How can caregivers deal with the anxiety of the person they are helping without depleting their “energy bank account”? An interesting discussion on geriatric anxiety with Sébastien Grenier, psychologist and associate professor with the Department of Psychology at the Université de Montréal.
03 June 2022
It’s anxiety like that found in other age groups, but with certain particularities. I don’t always like to use the term “geriatric” because it makes the person sound “very” old. I prefer to call it “anxiety in the elderly.” Even though I am the director of the Laboratory for the Study of Geriatric Anxiety and Depression!
There are different symptoms of anxiety that can affect the elderly: cognitive, behavioural or physical symptoms. The physical symptoms are the most common: hot flashes, dry mouth, sweating, heart palpitations, digestive problems, headaches and chronic pain. The most difficult task for doctors is to distinguish between the symptoms. What is caused by anxiety, by medication, by a physical illness? We talk about anxiety, but there are also what we call “anxiety disorders,” such as generalized anxiety disorder or panic disorder. What I mean is that there are different ways to define anxiety, and there are specific criteria that help doctors and psychologists make a diagnosis.
For caregivers, who are often elderly themselves, there is a double challenge. The caregiver has their own challenges related to aging. In therapy, I see caregivers who are completely exhausted and don’t know what to do anymore. We never think that we will become caregivers one day in our lives. When this reality occurs, it causes a lot of stress. Stress is made up of four active components: unpredictability, loss of control, novelty and threatened ego (for example, when your skills are challenged or your abilities are doubted).
For caregivers to maintain a healthy distance, to preserve their energy and well-being, the idea is to establish a framework. The principle is twofold: increase their ability to adapt and prevent exhaustion. This can be done by learning breath control or meditation, exercising, treating ourselves positively (e.g., talking to each other the way we would to our best friend, remembering that not everything is bad, remembering good times) and focusing on the things we can control.
I would suggest the following 8 points:
They are not foolproof. When you are constantly crying, when you can no longer sleep well, you must break the silence. If you are experiencing extreme fatigue, if your worries persist, if you have lost interest in the activities you used to enjoy, if you are no longer able to function or if you no longer recognize yourself, you should consult a health professional.
I have been a psychologist in private practice since 2002. When I saw older people, I found that things clicked well between them and me, compared to adolescents, with whom I had more difficulty. In my career, I also wanted to do research and work on the mental health of the aging person. There was little available research in the field of psychogeriatrics in Québec. When I completed my first postdoctoral fellowship in 2014, I set up the Laboratory on studies of late-life anxiety and depression (LEADER), housed at the research centre of the Institut universitaire de gériatrie de Montréal (CRIUGM). Since the beginning of the pandemic, the needs have greatly increased. There is now much more talk about the mental health of seniors. I already knew that this was an area of rapid evolution. Now it’s even more obvious.
The somatic manifestations of anxiety are pretty much the same. The difference lies more in the way the symptoms are described. We notice excessive worrying: “If I go out this afternoon, I might fall and get hurt and be hospitalized.” These are scenarios like that. Younger people are worried too, but not about the same things. Older people worry less about finances and work, but more about health and the risk of falling. They worry about being abandoned by their children, being placed in a nursing home, losing their memory or getting Alzheimer’s disease.
For a specific anxiety disorder, there is a specific treatment. Anxiety, in general, is characterized by anticipating events that might happen. It is the fear of being afraid and the feeling of losing control over one’s life. This worry is counterproductive because it tends to prevent the person from focusing on the present. Therapy is therefore about getting the person to focus on the present and to find concrete solutions in their own current life when problems actually arise. For example, if I am worried about my health, what am I doing about it today? Have I made an appointment with my doctor? Basically, the strategies consist of giving the person some direction so that they can regain control of their life. As we get older, we have to deal with the many losses, changes and bereavements that occur rapidly. Sometimes this becomes too much for an elderly person to cope with. This is when anxiety develops and is accompanied by a feeling of loss of control. The psychologist’s job is to give that control back to the person and to provide them with the keys to deal with one problem at a time, step by step. We can also teach proper breathing, meditation and relaxation practices.
In 50% of the cases, when the psychologist or doctor detects anxiety in the elderly person, they will also diagnose depression. When we notice a significant change in the behaviour or mood of the person we are caring for, without any reason, we may suspect the presence of anxiety or even an anxiety disorder. If they cry, have trouble sleeping, are on edge, have difficulty carrying out daily activities, experience a marked loss of motivation or have trouble “getting started” in the morning, we should be concerned. This advice applies to both the caregiver and the person we are caring for!
Interview by Karine Cloutier, Project Manager, Communications at l’Appui pour les proches aidants. Thank you to Sébastien Grenier for this insightful conversation!
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