Speaker 1: This is the Anxiety Bites podcast and I am your host,
Speaker 1: Jen Kirkman. Welcome to another episode of Anxiety Bites. I
Speaker 1: am your host Jen Kirkman. Today I am talking to
Speaker 1: Dr Sharon Orange. She is an associate Professor of Medicine
Speaker 1: at keech USC and she also has a private practice
Speaker 1: um as an internist, and I have linked to an
Speaker 1: article that she wrote I've linked to in the show
Speaker 1: notes about what anxiety looks like in older adults and
Speaker 1: in the elderly. A lot of you had emailed me
Speaker 1: that you would love to do what you would love
Speaker 1: to listen to an episode about anxiety in the elderly,
Speaker 1: because I think a lot of us noticed maybe some
Speaker 1: changes in our parents or older family members, older friends,
Speaker 1: older people in our life during the early lockdown parts
Speaker 1: of the pandemic, and then of course still continuing on
Speaker 1: to today, as certain things that we may take for
Speaker 1: granted that tend to help us cope with everyday anxiety.
Speaker 1: And you know, lift our moods is is social interactions,
Speaker 1: lack of isolation, obviously being free of disease or free
Speaker 1: of fear of disease. And I think all of us
Speaker 1: experienced an optick of that and still aren't as the
Speaker 1: pandemic still goes on. But I think for the first time,
Speaker 1: a lot of people realized, oh, I don't know how
Speaker 1: to talk to my parents or anyone elderly in my
Speaker 1: life about their anxiety, and so I thought I would
Speaker 1: definitely make this episode happen, and I'm glad that I did.
Speaker 1: Um So, I talked to Dr Sharon Orange about everything
Speaker 1: that she's noticed from from working with patients. Again, she's
Speaker 1: a not a psychiatrist, but she works as a medical
Speaker 1: doctor and has a ton of insight into how anxiety
Speaker 1: presents in the elderly population, something that I don't know,
Speaker 1: this might make you feel better about. You know, if
Speaker 1: if you get to live to an older or elderly age,
Speaker 1: that anxiety, in terms of generalized anxiety disorder or certain
Speaker 1: phobias and panic disorders, that tends to sort of just
Speaker 1: start to go away as you get older. And it's
Speaker 1: very rare that an elderly person would suddenly develop panic disorder.
Speaker 1: And it all has to do with just the way
Speaker 1: that our body ages and that you know, in Layman's terms,
Speaker 1: things just tend to slow down and they're not as reactive,
Speaker 1: and so you have that to look forward to. If
Speaker 1: you know there's other things about getting older you're not
Speaker 1: looking forward to, well, if you're a panicky person, they
Speaker 1: might start to lessen. But this is a great episode
Speaker 1: because again, you may be elderly yourself someday. You may
Speaker 1: be elderly right now listening to this, Or you may
Speaker 1: have someone in your family that you want to talk
Speaker 1: to about their anxiety that you've noticed. And obviously you're
Speaker 1: doing that because you love them and you want them
Speaker 1: to realize that there's help out there. But a lot
Speaker 1: of times we can push people away that we care
Speaker 1: about by our approach, and so our homework is understanding
Speaker 1: and learning about how best to approach this topic with
Speaker 1: somebody as you try to get them the information that
Speaker 1: you think they need about anxiety. So this is a
Speaker 1: good primer on how to do it, what to look for,
Speaker 1: and maybe learning about what someone older or elderly is
Speaker 1: and probably isn't going through when you think about their anxiety.
Speaker 1: So I'll just stop talking and we'll get right into
Speaker 1: the episode. You'll learn as much as I did. The
Speaker 1: people who wrote in their parents are not saying I
Speaker 1: have anxiety? What do I do? It's like the parents
Speaker 1: are doing nothing about it. They're probably not even admitting
Speaker 1: it from what I can gather from these letters. And
Speaker 1: so I mean, just starting there before we get into
Speaker 1: all the details of elderly people in anxiety, it's kind
Speaker 1: of tough to start with. How do we help people
Speaker 1: that may not want it think they need it? You know,
Speaker 1: we were would even begin if someone has anxious parents,
Speaker 1: how do they broach that conversation? So that is exactly
Speaker 1: the right question, and and your listeners are right to
Speaker 1: be confused by it, and they're also right to want
Speaker 1: to get involved. And here's why. Only one in five
Speaker 1: older adults brings up mental health concerns to need professional
Speaker 1: so any their primary care doctor or mental health professional.
Speaker 1: So only one in five will initiate the conversation on
Speaker 1: their own of our older adults over sixty, So family
Speaker 1: members are right to want to get involved. But it's tricky.
Speaker 1: I mean, as you you just hit the nail on
Speaker 1: the head. It's hard to talk to an older person
Speaker 1: about their mental health, particularly if it was someone that
Speaker 1: you've always looked up to and relied upon. And the
Speaker 1: flip side of that is for my older folks, when
Speaker 1: we're in the office. You know, they also worry that
Speaker 1: that their family members are going to lose faith in
Speaker 1: them if they see that they're not coping. So it's
Speaker 1: it's two sided. And I think for family members who realize, yes,
Speaker 1: I need to initiate the conversation because my older parents
Speaker 1: not going to do it on their own. It's obvious
Speaker 1: to be patient and compassionate and talk openly with them
Speaker 1: about what you think is going on. The mistake that
Speaker 1: we make is to try and help and not respect
Speaker 1: their independence. So the big mistake I see and I
Speaker 1: take care of families is Mom, you're depressed. You need
Speaker 1: to see your doctor and you need something for it. Mom,
Speaker 1: you have anxiety. Dad, you have anxiety and it's a
Speaker 1: problem and you need to go fix it. So yeah,
Speaker 1: and trust me, like that's my instinct two of my parents,
Speaker 1: and we really have to control that because that's not effective. Yeah,
Speaker 1: it's tough because I mean, for me, I have a
Speaker 1: good relationship with my parents. They're eighty three, and that's
Speaker 1: how we talk. There's no warming up, gently talking the
Speaker 1: way I might be a little more formal with someone
Speaker 1: I don't know very well. And you know, I don't know.
Speaker 1: I'm sure not everyone has this kind of informality with
Speaker 1: their parents, but that's you know, I just don't have
Speaker 1: time to be like, so, how you feeling, you know,
Speaker 1: I would just be like, oh, that's anxiety. You've always
Speaker 1: had it, you know. So you're exactly right. And I
Speaker 1: think that you have to just retrain yourself to to
Speaker 1: come in, you know, to focus on the changes you've noticed,
Speaker 1: and to come in and say I care about you,
Speaker 1: I'm worried. These are the things I've seen. You don't
Speaker 1: seem like yourself. You seem more tired than usual. I
Speaker 1: notice that your sleep seems disrupted, You're irritable. You have
Speaker 1: to come at it that way because you and I
Speaker 1: Jen have the same instinct to come in problem solve.
Speaker 1: You have anxiety, need to take a medication for it,
Speaker 1: but it's not gonna work because I take care of
Speaker 1: the older folks and I hear from them, it's not
Speaker 1: going to work that way. So we really have to say, hey,
Speaker 1: mom or dad, having anxiety or depression is like any
Speaker 1: other health issue, and it will affect how you feel.
Speaker 1: I'm not sure what's going on, but I think their
Speaker 1: treatments available. Let's go to your doctor together and talk
Speaker 1: about it. This is more of a comment than a question.
Speaker 1: But it's odd. I guess it's the word that you know,
Speaker 1: most people under I'll just say under fifty, most kids
Speaker 1: of parents who are still alive. And these kids that
Speaker 1: are under fifty, we have a totally different relationship to
Speaker 1: mental health. It's still nowhere near as less stigmatized as
Speaker 1: it needs to be. But we I know for a fact,
Speaker 1: we would not lose faith in our parents if they
Speaker 1: had anxiety. We would not see it as a sign
Speaker 1: of weakness. And at the same time, I mean, as
Speaker 1: parents get older, we do lose the normal amount of
Speaker 1: faith in them, Like they're not going to help me move,
Speaker 1: you know, It's like there's things they can't do anymore.
