Feeling anxious?

Age and anxiety sometimes go hand in hand. Hema Vijay on how the elderly can lead a stress-free life

Growing older and feeling increasingly anxious as each day rolls by? Well, you are not alone. Studies indicate that Generalised Anxiety Disorder (GAD) may be the most common mental disorder among the elderly. Social anxiety disorders, panic disorders, obsessive-compulsive disorders and phobias are other anxiety disorders elders are vulnerable to. Many older people don't seek treatment for anxiety, assuming it is part of the process of aging. But since anxiety seriously impacts the quality of life, treatment can make a world of difference. The difficulty lies in distinguishing between normal age-related anxiety and anxiety disorders, but qualified psychiatrists, neurologists or geriatricians will be able to identify the condition.

Unsuitable treatment

While seeking medical help for anxiety, many elders make the mistake of approaching a general or family physician, who often prescribes medication that's unsuitable. Worse, some elders resort to over-the-counter anti-anxiety drugs. “This can accentuate anxiety problems in the long run. Elderly persons can get addicted to some medication, and withdrawal from it can cause depression too,” warns Dr. S. Yogaraj, senior consultant neurologist, Apollo hospitals.

Anxiety can manifest itself in the form of physical problems such as irritable bowel syndrome, excessive sweating, belching, skin eruptions, an aggravation of psoriasis, hand tremors, attacks of wheezing, palpitations, aggravation of blood pressure conditions, lack of sleep and talking incessantly about a somatic problem. “We all have vulnerable body parts and these get impacted the most, when a person is experiencing anxiety,” says Dr. Lakshmi Vijaykumar, psychiatrist and founder, SNEHA, an organisation that works to prevent suicides.

Physical manifestation

Constant worries that are difficult to control, and physical symptoms such as fatigue and headache may accompany GAD. Phobias can be recognised when those gripped by them show severe and excessive fear of a place, thing, or event. Panic attacks of extreme anxiety and fear are of sudden-onset and short-lived (lasting less than 30 minutes) and may be accompanied by chest pain, shortness of breath, nausea, and/or other physical symptoms. “Panic attacks and heart attacks may have similar symptoms; so seek emergency medical attention to rule out a heart attack,” warns Dr. Lakshmi warns. Obsessive-compulsive disorder (characterised by undue repetitive actions such as repeated checking of doors or washing of hands) gets worse with age, informs Dr. V.S. Natarajan, geriatrician and recent Padma Bhushan Awardee.

Anxiety may be a stand-alone symptom. But, it is often associated with depression and physical illness. It can also be an early symptom of Alzheimer's or other dementias. So, if a person exhibits signs of anxiety, look for underlying or associated issues. “There is also a higher chance of anxiety or depression occurring in the surviving spouse in the year following the death of a spouse,” says Dr. Lakshmi. Retirement from one's job or children moving out of the home can cause anxiety in elderly persons.

Finally, here is something for younger people to think about. Joint pain, constipation even if for a day, problems with digestion… all these may seem monumental for an elderly person and may even lead to further symptoms. It could raise questions like “Will I continue to be independent?” or, “Am I a burden?”

Youngsters may laugh at this, but in an elderly person, these are neuro-psychological symptoms. Elaborates Dr. Lakshmi, “To understand, think of the somatic reactions you had before writing a crucial exam, especially one you were underprepared for. Also, elders constantly have underlying thoughts about death, and how the end is going to be. In the West, the fear of death is prevalent among senior citizens. But in our country, it is more of a wish for a problem-free death, rather than fear of death per se.”

Fight fear

* Alcohol and some kinds of medication can aggravate anxiety; so have your medication evaluated.

* Staying physically active is crucial, even if you have cardiac, lung or other problems.

* Some older people, especially those living alone, neglect their nutrition out of laziness or disenchantment but, actually, older people need good nutrition.

* Many elderly people sleep less, wake up early and become restless. Practising good sleep hygiene helps. This involves going to bed at a particular time, eating meals an hour-and-half before bed time, and drinking a glass of hot milk after dinner. Good sleep by itself will improve the quality of life and reduce anxiety. But as older people need just three to five hours of sleep a day, don't fret if they don't sleep like you do.

* A daily schedule of yoga, meditation or such calming exercises can provide great relief.

* Keep occupied, as worries occur mostly when you have nothing to do.

* To feel useful/active in society, participate at least once a week in social/philanthropic activity.