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I'm Dr. Regina Koepp. I'm a clinical geropsychologist, which means that I'm a psychologist who specializes with older adults and families. And this is the Psychology of Aging podcast, your "go to" resource for Mental Health and Aging.

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May is older Americans month, and may is also Mental Health Awareness Month. It's like the universe made a month just for me, because also in the month of May, is my wedding anniversary, Mother's Day and my birthday. So I think the universe kind of planned for me to be born in May because or planned for me to have a career focused on Mental Health and Aging. And that's what all episodes in May will focus on Mental Health and Aging. So today I'm going to talk about anxiety and aging. I've done quite a few episodes on depression. And so I'll be linking to some of those episodes on depression. But today, I'm going to focus on anxiety because anxiety and depression kind of run neck and neck for the most prevalent mental health conditions among older adults.

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I want to start by sharing a really important message, that anxiety is highly treatable in older adults. We have this common misconception that older adults can't change that older adults are stuck in their ways are rigid and stubborn. And that is totally inaccurate. And also that belief is actually quite harmful. Because if we believe that, then when we notice signs and symptoms of mental health concerns and distress, or not going to reach out to older adults, to encourage them to seek treatment, when treatment could actually be incredibly beneficial. So today I'm going to review the basics on anxiety among older adults. Anxiety is not normal with aging, and can can be effectively treated by mental health professionals. Unfortunately, anxiety in older adults often goes undetected and untreated because of this false belief that we have that it's normal as we get older, to have a mental health condition when mental health conditions are actually not normal in older adults, and are generally highly treatable in older adults. And that goes for anxiety. Anxiety, is highly treatable, and older adults say it with me, anxiety is highly treatable in older adults.

2:53
Today I'm going to talk about what is anxiety? What causes anxiety, what are the signs and symptoms? What happens if it goes untreated? What kinds of treatments are available? And how do you go about finding treatment for older adults with anxiety concerns and anxiety disorders?

3:11
What is anxiety? Of course, you know, there is some low level of anxiety that's kind of typical with the human experience. And especially with aging. So we we might be experiencing losses or health issues, concerns maybe about end of life transitions in life. And some anxiety is actually adaptive, and part of the emotional fabric of our emotional experience. And so, most of the time coping with these transitions, even if there is some anxiety, low levels of anxiety, it doesn't necessarily impair our ability to function or cause significant distress. And then there are times however, that anxiety intensifies and lasts and causes impairment to functioning. And that's more like excessive anxiety and worry that causes distress or interferes with our daily activities. Like I don't want to go to the grocery store anymore because I'm afraid of falling or having an incontinence accident. Or I don't want to leave my house because I'm worried I might embarrass myself, or I'm going to withdraw from my friends more often. Or I have a lot of fear about getting sick or a lot of fear that something bad is going to happen. And that interferes with our day to day activities. And that's when anxiety becomes problematic at kind of clinical levels. And when mental health care is actually really essential. In a few minutes I'll tell you what happens when anxiety disorders go untreated in older adults, so stick with me.

5:10
There are several different types of anxiety disorders: Agoraphobia is one. panic disorder is another generalized anxiety. Another specific phobias or anxiety disorders, and social anxiety disorder, which is also called social phobia are all anxiety disorders. And of course, older adults can experience any of these disorders.

5:40
Instead of diving deeply into each of the anxiety disorders, I am going to describe generally what the signs of anxiety in older adults are. And it's really important to be aware of these signs in older adults, because it will help older adults to access treatment sooner. Because the earlier anxiety is identified and addressed, the easier it is to reverse the symptoms. So here are some signs of anxiety in older adults, excessive worry or fear, refusing to do routine activities or being overly preoccupied with routine, like so rigid that the person if if their routine is changed, it's very upsetting. Avoiding social situations, being overly concerned about safety, having a racing heart, shallow breath, trembling, nausea, sweating, poor sleep, experiencing muscle tension or feeling weak and shaky, hoarding or collecting things, and self medicating with alcohol or other maybe CBD or marijuana cannabis.

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So how common is anxiety among older adults? A 2011 study from the International Journal of geriatric psychiatry found that more than 27% of older adults under the care of an aging service provider, so that could be like a home health agency reported significant symptoms of anxiety that didn't amount to a diagnosis, but caused distress and affected functioning. When we start to look at anxiety disorders in older adults. Studies show that 1.2% to about 15% of older adults meet criteria for anxiety disorders. And what was most surprising to me was that agoraphobia, was found to occur most frequently among older adults, at 4.9%.

