Anxiety in older adults often shows up as constant worry, frequent calls and sleeplessness. A guide to understanding and supporting your ageing parents.
When you call your mother, she picks up on the first ring and asks, "Where are you? Why did you call so late?" Your father, who used to go to the coffee house every morning, no longer leaves the house, saying, "I'll fall on the stairs." He wakes up at three in the morning to check whether the door is locked, reaches for the blood pressure monitor with every headache, and after every news item he sees on television he phones you to say, "Be careful, won't you." The people around you may be saying, "He's getting old, he's become a worrier, it's normal." Yet anxiety in older adults is often not an inevitable part of ageing but a condition that needs to be noticed and addressed. This article is written for adult children who have noticed growing restlessness, worry and sleeplessness in their parents. We will talk about what this change may mean, what should not be overlooked and how you can support them.
What Is Anxiety in Older Adults? Restlessness Mistaken for "Fretting"
Anxiety can appear at any age; but in later life it shows itself in different ways, which is why it is often missed. While younger people describe anxiety with sentences such as "I'm so tense, my mind always goes to bad things", older people often describe not their feelings but their bodies or the dangers around them: "My heart feels tight", "The streets aren't what they used to be", "If something happens to me, who will look after me?"
Most of this generation grew up at a time when talking about psychological difficulties was hardly the done thing. Expressions such as "my nerves are bad", "I feel suffocated inside" or "I'm a worrier" are culturally accepted ways of describing anxiety. Families also often see these expressions as personality traits: "Mum was always a worrier anyway." But anxiety that starts for the first time in old age, or increases markedly, is not just a matter of temperament.
Moreover, anxiety in older adults can seriously affect quality of life. Not leaving the house, cutting off from social relationships, sleepless nights and a constant state of alert wear down both physical health and mental functioning. That is why brushing it off with "it's normal in old age" can quietly allow a condition that could be helped to grow.
What Are the Symptoms of Anxiety in Older Adults?
Symptoms vary from person to person, but there are some signs that adult children often observe.
Physical complaints and health worries
Constantly saying that something hurts, frequently wanting to see the doctor or, on the contrary, never going because of fear of doctors, and interpreting every minor symptom as the sign of a serious illness are common faces of anxiety in older people. Measuring blood pressure several times a day, checking blood sugar again and again and becoming overly fixated on medication times may accompany this picture.
Repeated calls and questions
Calling their children and grandchildren several times a day, asking the same questions over and over, and panicking when the phone is not answered are common. Questions such as "Have you arrived?", "Have you eaten?" and "Did you lock the door?" are expressions of the need to be sure that loved ones are safe.
Not leaving the house, fear of falling
Especially in older people who have fallen once or had a near miss, fear of falling can become very decisive. The person begins to avoid stairs, kerbs, crowds and public transport. As movement decreases, muscles weaken, balance deteriorates and the risk of falling genuinely increases. In this way anxiety turns into a cycle that enlarges the very thing it fears.
Sleep and restlessness
Being unable to fall asleep, waking frequently in the night and tossing and turning with thoughts towards dawn are important signs of anxiety in older people. Being unable to sit still during the day, constantly busying themselves with something, difficulty concentrating and irritability may also be seen.
Why Does Anxiety Increase in Old Age?
Old age is a period in which many changes happen together, both in a person's body and in their life. Each of these changes can pave the way for anxiety:
Health problems: Chronic illnesses, pain, operations and hospital experiences create the feeling that the body can no longer be trusted. Every new symptom brings with it the question, "Is it serious this time?"
Losses: Losing a spouse, siblings or close friends means both grief and thinking more often about one's own mortality. As news of funerals becomes more frequent, it deeply affects the way the person looks at the future.
Loss of independence: Changes such as no longer being able to drive, being unable to go shopping alone or having their children pay the bills feed the sense that control is slipping away. The fear of "being a burden" is one of the most common, yet least voiced, sources of anxiety in older people.
