Anxiety In The Elderly

in the elderly. A lot of you had emailed me that you would love to do what you would love to listen to an episode about anxiety in the elderly, because I think a lot of us noticed maybe some changes in our parents or older family members, older friends, older people in our life during the early lockdown parts of the pandemic, and then of course still continuing on to today, as certain things that we may take for granted that tend to help us cope with everyday anxiety.

And you know, lift our moods is is social interactions, lack of isolation, obviously being free of disease or free of fear of disease. And I think all of us experienced an optick of that and still aren't as the pandemic still goes on. But I think for the first time, a lot of people realized, oh, I don't know how to talk to my parents or anyone elderly in my life about their anxiety, and so I thought I would definitely make this episode happen, and I'm glad that I did.

Um So, I talked to Dr Sharon Orange about everything that she's noticed from from working with patients. Again, she's a not a psychiatrist, but she works as a medical doctor and has a ton of insight into how anxiety presents in the elderly population, something that I don't know,

this might make you feel better about. You know, if if you get to live to an older or elderly age, that anxiety, in terms of generalized anxiety disorder or certain phobias and panic disorders, that tends to sort of just start to go away as you get older. And it's very rare that an elderly person would suddenly develop panic disorder. And it all has to do with just the way that our body ages and that you know, in Layman's terms, things just tend to slow down and they're not as reactive,

and so you have that to look forward to. If you know there's other things about getting older you're not looking forward to, well, if you're a panicky person, they might start to lessen. But this is a great episode because again, you may be elderly yourself someday. You may be elderly right now listening to this, Or you may have someone in your family that you want to talk to about their anxiety that you've noticed. And obviously you're doing that because you love them and you want them

to realize that there's help out there. But a lot of times we can push people away that we care about by our approach, and so our homework is understanding and learning about how best to approach this topic with somebody as you try to get them the information that you think they need about anxiety. So this is a good primer on how to do it, what to look for, and maybe learning about what someone older or elderly is and probably isn't going through when you think about their anxiety.

So I'll just stop talking and we'll get right into the episode. You'll learn as much as I did. The people who wrote in their parents are not saying I have anxiety? What do I do? It's like the parents are doing nothing about it. They're probably not even admitting it from what I can gather from these letters. And so I mean, just starting there before we get into all the details of elderly people in anxiety, it's kind of tough to start with. How do we help people

that may not want it think they need it? You know, we were would even begin if someone has anxious parents, how do they broach that conversation? So that is exactly the right question, and and your listeners are right to be confused by it, and they're also right to want to get involved. And here's why. Only one in five older adults brings up mental health concerns to need professional so any their primary care doctor or mental health professional.

So only one in five will initiate the conversation on their own of our older adults over sixty, So family members are right to want to get involved. But it's tricky. I mean, as you you just hit the nail on the head. It's hard to talk to an older person about their mental health, particularly if it was someone that you've always looked up to and relied upon. And the flip side of that is for my older folks, when

we're in the office. You know, they also worry that that their family members are going to lose faith in them if they see that they're not coping. So it's it's two sided. And I think for family members who realize, yes, I need to initiate the conversation because my older parents not going to do it on their own. It's obvious to be patient and compassionate and talk openly with them about what you think is going on. The mistake that we make is to try and help and not respect

their independence. So the big mistake I see and I take care of families is Mom, you're depressed. You need to see your doctor and you need something for it. Mom, you have anxiety. Dad, you have anxiety and it's a problem and you need to go fix it. So yeah, and trust me, like that's my instinct two of my parents, and we really have to control that because that's not effective. Yeah, it's tough because I mean, for me, I have a good relationship with my parents. They're eighty three, and that's

how we talk. There's no warming up, gently talking the way I might be a little more formal with someone I don't know very well. And you know, I don't know. I'm sure not everyone has this kind of informality with their parents, but that's you know, I just don't have time to be like, so, how you feeling, you know, I would just be like, oh, that's anxiety. You've always

had it, you know. So you're exactly right. And I think that you have to just retrain yourself to to come in, you know, to focus on the changes you've noticed, and to come in and say I care about you, I'm worried. These are the things I've seen. You don't seem like yourself. You seem more tired than usual. I notice that your sleep seems disrupted, You're irritable. You have to come at it that way because you and I Jen have the same instinct to come in problem solve.

You have anxiety, need to take a medication for it, but it's not gonna work because I take care of the older folks and I hear from them, it's not going to work that way. So we really have to say, hey, mom or dad, having anxiety or depression is like any other health issue, and it will affect how you feel. I'm not sure what's going on, but I think their treatments available. Let's go to your doctor together and talk about it. This is more of a comment than a question.