Speaker 1: I don't expect them to cook a full things giving
Speaker 1: dinner or you know. But um so, in that sense,
Speaker 1: it's too bad that I guess they feel that way.
Speaker 1: Not odd, it's too bad because if anyone is going
Speaker 1: to understand it is this generation of adult children. Absolutely,
Speaker 1: and the way we speak about and think about mental
Speaker 1: health is much different than our older parents. And and
Speaker 1: so if talking about feelings is difficult for the older person,
Speaker 1: and I can tell you from doing this for twenty
Speaker 1: one years. It is. We just have to change the
Speaker 1: focus a little bit. And I know it's not our
Speaker 1: instinction as and I'm older than you, but as are
Speaker 1: the younger generation. But we really have to reframe it
Speaker 1: and come to them and say mom or dad, how
Speaker 1: can I help you? You know, can I do the
Speaker 1: shopping for you? I'm here, You've taken care of me
Speaker 1: for so long. I'm here to help. We can't come
Speaker 1: in and go how are you feeling? Do you think
Speaker 1: have some anxiety symptoms? It's just not going to be
Speaker 1: the effective way to do it. It's you know, at
Speaker 1: least not as a starter. I think we need to
Speaker 1: start and change the focus from feelings to sort of
Speaker 1: the problems you've noticed and how you want to solve
Speaker 1: the problems really objectively. You know what, can I do
Speaker 1: the shopping for you? Um, let's hang out, you know,
Speaker 1: or I can do it on my own without you.
Speaker 1: Just really objective problem solving. It's like, don't boss them
Speaker 1: around and tell them what they have and you don't
Speaker 1: have to suddenly be like all touchy feeling and freak
Speaker 1: them out. It's like somewhere in the middle. But that's passionate.
Speaker 1: But but solutions, you know, right, we don't come in
Speaker 1: with a problem you have anxiety, you have a depression
Speaker 1: to come in with noticing changes that we've seen and
Speaker 1: things that we think we can do that will help
Speaker 1: that problem. But if we come in and say you
Speaker 1: have a problem, it's it's a non starter for most
Speaker 1: older adults. It may work in some but for my
Speaker 1: experience has been as a nonstarter. Yeah. I find that
Speaker 1: with my parents. I I mean, I don't know if
Speaker 1: I think they have anxiety or not. I have to
Speaker 1: be honest. I noticed it more when they were younger.
Speaker 1: I think they actually were people with anxiety, either disorders
Speaker 1: or just whatever anxiety. At times in the life, I
Speaker 1: I see them as less anxious maybe maybe Uh during
Speaker 1: the pandemic, I think my mom was kind of depressed,
Speaker 1: which you know, I understand because she was saying she
Speaker 1: was named. She was telling me that she was very
Speaker 1: sad at the way she felt the elderly people were
Speaker 1: being treated in the world, kind of like well, if
Speaker 1: you die, you die, or old anyway, you know that
Speaker 1: she felt kind of put out to pasture. And my
Speaker 1: parents are very active, more active than me, you know,
Speaker 1: I'm half their age, and they're like out and about
Speaker 1: at the casino every weekend, and so for my mom
Speaker 1: and dad to be stuck at side house for a
Speaker 1: year was challenging for them. Um. And you know, I
Speaker 1: don't think we'd have these in depth conversations about symptoms
Speaker 1: and this and that, but we do have those kind
Speaker 1: of conversations. And I find if I just sort of
Speaker 1: hug my mom, you know, I mean the way you
Speaker 1: always you know, hi, goodbye hugs, but just kind of
Speaker 1: out of the blue, like aw you doing? You know,
Speaker 1: I never do that, you know. I mean I do
Speaker 1: that now, but you know, maybe when she was fifty sixty,
Speaker 1: I wasn't doing that. But um, it does help. I've
Speaker 1: seen it where they talk about their feelings, and my
Speaker 1: dad has said things about being kind of, you know,
Speaker 1: addicted to the news, like that gets him all riled
Speaker 1: up in a way that makes them happy, he thinks,
Speaker 1: you know, and he's like, well, what else am I
Speaker 1: going to do? Him? All? Like you know that I
Speaker 1: can see the kind of almost like depression in them,
Speaker 1: and I don't try. I mean again, if I thought
Speaker 1: it was like really bad, I'd probably be more solution oriented.
Speaker 1: But I just sort of tried to validy because I
Speaker 1: would be depressed too. I mean, getting older, you know,
Speaker 1: time starts to go by really fast each year. And
Speaker 1: as my grandmother used to always say to me, she
Speaker 1: lived until getting older stinks because your mind is is
Speaker 1: just as active as it wasn't. You're younger, but you
Speaker 1: can't move anything. And and so anyway, all this to
Speaker 1: say that I find that just validation can really help
Speaker 1: um if it's kind of a more mild thing where
Speaker 1: it's like intermittent, you know, depression, or just those moments
Speaker 1: where they're like, God, I feel older, I feel embarrassed
Speaker 1: that I can't help you with this, or that you're
Speaker 1: exactly right. You said two things that are perfect, and
Speaker 1: I don't know if you know how perfectly you've done this.
Speaker 1: You said no, you just say to them, how are
Speaker 1: you doing? Or you just say come here, I'm just
Speaker 1: gonna give you a hug. You're doing You are giving
Speaker 1: them the soft open space to fall right to come
Speaker 1: to you and say, hey, the pandemic has been really
Speaker 1: hard for us, increasing social isolation. I don't know how
Speaker 1: you know more than a third of my patients are
Speaker 1: over the age of sixty five. I don't know how
Speaker 1: they came through this. It's for our kids. It's the
Speaker 1: same way, but the isolation, you know, for my newly
Speaker 1: widowed older patients who were at home alone, I don't
Speaker 1: know how they got through this. What you've done is perfect,
Speaker 1: which is really just to to give them a soft
Speaker 1: place to fall with their conversations and their concerns. And
Speaker 1: that's really half the battle right there, because then your
Speaker 1: mom is going to say, Jim, this has kind of
Speaker 1: sucked for us. Yeah, and I am feeling blue, but
Speaker 1: I know there's a light at the end of the tunnel,
Speaker 1: and there's the conversation. And then you would say to them,
Speaker 1: if it wasn't getting any better, you'd say, you're not alone.
Speaker 1: We can go get help. This is something we can
Speaker 1: modify or treat. You know, if you started to notice
Speaker 1: that either of your parents was really struggling. If people
Speaker 1: have a good relationship with their parents where they kind
Speaker 1: of know them the way you know yourself, I think
Speaker 1: you can. Right, would you suggest, like, just do something
Speaker 1: if if it takes the bird enough, do their shopping,
Speaker 1: clean their house. Just don't even ask because sometimes they
Speaker 1: won't answer you. Right A thousand percent and presented exactly
Speaker 1: what you did. Don't say, hey, mom or dad, do
Speaker 1: you I'm gonna go shopping for you. Say I'm at
Speaker 1: the store chicken or steak, whole, milk or so, do
Speaker 1: it like that. And you did the same thing. I'm
Speaker 1: booking you. You know, first class, you like aisle or window,
Speaker 1: so do it like that. And and because if we
Speaker 1: walk into our parents and say because remember these are
Speaker 1: the people we relied on who raised us, And if
Speaker 1: we say, do you want me to go to this
Speaker 1: store for you, They're not going to answer it in
Speaker 1: the affirmative. So we have to just do what you
Speaker 1: you have great instincts about this, but we have to
Speaker 1: do exactly what. And the patients who sit in my office,
Speaker 1: the older patients say to me, I don't want to
Speaker 1: put out my I don't want to put my daughter
Speaker 1: out I you know she's spending all her time on me.
