Heart pounding, hyperventilating, thoughts racing, and a sense of impending doom sitting heavily on the chest. Is anxiety always like that? It can feel like it. But in an older individual, anxiety is rarely that simple.
What does anxiety look like?
The American Psychiatric Association defines anxiety as the “anticipation for future threat”. On its own, anxiety is completely normal. Most people have experienced it. If you remember lying awake in bed the night before an exam or a big presentation-- that’s anxiety. But taken to the extremes and for an extended time, anxiety can become a disorder.
There are familiar symptoms of anxiety. It can feel like your heart is threatening to beat out of its rib cage. Your pulse races as fast as the fluttering of a hummingbird’s wings. You gasp for air but there’s never enough to fill your lungs. There’s a heaviness over your chest and it feels like something is terribly wrong.
Most know this feeling. Or, at least, most can look at this and agree to call it anxiety. So, why is anxiety under-recognized in the elderly? 
Hidden signs of anxiety
The usual symptoms of anxiety are due to the body’s stress responses to a perceived future threat. In elderly individuals, it’s harder to see these stress responses. Older individuals also have other conditions that mimic symptoms of anxiety. So, when sleuthing for the hidden signs of anxiety, what should be on the checklist?
Go with your gut.
Exposure to stress hormones, as seen in states of anxiety, can modify the “brain-gut-axis”. That’s the two-way street that connects your emotional state and your gastrointestinal tract to each other.  Higher psychological distress is associated with more gastrointestinal symptoms in older adults. 
This may manifest as stomach cramps or heartburn. Sometimes, it comes with bloatedness that won’t go away. A change in bowel habits can also herald an increased amount of stress. Even being more gassy than usual. 
Other signs you’re sleeping on.
Sleep can elude the elderly when they’re feeling anxious.
Anxious seniors can lie awake in bed for longer than 30 minutes, unable to sleep. Often, this condition can mix with persistent worrying about the day ahead or the day that passed. When they do fall asleep, they can also find it hard to stay asleep. They are often awakened in the middle of the night or early in the morning. This leads to being rather sleepy the next day. They might end up compensating for the sleepiness by taking long naps to catch up on sleep debt. They can also begin to use more sleep medication to get through the evenings.
What was that again?
Worrying also makes it hard for older individuals to concentrate on a certain task. When anxiety and high stress levels abound, it is harder to follow a simple conversation. This difficulty concentrating can predict the severity of anxiety disorders. [5,7]
This symptom is often discovered during school or work where concentration is necessary. It is harder to notice this in those who are retired and don’t go out as often. The isolation that many elderly people deal with can mask these symptoms. 
Worry warts and all.
Anxiety can feel like the person can’t control their worries. They can’t reign these fears in and assuage themselves that things will work out. It, instead, spirals out like a turbulent and persistent typhoon. It can even feel like they can’t control their lives. Or, they often worry that something terrible is going to happen-- even if they can’t put a finger on what it could be.
Like other symptoms, this is harder to notice in retired seniors who may be in nursing homes. They may not have as many freedoms as they did while living alone and they may not be able to socialize as much as they used to be. Thus, their concerns may be dismissed as normal or age-appropriate.
That’s “knot” all.
Anxiety can build a home in sore muscles. Specifically, they build knots and areas of tension which can grow in number and severity. [5,8] These aches and pains can run along the back. If they rest on the crook of the neck or at the base of the head, this could lead to headaches. Tension headaches are found more often in those with anxiety. 
Ways to calm them down?
Identifying the unseen symptoms of anxiety is just the first step. What do you do now that you know what you’re dealing with?
Talk to them
Humans are social beings, after all. Talking can be one of the most reassuring practices of care that one can get from another person. But in anxiety, there is a specific way of talking. There is also a specific way one shouldn’t talk.
It’s easy to sense the frustration in the voice of someone talking to you. A harsh and snappy tone communicates impatience and general negativity. This can exacerbate feelings of anxiety instead of dispelling it. 
Instead, use a neutral tone. Speak in clear sentences or words, so this could be easy to follow for anyone. When giving instructions, keep it at a steady pace of one instruction at a time. 
Keeping the time you spend with older individuals makes you a stable and positive presence in their lives.
I like to move it, move it
Create a regular routine that involves exercise. I’m not talking about doing cartwheels on people who could get a hip fracture just thinking about it. But, both sports and dance can reduce the amount of anxiety felt by older people.[11,12] So, this is good to keep in mind when dealing with anxiety.