But it's odd. I guess it's the word that you know, most people under I'll just say under fifty, most kids of parents who are still alive. And these kids that are under fifty, we have a totally different relationship to mental health. It's still nowhere near as less stigmatized as it needs to be. But we I know for a fact, we would not lose faith in our parents if they had anxiety. We would not see it as a sign

of weakness. And at the same time, I mean, as parents get older, we do lose the normal amount of faith in them, Like they're not going to help me move, you know, It's like there's things they can't do anymore. I don't expect them to cook a full things giving dinner or you know. But um so, in that sense, it's too bad that I guess they feel that way. Not odd, it's too bad because if anyone is going

to understand it is this generation of adult children. Absolutely, and the way we speak about and think about mental health is much different than our older parents. And and so if talking about feelings is difficult for the older person, and I can tell you from doing this for twenty one years. It is. We just have to change the focus a little bit. And I know it's not our instinction as and I'm older than you, but as are

the younger generation. But we really have to reframe it and come to them and say mom or dad, how can I help you? You know, can I do the shopping for you? I'm here, You've taken care of me for so long. I'm here to help. We can't come in and go how are you feeling? Do you think have some anxiety symptoms? It's just not going to be the effective way to do it. It's you know, at

least not as a starter. I think we need to start and change the focus from feelings to sort of the problems you've noticed and how you want to solve the problems really objectively. You know what, can I do the shopping for you? Um, let's hang out, you know, or I can do it on my own without you. Just really objective problem solving. It's like, don't boss them around and tell them what they have and you don't have to suddenly be like all touchy feeling and freak

them out. It's like somewhere in the middle. But that's passionate. But but solutions, you know, right, we don't come in with a problem you have anxiety, you have a depression to come in with noticing changes that we've seen and things that we think we can do that will help that problem. But if we come in and say you have a problem, it's it's a non starter for most older adults. It may work in some but for my experience has been as a nonstarter. Yeah. I find that

with my parents. I I mean, I don't know if I think they have anxiety or not. I have to be honest. I noticed it more when they were younger. I think they actually were people with anxiety, either disorders or just whatever anxiety. At times in the life, I I see them as less anxious maybe maybe Uh during the pandemic, I think my mom was kind of depressed, which you know, I understand because she was saying she

was named. She was telling me that she was very sad at the way she felt the elderly people were being treated in the world, kind of like well, if you die, you die, or old anyway, you know that she felt kind of put out to pasture. And my parents are very active, more active than me, you know, I'm half their age, and they're like out and about at the casino every weekend, and so for my mom and dad to be stuck at side house for a

year was challenging for them. Um. And you know, I don't think we'd have these in depth conversations about symptoms and this and that, but we do have those kind of conversations. And I find if I just sort of hug my mom, you know, I mean the way you always you know, hi, goodbye hugs, but just kind of out of the blue, like aw you doing? You know, I never do that, you know. I mean I do that now, but you know, maybe when she was fifty sixty,

I wasn't doing that. But um, it does help. I've seen it where they talk about their feelings, and my dad has said things about being kind of, you know, addicted to the news, like that gets him all riled up in a way that makes them happy, he thinks, you know, and he's like, well, what else am I going to do? Him? All? Like you know that I can see the kind of almost like depression in them, and I don't try. I mean again, if I thought it was like really bad, I'd probably be more solution oriented.

But I just sort of tried to validy because I would be depressed too. I mean, getting older, you know, time starts to go by really fast each year. And as my grandmother used to always say to me, she lived until getting older stinks because your mind is is just as active as it wasn't. You're younger, but you

can't move anything. And and so anyway, all this to say that I find that just validation can really help um if it's kind of a more mild thing where it's like intermittent, you know, depression, or just those moments where they're like, God, I feel older, I feel embarrassed that I can't help you with this, or that you're exactly right. You said two things that are perfect, and I don't know if you know how perfectly you've done this. You said no, you just say to them, how are

you doing? Or you just say come here, I'm just gonna give you a hug. You're doing You are giving them the soft open space to fall right to come to you and say, hey, the pandemic has been really hard for us, increasing social isolation. I don't know how you know more than a third of my patients are over the age of sixty five. I don't know how

they came through this. It's for our kids. It's the same way, but the isolation, you know, for my newly widowed older patients who were at home alone, I don't know how they got through this. What you've done is perfect, which is really just to to give them a soft place to fall with their conversations and their concerns. And that's really half the battle right there, because then your mom is going to say, Jim, this has kind of

sucked for us. Yeah, and I am feeling blue, but I know there's a light at the end of the tunnel, and there's the conversation. And then you would say to them, if it wasn't getting any better, you'd say, you're not alone. We can go get help. This is something we can modify or treat. You know, if you started to notice that either of your parents was really struggling. If people have a good relationship with their parents where they kind of know them the way you know yourself, I think

you can. Right, would you suggest, like, just do something if if it takes the bird enough, do their shopping, clean their house. Just don't even ask because sometimes they won't answer you. Right A thousand percent and presented exactly what you did. Don't say, hey, mom or dad, do you I'm gonna go shopping for you. Say I'm at the store chicken or steak, whole, milk or so, do it like that. And you did the same thing. I'm booking you. You know, first class, you like aisle or window,

so do it like that. And and because if we walk into our parents and say because remember these are the people we relied on who raised us, And if we say, do you want me to go to this store for you, They're not going to answer it in the affirmative. So we have to just do what you you have great instincts about this, but we have to

do exactly what. And the patients who sit in my office, the older patients say to me, I don't want to put out my I don't want to put my daughter out I you know she's spending all her time on me. You know, they are worried that we are spending our time on them. But if you say I'm at the store you like whole or two percent, wellcome coming by then, or I'm ordering it for you a whole or two percent. So you we just make the decisions and make it

happen and take it off their plate. Is there anything to like I just was kind of came up with this, like, is there anything to grief um being the thing underneath it all that causes the irritability or something. Well, I think there is. There's a there's a change in role. So I would say the grieving is about the differences and roles. Right, So, all of a sudden, the parent is you know, who was the patriarch of the matriarch now is concerned that they will become a burden to you,