Speaker 1: You know, they are worried that we are spending our
Speaker 1: time on them. But if you say I'm at the
Speaker 1: store you like whole or two percent, wellcome coming by then,
Speaker 1: or I'm ordering it for you a whole or two percent.
Speaker 1: So you we just make the decisions and make it
Speaker 1: happen and take it off their plate. Is there anything
Speaker 1: to like I just was kind of came up with this, like,
Speaker 1: is there anything to grief um being the thing underneath
Speaker 1: it all that causes the irritability or something. Well, I
Speaker 1: think there is. There's a there's a change in role.
Speaker 1: So I would say the grieving is about the differences
Speaker 1: and roles. Right, So, all of a sudden, the parent
Speaker 1: is you know, who was the patriarch of the matriarch
Speaker 1: now is concerned that they will become a burden to you,
Speaker 1: to their families. They also feel slightly misunderstood by the
Speaker 1: quote unquote younger generation. That's what I hear over and
Speaker 1: over again in the office. And they really feel like
Speaker 1: they'll be treated differently if they admit to not coping. Well,
Speaker 1: So if we talk about grieving, I would say they
Speaker 1: grieve the role, right, the role of losing I'm the
Speaker 1: matriarch on the patriarch and now I'm depending on gent
Speaker 1: you know, my son or daughter. And I think similarly
Speaker 1: for the for us, these are the people that we
Speaker 1: looked up to, These are the people that raised us.
Speaker 1: And we start to say, huh, are we changing roles?
Speaker 1: Where we are the caretaker, and so yes, the grieving
Speaker 1: and sort of bereavement, I would say, is related to
Speaker 1: the change in roles that occurs naturally. And I think
Speaker 1: once we just flow into it and have open conversations
Speaker 1: about it, it's it's really nice. And then, you know,
Speaker 1: because what you said. Older adults in my office say
Speaker 1: to me, this just happened to me yesterday. Every day
Speaker 1: they say, I don't want to be a burden to
Speaker 1: my children. If I haven't finished the sentence, doctor, the biggest,
Speaker 1: one of the biggest, as I'm worried about getting older.
Speaker 1: They finished the sentence and they say, being a burden
Speaker 1: to my children, and I, you know, through tears makes
Speaker 1: me choked up. But through tears I say to them,
Speaker 1: this is what we're here for. We we are desperate
Speaker 1: to help you out. You did it all these years.
Speaker 1: We want to help you out. And I try and
Speaker 1: say them, as their doctor, your family members are here,
Speaker 1: the people who love you are dying to surround you
Speaker 1: and help you out. But it's really hard to get
Speaker 1: our older folks to accept that help. Yeah. I mean,
Speaker 1: I don't have kids in my own and I don't
Speaker 1: want to, and I'm I'm living in New York right now.
Speaker 1: My families in Massachusetts, and I'm sort of living on
Speaker 1: both coasts. But I'm like, you know, eventually, I mean,
Speaker 1: I prefer the East coast, but I'm like, I think
Speaker 1: I'll move back to New York permanently so I can
Speaker 1: be closer to my family and as they're getting older.
Speaker 1: I've never said that out loud to them, you know
Speaker 1: what I mean. Isn't that funny? And you know, with COVID,
Speaker 1: a lot of people moved back home, you know, and
Speaker 1: and start to say, wait, why aren't I staying closer
Speaker 1: to my parents? A lot of folks, I think think
Speaker 1: the way you do and haven't articulated it. And that's okay.
Speaker 1: And that's why this sentence, you know you've always helped me.
Speaker 1: I think it's time I helped you out is really
Speaker 1: affective for the older people I take when they hear
Speaker 1: that from their sons and daughters, it's really effective that
Speaker 1: one sentence. If you said I'm going to move closer
Speaker 1: to you, you'll watch your parents will say, I don't
Speaker 1: know that worked for you. I don't is that okay?
Speaker 1: Is that okay? But you just say you've always helped
Speaker 1: me out? It's time for me to help you out.
Speaker 1: We'll be right back. So I wanted to ask you
Speaker 1: just some like factoids that I got from reading your article.
Speaker 1: So let's say an elderly person is experiencing some anxiety.
Speaker 1: It's not that they have an anxiety disorder, but for
Speaker 1: whatever reason, they're experiencing anxiety. But they're not going to
Speaker 1: go to therapy necessarily, um because you know, maybe that's
Speaker 1: just not what they need. What are some like great
Speaker 1: coping tools? Is it different for seniors than it is
Speaker 1: for everybody else? Yes, So you know, we think of
Speaker 1: coping mechanisms for you and I. We think of support
Speaker 1: from others, you know, being social, going out or engaging activities.
Speaker 1: And if I'm an older person, either you know, living
Speaker 1: in a skilled nursing facility, or I'm not driving anymore,
Speaker 1: I have limited mobility, you know, limited physical activity, I'm
Speaker 1: not surrounded by the people who love me. Those coping
Speaker 1: mechanisms are going to be much different the way that
Speaker 1: I approached this conversation with my sixty five and over
Speaker 1: group who's experienced in some anxiety, instead of saying, hey,
Speaker 1: get on the headspace appter the aura app because they're
Speaker 1: gonna look at me like I'm crazy, as I say,
Speaker 1: we're going to go after this, these these anxiety symptoms
Speaker 1: the same way we go after preserving memory. So it's
Speaker 1: like brain health because older folks are afraid of dementia
Speaker 1: and memory issues, and we know that anxiety is tied
Speaker 1: to that. So anxiety disorders are a risk factor for
Speaker 1: memory and cognitive decline issues. So I'll say to my
Speaker 1: older folks, here's the multi pronged approach we're going to
Speaker 1: use to combat some of your anxiety, and it's going
Speaker 1: to help your brain and your memory as well. So
Speaker 1: no real magic here, but exercise. So both aerobic and
Speaker 1: strength training. That's real, that's not voodoo. And you can
Speaker 1: be you know, God bless you in a wheelchair and
Speaker 1: I can find home physical therapy or home occupational therapy
Speaker 1: is going to give you an exercise regimen. So exercise,
Speaker 1: both aerobic and strength training. Mindfulness, that word means nothing
Speaker 1: to my older patients. So you have to say, what
Speaker 1: does mindfulness mean for you? How do you have quiet
Speaker 1: time in your space and your head alone, whether it's
Speaker 1: you know, prayer, hot bads, candles, what you know, time
Speaker 1: and nature walking, So mindfulness, whatever it means to them.
Speaker 1: And then you know, the third thing really is cognitive training,
Speaker 1: and by that we mean, you know, using your brain
Speaker 1: in different ways. So coping mechanisms for anxiety in older
Speaker 1: patients is really exercise, mindfulness, and cognitive training. Those are
Speaker 1: the things that have data to show us that they're
Speaker 1: going to help you lessen your anxieties and m and
Speaker 1: improve your memory and lower your risk of dimension cognitive decline.
