October is mental health awareness month.
Today’s blog is about anxiety in older adults.
Guest Author: Monica Freund Kaufman, PharmD Candidate 2023
Anxiety affects approximately 10-20% of adults over 65. Symptoms of anxiety include shakiness and a panicky feeling, difficulty breathing, sweating, dizziness/lightheadedness, muscle tension, fatigue, digestion problems, nausea, and chest pain. There are many causes for anxiety, but there are definite strategies to use to decrease these feelings.
Medications and Medical Conditions That Cause Anxiety
Sometimes anxiety can be a side effect of medications. Corticosteroids (dexamethasone, prednisone) used for arthritis, asthma, and allergies, can cause symptoms of anxiety. Similarly, asthma medications such as albuterol, salmeterol (Serevent Discus), and theophylline can make patients shaky and panicky. Anti-seizure drugs like phenytoin, and Parkinson’s drugs (levodopa/carbidopa) are also culprits. Make sure to talk to your doctor or pharmacist if you feel these side effects from medication.
Medical conditions such as angina (chest pain), arrythmias (abnormal heartbeat), multiple sclerosis, irritable bowel syndrome, hyperthyroidism, liver failure, hypoglycemia (low blood sugar), and disturbances in electrolytes in your body can also lead to anxiety.
Activities and Habits That Alleviate Anxiety
So what to do? It is preferred to work on factors we can control in our lives to prevent anxiety in the first place rather than jumping straight to medication. Some non-medicine strategies include:
- Relaxation technique
- Breathing exercises, mindfulness, meditation, massage, yoga and Tai Chi are great.
- Physical activity
- Even a few minutes a day of walking or upper body exercises for wheelchair-bound seniors can make you feel a lot calmer. Yoga and tai chi are gentle exercises that also calm the mind.
- Social interaction
- Senior centers are fantastic places to meet others and decrease social isolation. There are often lots of planned activities like lectures, book clubs, trips, art therapy, dance, live music, and playing card or board games that are great ways to unwind and connect with others.
- If homebound, reach out to friends and family on Facebook, Skype, Zoom or FaceTime. Playing online games is fun, and a way to feel less isolated.
- Pursuing hobbies
- Knitting, woodworking, painting, puzzles, crosswords, Sudoku, and trivia are great ways to keep busy.
- Good sleep hygiene
- As we age, our sleep schedules change, meaning we sleep less, have trouble falling asleep and/or wake up in the middle of the night. Some medical conditions cause us to use the bathroom during the night. It is normal to sleep less.
- Making sure your bedroom is cool and dark, with no TV, refraining from using the computer or your phone for an hour before bedtime can help with sleep disturbances.
- Having a pad of paper on your bedside table can help reduce anxiety at night by jotting down things to do tomorrow, thoughts, or intentions, in order to get them out of your thoughts and be able to relax.
- Good nutrition
- Older adults often have a decreased appetite. This could very well be a side effect of certain medications. Talk to your doctor or pharmacist if you’re concerned about appetite loss.
- It is very important to eat balanced meals, with fruits and vegetables for fiber and vitamins, to ward off weight loss, anemia, weakened bones, weakened immune system, vision and cognitive changes, and to prevent constipation. If preparing meals is challenging, there are meal services online that provide pre-cooked balanced meals that just require reheating. Some services are Fresh N Lean, Cook Unity, and BistroMD among others.
- Meals on Wheels is a great way to get prepared meals and also have the opportunity to chat with the delivery person every day, Monday-Friday.
- Limit alcohol and caffeine
- Caffeine and alcohol can increase anxiety. Best to use in moderation.
Medications That Treat Anxiety
When non-pharmacological options don’t work, the first line treatment for anxiety is a class of medications called SSRIs. Examples of these are sertraline, citalopram, and escitalopram. With the latter two medications, it is important to be on a low dose because it can affect how your heart beats (QTc prolongation). It is not preferred, but if needed, a short course of a benzodiazepine (lorazepam, temazepam and oxazepam) can help with acute anxiety until the SSRI is fully effective. Older adults should not be on a benzodiazepine for a long time because of the increased risk of falls, sedation, lower breathing rate and it can build up tolerance and dependence. Non-pharmacological options listed above actually prevent anxiety, whereas a benzodiazepine is a limited option to alleviate the underlying problem.
Your doctor will decide the best medical option to treat anxiety that interferes with activities of daily living. Be sure to ask your doctor or pharmacist if any of your current medications or health conditions are causing anxiety. Advocate for your best interests, and be Wise and Well!
I think it’s really wonderful that anxiety in older adults is being addressed in ways that don’t require them to take additional medication on top of all of the other ones they already have to take. I think alternatives like yoga or painting and doing puzzles are wonderful alternatives that also give older adults the opportunity to stay active, create and connect with others through having similar hobbies.