to their families. They also feel slightly misunderstood by the quote unquote younger generation. That's what I hear over and over again in the office. And they really feel like they'll be treated differently if they admit to not coping. Well, So if we talk about grieving, I would say they grieve the role, right, the role of losing I'm the matriarch on the patriarch and now I'm depending on gent

you know, my son or daughter. And I think similarly for the for us, these are the people that we looked up to, These are the people that raised us. And we start to say, huh, are we changing roles? Where we are the caretaker, and so yes, the grieving and sort of bereavement, I would say, is related to the change in roles that occurs naturally. And I think once we just flow into it and have open conversations about it, it's it's really nice. And then, you know,

because what you said. Older adults in my office say to me, this just happened to me yesterday. Every day they say, I don't want to be a burden to my children. If I haven't finished the sentence, doctor, the biggest, one of the biggest, as I'm worried about getting older. They finished the sentence and they say, being a burden to my children, and I, you know, through tears makes me choked up. But through tears I say to them, this is what we're here for. We we are desperate

to help you out. You did it all these years. We want to help you out. And I try and say them, as their doctor, your family members are here, the people who love you are dying to surround you and help you out. But it's really hard to get our older folks to accept that help. Yeah. I mean, I don't have kids in my own and I don't want to, and I'm I'm living in New York right now. My families in Massachusetts, and I'm sort of living on

both coasts. But I'm like, you know, eventually, I mean, I prefer the East coast, but I'm like, I think I'll move back to New York permanently so I can be closer to my family and as they're getting older. I've never said that out loud to them, you know what I mean. Isn't that funny? And you know, with COVID, a lot of people moved back home, you know, and and start to say, wait, why aren't I staying closer to my parents? A lot of folks, I think think

the way you do and haven't articulated it. And that's okay. And that's why this sentence, you know you've always helped me. I think it's time I helped you out is really affective for the older people I take when they hear that from their sons and daughters, it's really effective that one sentence. If you said I'm going to move closer to you, you'll watch your parents will say, I don't know that worked for you. I don't is that okay? Is that okay? But you just say you've always helped

me out? It's time for me to help you out. We'll be right back. So I wanted to ask you just some like factoids that I got from reading your article. So let's say an elderly person is experiencing some anxiety. It's not that they have an anxiety disorder, but for whatever reason, they're experiencing anxiety. But they're not going to go to therapy necessarily, um because you know, maybe that's just not what they need. What are some like great coping tools? Is it different for seniors than it is

for everybody else? Yes, So you know, we think of coping mechanisms for you and I. We think of support from others, you know, being social, going out or engaging activities. And if I'm an older person, either you know, living in a skilled nursing facility, or I'm not driving anymore, I have limited mobility, you know, limited physical activity, I'm

not surrounded by the people who love me. Those coping mechanisms are going to be much different the way that I approached this conversation with my sixty five and over group who's experienced in some anxiety, instead of saying, hey, get on the headspace appter the aura app because they're gonna look at me like I'm crazy, as I say, we're going to go after this, these these anxiety symptoms

the same way we go after preserving memory. So it's like brain health because older folks are afraid of dementia and memory issues, and we know that anxiety is tied to that. So anxiety disorders are a risk factor for memory and cognitive decline issues. So I'll say to my older folks, here's the multi pronged approach we're going to use to combat some of your anxiety, and it's going to help your brain and your memory as well. So no real magic here, but exercise. So both aerobic and

strength training. That's real, that's not voodoo. And you can be you know, God bless you in a wheelchair and I can find home physical therapy or home occupational therapy is going to give you an exercise regimen. So exercise, both aerobic and strength training. Mindfulness, that word means nothing to my older patients. So you have to say, what

does mindfulness mean for you? How do you have quiet time in your space and your head alone, whether it's you know, prayer, hot bads, candles, what you know, time and nature walking, So mindfulness, whatever it means to them. And then you know, the third thing really is cognitive training, and by that we mean, you know, using your brain in different ways. So coping mechanisms for anxiety in older

patients is really exercise, mindfulness, and cognitive training. Those are the things that have data to show us that they're going to help you lessen your anxieties and m and improve your memory and lower your risk of dimension cognitive decline.

So if you're at home on your own and you're not working with you know, a therapist or some kind of I don't know what someone with the brain, like someone doing cognitive coaching, would that be like doing crossword puzzles or some kind of you know those books they make for people who are trying to get their brain functions exactly, you know, like stroke or something. Right, it's

using your brain in a different way. So if I was an accountant and I was retired, doing my taxes won't count for this, right, So it'll be that's the example I always give. It will be using your brain in a new way. So puzzles, uh, learning basic Italian, joining a bridge group online, you know, something that you haven't done before, So training your mind to do new things you can also do. You know a lot of my older patients, do you know, they do wordle and

they do the games that you can get online. But anything where you're using your brain in your head in a different way, a new way, Like for me, it would be doing something non medicine like learning to play guitar or something like that. That is the that's what the brain loves. So it sounds like it's a lot less about let's figure out where this anxiety came from,

and let's blah blah blah. It's really just seems like it's about strengthening the brain, keeping the body um healthy, but also I guess for the nervous system to keep the keep it out of our bodies, you know, decreased stress, maybe help with blood pressure. It's really more of a physical and kind of brain health and and it's less like emotional anxiety, if that makes sense exactly. So late

life anxiety is really characterized. I mean it's associated with chronic illness, disability, caregiver status, social isolation, things you and I can't change, right, So so we then we say, okay, I mean I never want to sound do me like getting old sucks because it doesn't. But you're dealing with a lot of challenges that lead to some anxiety symptoms. So the obvious things chronic illness, disability, isolation. You're a caregiver.