Speaker 1: So if you're at home on your own and you're
Speaker 1: not working with you know, a therapist or some kind
Speaker 1: of I don't know what someone with the brain, like
Speaker 1: someone doing cognitive coaching, would that be like doing crossword
Speaker 1: puzzles or some kind of you know those books they
Speaker 1: make for people who are trying to get their brain
Speaker 1: functions exactly, you know, like stroke or something. Right, it's
Speaker 1: using your brain in a different way. So if I
Speaker 1: was an accountant and I was retired, doing my taxes
Speaker 1: won't count for this, right, So it'll be that's the
Speaker 1: example I always give. It will be using your brain
Speaker 1: in a new way. So puzzles, uh, learning basic Italian,
Speaker 1: joining a bridge group online, you know, something that you
Speaker 1: haven't done before, So training your mind to do new
Speaker 1: things you can also do. You know a lot of
Speaker 1: my older patients, do you know, they do wordle and
Speaker 1: they do the games that you can get online. But
Speaker 1: anything where you're using your brain in your head in
Speaker 1: a different way, a new way, Like for me, it
Speaker 1: would be doing something non medicine like learning to play
Speaker 1: guitar or something like that. That is the that's what
Speaker 1: the brain loves. So it sounds like it's a lot
Speaker 1: less about let's figure out where this anxiety came from,
Speaker 1: and let's blah blah blah. It's really just seems like
Speaker 1: it's about strengthening the brain, keeping the body um healthy,
Speaker 1: but also I guess for the nervous system to keep
Speaker 1: the keep it out of our bodies, you know, decreased stress,
Speaker 1: maybe help with blood pressure. It's really more of a
Speaker 1: physical and kind of brain health and and it's less
Speaker 1: like emotional anxiety, if that makes sense exactly. So late
Speaker 1: life anxiety is really characterized. I mean it's associated with
Speaker 1: chronic illness, disability, caregiver status, social isolation, things you and
Speaker 1: I can't change, right, So so we then we say, okay,
Speaker 1: I mean I never want to sound do me like
Speaker 1: getting old sucks because it doesn't. But you're dealing with
Speaker 1: a lot of challenges that lead to some anxiety symptoms.
Speaker 1: So the obvious things chronic illness, disability, isolation. You're a caregiver.
Speaker 1: You and I can't change that for those people. But
Speaker 1: what we can do is try and improve the way
Speaker 1: that they can handle or manage those symptoms. And really
Speaker 1: it sounds so basic and maybe unhelpful, but it's those
Speaker 1: things we talked about. It's it's whatever your path to
Speaker 1: mindfulness is. It's exercise, it's cognitive training, it's you know,
Speaker 1: and again it is trying to increase your social network.
Speaker 1: That that's a tall order in our older folks, right,
Speaker 1: I know that's really challenging. You know, it doesn't sound
Speaker 1: basic and unhelpful, but I know what you mean. It's
Speaker 1: it's like that classic simple but maybe not easy, you know,
Speaker 1: because someone doesn't want to, you know, get started in it.
Speaker 1: But I feel like every episode of this podcast it
Speaker 1: always comes down to these basic things, and in a
Speaker 1: good way basic, and I think people just need to
Speaker 1: hear it over and over here in different ways here
Speaker 1: from different people here, it in different situations, because it's
Speaker 1: it's almost a stounding to think that these sometimes powerful
Speaker 1: feelings we have, whether their thoughts or bodily sensations. It's
Speaker 1: it's hard to believe there's a solution and that it's
Speaker 1: like actually doable, and you don't have to be rich,
Speaker 1: and you don't have to be smart, and you don't
Speaker 1: have to be in tune with your feeling like you
Speaker 1: can just anyone can do them exactly. And I will
Speaker 1: say this because I'm I'm an internist who does write prescriptions.
Speaker 1: So it does deserve a conversation that that the you know,
Speaker 1: the low dose antidepressants, the s s R eyes and
Speaker 1: sn our eyes are effective in our older folks who
Speaker 1: have you know, generalized anxiety disorder, excessive worry on on
Speaker 1: more days than they don't. So we also want to say, look,
Speaker 1: if these coping mechanisms have failed us, it's not screwy
Speaker 1: or on your own. We do have you know, medications
Speaker 1: do help, and and we keep a close eye on
Speaker 1: our folks who are on a lot of different medications,
Speaker 1: but they do help. Cognitive behavioral therapy is sort of
Speaker 1: a discussion about whether or not it helps in older folks.
Speaker 1: It looks fair, not not terrific, and my older folks
Speaker 1: are sort of have been sort of resistant to that.
Speaker 1: But I have respect for CBT, and I think for
Speaker 1: our patients who are our older patients who are willing
Speaker 1: to do what we should do it. But there are
Speaker 1: options when these coping mechanisms haven't worked, So there are
Speaker 1: medications that help. UM. The problem that I see every
Speaker 1: week again in practice because I take care of families,
Speaker 1: is someone comes in and goes, you gotta give my
Speaker 1: mom a medication for anxiety. You gotta give my mom
Speaker 1: a medication for see, and I always go, wait, wait, wait,
Speaker 1: let's about start there. But it doesn't mean that I'm
Speaker 1: dissing it or dismissing it. It just means that the
Speaker 1: things you and I were talking about, which take time,
Speaker 1: do work. So we just have to sort of get
Speaker 1: people on board. It is not as easy as swallowing
Speaker 1: a pill um and and again no disrespect to the pills,
Speaker 1: because they do work in certain people, but we have
Speaker 1: to start with the hard work, which is what we
Speaker 1: talked about. Yeah, for sure, And you mentioned that there's
Speaker 1: an anxiety risk factor for dimension. How does that mean
Speaker 1: if you had anxiety your whole life, you're more at
Speaker 1: risk to get dementias? And what that means yes, so
Speaker 1: it works both ways. So so anxiety is a risk
Speaker 1: factor for the development of cognitive decline dementia, and anxiety
Speaker 1: is an early symptom of dementia. So the relationship is tricky,
Speaker 1: but yes, so long term generalized anxiety disorder, you know,
Speaker 1: we see actual changes in the brain and those changes
Speaker 1: lead to cognitive decline, which is another reason why I
Speaker 1: always say to patients treating and by treating, we talked
Speaker 1: about those coping mechanisms, it doesn't always mean a pell,
Speaker 1: but treating anxiety is a no brainer because it's going
Speaker 1: to decrease your risk of cognitive decline. It's just like
Speaker 1: any other illness. So we do need to address generalize
Speaker 1: anxiety disorder in our older folks, just as we do depression,
Speaker 1: because anxiety does lead to It is a risk, a
Speaker 1: well described, well known risk factor for cognitive decline and dimension.
Speaker 1: So if someone never had anxiety but they start having it,
Speaker 1: maybe in their late sixties, that could be a sign
Speaker 1: of that they're going to develop um cognitive decline or dementia. Exactly.
Speaker 1: Whenever I say that, it sounds really terrifying and do me.
Speaker 1: But it could be that anxiety is the earliest, you know,
Speaker 1: we call it a pro drum or the earliest symptom
Speaker 1: of of memory impairment or cognitive decline could be anxiety.
Speaker 1: So I guess I would say that not to be
Speaker 1: doom me, but more to say it needs to be addressed.
Speaker 1: So if you're a family member and you see your
Speaker 1: mom or your dad with anxiety symptoms, irritability, not sleeping,
Speaker 1: you know, not themselves, you do, we do need to say, hey,
Speaker 1: maybe we should just pop in and see your doctor
Speaker 1: and just talk about what I'm noticing or what you're feeling,
Speaker 1: and see if there's something we can do about it. Yeah. Absolutely,
Speaker 1: And what about sleep, because I know that the older
Speaker 1: people in my life, you know, they can't stay asleep
Speaker 1: as long anymore. Um, my parents sleeping hours have changed.
Speaker 1: My mom falls asleep. She might fall asleep on the
Speaker 1: couch at like ten, but then she's up and then
Speaker 1: she's up all night, and then falls back asleep at
Speaker 1: like five in the morning and sleeps in now like
Speaker 1: sleeps till nine or ten, you know, or they only
Speaker 1: get four hours of sleep at night and they're like,
Speaker 1: my body is just awake. I don't I'm fine, I
Speaker 1: just sleep less so like if someone is sleeping less
Speaker 1: or weirder, but otherwise they feel okay, is that cause
Speaker 1: for concern or is that just as we get older,
Speaker 1: bizarre things happen with our sleep. So you're you're so good, Jen,
Speaker 1: So yeah, so sleep sleep architecture changes as we're older.
Speaker 1: So what you describe so your mom's we say sleep architecture,
Speaker 1: think about her her sort of pattern during the night.
