August 3, 2022 • 55 mins
Jen talks to Dr. Sharon Orrange, MD about how anxiety shows up in the elderly and what adult children can do about it without being bossy as well as how anxiety symptoms in the elderly are different than in younger adults.
Dr. Sharon Orrange, MD specializes in Internal Medicine and is an Associate Professor in Medicine at Keck Medicine USC.
To read Sharon's article about anxiety in elderly patients go here: https://www.goodrx.com/conditions/generalized-anxiety-disorder/how-does-anxiety-look-different-in-older-adults
For more information on Jen Kirkman, the host of Anxiety Bites, please go here: https://jenkirkman.bio.link
and to get the takeaways for this episode please visit: http://www.jenkirkman.com/anxietybitespodcast
To send an email to the show write to anxietybitesweekly at gmail dot com.
Follow Jen on Twitter @jenkirkman or Instagram @jenkirkman
Anxiety Bites is distributed by the iHeartPodcast Network and co-produced by Dylan Fagan and JJ Posway.
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Episode Transcript
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Speaker 1 (00:08):
This is the Anxiety Bites podcast and I am your host,
Jen Kirkman. Welcome to another episode of Anxiety Bites. I
am your host Jen Kirkman. Today I am talking to
Dr Sharon Orange. She is an associate Professor of Medicine
at keech USC and she also has a private practice
(00:32):
um as an internist, and I have linked to an
article that she wrote I've linked to in the show
notes about what anxiety looks like in older adults and
in the elderly. A lot of you had emailed me
that you would love to do what you would love
(00:53):
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
(01:13):
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
(01:36):
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.
(01:59):
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,
(02:23):
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
(02:46):
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
(03:07):
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
(03:27):
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
(03:49):
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
(04:11):
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
(04:33):
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
(04:56):
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
(05:19):
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,
(05:42):
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
(06:04):
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
(06:25):
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
(06:46):
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,
(07:08):
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.
(07:31):
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
(07:51):
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
(08:12):
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,
(08:34):
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
(08:54):
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
(09:16):
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
(09:37):
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
(09:59):
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
(10:19):
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
(10:40):
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,
(11:01):
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,
(11:24):
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,
(11:44):
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
(12:05):
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
(12:27):
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
(12:48):
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,
(13:11):
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,
(13:33):
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,
(13:54):
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
(14:16):
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
(14:36):
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
(14:58):
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
(15:20):
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
(15:43):
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
(16:03):
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
(16:25):
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
(16:45):
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
(17:06):
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
(17:33):
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
(17:54):
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
(18:15):
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
(18:36):
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
(18:56):
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,
(19:19):
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.
(19:41):
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.
(20:06):
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
(20:26):
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
(20:47):
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
(21:07):
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,
(21:28):
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
(21:52):
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
(22:14):
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,
(22:35):
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
(22:58):
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
(23:19):
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
(23:40):
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.
(24:01):
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
(24:22):
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
(24:44):
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
(25:04):
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
(25:26):
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,
(25:48):
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.
(26:10):
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,
(26:32):
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.
(26:56):
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
(27:16):
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.
(27:38):
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
(27:59):
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
(28:19):
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
(28:41):
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
(29:05):
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.
(29:28):
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
(29:49):
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
(30:10):
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
(30:31):
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
(30:53):
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
(31:16):
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
(31:39):
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
(32:01):
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,
(32:23):
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
(32:44):
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.
(33:05):
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
(33:26):
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
(33:48):
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
(34:08):
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.
(34:28):
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
(34:50):
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,
(35:12):
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
(35:35):
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
(35:56):
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
(36:18):
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
(36:39):
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.
(37:02):
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
(37:23):
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
(37:44):
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
(38:05):
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
(38:28):
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
(38:49):
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,
(39:12):
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
(39:33):
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
(39:54):
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
(40:17):
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
(40:39):
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
(41:02):
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
(41:23):
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,
(41:45):
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
(42:06):
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.
(42:31):
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
(42:56):
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
(43:18):
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
(43:41):
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
(44:02):
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,
(44:26):
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
(44:49):
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
(45:10):
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
(45:33):
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
(45:55):
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.
