Panic Attack

This brings up an unusual conundrum. How do you tell the difference between a panic attack and a heart attack? Once you reach 50 or older, it may be a good idea to go to a doctor anyway, even if you believe you're suffering from a panic attack. "Better safe than sorry" is a good motto to have. But if yon t to try to differentiate between the two when you're in the moment, here are a few ways to tell the difference between a panic attack and a heart attack.

· Does it Recur in a Common Place?

It's very difficult – potentially impossible – to tell the difference between a panic attack and a heart attack the first time you have a panic attack. But often panic attacks tend to recur in similar places or during similar situations. For example, if you have a panic attack while at the mall, and you start having one again at a mall, it's a bit more likely to be a panic attack. It may not just be places as well. It could also be a result to a similar feeling.

· Were You Worrying About Having a Panic Attack?

Panic attacks can also trigger themselves. If you were worried about getting a panic attack, you may have increased your chances of developing panic attacks. Any time you've been spending most of the day monitoring your body's reactions and worrying that you might get a panic or heart attack, your panic attack risk increases.

· Did You Recently Have a Panic Attack and Your Heart Checked Out?

Panic attacks can often occur in group. If you had a panic attack, went to the doctor, and your heart appeared to be fine, and then the next day when you were out you start experiencing these symptoms again, there's a bit of a better chance that it was a panic attack.

What to Do

It would be dangerous and irresponsible to tell you to assume you're having a panic attack over a heart attack, because heart attacks are a very real concern. That's why it's so unfortunate that panic attacks and heart attacks can have such similar symptoms, because there are very few ways to tell the difference. The above tips potentially work, but going to your doctor just in case is never a bad idea.

However, because of the similarities between the two, it's very important that you seek some type of mental health treatment to reduce the frequency of your panic attacks. Panic attacks can be legitimately terrifying, and if you're already concerned about your own health, it's always a good idea to make sure that you don't allow a mental health disorder to add to your worries.

About the Author: Ryan Rivera was frequently hospitalized for his panic attacks before he learned what they were and how to control them. He supplies information on panic attacks and anxiety symptoms on his website at