Managing fear and worry

My name is Brian Lawlor and I’m a Professor of old age psychiatry at Trinity College Dublin. It’s hard not to worry, no matter what stage of life you’re at. Worry, fear, and anxiety can be a normal part of life. However, when worry, fear, and anxiety get severe or is persistent and excessive and interferes with your quality of life, well, then it’s a problem and you may need to take action and have it dealt with. Worry and anxiety are usually experienced in your head. You think about something, it’s on your mind, and it can be unpleasant for you or cause you concern.

For example, you might worry about your health, your children and your family, and of course, money– usually not having enough of it, of course. Some of these types of worries can increase as you get older, but that can be normal. Another fear or worry that older people can have is often related to their sense of safety and security. Worry and anxiety, in particular, can also have physical consequences, usually if that worry or anxiety is more severe.

So anxiety can show itself not just as a mental symptom, but also as a physical symptom. For example, sweaty palms, shortness of breath, palpitations and queasiness in the stomach, nausea, or loose bowel motions can all be part of anxiety, worry, or fear, and cause loss of function or make the person reluctant to go out. Sometimes the older person may not realise that these physical symptoms are actually a manifestation of anxiety and can go and visit the doctor, believing that their physical symptoms are due to a medical problem and not actually due to anxiety. This can sometimes result in a lot of medical investigations that end up showing no physical cause for the person’s symptoms.

So if anxiety becomes severe and prolonged, it is probably what we call an anxiety disorder. And this needs to be treated because if it isn’t, it usually gets worse over time. If you’ve experienced a stressful or traumatic event, for example a severe accident or a mugging, and it’s causing you a lot of anxiety, stopping you from going out, or causing you to have nightmares, or if anxiety and fear has become chronic and bothering you a lot, you should see your doctor to decide if you need psychological or medical treatment.

It’s also a good idea to see your doctor if you have that level of anxiety, as sometimes an overactive thyroid could be the cause and this can be checked out by a simple blood test. Anxiety disorders can be treated either with psychological approaches and anxiety management or with medication, both of which can be effective either on their own or in combination.

A final point about someone who develops very significant anxiety later in life. It’s important to ask about depression and depressive symptoms because when older people develop depression, it can present as a very anxious state and it’s important to be aware of this so that the person gets treated for depression and not just the anxiety.