Loneliness: Children moving to big cities or abroad, the neighbourhood changing, and familiar neighbours no longer being in the apartment building make an older person increasingly lonely. Loneliness, in turn, is a powerful factor that feeds both anxiety and depression.
Loss of role: With retirement, the work identity may change, and so may the role of being the elder in the family who makes the decisions. We look separately at the difficulties of this transition in our article on retirement syndrome.
Financial worries: A pension melting away in the face of the cost-of-living crisis, the expense of medicines and treatment, and the feeling of no longer being able to support their children are a daily source of worry.
Events in society: Earthquake news, pandemic periods and negative news watched for hours on television can markedly increase older people's perception of danger. Particularly for someone who sits at home all day with the television on, the world can look like a far more dangerous place than it is.
Let's think through an example of how these factors become intertwined. Let's say a 74-year-old woman who lost her husband a few years ago lives alone on the third floor of a four-storey apartment building in a small Anatolian town. One of her children is in Istanbul, the other in Ankara. One winter morning she slips on an icy pavement and sprains her wrist. From that day on she stops going down to the market, makes do with the bread her neighbour brings, and wakes at every creak in the night. She tells her children every evening, "I'm fine", but after hanging up she spends hours thinking, "What will happen if I fall again?" There is no single cause here; grief, loneliness, a health event and the fear of losing her independence have piled on top of one another.
Is It Anxiety or Something Else? Things to Watch Out For
Symptoms of anxiety in older adults can be confused with certain physical and mental conditions. That is why the first step should always be a thorough medical assessment.
Physical causes: Thyroid disorders, heart rhythm problems, respiratory diseases, fluctuations in blood sugar and some vitamin deficiencies can create symptoms similar to anxiety.
Medication: Older people often take more than one medicine. Some medicines, or interactions between medicines, can cause restlessness, palpitations and sleeplessness. It is important to take a list of all the medicines being used to the doctor. The decision to change any medication always rests with the doctor.
Depression: Anxiety and depression frequently occur together in older people. If lack of motivation, inability to enjoy things, hopelessness and sentences such as "there's no point in living any more" accompany the anxiety, the possibility of depression in old age also needs to be considered.
Cognitive changes: Forgetfulness, frequently repeating the same questions, difficulty finding the way and marked changes in personality may be signs of a process that goes beyond anxiety. Intense anxiety appearing for the first time in later life can sometimes be an early herald of cognitive decline; for this reason a neurological or psychiatric assessment is important. During this process, our article on being the relative of someone with dementia may also offer families some guidance.
What Can Adult Children Do?
Supporting an anxious parent takes patience as much as love. The following approaches can make things easier:
Don't belittle the anxiety. Saying "Oh, never mind, Mum, nothing will happen", however well meant, leads the person to feel misunderstood. First acknowledge the feeling: "Watching that news makes you uneasy, I understand." Then make a realistic assessment together.
Set up a predictable pattern of contact. A short call at the same time every day is much more reassuring than constant, irregular phone calls. When the person knows the call is coming, their need to ring you in between may decrease.
Don't do everything for them. Taking over every task to reduce anxiety brings relief in the short term but reduces independence and self-confidence even further. Doing the grocery shopping together, or paying a bill together, keeps some of the control in their hands.
Support movement. If there is a fear of falling, physiotherapy or balance exercises recommended by a doctor, grab bars at home, non-slip mats and good lighting increase both safety and confidence. Short, regular walks can help reduce anxiety.
Revive social ties. Senior day centres in the neighbourhood, public education courses, the mosque congregation, visits to neighbours or video calls with grandchildren can break the loneliness. A regular social activity, however small, gives the day a purpose.
Limit the news flow. Having the television left on a news channel all day, or health messages of doubtful accuracy arriving on the phone, constantly feeds anxiety. Finding alternatives together, such as documentaries, music or favourite old series, can help.