Easier said than done-- especially when your mind is running at a pace of 60 miles per hour. But, there are specific things to do to induce relaxation.
I’m talking about progressive muscle relaxation. That is the act of tensing a muscle group, holding that tension for a few seconds, and then releasing it. It can lessen anxiety, lessen muscle tension, lessen the time it takes to fall asleep, and the number of times woken up from sleep. It even helps with headaches! 
Make this a regular part of life, especially before bedtime.
Seek medical advice
The reality is that the longer a person lives, the more medical conditions they can have in a lifetime.  Having more medical conditions can translate to taking in more medicine.  Many of these conditions and medications can mimic the symptoms of anxiety. Seeing a medical professional can help determine and treat other causes of anxiety. 
In the end, there are many subtle symptoms of anxiety in older people that we may not notice immediately. But, there are also many things we can do to ease this anxiety and bring peace to an otherwise tumultuous mind.
- Phillips, KA. Anxiety Disorders. In: Diagnostic and Statistical Manual of Mental Disorders (5th Ed.) Washington DC: American Psychiatric Association; 2013: 189
- Bryant C, Mohlman J, Gum A, et al. Anxiety disorders in older adults: looking to DSM5 and beyond... Am J Geriatr Psychiatry. 2013;21(9):872-876. doi:10.1016/j.jagp.2013.01.011
- Konturek PC, Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. J PhysiolPharmacol. 2011;62(6):591-599.
- Ganda Mall, JP., Östlund-Lagerström, L., Lindqvist, C.M. et al. Are self-reported gastrointestinal symptoms among older adults associated with increased intestinal permeability and psychological distress?.BMC Geriatr 18, 75 (2018). https://doi.org/10.1186/s12877-018-0767-6
- Segal DL, June A, Payne M, Coolidge FL, Yochim B. Development and initial validation of a self-report assessment tool for anxiety among older adults: the Geriatric Anxiety Scale. J Anxiety Disord. 2010;24(7):709-714. doi:10.1016/j.janxdis.2010.05.002
- Leblanc MF, Desjardins S, Desgagné A. Sleep problems in anxious and depressive older adults. Psychol Res BehavManag. 2015;8:161-169. Published 2015 Jun 11. doi:10.2147/PRBM.S80642
- Hallion LS, Steinman SA, Kusmierski SN. Difficulty concentrating in generalized anxiety disorder: An evaluation of incremental utility and relationship to worry. J Anxiety Disord. 2018;53:39-45. doi:10.1016/j.janxdis.2017.10.007
- Pluess M, Conrad A, Wilhelm FH. Muscle tension in generalized anxiety disorder: a critical review of the literature. J Anxiety Disord. 2009;23(1):1-11. doi:10.1016/j.janxdis.2008.03.016
- Mercante JP, Peres MF, Bernik MA. Primary headaches in patients with generalized anxiety disorder. J Headache Pain. 2011;12(3):331-338. doi:10.1007/s10194-010-0290-4
- Subramanyam AA, Kedare J, Singh OP, Pinto C. Clinical practice guidelines for Geriatric Anxiety Disorders. Indian J Psychiatry. 2018;60(Suppl 3): S371-S382. doi:10.4103/0019-5545.224476
- Kazeminia, M., Salari, N., Vaisi-Raygani, A. et al. The effect of exercise on anxiety in the elderly worldwide: a systematic review and meta-analysis. Health Qual Life. Outcomes. 2020;18: 363. https://doi.org/10.1186/s12955-020-01609-4
- Koch SC, Riege RFF, Tisborn K, Biondo J, Martin L, Beelmann A. Effects of Dance Movement Therapy and Dance on Health-Related Psychological Outcomes. A Meta-Analysis Update. Front Psychol. 2019;10:1806. Published 2019 Aug 20. doi:10.3389/fpsyg.2019.01806
- De Berry S. An Evaluation of Progressive Muscle Relaxation on Stress Related Symptoms in a Geriatric Population. The International Journal of Aging and Human Development. 1982;14(4): 255-269 doi:10.2190/5C1R-9D61-YG2N-A7LV
- Divo MJ, Martinez CH, Mannino DM. Aging and the epidemiology of multimorbidity. Eur Respir J. 2014;44(4):1055-1068. doi:10.1183/09031936.00059814
- Khezrian M, McNeil CJ, Murray AD, Myint PK. An overview of prevalence, determinants, and health outcomes of polypharmacy. Ther Adv Drug Saf. 2020;11:2042098620933741. Published 2020 Jun 12. doi:10.1177/204209862093374