Speaker 1: If that's been her pattern during the night, but she
Speaker 1: still wakes up feeling restored, that's quote unquote okay, because
Speaker 1: it's there's no question that in the elderly sleep architecture changes.
Speaker 1: Disrupted sleep is commonly associated with anxiety, and that is
Speaker 1: also a risk factor for cognitive decline. Not to again
Speaker 1: be doomy, but that would be where your mom comes
Speaker 1: and says to you. You know, I've I've always been
Speaker 1: able to get my nice chunks of restorative sleep after
Speaker 1: I leave the couch and I wake up okay, but
Speaker 1: lately it's been you know, two hours, and I'm just
Speaker 1: feeling worn out during the day and exhausted. So if
Speaker 1: you see a change in that, you know, disrupted sleep pattern,
Speaker 1: I then it needs to be addressed. And you need
Speaker 1: to say, hey, mom or dad, could some of this
Speaker 1: be anxiety? Anxiety the elderly, and honestly in younger folks
Speaker 1: as well, is commonly associated with insomnia. And that's why,
Speaker 1: to add another topic here, it is vexing to see.
Speaker 1: But what physicians like me do that is wrong is
Speaker 1: treat our older patients with sleep medications and benzod as
Speaker 1: Appian's examics and at a van So we can because
Speaker 1: it's easy, because I can say, I'm going to get
Speaker 1: Jen's mom to sleep tonight, and I know how to
Speaker 1: do it, and I'm going to write the prescription. What's
Speaker 1: hard is talking about trying to do the stuff we
Speaker 1: talked about to improve sleep pattern and sleep hygiene. That's hard.
Speaker 1: Those are long conversations. They take a lot of time time.
Speaker 1: So physicians we what we do wrongly is prescribed medications
Speaker 1: for disrupted sleep and anxiety in this population that leads
Speaker 1: to falls and fall risk and worsening memory. Now I
Speaker 1: know that if I only slept, if I sleep less
Speaker 1: than eight hours, I'm a mess. And so I'm just
Speaker 1: so tired I can't recover. But you know, again, I've
Speaker 1: I've heard and seen as people get older like sometimes
Speaker 1: they just get five hours and they're restored and they're fine.
Speaker 1: Is that true? I guess. I mean, can they exist
Speaker 1: on less sleep and it doesn't affect them in terms
Speaker 1: of like being susceptible to a fall or having irritability
Speaker 1: or anxiety? It is true? I mean so, so it's
Speaker 1: what we've always noticed. You know, older folks wake up
Speaker 1: a lot earlier. They're there, their sleep architecture does change,
Speaker 1: and they need less sleep. So you and I might
Speaker 1: need eight hours of restored to chunks of sleep. That's
Speaker 1: not going to be true for our older folks. The
Speaker 1: best way to figure out is how the person feels.
Speaker 1: So if I have a seventy two year old who's
Speaker 1: been sleeping six hours and for the last eight years
Speaker 1: and says he or she feels great and doesn't have it,
Speaker 1: you know, it doesn't feel zonked or exhausted during the
Speaker 1: day or irritable or concentration difficulties, you know where people
Speaker 1: say I feel like my memory is just shocked when
Speaker 1: I haven't gotten enough sleep, that sleep disrupted sleep where
Speaker 1: that's you know, that's a problem. So if people notice
Speaker 1: they don't feel good when they wake up because they
Speaker 1: haven't slept, well, that's an issue. But if they're done
Speaker 1: five to six hours of of what for them is
Speaker 1: restorative and they wake up feeling restored, that's okay. That's
Speaker 1: my one thing about getting older. I'm looking forward to
Speaker 1: if that happens to me, like that'd be great because
Speaker 1: sometimes I want more hours in the day. Right, We'll
Speaker 1: continue the interview on the flip side of a quick
Speaker 1: message from our sponsors. So I think we may have
Speaker 1: covered this with with kind of the coping mechanisms, but
Speaker 1: just to really spell it out, are there differences or
Speaker 1: their stark differences and anxiety symptoms of elderly people with
Speaker 1: anxiety as opposed to a teenager or twenty something you
Speaker 1: know with anxiety, Yes, quite a bit. So so are
Speaker 1: older folks first of all, minimize the symptoms and attribute
Speaker 1: them to a physical illness more often, So they'll come
Speaker 1: in and say, like, I think it's just my stomach,
Speaker 1: but I feel like, you know, my appetites gone. So
Speaker 1: they'll do that. So we know that older folks just
Speaker 1: aren't as good as describing their symptoms that are related
Speaker 1: to anxiety. They minimize their symptoms and they attribute them
Speaker 1: to a physical illness more often than our younger folks do.
Speaker 1: What's also very cool is we don't you know, panic
Speaker 1: disorder panic attacks are associated with anxiety do not really
Speaker 1: happen in the elderly, probably because of the changes with
Speaker 1: our central and peripheral nervous systems. So my twenty year
Speaker 1: olds coming in with that fight or flight panicky chest pressure, shaking,
Speaker 1: we don't hear. We don't see that in our older
Speaker 1: patients with anxiety, So we don't see the Hannock symptoms
Speaker 1: associated with anxiety that we do in our younger folks.
Speaker 1: And that's because their nervous systems. Is it just like
Speaker 1: to put it in a like non medical way, like
Speaker 1: you just kind of slow down when you get older
Speaker 1: or what is that? Simply put? Pretty much? Yeah, our
Speaker 1: central and peripheral nervous system are different. They just don't respond.
Speaker 1: There's a lot less panic disorder generally in older patients,
Speaker 1: and there are younger patients, So it is it's probably,
Speaker 1: I mean, honestly, it's probably a good coping mechanism that
Speaker 1: the nervous system just does not respond in the same way,
Speaker 1: because can you imagine having a seventy two year old
Speaker 1: who's like, I'm having chess pressure shortens the breath shaking.
Speaker 1: We would be going crazy, like it's a heart attack
Speaker 1: on my God, admit to the e er when it's
Speaker 1: a twenty year old who can describe to me, you
Speaker 1: know this happened to me two weeks ago. I'm having
Speaker 1: a panic attack. Then, I you know, I know that
Speaker 1: I know exactly what that is. But we just don't
Speaker 1: see that in older folks with anxiety. So there's some
Speaker 1: really interesting differences in the way that they present. I mean,
Speaker 1: I think you know in our older folks amatic or
Speaker 1: body complaints related to anxiety or common palpitations, dizziness, vertigo.
Speaker 1: But the most important thing for family members to remember,
Speaker 1: and I hope they do remember this, is let us decide,
Speaker 1: so come in and talk to the doctor about those symptoms.
Speaker 1: But that's why you can say to your mom, Mom,
Speaker 1: maybe this is anxiety, but let's just talk. Let's just
Speaker 1: list what's going on. You have palpitations, you feel dizzy,
Speaker 1: Let's just see what the doctor thinks. And we absolutely
Speaker 1: can't attribute everything to anxiety. I've I've met so many
Speaker 1: people who are in and out of the are told
Speaker 1: they had anxiety and they had something else going on. So,
Speaker 1: so as important as anxiety is, let's make sure that
Speaker 1: we also ensure there is no underlying medical explanation for
Speaker 1: those symptoms. And that's another reason to bring folks into
Speaker 1: the primary care doctor when when you're noticing changes that
Speaker 1: in your parents. On the flip side of that, do
Speaker 1: you think most primary care doctors for elderly patients are
Speaker 1: trained in the sensitive situation of their coming in and
Speaker 1: you're really not finding anything physical and you have to
Speaker 1: suggest maybe this is kind of like a so metical
Speaker 1: response to anxiety. It's tricky. So it's it is tricky.
Speaker 1: I mean, I know that for my colleagues. I'm in
Speaker 1: a huge practice, and I know for my colleagues, what
Speaker 1: we always do is become when we say we have
Speaker 1: ruled out the sinister explanations. You know, your heart looks great,
Speaker 1: your lungs look great, so we do a reassurance and
Speaker 1: then we describe for people, you know, because my patients
Speaker 1: will say, so you're saying this is all in my head.
