Your mom used to drive across town to see friends. Now she won't leave the house after 3 p.m., calls you five times a day to check whether you got home safely, and has been to the emergency room twice this year for chest pain that turned out not to be her heart. She says she's "just a worrier." But the worry is taking over her days, and it's taking a toll on you, too.
This guide uses the National Institute of Mental Health, MedlinePlus and Medicare.gov. It isn't medical advice. If your parent talks about suicide or self-harm, call or text 988 right away, or call 911 in an emergency4.
Normal worry vs. an anxiety disorder
Feeling anxious is a normal part of life. Many people worry about health, money or family1. Anxiety can even help: it can give a boost of energy or help a person focus before a big decision2.
Anxiety disorders are different. The anxiety does not go away, is felt in many situations, and can get worse over time1. The symptoms can interfere with daily activities and relationships2. In severe cases, a person may feel intense fear in common situations, avoid social contact, or refuse to leave home1. Worry often disrupts sleep; see insomnia in the elderly.
For older adults, the question to ask is simple: is the worry out of proportion to the situation, and is it keeping your parent from living the way they want to?
Types of anxiety disorders
- Generalized anxiety disorder (GAD). Excessive worry about ordinary issues like health, money and family, almost every day for at least six months2.
- Panic disorder. Sudden, repeated periods of intense fear when there is no danger, coming on quickly and lasting minutes or more2.
- Phobias. Intense fear of something that poses little or no actual danger, such as crowded places or social situations2.
- Social anxiety disorder. Fear of social situations12.
In older adults, a common pattern is fear of falling that leads to avoiding activity. Some caution after a fall makes sense, but if fear keeps your parent from walking or going out, it can weaken muscles and isolate them. See fall prevention for the elderly.
Signs of anxiety in an older parent
All anxiety disorders share a combination of anxious thoughts that are hard to control, physical symptoms and changes in behavior2:
- Anxious thoughts. Restlessness and tension, worry that doesn't go away and gets in the way of daily life2.
- Physical symptoms. A pounding or rapid heartbeat, unexplained aches and pains, dizziness and shortness of breath2. Sweating can also occur2.
- Behavior changes. Avoiding everyday activities they used to do2.
- Repeated reassurance-seeking. Frequent calls or questions about the same worries.
- Sleep problems. Trouble falling or staying asleep because of racing thoughts.
Because many of these symptoms overlap with heart and lung problems, older adults often end up in the emergency room or at the cardiologist. That's appropriate: chest pain and shortness of breath always deserve a medical check. But if tests come back clear again and again, ask the doctor whether anxiety could be part of the picture.
What causes anxiety in later life
The exact cause of anxiety is unknown. Genetics, brain biology and chemistry, stress and environment may all play a role2. General risk factors include certain personality traits, traumatic events, a family history of anxiety or other mental disorders, and some physical health conditions, such as thyroid problems or arrhythmia2.
Later life brings its own stresses: a new diagnosis, losing a spouse or friends, money worries, giving up driving, hearing or vision loss, or a move. Caffeine, other substances and certain medicines can make anxiety symptoms worse2, so a medicine review is worth asking for.
Anxiety also overlaps with other conditions. It often occurs alongside depression1. See depression in the elderly. New worry, agitation or restlessness can also be an early sign of memory changes; see early signs of dementia. And sudden confusion with agitation can be delirium, which needs prompt medical care; see delirium in the elderly.
Getting a diagnosis
To diagnose an anxiety disorder, a health care provider asks about symptoms and medical history and may do a physical exam and lab tests to make sure a different health problem isn't the cause2. If no other problem is found, the next step is a psychological evaluation, done by the provider or a mental health professional2.
Before the visit, write down what you've noticed: when the worry started, what triggers it, physical symptoms, ER visits, and every medicine and supplement. Ask your parent's permission to come along or join by phone. Medicare covers a yearly depression screening in primary care5, and the Medicare Annual Wellness Visit is a natural time to raise mood and worry.
Treatment options
The main treatments for anxiety disorders are psychotherapy (talk therapy), medicines, or both2.
- Cognitive behavioral therapy (CBT). Teaches different ways of thinking and behaving and can change how a person reacts to things that cause fear. It may include exposure therapy, gently facing fears to stop avoiding them2.
