According to the researcher Hogstel, “Anxiety is a diffuse feeling of panic, dread and lack of control that can be insufferable in its acute stages.” He further states, “Little is known about anxiety and its numerous manifestations even when it has not reached negative clinical proportions. It is a multi-response to helplessness, isolation, alienation and emotional insecurity. Evidence of anxiety in the elderly is often not as apparent as in younger clients.”

According to the research, “Anxiety is the motor that keeps people moving toward mastery of new and threatening situations.” The researchers Jarvik & Russell claim, “Anxiety runs with a soft, pleasurable purr that is not always perceptible. However, when it’s an extreme or prolonged personal stress, it is likely to initiate episodes of anxiety that is experienced as a noticeable jittering hum in the gastric area.”

“Elderly people who are experiencing stress, don’t usually react in the same way as a young person.” Jarvik & Russell further suggest, “Aged people do not fight or flee when endangered. Instead they develop a passive freeze reaction. Fighting or fleeing requires a heavy physical expenditure that is not appropriate or possible for many aged individuals. The term ‘freezing’ does not imply a means of giving up but rather is a form of energy conservation in response to chronic issues, a lack of privacy and pervasive apathy.”

Unrelenting anxiety of a persistent and chronic nature may very well require a need for what is known as a crisis intervention. The following illustrates how this is employed and in the form of a case study that can demonstrate how the technique functions.

Case Study – Mrs. S was brought to the nursing home without her consent or any prior preparation. She sits mutely, staring out the window of her room. The nurse assigned to orient Mrs. S to the facility’s surroundings, recognizes the importance of the situation but is uncertain of Mrs. S’s perception of her admission. The nurse enters with the following conversation taking place. (Note: the nurse is Nurse D and the newly arrived resident is Mrs. S.)

Nurse D: “Mrs. S, I am Nurse D. I noticed you were looking out the window as I came in the room. Is there anyone you were looking for?”

Mrs. S: Not moving and muttering, “I am lost…lost,” she declares.

Nurse D: “You may feel lost, but I am here to assist you. Tell me what happened today.”

Mrs. S: “I am lost…no one wants me!”

Nurse D: The nurse repeats, “Tell me what happened today”

Mrs. S: “They didn’t tell me!”

Nurse D: “Who are they you are referring to?”

Mrs. S: “My daughter, she left me here!”

Nurse D: “Mrs. S, this must be a terrible time for you!”

Mrs. S: (beginning to cry) “You don’t know – you’re young.”

Nurse D: “You are right, I am young, but I still want to help if I can.”

Mrs. S: “No one can help” (she sobs inconsolably).

Nurse D: “Come with me to the kitchen and we’ll have a cup of fresh coffee and talk about it.”

Mrs. S: “It won’t help.”

Nurse D: “You have a right to be angry and upset.”

Mrs. S: “I am not angry…I am lost.”

Nurse D: “Come!” Nurse D urges her. “I’ll show you where we can get some freshly brewed coffee and I’ll even stay with you for a while and talk.”

Mrs. S and Nurse D walk to the kitchen, however reluctantly, hand-in-hand,

What has Nurse D been able to accomplish in this scenario?

• conveyed a supportive relationship with a calm and reassuring approach;
• avoided suggesting to Mrs. S any misunderstanding about her “new home”;
• stimulated the resident’s interest and an offer of a past comforting routine of
• a cup of hot coffee);
• voiced several opportunities to sort out any misperceptions related to Mrs. S’s admission to the facility, her immediate surroundings, where dining service occurs, the many activities the Home has to offer and some of the friendly residents in her area she can chat with and get to know.

The research further offers another aspect about the chronicity of worrying, i.e.: “worrying can foment confusion with the elderly person.” Mrs. S clearly shows confusion as she continues to worry over her predicament.

There are several other common perceptions concerning the concept of stress as it relates to worry and anxiety and that can adversely affect the decline in the aging process. They are: increased potential for falls, dwindling finances, decreased opportunities for social engagement, or a loved one’s decline in health.

The researcher Borkovee refers to the concept of worry in the elderly as “a limited emotion.” He further states, “The uncontrollability of negative thoughts and images is a central component of worry.” Additionally, Borkovee says, “An older person who is in a crisis mode may be radically different from a younger person.” The presence of a chronic psychological problem can, over time, worsen and decrease the elderly individual’s ability to continue managing independently. Also the likelihood of living alone can further produce a situation that may require more than a single crisis intervention session.

Final Thoughts
Here are several recommendations when caring for an elderly loved one who is exhibiting signs of anxiety and worry.

• What are the events in your day to day activities that are worrisome such as a loved one who has recently passed away and how I am coping with the loss;
• What is your most common worry and how do you deal with it – insufficient funds to pay my bills, an ill loved one living a great distance away, persistent loneliness that extends beyond my daily responsibilities, etc.;
• What issues have recently been encountered that have caused, what research scientists call “an emotional loss of control” such as dealing with a serious medical problem and being unable to obtain a clear direction or advice from medical professionals and related agencies;
• How do you envision the years ahead and what can you do to make them more satisfying and productive? With my advanced age, it can be very upsetting. However, I am considering volunteering at the local hospital, doing some bicycling, joining a senior citizens club, doing a little traveling to relatives and friends and see how they are getting along. But above all, make new friends of my generation, whether at religious or social venues.