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Agoraphobia is the fear of being in situations where escape may be difficult or embarrassing, or help may not be available in the event of panic symptoms or other embarrassing symptoms, like a fear of falling or a fear of incontinence. And this fear is out of proportion to the actual situation, and last generally six months or longer and causes problems and functioning. And so that studies show is the most common anxiety disorder among older adults, even more common than generalized anxiety disorder, which I thought would be the number one anxiety disorder but I was wrong.

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So what causes anxiety in older adults? while we don't know the exact cause, there are some experiences that can increase our risk for developing anxiety in older adulthood. And I'm going to break some of these down. So chronic medical conditions, especially medical conditions that affect our breathing and our heart, like a chronic obstructive pulmonary disease, heart disease, like arrhythmias and angina, thyroid disease, diabetes. Overall feelings of poor health could increase our risk for anxiety, sleep disturbance, side effects of medications like steroids, antidepressant stimulants, and even inhalers like albuterol. Our anxiety also could be increased when we're using alcohol or prescription medications, like we're abusing them really have having more physical limitations in our day to day functioning and using home health assistance that has been shown also to increase the risk of having an anxiety disorder. And remember about a agoraphobia like worried that you're going to have a fall or incontinence if you're in public fear of embarrassing yourself out of out of proportion to what the likelihood is. stressful life events could increase our risk for anxiety. So imagine all the transitions that older adults go through having being more vulnerable to medical problems and, and more transitions with like stopping driving or losing a spouse or losing an adult child. All sorts of stressful life events. And then negative or difficult events in childhood, like did you experience childhood neglect or maltreatment, trauma, and those sorts of things, all of those experiences can increase our risk for anxiety.

10:40
I do want to make a note about anxiety and depression, anxiety and depression commonly go together in older adults, they commonly co occur. And older adults experiencing both anxiety and depression often have more severe symptoms of depression and more severe symptoms of anxiety. And this is why it's so important to talk with providers, medical providers, mental health providers about the mental health experiences of older adults. Because if you're living with both anxiety and depression, or your loved one is living with both anxiety and depression that is very distressing. And I'm going to talk a little bit about what happens if it actually goes untreated. But without getting treatment, people are suffering when they don't have to be because treatment is highly effective for depression and highly effective for anxiety.

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What happens if anxiety is not treated in older adults? When anxiety is not treated with older adults, there are actually poor health outcomes. So a person is more likely then to have a cognitive impairment or dementia disorder, they are more likely to have worse medical experiences like or illness or stay sick or longer, or lose functioning faster. They're going to have a diminished quality of life. And here's the other thing, it doesn't only affect them. It affects the people in their lives too. Caregivers tend to be more stressed when older adults are more stressed and anxious. The same is true for depression. Caregivers tend to have more stress when their loved one is depressed. But here's the good news.

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Anxiety is highly treatable in older adults, and the earlier we can identify it and address it, the easier it is to reverse the symptoms and the better quality of life for the older adult and their family. So the most effective treatments for older adults with anxiety include a combination of talk therapy and medications. You know, talk therapy might include what we call cognitive behavioral therapy, others might use an integrationist approach where they might use cognitive behavioral therapy and other methods as well. And then there's medications. And some older adults don't want to use medications because many think, well, I'm already on too many medications, or I don't want to experience all those side effects. And that's okay. Often, when I meet with families or older adults, I'll say well, let's start with talk therapy and see how it goes. And then we can always return to the conversation about medications if we're not seeing the benefits that we're hoping for. But oftentimes, we do see the benefits. And so medication might not even be needed. So don't let medication and the side effects of medication be a barrier to you get treatment if if you're experiencing distress- talk therapy is highly effective. And we know that because we do research on it. And we see what the outcomes are. Of course, I can't tell you which treatment will be right for you, just on a podcast. But I highly recommend that you meet with a mental health professional to identify what's happening for you like to help identify if you are indeed living with a mental health condition like anxiety or depression or substance use disorder and identify what what the condition is and then what the recommended treatment is, so that you can start to get better.