Involve them in decisions. Rather than making decisions about health, the home or money on their behalf, talk through the options together. Feeling that they have a say in their own life reduces the sense that control is slipping away and soothes anxiety. If a lack of information is making a decision harder, for example if they do not know what a test is for, explaining it in plain language also helps.
Protect yourself too. Adult children who provide care can get squeezed between their own work, their children and their parents. Sharing this load with siblings and knowing your own limits are preconditions for support that can last.
An older relative's constant worry is often a way of saying "Don't forget me, I'm still here"; hearing that voice is the first step in soothing the anxiety.
When Should You Seek Professional Support?
It is appropriate to seek support from a professional in the following situations:
- If the anxiety is new or has increased markedly in recent months
- If avoidance such as not leaving the house or withdrawing from social relationships is narrowing their life
- If sleeplessness has lasted for weeks
- If the anxiety is accompanied by lack of motivation, hopelessness and joylessness
- If you observe forgetfulness, confusion or changes in personality
- If they are turning to over-the-counter medicines, or other people's medicines, to calm down
When symptoms of anxiety first appear, it is a good start to see the family doctor first so that the physical causes mentioned above can be ruled out. A subsequent meeting with a mental health professional then clarifies how far the anxiety is affecting daily life.
If your older relative often says things like "I wish I were dead and done with it" or "I'm a burden on you", take this seriously and talk to a professional. In an emergency where you think there is a risk of self-harm, call 112 (emergency services).
How Is Anxiety in Older Adults Addressed in Therapy?
The belief that people in later life cannot benefit from therapy is widespread but wrong. Cognitive behavioural therapy (CBT) is one of the research-supported approaches for addressing anxiety in older adults. Therapy is adapted to the person's hearing, sight, mobility and memory: sessions may proceed more slowly, and written summaries and reminders can be used.
In therapy, catastrophic thoughts ("If I fall, nobody will find me", "This pain is definitely something bad") are noticed and compared with realistic alternatives. Avoided activities, such as a short walk or a visit to a neighbour, are returned to in small steps. Relaxation and breathing exercises, sleep adjustments and planning meaningful activities during the day are part of the process. Reviewing one's life story and remembering past strengths in coping can also be especially valuable for older people.
Involving family members in the process is often helpful. Children and grandchildren can notice behaviours that unknowingly reinforce the anxiety and learn how to offer support. For families living in another city, online therapy can make it possible for an older person to join sessions from their own home with technical help from a family member. Where needed, an assessment by a psychiatrist is also added to the process.
Frequently Asked Questions
Is it normal to become a worrier in old age?
It is understandable for worries about health and safety to increase somewhat with age. But if these worries are narrowing the person's life, disrupting their sleep or creating constant restlessness, they should not be brushed aside as "normal ageing". Anxiety in older adults is a treatable condition.
Are online sessions suitable for an older person?
Many older people adapt to video calls surprisingly easily once a family member sets up the connection. A quiet room, a well-adjusted volume and the screen at eye level make the session more comfortable. If hearing or sight difficulties are marked, or if the person feels safer meeting face to face, this preference is considered together.
My father keeps asking the same things. Is it anxiety or forgetfulness?
An anxious person often asks the same question to get reassurance and remembers the answer, yet still does not feel relieved. With forgetfulness, the person genuinely does not remember the answer. The two can also occur together; it is best to make this distinction through an assessment by a doctor and a mental health professional.
Why does my mother become more restless after a holiday visit?
When the house falls silent again after crowded, cheerful days, loneliness is felt more sharply. Moments of parting can also trigger thoughts in an older person such as "Will I live to see the next holiday?" Calling a little more often for a few days after the visit, and planning the next get-together with a concrete date, can soften this transition.
Bu yazı genel bilgilendirme amaçlıdır; tanı veya tedavi yerine geçmez. Yaşadığınız güçlükler için bir ruh sağlığı uzmanına başvurmanız önerilir. Acil bir durumda lütfen 112'yi arayın.
Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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