- Acceptance and commitment therapy. Uses strategies like mindfulness and goal setting to reduce anxiety2.
- Medicines. Anti-anxiety medicines and certain antidepressants. It may take trying more than one to find the right fit2.
- Support groups and stress management. These may also help2.
For older adults, medicine choices deserve extra care. Some medicines can cause drowsiness or unsteadiness, which raises fall risk, and they can interact with other prescriptions. Ask the doctor or pharmacist about side effects, and never stop a medicine suddenly without medical advice.
What Medicare covers
Medicare Part B covers outpatient mental health services, such as individual and group psychotherapy, from qualified providers including psychiatrists, psychologists, clinical social workers and other licensed professionals who accept Medicare3. Some services can be done by telehealth3. Prescription medicines are generally covered by a Part D plan or a Medicare Advantage plan with drug coverage.
If cost is a barrier, see Medicare Savings Programs and Extra Help. To find mental health providers, FindTreatment.gov lists services by location6.
How families can help day to day
- Listen without dismissing. "Don't worry" rarely helps. Try, "That sounds really stressful. What would make it easier?"
- Avoid feeding avoidance. Doing everything for your parent can keep fears going. Encourage small steps instead, like a short outing with you.
- Keep routines steady. Regular meals, sleep, activity and daylight can help.
- Cut back on caffeine. It can make symptoms worse2.
- Limit the news. Constant news can feed worry for some people.
- Stay connected. Isolation and anxiety can feed each other. See loneliness in the elderly.
- Set limits kindly. If calls become constant, agree on set check-in times so your parent knows when they'll hear from you.
When your parent resists help
Many older adults grew up at a time when mental health problems carried a heavy stigma. Your parent may hear "anxiety" as "you're crazy" or "it's all in your head." Try talking about the effects instead of the label: "You've seemed so tense lately, and I hate seeing you miss your card games. Would you be willing to talk to the doctor about it?"
Point out that anxiety has physical symptoms and is treatable, like high blood pressure2. Suggest starting with the primary care doctor your parent already trusts, rather than a new specialist. Offer practical help, such as driving, setting up a telehealth visit, or sitting in if your parent wants you there. If your parent still says no, keep the door open and try again later. Pushing hard often increases worry.
Questions to ask the doctor
- Could a health problem or medicine be causing these symptoms? Thyroid problems, heart rhythm problems and some medicines can play a role2.
- Is this an anxiety disorder, depression, or both? They often occur together1.
- Would talk therapy help, and can it be done by telehealth? Medicare covers some telehealth mental health services3.
- What are the side effects of this medicine for someone my parent's age? Ask especially about drowsiness, dizziness and falls.
- What should we watch for, and when should we call? Get a clear plan for follow-up.
Write the answers down, or ask whether your parent can get a visit summary through the patient portal.
Anxiety around big changes
Moves, hospital stays and new caregivers can trigger anxiety, especially for a parent with memory changes. Prepare your parent ahead of time, keep familiar items and routines, and visit often in the first weeks. If your parent is moving to senior living, ask the community how staff support new residents who are anxious. See moving a parent to senior living.
Hearing, vision and anxiety
Untreated hearing loss can make social situations stressful and isolating, and that can feed worry and avoidance. Getting hearing checked is a simple step. See hearing loss in the elderly.
When to get help right away
Get help immediately if your parent talks about suicide or self-harm, stops eating or drinking, or has a sudden change in thinking or behavior. Call or text 988 for the Suicide and Crisis Lifeline, or call 911 in a life-threatening situation41.
Taking care of yourself
Living with a parent's constant worry is draining. It's okay to set boundaries, share the load with siblings, and get support for yourself. See caregiver burnout.
An example
Harold, 79, began calling his daughter several times a day after his wife died, worried about his heart and his bills. After two ER visits with normal tests, his daughter went with him to his doctor, bringing a list of symptoms and medicines. The doctor checked his thyroid, cut back an over-the-counter decongestant, and connected him with a therapist who offers telehealth. They agreed on two set check-in calls a day. Within a few months, Harold was back at his weekly breakfast with friends. This is an illustration; your parent's situation may differ.