Speaker 1: It is, but what you're feeling, the physiologic manifestations are real.
Speaker 1: So you really are feeling sweats and vertigo and palpitations,
Speaker 1: You really are feeling it as a result of this
Speaker 1: underlying storm, and the storm is is anxiety. So it's
Speaker 1: the way you approach it because it's I would never
Speaker 1: walk in and say, this is all in your head,
Speaker 1: it's anxiety, You've got nothing going on. It's it's about
Speaker 1: reassurance that there's no other underlying medical explanation, and also
Speaker 1: just letting older patients know what you're feeling. Those symptoms
Speaker 1: are real, they're just triggered. Those are the physiologic manifestations
Speaker 1: of anxiety. Yeah, I think I think it's really just
Speaker 1: like only younger people are starting to grasp that where
Speaker 1: it's like it's in your like, yes, your brain and
Speaker 1: thoughts are causing these physical things because our mind and
Speaker 1: body are connected, but it's not in your head like oh,
Speaker 1: you know, it's not like the eighteen hundreds, like this
Speaker 1: woman's hysterical. You know, it's like exactly kind of just
Speaker 1: wish it away. Yeah, exactly right. If an older person,
Speaker 1: elderly person does actually want to seek a therapist about
Speaker 1: anxiety and they've never been before, do you have any
Speaker 1: advice for what kind of therapists should go. Do you
Speaker 1: think it should be someone that is practiced in working
Speaker 1: with elderly patients. That's a good question. I don't know
Speaker 1: if I target those working with elderly patients as much,
Speaker 1: but what I do, so, what we know helps is
Speaker 1: is cognitive behavioral therapy targeting the uncontrolled and excessive worry, worry.
Speaker 1: And again I'm not a therapist, i'min interness, but I
Speaker 1: prefer a ton of my patients, so I have them
Speaker 1: find start with a cognitive behavioral therapist because we know
Speaker 1: that that helps um. And then really most importantly, I
Speaker 1: look at you know, are there options for telephone or
Speaker 1: telemed connections, because then that eliminates our older person having
Speaker 1: to get there, especially if they're not driving. Do they
Speaker 1: do appointment reminders in between appointments? I also look at
Speaker 1: that so and of course, of course most importantly do
Speaker 1: you resonate with the person you're with? But I look
Speaker 1: for someone who is a common behavioral therapist who can
Speaker 1: focus on anxiety. I don't know that I've looked for
Speaker 1: targeting in the older population, but that's a really good point.
Speaker 1: And then I look for accessibility. How easy is that
Speaker 1: person to reach with telephone or telemedicine? Do they send
Speaker 1: reminders to my my patient in between? Because when it's
Speaker 1: hard to get in yeah, and it's hard to get
Speaker 1: on a zoom link or you know, do we have
Speaker 1: access to telephone? So how much support is there in
Speaker 1: between those appointments, right if they're like just find me
Speaker 1: on the app and they're like, I don't know what. Yeah. Um,
Speaker 1: And you said that there was some point that I
Speaker 1: picked up on something you wrote as that anxietily anxiraily.
Speaker 1: The anxiety doesn't necessarily become more common with age, so
Speaker 1: it's not like, oh, everyone's getting anxious about getting older.
Speaker 1: Like that was kind of good to hear. It is
Speaker 1: good to hear, I know, because we all think, okay,
Speaker 1: aging sucks. But the incidents of generalized anxiety disorders actually
Speaker 1: less a little bit less in the older population than
Speaker 1: the younger population. And there are a lot of anxiety
Speaker 1: syndromes that are much less common. You know, specific phobia
Speaker 1: sort of vanished, with the exception of of fear of falling,
Speaker 1: social phobia disorder sort of vanishes, panic disorder sort of vantishes,
Speaker 1: and I don't want to say vanishes. But over the
Speaker 1: age of sixty five, a new diagnosis of those anxiety
Speaker 1: syndromes is really unusual. So a lot of the anxiety
Speaker 1: syndromes burnout and and don't occur newly in our older folks,
Speaker 1: and generalized anxiety disorder does, but it's it is a
Speaker 1: slightly lower incidents than it is in our younger population.
Speaker 1: You know. I'm also wondering this is more of like
Speaker 1: a philosophical thought, but I know when I was younger
Speaker 1: in my twenties, my anxiety and panic were way worse
Speaker 1: even in my thirties. And I and when I hear
Speaker 1: from younger people, UM, there's a lot of like, yeah, yeah,
Speaker 1: I listen to your podcast, but nothing you say works
Speaker 1: for me because I don't know what I graduated in
Speaker 1: a recession or there's you know, the pandemic or what like.
Speaker 1: There's all these like world problems that that definitely affect.
Speaker 1: But there's not a lot of perspective And I don't
Speaker 1: mean that to sound dismissive, but there isn't that like
Speaker 1: personal perspective of I've been through blank and blank and
Speaker 1: blank because they're they're young, so they're ten year ago
Speaker 1: memories when they were twelve. But is there something to
Speaker 1: getting older where um, maybe therapy, whatever the therapy is,
Speaker 1: whether it's like what you said, Um, they see it
Speaker 1: a CBT cognitive behavioral therapist, or they do more exercise
Speaker 1: and do more you know, puzzles and connection with others
Speaker 1: that it's like a little easier to to wrangle because
Speaker 1: they're there, even if they're resistant to therapy, Like it's
Speaker 1: not something that's been in their life. Do they not
Speaker 1: have as many like but it's worse for me because
Speaker 1: like do they have more perspective? Does that help at all? Like, oh,
Speaker 1: I remember this hard time when I was fifty or
Speaker 1: when I was thirty year I got to imagine that helps. Yeah,
Speaker 1: it's got to be And I don't know if that
Speaker 1: you know, if there are I think you and I
Speaker 1: are just guessing on this. But there's got to be
Speaker 1: something to that, right, There's got to be something that's
Speaker 1: allowing our older folks to cope or at least say, well,
Speaker 1: it's not a heart attack and it's not you know,
Speaker 1: it's not INSI independent diabetes and it's not. So there's
Speaker 1: got to be something that's allowing them to minimize in
Speaker 1: a good way, you know, some of the anxiety symptoms
Speaker 1: or or allowing them to cope. And I just don't
Speaker 1: I think it's an unidentified thing. But I think that's
Speaker 1: exactly why we see that anxiety doesn't necessarily increase with age,
Speaker 1: is that there's got to be something about perspective and
Speaker 1: experience that allows you to cope in a way that
Speaker 1: a twentysomething can't. I think they've endured more and seeing
Speaker 1: that they can come out on the other end when
Speaker 1: you're older. And I think also it's perspective exactly right,
Speaker 1: it's it's you know, my five. I have many patients
Speaker 1: who are in their high nineties now, which is which
Speaker 1: is fun, but they don't, you know, they're just stoked
Speaker 1: to be able to still see and hear and move
Speaker 1: around and be surrounded by people who love them. So
Speaker 1: you know, yes, there's got to be something that that
Speaker 1: happens with aging that allows you to put all of
Speaker 1: this into perspective and you've endured so much and come
Speaker 1: out on the other end, And that's got to be
Speaker 1: an unidentified coping mechanism, right. It's almost like a smidge
Speaker 1: of gratitude that's like just naturally happening. UM. So I
Speaker 1: was surprised by this that that I had read that
Speaker 1: you said that UM in your experience, UM, generalized anxiety
Speaker 1: is more common among women than men. Older women, especially
Speaker 1: if they're widowed or divorce. I don't know why that
Speaker 1: surprised me. I think I'm just going to give my
Speaker 1: personal anecdotes for why is that. When I was a
Speaker 1: kid on my street, four houses across the street, four
Speaker 1: widows who were thriving, and all I did, I didn't
Speaker 1: go to nursery school. I would jump from widow's house
Speaker 1: to widows house and like, you know, watch game shows
Speaker 1: and have tea and all that. And to me, I
Speaker 1: mean not like they were going to tell me about
Speaker 1: their anxiety. I was a kid, But to me, I
Speaker 1: just remember thinking like, wow, you know, when you're when
Speaker 1: you're older, you marry a man, he dies first, and
Speaker 1: then you get this like second fabulous life where you
Speaker 1: just like do whatever you want. And I always think
Speaker 1: of women as a little more capable in that sense, right,
Speaker 1: especially from that generation where they know how to cook, clean,
Speaker 1: so take care of things. And I think of men like,
Speaker 1: oh god, if the wife dies first, Like I'm being funny,
Speaker 1: but I really mean it, they remarry someone younger, you know,
Speaker 1: they die right away. They're just a mess. And I'm
Speaker 1: so I was surprised that the women would have anxiety,
Speaker 1: because I would think it would be the men because
Speaker 1: they don't know what they're doing. Totally just generalizing, but
Speaker 1: I think you're generalizing right, and I'm gonna be I'm
Speaker 1: careful here because I say this from a place of
Speaker 1: love taking care of so many older women. But I
Speaker 1: believed what you believe, and I think you know, they
Speaker 1: have older life expectancy. Honestly, they they're coming in, driving
Speaker 1: their husbands in, you know, they look so much more capable.
