Anxiety in older adults is often under recognized.  One reason for this is that symptoms are increasingly varied; each older adult exhibits signs of anxiety in a unique way.  Another reason is that anxiety symptoms can be less pronounced for older adults, but they often have an increased impact on an individual's ability to function as he or she ages.  10-15% of older adults exhibits symptoms that lead to a diagnosis of an anxiety disorder, but 15-50% of older adults have individual symptoms that do not add up to the level of a formal diagnosis.  The results is lack of treatment for sub-syndrome symptoms, even though the impact on disability is significant, and increases with age.  

The most Frequently reported anxiety among older adults is a fear of falling.  This may be based on the very real statistic that falls increase the risk of early death, and that they are the leading cause of fractured and disability among older adults.  the anxiety symptoms liked to the fear of falling are typically avoidance behaviors that lead to a decrease in overall activity outside of the home.  This reduction in physical activity actually increases the risk that an older adult will fall because of the loss of physical fitness, creating a vicious cycle of increasing disability and fear. 

Depression in older adults often leads to a greater levels of disability and exacerbated chronic heal conditions.  There appears to be a correlation between poor health and depression in older adults; the percentage of older adults reporting symptoms of depression increases as medical interventions increases.  Symptoms of depression in older adults can be missed by healthcare providers due to their unique presentation, and they often have a greater impact on daily function that in younger people.  Older adults with depression often do not appear sad, or report an increase in negative emotions.  Instead we see a decrease in motivation and energy, unexplained aches and pains, neglect of personal care, feeling of hopelessness, and changes in sleep patters.  This constellation of symptoms can be misread as cognitive decline or dementia, making the use of screening tools for depression extremely important to effective treatment.

Dementia is not a specific disease. It’s an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities. Alzheimer’s disease accounts for 60 to 80 percent of cases. Vascular dementia, which occurs after a stroke, is the second most common dementia type. But there are many other conditions that can cause symptoms of dementia, including some that are reversible, such as thyroid problems and vitamin deficiencies.

Dementia is often incorrectly referred to as “senility” or “senile dementia,” which reflects the formerly widespread but incorrect belief that serious mental decline is a normal part of aging.

 

Often older adults take multiple medications to manage chronic health conditions such as hypertension, high cholesterol, or diabetes.  The use of alcohol can have a adverse interactions with prescription medications, resulting in:

• Increased risk of stomach bleeding
• Increased risk of stroke
• Increased risk of depression
• Increased risk of liver damage
• High blood pressure
• Memory loss
• Excessive drowsiness with resulting Motor Vehicle Accidents or injurious falls

The physical changes associated with aging can change the way that the body processes alcohol.  This means that the drinking habits developed earlier in the life may have to change as we get older.  If the use of alcohol leads to obvious health consequences, continued use could be considered alcohol abuse.  Some of the consequences of alcohol abuse include:

• Increased risk of hypertension
• Increased risk of stroke
• Increased risk of liver diseases
• Decreased bone density
• Increased risk of falls
• Immune system impairment
• Depression and anxiety
• Impairment in IADLs
• Malnutrition

Good communication between you and your healthcare providers is essential to your health.  This can be challenging to accomplish in a short visit, especially if you're not feeling well.  It's important that you share all the information about yourself and your health that your providers need to provide quality care.  And it's important that they explain what you need to do to stay as healthy as possible, in a way that you understand.

Make a list: Write down your goals for the visit and the things you most want to talk about with your provider, and bring it to your appointment.  Try to keep your list to the 2-3 most important items.  Also create and maintain a personal health record.  Write down all your past and current health problems, and any surgery or other treatments you've had.  Note the names of any medications you've taken that have caused unwanted side effects.  Keep this record updated and bring it to your visit, too.

Bring your medications, vitamins, and other remedies: Put all of the prescription drugs, over-the-counter medications, herbs, vitamins, and other supplements you take in a bag, and bring them to your visit.  This way, your provider will know exactly what you're taking, when, and what does. This is important because some drugs, herbs, and supplements can interact with medications your provider might prescribe.

Bring Pen and Paper:  Bring paper or a notebook to your appointment so you can write down what your healthcare provider tells you.  If you have trouble remembering later on, you can look at your notes.

Consider asking a buddy along:  A family member or close friend who goes to your appointment with you can provide information that you might forget or overlook.  If you want to discuss something privately, you can always ask your relative or friend to leave the room while you do so.

“Social isolation, loneliness could be greater threat to public health than obesity” American Psychological Association, August 5, 2017

Loneliness and social isolation may represent a greater public health hazard than obesity, and their impact has been growing, according to research presented at the 125th Annual Convention of the American Psychological Association.

 “Being connected to others socially is widely considered a fundamental human need — crucial to both well-being and survival. Extreme examples show infants who lack human contact fail to thrive, and indeed, social isolation or solitary confinement has been used as a form of punishment,” said Julianne Holt-Lunstad, PhD, professor of psychology at Brigham Young University. “Yet an increasing portion of the U.S. population now experiences isolation regularly.“

 Social isolation is linked with

• lower general well-being
• more depression
• common colds
• higher level of disability from chronic diseases
• higher rates of premature death
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Why Are older adults more likely to be socially isolated?

• Retirement and loss of contact
• Loss of significant others
• Reduced sense of purpose
• Reduced ability to get around or move
• Changing family structure
• Living alone
• Physical changes (e.g., hearing and vision loss)