You and I can't change that for those people. But what we can do is try and improve the way that they can handle or manage those symptoms. And really it sounds so basic and maybe unhelpful, but it's those things we talked about. It's it's whatever your path to mindfulness is. It's exercise, it's cognitive training, it's you know, and again it is trying to increase your social network. That that's a tall order in our older folks, right, I know that's really challenging. You know, it doesn't sound

basic and unhelpful, but I know what you mean. It's it's like that classic simple but maybe not easy, you know, because someone doesn't want to, you know, get started in it.

But I feel like every episode of this podcast it always comes down to these basic things, and in a good way basic, and I think people just need to hear it over and over here in different ways here from different people here, it in different situations, because it's it's almost a stounding to think that these sometimes powerful

feelings we have, whether their thoughts or bodily sensations. It's it's hard to believe there's a solution and that it's like actually doable, and you don't have to be rich, and you don't have to be smart, and you don't have to be in tune with your feeling like you can just anyone can do them exactly. And I will say this because I'm I'm an internist who does write prescriptions.

So it does deserve a conversation that that the you know, the low dose antidepressants, the s s R eyes and sn our eyes are effective in our older folks who have you know, generalized anxiety disorder, excessive worry on on more days than they don't. So we also want to say, look, if these coping mechanisms have failed us, it's not screwy or on your own. We do have you know, medications do help, and and we keep a close eye on our folks who are on a lot of different medications,

but they do help. Cognitive behavioral therapy is sort of a discussion about whether or not it helps in older folks. It looks fair, not not terrific, and my older folks are sort of have been sort of resistant to that. But I have respect for CBT, and I think for our patients who are our older patients who are willing to do what we should do it. But there are options when these coping mechanisms haven't worked, So there are

medications that help. UM. The problem that I see every week again in practice because I take care of families, is someone comes in and goes, you gotta give my mom a medication for anxiety. You gotta give my mom a medication for see, and I always go, wait, wait, wait, let's about start there. But it doesn't mean that I'm dissing it or dismissing it. It just means that the things you and I were talking about, which take time, do work. So we just have to sort of get

people on board. It is not as easy as swallowing a pill um and and again no disrespect to the pills, because they do work in certain people, but we have to start with the hard work, which is what we talked about. Yeah, for sure, And you mentioned that there's an anxiety risk factor for dimension. How does that mean if you had anxiety your whole life, you're more at risk to get dementias? And what that means yes, so

it works both ways. So so anxiety is a risk factor for the development of cognitive decline dementia, and anxiety

is an early symptom of dementia. So the relationship is tricky, but yes, so long term generalized anxiety disorder, you know, we see actual changes in the brain and those changes lead to cognitive decline, which is another reason why I always say to patients treating and by treating, we talked about those coping mechanisms, it doesn't always mean a pell, but treating anxiety is a no brainer because it's going to decrease your risk of cognitive decline. It's just like

any other illness. So we do need to address generalize anxiety disorder in our older folks, just as we do depression, because anxiety does lead to It is a risk, a well described, well known risk factor for cognitive decline and dimension. So if someone never had anxiety but they start having it, maybe in their late sixties, that could be a sign of that they're going to develop um cognitive decline or dementia. Exactly. Whenever I say that, it sounds really terrifying and do me.

But it could be that anxiety is the earliest, you know, we call it a pro drum or the earliest symptom of of memory impairment or cognitive decline could be anxiety. So I guess I would say that not to be doom me, but more to say it needs to be addressed.

So if you're a family member and you see your mom or your dad with anxiety symptoms, irritability, not sleeping, you know, not themselves, you do, we do need to say, hey, maybe we should just pop in and see your doctor and just talk about what I'm noticing or what you're feeling, and see if there's something we can do about it. Yeah. Absolutely, And what about sleep, because I know that the older people in my life, you know, they can't stay asleep

as long anymore. Um, my parents sleeping hours have changed. My mom falls asleep. She might fall asleep on the couch at like ten, but then she's up and then she's up all night, and then falls back asleep at like five in the morning and sleeps in now like sleeps till nine or ten, you know, or they only get four hours of sleep at night and they're like,

my body is just awake. I don't I'm fine, I just sleep less so like if someone is sleeping less or weirder, but otherwise they feel okay, is that cause for concern or is that just as we get older, bizarre things happen with our sleep. So you're you're so good, Jen, So yeah, so sleep sleep architecture changes as we're older. So what you describe so your mom's we say sleep architecture, think about her her sort of pattern during the night.

