Anxiety and depression in older people

This article was written by our community partner, Beyond Blue. Medibank and Beyond Blue are working together to empower all people in Australia to be better connected with knowledge, resources and support to improve their mental health and wellbeing. Visit the Beyond Blue website for more information on mental health and older people.

Anxiety in older people

The symptoms of anxiety in older people are sometimes not all that obvious as they often develop gradually and, given that we all experience some anxiety at some points in time, it can be hard to know how much is too much. Often older people with anxiety will experience a range of symptoms from the categories below:

Behavioural

• Avoiding objects or situations which cause anxiety.
• Urges to perform certain rituals in a bid to relieve anxiety.
• Not being assertive (i.e. avoiding eye contact).
• Difficulty making decisions.
• Being startled easily.

Feelings

• Overwhelmed.
• Fear (particularly when facing certain objects, situations or events).
• Worried about physical symptoms (such as fearing there is an undiagnosed medical
• problem).
• Dread (such as fearing that something bad is going to happen).
• Constantly tense or nervous.
• Uncontrollable or overwhelming panic.

Thoughts

• “I’m going crazy.”
• “I can’t control myself.”
• “I’m about to die.”
• “People are judging me.”
• Having upsetting dreams or flashbacks of a traumatic event.
• Finding it hard to stop worrying, unwanted or intrusive thoughts.

Physical symptoms

• Increased heart rate/ racing heart.
• Vomiting, nausea or pain in the stomach.
• Muscle tension and pain.
• Feeling detached from your physical self or surroundings.
• Having trouble sleeping.
• Sweating, shaking.
• Dizzy, lightheaded or faint.
• Numbness or tingling.
• Hot or cold flushes.

Depression in older people

An older person may have depression if, for more than two weeks, he or she has felt sad, down or miserable most of the time or has lost interest or pleasure in most of his or her usual activities, and similar to anxiety, has experienced several of the signs and symptoms across at least three of the categories below.

It's important to note that everyone experiences some of these symptoms from time to time and it may not necessarily mean that the person is depressed. Equally, not every person who is experiencing depression will have all of these symptoms.

Older people with depression tend to present with more symptoms from the physical category compared to the other categories. So an older person is more likely to present to their GP with various physical complaints and difficulty sleeping rather than complaints of sadness or low mood.

Different language may also be used when older people refer to their depression. Instead of describing 'sadness', for example, they may talk about 'their nerves'.

Behaviours

• General slowing down or restlessness.
• Neglect of responsibilities and self-care.
• Withdrawing from family and friends.
• Decline in day-to-day ability to function, being confused, worried and agitated.
• Inability to find pleasure in any activity.
• Difficulty getting motivated in the morning.
• Behaving out of character.
• Denial of depressive feelings as a defence mechanism.

Thoughts

• Indecisiveness.
• Loss of self-esteem.
• Persistent suicidal thoughts.
• Negative comments like 'I'm a failure, 'It's my fault' or 'Life is not worth living'.
• Excessive concerns about financial situation.
• Perceived change of status within the family.

Feelings

• Moodiness or irritability, which may present as angry or aggressive.
• Sadness, hopelessness or emptiness.
• Overwhelmed.
• Feeling worthless or guilty.

Physical symptoms

• Sleeping more or less than usual.
• Feeling tired all the time.
• Slowed movement.
• Memory problems.
• Unexplained headaches, backache, pain or similar complaints.
• Digestive upsets, nausea, changes in bowel habits.
• Agitation, hand wringing, pacing.
• Loss or change of appetite.
• Significant weight loss (or gain).

Dementia and depression

Depression is thought to affect 1 in 5 people experiencing dementia.

When dementia and depression occur at the same time it may be difficult to distinguish between them because the signs and symptoms are similar. However, dementia and depression are very different conditions that require different responses and treatment, so a thorough assessment by a health professional is recommended.

In older people, both personal carers (e.g. a partner, family member or friend) and professional carers are a valuable source of information. Both personal and professional carers should be included in healthcare discussions and assessment where possible.