(46:17):
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
(46:40):
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
(47:01):
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
(47:23):
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
(47:44):
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
(48:05):
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
(48:29):
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
(48:53):
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
(49:14):
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,
(49:38):
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
(50:00):
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,
(50:23):
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
(50:43):
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
(51:05):
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
(51:27):
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
(51:49):
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
(52:15):
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
(52:38):
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
(53:00):
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
(53:23):
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,
(53:45):
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.
(54:07):
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,
(54:28):
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
(54:48):
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
(55:09):
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,
(55:32):
Apple podcast, or wherever you listen to your favorite shows.
This is the Anxiety Bites podcast and I am your host,
Jen Kirkman. Welcome to another episode of Anxiety Bites. I
am your host Jen Kirkman. Today I am talking to
Dr Sharon Orange. She is an associate Professor of Medicine
at keech USC and she also has a private practice
(00:32):
um as an internist, and I have linked to an
article that she wrote I've linked to in the show
notes about what anxiety looks like in older adults and
in the elderly. A lot of you had emailed me
that you would love to do what you would love
(00:53):
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
(01:13):
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
(01:36):
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.
(01:59):
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,
(02:23):
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
(02:46):
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
(03:07):
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
(03:27):
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
(03:49):
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
(04:11):
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
(04:33):
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
(04:56):
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
(05:19):
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,
(05:42):
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
(06:04):
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
(06:25):
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
(06:46):
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,
(07:08):
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.
(07:31):
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
(07:51):
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
(08:12):
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,
(08:34):
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
(08:54):
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
(09:16):
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
(09:37):
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
(09:59):
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
(10:19):
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
(10:40):
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,
(11:01):
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,
(11:24):
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,
(11:44):
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
(12:05):
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
(12:27):
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
(12:48):
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,
(13:11):
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,
(13:33):
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,
(13:54):
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
(14:16):
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
(14:36):
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
(14:58):
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
(15:20):
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
(15:43):
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
(16:03):
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
(16:25):
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
(16:45):
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
(17:06):
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
(17:33):
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
(17:54):
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
(18:15):
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
(18:36):
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
(18:56):
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,
(19:19):
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.
(19:41):
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.
(20:06):
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
(20:26):
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
(20:47):
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
(21:07):
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,
(21:28):
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
(21:52):
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
(22:14):
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,
(22:35):
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
(22:58):
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
(23:19):
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
(23:40):
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.
(24:01):
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
(24:22):
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
(24:44):
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
(25:04):
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
(25:26):
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,
(25:48):
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.
(26:10):
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,
(26:32):
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.
(26:56):
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
(27:16):
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.
(27:38):
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
(27:59):
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
(28:19):
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
(28:41):
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
(29:05):
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.
(29:28):
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
(29:49):
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
(30:10):
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
(30:31):
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
(30:53):
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
(31:16):
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
(31:39):
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
(32:01):
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,
(32:23):
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
(32:44):
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.
(33:05):
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
(33:26):
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
(33:48):
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
(34:08):
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.
(34:28):
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
(34:50):
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,
(35:12):
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
(35:35):
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
(35:56):
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
(36:18):
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
(36:39):
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.
(37:02):
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
(37:23):
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
(37:44):
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
(38:05):
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
(38:28):
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
(38:49):
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,
(39:12):
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
(39:33):
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
(39:54):
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
(40:17):
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
(40:39):
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
(41:02):
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
(41:23):
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,
(41:45):
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
(42:06):
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.
(42:31):
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
(42:56):
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
(43:18):
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
(43:41):
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
(44:02):
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,
(44:26):
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
(44:49):
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
(45:10):
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
(45:33):
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
(45:55):
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.
(46:17):
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
(46:40):
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
(47:01):
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
(47:23):
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
(47:44):
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
(48:05):
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
(48:29):
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
(48:53):
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
(49:14):
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,
(49:38):
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
(50:00):
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,
(50:23):
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
(50:43):
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
(51:05):
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
(51:27):
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
(51:49):
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
(52:15):
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
(52:38):
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
(53:00):
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
(53:23):
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,
(53:45):
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.
(54:07):
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,
(54:28):
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
(54:48):
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
(55:09):
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,
(55:32):
Apple podcast, or wherever you listen to your favorite shows.
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