If that's been her pattern during the night, but she still wakes up feeling restored, that's quote unquote okay, because it's there's no question that in the elderly sleep architecture changes. Disrupted sleep is commonly associated with anxiety, and that is also a risk factor for cognitive decline. Not to again be doomy, but that would be where your mom comes

and says to you. You know, I've I've always been able to get my nice chunks of restorative sleep after I leave the couch and I wake up okay, but lately it's been you know, two hours, and I'm just feeling worn out during the day and exhausted. So if you see a change in that, you know, disrupted sleep pattern, I then it needs to be addressed. And you need to say, hey, mom or dad, could some of this be anxiety? Anxiety the elderly, and honestly in younger folks

as well, is commonly associated with insomnia. And that's why, to add another topic here, it is vexing to see. But what physicians like me do that is wrong is treat our older patients with sleep medications and benzod as Appian's examics and at a van So we can because it's easy, because I can say, I'm going to get Jen's mom to sleep tonight, and I know how to do it, and I'm going to write the prescription. What's hard is talking about trying to do the stuff we

talked about to improve sleep pattern and sleep hygiene. That's hard. Those are long conversations. They take a lot of time time. So physicians we what we do wrongly is prescribed medications for disrupted sleep and anxiety in this population that leads to falls and fall risk and worsening memory. Now I know that if I only slept, if I sleep less than eight hours, I'm a mess. And so I'm just

so tired I can't recover. But you know, again, I've I've heard and seen as people get older like sometimes they just get five hours and they're restored and they're fine. Is that true? I guess. I mean, can they exist on less sleep and it doesn't affect them in terms of like being susceptible to a fall or having irritability or anxiety? It is true? I mean so, so it's what we've always noticed. You know, older folks wake up a lot earlier. They're there, their sleep architecture does change,

and they need less sleep. So you and I might need eight hours of restored to chunks of sleep. That's not going to be true for our older folks. The best way to figure out is how the person feels.

So if I have a seventy two year old who's been sleeping six hours and for the last eight years and says he or she feels great and doesn't have it, you know, it doesn't feel zonked or exhausted during the day or irritable or concentration difficulties, you know where people say I feel like my memory is just shocked when I haven't gotten enough sleep, that sleep disrupted sleep where that's you know, that's a problem. So if people notice they don't feel good when they wake up because they

haven't slept, well, that's an issue. But if they're done five to six hours of of what for them is restorative and they wake up feeling restored, that's okay. That's my one thing about getting older. I'm looking forward to if that happens to me, like that'd be great because sometimes I want more hours in the day. Right, We'll continue the interview on the flip side of a quick

message from our sponsors. So I think we may have covered this with with kind of the coping mechanisms, but just to really spell it out, are there differences or their stark differences and anxiety symptoms of elderly people with anxiety as opposed to a teenager or twenty something you know with anxiety, Yes, quite a bit. So so are older folks first of all, minimize the symptoms and attribute them to a physical illness more often, So they'll come in and say, like, I think it's just my stomach,

but I feel like, you know, my appetites gone. So they'll do that. So we know that older folks just aren't as good as describing their symptoms that are related to anxiety. They minimize their symptoms and they attribute them to a physical illness more often than our younger folks do. What's also very cool is we don't you know, panic disorder panic attacks are associated with anxiety do not really happen in the elderly, probably because of the changes with

our central and peripheral nervous systems. So my twenty year olds coming in with that fight or flight panicky chest pressure, shaking, we don't hear. We don't see that in our older patients with anxiety, So we don't see the Hannock symptoms associated with anxiety that we do in our younger folks. And that's because their nervous systems. Is it just like to put it in a like non medical way, like you just kind of slow down when you get older or what is that? Simply put? Pretty much? Yeah, our

central and peripheral nervous system are different. They just don't respond. There's a lot less panic disorder generally in older patients, and there are younger patients, So it is it's probably, I mean, honestly, it's probably a good coping mechanism that the nervous system just does not respond in the same way, because can you imagine having a seventy two year old who's like, I'm having chess pressure shortens the breath shaking.

We would be going crazy, like it's a heart attack on my God, admit to the e er when it's a twenty year old who can describe to me, you know this happened to me two weeks ago. I'm having a panic attack. Then, I you know, I know that I know exactly what that is. But we just don't see that in older folks with anxiety. So there's some

really interesting differences in the way that they present. I mean, I think you know in our older folks amatic or body complaints related to anxiety or common palpitations, dizziness, vertigo. But the most important thing for family members to remember, and I hope they do remember this, is let us decide, so come in and talk to the doctor about those symptoms. But that's why you can say to your mom, Mom, maybe this is anxiety, but let's just talk. Let's just

list what's going on. You have palpitations, you feel dizzy, Let's just see what the doctor thinks. And we absolutely can't attribute everything to anxiety. I've I've met so many people who are in and out of the are told they had anxiety and they had something else going on. So, so as important as anxiety is, let's make sure that we also ensure there is no underlying medical explanation for

those symptoms. And that's another reason to bring folks into the primary care doctor when when you're noticing changes that in your parents. On the flip side of that, do you think most primary care doctors for elderly patients are trained in the sensitive situation of their coming in and you're really not finding anything physical and you have to suggest maybe this is kind of like a so metical response to anxiety. It's tricky. So it's it is tricky.

I mean, I know that for my colleagues. I'm in a huge practice, and I know for my colleagues, what we always do is become when we say we have ruled out the sinister explanations. You know, your heart looks great, your lungs look great, so we do a reassurance and then we describe for people, you know, because my patients will say, so you're saying this is all in my head. It is, but what you're feeling, the physiologic manifestations are real.