Speaker 1: And then, bless their hearts when they lose their partner,
Speaker 1: especially if I take care of both of them, and I,
Speaker 1: you know, of course we grieve it. I say, don't
Speaker 1: you feel don't you feel slight relief though he is,
Speaker 1: you know, no longer suffering, And they just look at
Speaker 1: me and their purpose is gone. Over and over again.
Speaker 1: I'm just shocked, you know, and I don't again. I
Speaker 1: say this from a place of huge love, so I
Speaker 1: don't mean any disrespect to my older women. They seem
Speaker 1: so independent, they seem like renaissance women. Their purpose is gone.
Speaker 1: And it's not just that they don't know how to
Speaker 1: pay the mortgage aware or how much it is or
Speaker 1: where the checkbook is, and that does exist in in
Speaker 1: the older generation, but it's got you know, women feel
Speaker 1: things deeply and that's why. And I'm probably because we're
Speaker 1: some some of us our parents, but I think their
Speaker 1: purpose in a lot of ways is gone and they
Speaker 1: just feel like the rug was pulled out from underneath them.
Speaker 1: And I see that over and over again, and in
Speaker 1: my older women who I thought would hit the ground
Speaker 1: running right volunteering at Hydington Library and still playing tennis,
Speaker 1: and they lose their mate and the rugs just pulled
Speaker 1: out from underneath them. I don't know what that is,
Speaker 1: you know. And again it goes to your mom speaking
Speaker 1: about hormones and whatnot. And I don't know what that
Speaker 1: is about us and child rearing or whether it's hormonal.
Speaker 1: But we women have more anxiety disorders, and as we're older,
Speaker 1: and it usually is tied to some bereve and loss
Speaker 1: of a partner. I think it's being alone all of
Speaker 1: a sudden, and you know, maybe not being as financially savvy.
Speaker 1: And again, I think the caretaker role in when it's
Speaker 1: taken away, is a loss for some of my older
Speaker 1: female patients. And and I mean, look my male patients
Speaker 1: fall apart as well, and they lose their female part ors.
Speaker 1: I mean not to say that they don't, but there
Speaker 1: is women just struggle with a little bit more anxiety
Speaker 1: over the age of sixty than men. Anxiety bites will
Speaker 1: be right back after a quick little message from one
Speaker 1: of our sponsors. So another thing is you said older adults,
Speaker 1: there is a something like there could be a substance
Speaker 1: abuse disorder like that does coexist sometimes in in the elderly.
Speaker 1: So depressing because we're seeing an increased rate of that
Speaker 1: and it's it's honestly, it's our fault, it's physicians fault.
Speaker 1: So because of the problems we've just been talking about,
Speaker 1: you know, disrupted sleep and anxiety, we prescribe you know,
Speaker 1: a lot of benzo diazepines which is exam x valium
Speaker 1: at a van and opioids for our older folks who
Speaker 1: are in pain. And we're actually seeing more opioid and
Speaker 1: benzodiazepine substance disorders in our older folks, and to usually
Speaker 1: for anxiety because if someone comes in like I'm stressed,
Speaker 1: I can't sleep, we're prescribing zanex or out of vant
Speaker 1: So there is you know, this is true for the
Speaker 1: for younger folks too, But there is a connection with
Speaker 1: substance abuse disorders and anxiety and the elderly, and sadly
Speaker 1: it's increasing rather than decreasing because we are free to
Speaker 1: write prescriptions. I mean we freely write them, I think
Speaker 1: because it's easier to do that than to talk about
Speaker 1: what we've spent time talking about, which are those tools
Speaker 1: for coping. So it's a it's an US problem. And um,
Speaker 1: there's no question that we're seeing in increased risk of
Speaker 1: of elderly folks being treated for substance abuse, and usually
Speaker 1: it's prescription medications that we've given and often in response
Speaker 1: to some anxiety symptoms and disrupted sleep. So that's could
Speaker 1: be something for children of elderly people to keep an
Speaker 1: eye on, you know, if there is, if they are
Speaker 1: talking to their parents about sleep and their doctors a
Speaker 1: little bit, you know, script happy, it's like maybe just
Speaker 1: you know, just being aware of that that that they
Speaker 1: don't even want to start to go down that road,
Speaker 1: that sense please keep an eye on it. And it's
Speaker 1: you know, that's and it's again when we talk about
Speaker 1: keeping an eye on it, I want to make sure
Speaker 1: that that people know I'm fine. A family members write
Speaker 1: a little note, send an email, wait in the waiting
Speaker 1: room to see if they can just talk to me
Speaker 1: quickly after I'm in the room with their mom or dad.
Speaker 1: So you can do that and it's not annoying or disruptive.
Speaker 1: And because we see someone for a very quick snapshot
Speaker 1: in time in the office, and what you see jen
Speaker 1: with your mom and dad is much more helpful. We
Speaker 1: don't mind input from family members, So I want people
Speaker 1: to know that I don't care if you pass me
Speaker 1: a little note or you talk to me in the
Speaker 1: hallway you say, can I have two minutes after you've
Speaker 1: done with my mom or dad. It may feel like
Speaker 1: we're rushed, and sometimes we are, but it's that is
Speaker 1: really helpful. And I think for for family members knowing
Speaker 1: their yeah, the medication list of their parents, because their
Speaker 1: parents might not know I'm taking I'm taking Xanax every
Speaker 1: night to sleep and it's been working great, and it's
Speaker 1: good for us to keep an eye on that us
Speaker 1: his family members. That's good to know that that some
Speaker 1: doctors are amenable to that, because you know, it's like
Speaker 1: you could come into the room and talk to the
Speaker 1: doctor and behalf of your mom for two minutes and
Speaker 1: and be like, oh, do my mom do that thing
Speaker 1: where she made fifty jokes? Yeah, she does that, but
Speaker 1: actually that's because she's um needs to look perfect in
Speaker 1: front of doctors. But really what she told me is
Speaker 1: every night to cyperventilating. So it's needs you no, no no,
Speaker 1: you know, it's like but just a reslope, you know,
Speaker 1: when someone barging in, like you don't know what you're doing,
Speaker 1: you know, but it's like to give information that normally
Speaker 1: we think of like that's confidential, but it seems like
Speaker 1: that could be important the way again you would take
Speaker 1: care of a kid in a way so important, and
Speaker 1: I think it goes back to respecting your mom or
Speaker 1: dad's independence, but giving helpful information. It is so important
Speaker 1: for for memory issues, for you know, anxiety behaviors, you're saying,
Speaker 1: for depressive behaviors. You're saying, it's so important for us
Speaker 1: to hear from family members because what we're getting in
Speaker 1: the twenty minute visit in the office isn't always the
Speaker 1: full story. So it is it's imperative that family members
Speaker 1: weigh and if they feel like there's something wrong, and
Speaker 1: any physician who seems irritated by that, find a new physician.