How to talk with older adults about getting mental health care
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Alright, if you are noticing signs and symptoms of anxiety and your older loved one, please don't ignore them, instead lean in and share your concerns and help your older loved one get connected to mental health care. You could start by talking with your loved one about what you've been noticing. be straightforward and be compassionate and concerned. So I have a couple of ideas I want to share with you. I've been noticing that you haven't been yourself lately. You seem to be more worried and restless than usual. I'm concerned about you. Have you noticed that Or how about this one? I'm really worried about you. Can we talk about what you're experiencing? If you aren't comfortable talking to me, can I help you get in touch with somebody who are comfortable talking to you? Or here's a third, it seems like you're going through a really hard time, how can I help you find help. And I like this last one, because you are suggesting a solution that we know actually is effective. getting help.

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If your older loved one is experiencing anxiety, it's also important to encourage them to see their primary care provider to rule out any medical concerns that could be causing anxiety, or medication interactions, like we talked about earlier. You could also offer to join them at the appointment. And if they're open to it to talk with their provider about what you're noticing as well. Sometimes family members are the first to notice when something is off or their loved one is distressed. Older adults really fear being a burden on their families. And so they might withhold I have worked with many, many older adults who will withhold from their family, their deep feelings of anxiety or depression or sadness loss, even suicidal thoughts, because they don't want to be a burden to their family. And this is where mental health is so helpful is that it gives an older adult another place to really reveal what's happening deeply within them.

16:36
So the third then is to help older adults get connected with a mental health provider who specializes with older adults. And this leads me to my very special exciting announcement about the Center for Mental Health and Aging.

Introducing the Center for Mental Health and Aging
So I have been working tirelessly over the last several months to build the Center for Mental Health and Aging, so that you have a place that you can go to online for the mental health care of older adults. Our mission is to improve mental health care for older adults by providing education like to help you understand what's typical with aging, what's not typical when to be concerned, especially as it relates to Mental Health and Aging, and then to get you access to mental health providers. Because one of the most significant reasons that older adults do not get the mental health care that they need is because lack of access to mental health providers. And so we want to change that we want to be sure that any older adult who needs mental health care can get it. You can learn more at www.mentalhealthandaging.com

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Are you a licensed therapist, psychiatrist or neuro psychologist who specializes with older adults, I would love for you to have a profile in the mental health and ageing provider directory, I would love for you to join me in the movement to make mental health care for older adults and caregivers easier to find. Together we'll build the largest geriatric and the only geriatric mental health provider directory in the nation. Let's make it easier for older families to get the mental health care that they need. By helping them get access to you to be the first to know when this provider directory is available. Go To www.drreginakoepp.com/facts And that will take you to download a guide which is the five must know facts when you're working with older adults. If you go, if you go there and download that guide, you will be the first to know when the provider directory is available. And I cannot wait until the Center for Mental Health and Aging is launched. I'm counting down the days, I cannot wait. So head on over to my website www.drreginakoepp.com/facts . And you'll be the first to know, let's make it easier for older families to get the mental health care they need by helping them get access to you.

Are you a licensed therapist, psychiatrist or neuropsychologist who specializes with older adults?
17:44
Are you a licensed therapist, psychiatrist or neuropsychologist who specializes with older adults? I would love for you to have a profile in the Mental Health and Aging provider directory. I would love for you to join me in the movement to make mental health care for older adults and caregivers easier to find. Together we'll build the largest geriatric and the only geriatric mental health provider directory in the nation. Let's make it easier for older families to get the mental health care that they need. By helping them get access to you to be the first to know when this provider directory is available. Go To www.drreginakoepp.com/facts and that will take you to download a guide which is the five must know facts when you're working with older adults. If you go if you go there and download that guide, you will be the first to know when the provider directory is available. And I cannot wait until the Center for Mental Health and Aging is launched. I'm counting down the days. I cannot wait. So head on over to my website www.drreginakoepp.com/facts and you'll be the first to know let's make it easier for older families to get the mental health care they need by helping them get access to you.

Subscribe & Leave a Review
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That's all for today. If you like this episode, I would really appreciate a subscription wherever you listen to this podcast and a review. And here's why you can join the movement to because the more people who subscribe and leave a review for this podcast, the more the podcast algorithm sends this podcast to other people who might be looking for similar things. And this begins to spread the message around Mental Health and Aging or mental health care for older adults. I can't do this by myself. I really need your help. together. We can do this. Together we can address the mental health crisis for older adults and their families. I'll see you next week. Same time, same place. Lots of love to you and your families. Bye for now.