So you really are feeling sweats and vertigo and palpitations, You really are feeling it as a result of this underlying storm, and the storm is is anxiety. So it's the way you approach it because it's I would never walk in and say, this is all in your head, it's anxiety, You've got nothing going on. It's it's about reassurance that there's no other underlying medical explanation, and also just letting older patients know what you're feeling. Those symptoms

are real, they're just triggered. Those are the physiologic manifestations of anxiety. Yeah, I think I think it's really just like only younger people are starting to grasp that where it's like it's in your like, yes, your brain and thoughts are causing these physical things because our mind and body are connected, but it's not in your head like oh, you know, it's not like the eighteen hundreds, like this woman's hysterical. You know, it's like exactly kind of just

wish it away. Yeah, exactly right. If an older person, elderly person does actually want to seek a therapist about anxiety and they've never been before, do you have any advice for what kind of therapists should go. Do you think it should be someone that is practiced in working

with elderly patients. That's a good question. I don't know if I target those working with elderly patients as much, but what I do, so, what we know helps is is cognitive behavioral therapy targeting the uncontrolled and excessive worry, worry. And again I'm not a therapist, i'min interness, but I prefer a ton of my patients, so I have them find start with a cognitive behavioral therapist because we know

that that helps um. And then really most importantly, I look at you know, are there options for telephone or telemed connections, because then that eliminates our older person having to get there, especially if they're not driving. Do they do appointment reminders in between appointments? I also look at that so and of course, of course most importantly do you resonate with the person you're with? But I look for someone who is a common behavioral therapist who can

focus on anxiety. I don't know that I've looked for targeting in the older population, but that's a really good point. And then I look for accessibility. How easy is that person to reach with telephone or telemedicine? Do they send reminders to my my patient in between? Because when it's hard to get in yeah, and it's hard to get on a zoom link or you know, do we have access to telephone? So how much support is there in between those appointments, right if they're like just find me

on the app and they're like, I don't know what. Yeah. Um, And you said that there was some point that I picked up on something you wrote as that anxietily anxiraily. The anxiety doesn't necessarily become more common with age, so it's not like, oh, everyone's getting anxious about getting older. Like that was kind of good to hear. It is good to hear, I know, because we all think, okay,

aging sucks. But the incidents of generalized anxiety disorders actually less a little bit less in the older population than the younger population. And there are a lot of anxiety syndromes that are much less common. You know, specific phobia sort of vanished, with the exception of of fear of falling, social phobia disorder sort of vanishes, panic disorder sort of vantishes, and I don't want to say vanishes. But over the age of sixty five, a new diagnosis of those anxiety

syndromes is really unusual. So a lot of the anxiety syndromes burnout and and don't occur newly in our older folks, and generalized anxiety disorder does, but it's it is a slightly lower incidents than it is in our younger population. You know. I'm also wondering this is more of like a philosophical thought, but I know when I was younger in my twenties, my anxiety and panic were way worse

even in my thirties. And I and when I hear from younger people, UM, there's a lot of like, yeah, yeah, I listen to your podcast, but nothing you say works for me because I don't know what I graduated in a recession or there's you know, the pandemic or what like. There's all these like world problems that that definitely affect.

But there's not a lot of perspective And I don't mean that to sound dismissive, but there isn't that like personal perspective of I've been through blank and blank and blank because they're they're young, so they're ten year ago

memories when they were twelve. But is there something to getting older where um, maybe therapy, whatever the therapy is, whether it's like what you said, Um, they see it a CBT cognitive behavioral therapist, or they do more exercise and do more you know, puzzles and connection with others that it's like a little easier to to wrangle because they're there, even if they're resistant to therapy, Like it's

not something that's been in their life. Do they not have as many like but it's worse for me because like do they have more perspective? Does that help at all? Like, oh, I remember this hard time when I was fifty or when I was thirty year I got to imagine that helps. Yeah, it's got to be And I don't know if that you know, if there are I think you and I

are just guessing on this. But there's got to be something to that, right, There's got to be something that's allowing our older folks to cope or at least say, well, it's not a heart attack and it's not you know, it's not INSI independent diabetes and it's not. So there's got to be something that's allowing them to minimize in a good way, you know, some of the anxiety symptoms or or allowing them to cope. And I just don't

I think it's an unidentified thing. But I think that's exactly why we see that anxiety doesn't necessarily increase with age, is that there's got to be something about perspective and experience that allows you to cope in a way that a twentysomething can't. I think they've endured more and seeing that they can come out on the other end when you're older. And I think also it's perspective exactly right,

it's it's you know, my five. I have many patients who are in their high nineties now, which is which is fun, but they don't, you know, they're just stoked to be able to still see and hear and move around and be surrounded by people who love them. So you know, yes, there's got to be something that that happens with aging that allows you to put all of this into perspective and you've endured so much and come out on the other end, And that's got to be

an unidentified coping mechanism, right. It's almost like a smidge of gratitude that's like just naturally happening. UM. So I was surprised by this that that I had read that you said that UM in your experience, UM, generalized anxiety is more common among women than men. Older women, especially if they're widowed or divorce. I don't know why that surprised me. I think I'm just going to give my

personal anecdotes for why is that. When I was a kid on my street, four houses across the street, four widows who were thriving, and all I did, I didn't go to nursery school. I would jump from widow's house to widows house and like, you know, watch game shows and have tea and all that. And to me, I mean not like they were going to tell me about