Speaker 1: Well that's perfect advice to end on. Thank you so
Speaker 1: much Sharon for doing my show. This is gonna be
Speaker 1: really helpful. I hope everyone who wrote in about this
Speaker 1: topic is full of new information. I know that I
Speaker 1: am for sure. Hi, I hope you enjoyed my talk
Speaker 1: with Sharon Orange, Dr Sharon Orange. So let's look at
Speaker 1: some of the takeaways, and these again are up as
Speaker 1: always on my website. You can click the link in
Speaker 1: the show notes or go to Jen Kirkman dot com
Speaker 1: and then you can just click on Anxiety Bites from
Speaker 1: there and you can read along or board it to
Speaker 1: someone whatever you want to do. But here are the
Speaker 1: big takeaways to remember from this episode. So only one
Speaker 1: in five elderly adults will bring up the topic of
Speaker 1: mental health on their own in any conversation with a
Speaker 1: health professional. Some older people don't want to admit to
Speaker 1: having anxiety because they're afraid that their families will lose
Speaker 1: faith in them if they see that they're not coping.
Speaker 1: The biggest mistake that younger people or middle aged people
Speaker 1: can make when addressing anxiety and their elderly friends or
Speaker 1: relatives is trying to help but not respecting the independence
Speaker 1: of their elderly friend or relative. The conversation must be
Speaker 1: approached with patience and compassion, rather than trying to control
Speaker 1: the situation by declaring you have anxiety. That's probably a
Speaker 1: good rule of thumb when talking to anybody of any age. Really,
Speaker 1: a way to bring up a conversation about mental health
Speaker 1: with the older adult in your life is to focus
Speaker 1: on any changes you've noticed and start there. Some examples are,
Speaker 1: you don't seem like yourself, you seem more tired than usual,
Speaker 1: you seem irritable. I noticed that your sleep has been disrupted.
Speaker 1: It's important for children of elderly parents who have anxiety
Speaker 1: or depression to approach the conversation by reminding them that
Speaker 1: anxiety and depression is like any other health issue. There
Speaker 1: are treatments available, and let's go talk to a doctor
Speaker 1: about it. And you can start by talking to an internist.
Speaker 1: You don't have to start with a psychologist or psychiatrist.
Speaker 1: If the doctor is as great as dr Share an Orange,
Speaker 1: then they should be able to point you in the
Speaker 1: right direction. And it may not even be that the
Speaker 1: elderly person in your life needs to go to traditional therapy,
Speaker 1: but it may be other things that they need to
Speaker 1: start doing, whether it's learning how to delegate more and
Speaker 1: let their children do things for them and really understand
Speaker 1: and hear their children that it's not a burden, you know,
Speaker 1: whether it's they need to do more puzzles and mind exercises,
Speaker 1: or expand their social circle in any way that they
Speaker 1: can that's safe for them, but it doesn't was involved
Speaker 1: cognitive behavior therapy and talk therapy the way that the
Speaker 1: anxiety that younger and middle aged people have UH tends
Speaker 1: to need that in order to help people get out
Speaker 1: of the underwater feeling that they're in. When talking to
Speaker 1: older adults about anxiety, as opposed to younger people, the
Speaker 1: focus should not be on just feelings. The focus needs
Speaker 1: to be changed to trying to figure out some objective
Speaker 1: problem solving like running errands are simply letting parents know
Speaker 1: that you're there to help, after all, they took care
Speaker 1: of you for so long. Coping mechanisms that help with
Speaker 1: anxiety and older adults will differ than ones that younger
Speaker 1: adults will use. For example, an older person may live
Speaker 1: in a nursing facility. They may not be able to drive, anymore.
Speaker 1: They may have limited mobility or limited physical activity, which
Speaker 1: of course will impact what kinds of exercises they can
Speaker 1: do to decrease anxiety. So coping mechanisms for anxiety and
Speaker 1: the elderly involves more concrete tasks, like working to improve
Speaker 1: memory things related to brain health. Older adults are afraid
Speaker 1: of dementia and memory issues, and oftentimes their anxiety is
Speaker 1: simply tied to that. Approaching the elderly with solutions like
Speaker 1: an iPhone app for mindfulness may not have the same
Speaker 1: impact as it would on someone younger, but offering for
Speaker 1: an elderly person to have some quiet time or time
Speaker 1: for prayer, hot baths time, and nature walking this can
Speaker 1: help and get the same results without having to discuss
Speaker 1: mindfulness or some kind of app on a phone that
Speaker 1: they may not have. Another way that elderly people can
Speaker 1: cope with anxiety is by doing some cognitive training like
Speaker 1: doing puzzles, joining a bridge group, any group online, learning
Speaker 1: a new language, even doing something quick and simple as
Speaker 1: doing wordle every day. A lot of anxiety and older
Speaker 1: people is tied in with chronic illness, disability, caregiver status,
Speaker 1: social isolation, things that younger friends and family members really
Speaker 1: have no control over changing. Anxiety is a risk factor
Speaker 1: for the development of cognitive decline and dementia. Anxiety is
Speaker 1: an early symptom of dementia, which it does not mean
Speaker 1: that because you have anxiety, you will have dementia. Although
Speaker 1: insomnia is a symptom of anxiety, many elderly people just
Speaker 1: need less sleep. The focus should not be on how
Speaker 1: many hours that they're getting of sleep, but more about
Speaker 1: is their sleep restorative, how is their sleep pattern or
Speaker 1: their sleep hygiene. If they're waking up feeling alert, not exhausted,
Speaker 1: but they're just getting less hours of sleep, that's not
Speaker 1: inherently a symptom of anxiety. Older adults tend to minimize
Speaker 1: their anxiety symptoms and attribute them to a physical illness,
Speaker 1: like something's wrong with their appetite, and they're not as
Speaker 1: adept as described in describing their emotional feelings of anxiety
Speaker 1: when talking to a doctor. Panic disorders and panic attacks
Speaker 1: are less common in the elder due to changes in
Speaker 1: our central and peripheral nervous system. That's kind of a relief.
Speaker 1: Anxiety does not become more common with age, simply because
Speaker 1: there are things to worry about, like mortality and illness.
Speaker 1: Generalized anxiety disorder is less common of a diagnosis in
Speaker 1: the older population than in the younger population. Specific phobias
Speaker 1: seems to kind of vanish, like a social phobia, for example,
Speaker 1: or a panic disorder. Over the age of sixty five,
Speaker 1: A brand new diagnosis of any of those kind of
Speaker 1: anxiety syndromes is unusual. There is an increased rate of
Speaker 1: medication addiction in the elderly, so it's important to keep
Speaker 1: an eye on your parents and talk to their doctor
Speaker 1: about any unusual behavior or signs of addiction that you
Speaker 1: may see. Again, you can learn more about Dr Share
Speaker 1: and Orange by clicking the link in the description and
Speaker 1: the show notes. You can learn more about me by
Speaker 1: doing the same thing. You can leave a comment on
Speaker 1: social media at Jen Kirkman on Twitter and also on Instagram,
Speaker 1: and you can check out the fun little audio grams
Speaker 1: that I put up from every episode. They are available
Speaker 1: as well on my YouTube channel. Again, all of this
Speaker 1: is in the link in the show notes. And I
Speaker 1: think that's all I'm going to leave you with today.
Speaker 1: Just remember anxiety Bites, but you're in control. For more
Speaker 1: podcasts from my heart Radio, visit the I heart radio, app,
Speaker 1: Apple podcast, or wherever you listen to your favorite shows.