Anxiety is the ‘unpleasant emotion associated with a sense of impending danger that is not obvious to an observer’ (Marks 2001). Feeling anxious from time to time is a normal human experience. When someone is anxious they might experience feelings of tension, nervousness, heightened awareness, fear or uncertainty, dry mouth and throat, and tightness in the chest. They might appear ‘edgy’, irritable and tearful or be unable to relax.
Anxiety becomes abnormal if it is out of proportion to the situation, if it persists when the situation is resolved or if it appears for no apparent reason. The effects of anxiety are caused by a physiological process. The release of adrenaline prepares the body for a ‘fight or flight’ response. As well as changes in behaviour, signs that someone is anxious include sweating, pallor, dilated pupils, trembling, raised blood pressure and pulse, need to pass urine urgently, diarrhoea or nausea.
Mental health - What can I do to help an older person who is experiencing anxiety?
Panic attacks
Of the older population, 10 to 20 per cent are thought to have some form of anxiety (National Institute of Mental Health 2007). Like many other mental health problems, anxiety in the older population is often underdiagnosed.
Some physical illnesses that are common in older people are linked to an increased incidence of anxiety. These include chronic obstructive pulmonary disease (Willgoss et al 2011) and cardiac disease. Separating a medical condition from a physical symptom of anxiety disorder can be complicated and may require specialist mental health assessment.
Self-help or self-management strategies often work well for people who are anxious, for example, the free podcasts from the Mental Health Foundation. Taking regular exercise, having adequate sleep, avoiding caffeine, smoking and alcohol can all help. Older people can be taught controlled breathing, relaxation or distraction techniques to use before or when they feel anxious. Cognitive behaviour therapy can be helpful and emphasises the relationship between thoughts, feelings and behaviours. Bibliotherapy (written information about anxiety and anxiety management) and computerised self-help packages are increasingly being used.
Occasionally medication may be appropriate for managing severe anxiety or panic. Benzodiazepines can provide short-term relief from unpleasant symptoms, but need to be used with caution in older people due to their side effect profile and potential to cause dependence. The National Institute for Health and Clinical Excellence (2011) recommends that they are used for two to four weeks only. Some antidepressant medication is licensed for the longer-term management of anxiety and usually prescribed at the lowest possible dose. Pregabalin, although classified as an anti-epileptic drug, is also licensed for treatment of generalised anxiety disorder but is usually initiated by specialist mental health services.
Nursing strategies
A calm approach is often enough to reassure a person who is anxious. Acknowledging the presence of anxiety and explaining that it is ‘normal’ in the person’s circumstances can help. Listening to a person’s worries and fears is a crucial nursing role. Giving the person information about anxiety, its causes and techniques that may help is often sufficient to enable them to reduce and manage their symptoms. However, in the case of severe or prolonged anxiety it may be appropriate to refer the person to specialist mental health services.
References
Marks I (2001) Living with Fear. Understanding and Coping with Anxiety. Second edition. McGraw-Hill, Maidenhead.
National Institute for Health and Clinical Excellence (2011) Generalised Anxiety Disorder and Panic Disorder (With or Without Agoraphobia) in Adults. Management in Primary, Secondary and Community Care. Clinical Guideline 113. NICE, London.
National Institute of Mental Health (2007) Anxiety Disorders. NIH Publication No. 09-3879. Available at: http://tinyurl.com/7ytzd62 (Last accessed: February 9 2012.)
Willgoss T, Yohannes A, Goldbart J et al (2011) COPD and anxiety: its impact on patients’ lives. Nursing Times. 107, 15-16, 16-19.