their anxiety. I was a kid, But to me, I just remember thinking like, wow, you know, when you're when you're older, you marry a man, he dies first, and then you get this like second fabulous life where you just like do whatever you want. And I always think of women as a little more capable in that sense, right, especially from that generation where they know how to cook, clean,

so take care of things. And I think of men like, oh god, if the wife dies first, Like I'm being funny, but I really mean it, they remarry someone younger, you know, they die right away. They're just a mess. And I'm so I was surprised that the women would have anxiety, because I would think it would be the men because they don't know what they're doing. Totally just generalizing, but I think you're generalizing right, and I'm gonna be I'm careful here because I say this from a place of

love taking care of so many older women. But I believed what you believe, and I think you know, they have older life expectancy. Honestly, they they're coming in, driving their husbands in, you know, they look so much more capable. And then, bless their hearts when they lose their partner, especially if I take care of both of them, and I, you know, of course we grieve it. I say, don't you feel don't you feel slight relief though he is, you know, no longer suffering, And they just look at

me and their purpose is gone. Over and over again. I'm just shocked, you know, and I don't again. I say this from a place of huge love, so I don't mean any disrespect to my older women. They seem so independent, they seem like renaissance women. Their purpose is gone. And it's not just that they don't know how to pay the mortgage aware or how much it is or where the checkbook is, and that does exist in in the older generation, but it's got you know, women feel

things deeply and that's why. And I'm probably because we're some some of us our parents, but I think their purpose in a lot of ways is gone and they just feel like the rug was pulled out from underneath them. And I see that over and over again, and in my older women who I thought would hit the ground running right volunteering at Hydington Library and still playing tennis, and they lose their mate and the rugs just pulled out from underneath them. I don't know what that is,

you know. And again it goes to your mom speaking about hormones and whatnot. And I don't know what that is about us and child rearing or whether it's hormonal. But we women have more anxiety disorders, and as we're older, and it usually is tied to some bereve and loss of a partner. I think it's being alone all of a sudden, and you know, maybe not being as financially savvy. And again, I think the caretaker role in when it's taken away, is a loss for some of my older

female patients. And and I mean, look my male patients fall apart as well, and they lose their female part ors. I mean not to say that they don't, but there is women just struggle with a little bit more anxiety over the age of sixty than men. Anxiety bites will be right back after a quick little message from one of our sponsors. So another thing is you said older adults, there is a something like there could be a substance abuse disorder like that does coexist sometimes in in the elderly.

So depressing because we're seeing an increased rate of that and it's it's honestly, it's our fault, it's physicians fault. So because of the problems we've just been talking about, you know, disrupted sleep and anxiety, we prescribe you know, a lot of benzo diazepines which is exam x valium at a van and opioids for our older folks who

are in pain. And we're actually seeing more opioid and benzodiazepine substance disorders in our older folks, and to usually for anxiety because if someone comes in like I'm stressed, I can't sleep, we're prescribing zanex or out of vant So there is you know, this is true for the for younger folks too, But there is a connection with substance abuse disorders and anxiety and the elderly, and sadly it's increasing rather than decreasing because we are free to

write prescriptions. I mean we freely write them, I think because it's easier to do that than to talk about what we've spent time talking about, which are those tools for coping. So it's a it's an US problem. And um, there's no question that we're seeing in increased risk of of elderly folks being treated for substance abuse, and usually it's prescription medications that we've given and often in response

to some anxiety symptoms and disrupted sleep. So that's could be something for children of elderly people to keep an eye on, you know, if there is, if they are talking to their parents about sleep and their doctors a little bit, you know, script happy, it's like maybe just you know, just being aware of that that that they don't even want to start to go down that road,

that sense please keep an eye on it. And it's you know, that's and it's again when we talk about keeping an eye on it, I want to make sure that that people know I'm fine. A family members write a little note, send an email, wait in the waiting room to see if they can just talk to me quickly after I'm in the room with their mom or dad. So you can do that and it's not annoying or disruptive. And because we see someone for a very quick snapshot in time in the office, and what you see jen

with your mom and dad is much more helpful. We don't mind input from family members, So I want people to know that I don't care if you pass me a little note or you talk to me in the hallway you say, can I have two minutes after you've done with my mom or dad. It may feel like we're rushed, and sometimes we are, but it's that is

really helpful. And I think for for family members knowing their yeah, the medication list of their parents, because their parents might not know I'm taking I'm taking Xanax every night to sleep and it's been working great, and it's good for us to keep an eye on that us

his family members. That's good to know that that some doctors are amenable to that, because you know, it's like you could come into the room and talk to the doctor and behalf of your mom for two minutes and and be like, oh, do my mom do that thing where she made fifty jokes? Yeah, she does that, but actually that's because she's um needs to look perfect in front of doctors. But really what she told me is

every night to cyperventilating. So it's needs you no, no no, you know, it's like but just a reslope, you know, when someone barging in, like you don't know what you're doing, you know, but it's like to give information that normally we think of like that's confidential, but it seems like that could be important the way again you would take care of a kid in a way so important, and I think it goes back to respecting your mom or

dad's independence, but giving helpful information. It is so important for for memory issues, for you know, anxiety behaviors, you're saying, for depressive behaviors. You're saying, it's so important for us to hear from family members because what we're getting in the twenty minute visit in the office isn't always the full story. So it is it's imperative that family members weigh and if they feel like there's something wrong, and any physician who seems irritated by that, find a new physician.

Well that's perfect advice to end on. Thank you so much Sharon for doing my show. This is gonna be really helpful. I hope everyone who wrote in about this topic is full of new information. I know that I am for sure. Hi, I hope you enjoyed my talk with Sharon Orange, Dr Sharon Orange. So let's look at some of the takeaways, and these again are up as

always on my website. You can click the link in the show notes or go to Jen Kirkman dot com and then you can just click on Anxiety Bites from there and you can read along or board it to someone whatever you want to do. But here are the big takeaways to remember from this episode. So only one in five elderly adults will bring up the topic of mental health on their own in any conversation with a

health professional. Some older people don't want to admit to having anxiety because they're afraid that their families will lose faith in them if they see that they're not coping. The biggest mistake that younger people or middle aged people can make when addressing anxiety and their elderly friends or relatives is trying to help but not respecting the independence

of their elderly friend or relative. The conversation must be approached with patience and compassion, rather than trying to control the situation by declaring you have anxiety. That's probably a good rule of thumb when talking to anybody of any age. Really, a way to bring up a conversation about mental health with the older adult in your life is to focus on any changes you've noticed and start there. Some examples are, you don't seem like yourself, you seem more tired than usual,

you seem irritable. I noticed that your sleep has been disrupted. It's important for children of elderly parents who have anxiety or depression to approach the conversation by reminding them that anxiety and depression is like any other health issue. There are treatments available, and let's go talk to a doctor about it. And you can start by talking to an internist. You don't have to start with a psychologist or psychiatrist.

If the doctor is as great as dr Share an Orange, then they should be able to point you in the

right direction. And it may not even be that the elderly person in your life needs to go to traditional therapy, but it may be other things that they need to start doing, whether it's learning how to delegate more and let their children do things for them and really understand and hear their children that it's not a burden, you know, whether it's they need to do more puzzles and mind exercises, or expand their social circle in any way that they

can that's safe for them, but it doesn't was involved cognitive behavior therapy and talk therapy the way that the anxiety that younger and middle aged people have UH tends to need that in order to help people get out of the underwater feeling that they're in. When talking to older adults about anxiety, as opposed to younger people, the

focus should not be on just feelings. The focus needs to be changed to trying to figure out some objective problem solving like running errands are simply letting parents know that you're there to help, after all, they took care of you for so long. Coping mechanisms that help with anxiety and older adults will differ than ones that younger adults will use. For example, an older person may live in a nursing facility. They may not be able to drive, anymore.

They may have limited mobility or limited physical activity, which of course will impact what kinds of exercises they can do to decrease anxiety. So coping mechanisms for anxiety and the elderly involves more concrete tasks, like working to improve memory things related to brain health. Older adults are afraid of dementia and memory issues, and oftentimes their anxiety is

simply tied to that. Approaching the elderly with solutions like an iPhone app for mindfulness may not have the same impact as it would on someone younger, but offering for an elderly person to have some quiet time or time for prayer, hot baths time, and nature walking this can help and get the same results without having to discuss mindfulness or some kind of app on a phone that

they may not have. Another way that elderly people can cope with anxiety is by doing some cognitive training like doing puzzles, joining a bridge group, any group online, learning a new language, even doing something quick and simple as doing wordle every day. A lot of anxiety and older people is tied in with chronic illness, disability, caregiver status, social isolation, things that younger friends and family members really have no control over changing. Anxiety is a risk factor

for the development of cognitive decline and dementia. Anxiety is an early symptom of dementia, which it does not mean that because you have anxiety, you will have dementia. Although insomnia is a symptom of anxiety, many elderly people just need less sleep. The focus should not be on how many hours that they're getting of sleep, but more about is their sleep restorative, how is their sleep pattern or

their sleep hygiene. If they're waking up feeling alert, not exhausted, but they're just getting less hours of sleep, that's not inherently a symptom of anxiety. Older adults tend to minimize their anxiety symptoms and attribute them to a physical illness, like something's wrong with their appetite, and they're not as adept as described in describing their emotional feelings of anxiety when talking to a doctor. Panic disorders and panic attacks are less common in the elder due to changes in

our central and peripheral nervous system. That's kind of a relief. Anxiety does not become more common with age, simply because there are things to worry about, like mortality and illness. Generalized anxiety disorder is less common of a diagnosis in the older population than in the younger population. Specific phobias seems to kind of vanish, like a social phobia, for example, or a panic disorder. Over the age of sixty five, A brand new diagnosis of any of those kind of

anxiety syndromes is unusual. There is an increased rate of medication addiction in the elderly, so it's important to keep an eye on your parents and talk to their doctor about any unusual behavior or signs of addiction that you may see. Again, you can learn more about Dr Share and Orange by clicking the link in the description and the show notes. You can learn more about me by

doing the same thing. You can leave a comment on social media at Jen Kirkman on Twitter and also on Instagram, and you can check out the fun little audio grams that I put up from every episode. They are available as well on my YouTube channel. Again, all of this is in the link in the show notes. And I think that's all I'm going to leave you with today.

Just remember anxiety Bites, but you're in control. For more podcasts from my heart Radio, visit the I heart radio, app, Apple podcast, or wherever you listen to your favorite shows.