A woman sits cross-legged on a yoga mat meditating

Concerns about your health or loss of autonomy might seem like a normal part of aging, but for the more than 40 million adults living with anxiety, such fears can be all-consuming.

“Everybody worries, but not everybody who worries has clinical anxiety,” says Carmen Andreescu, M.D., an associate professor of psychiatry at the University of Pittsburgh School of Medicine.

The prevalence of anxiety ­decreases with age, but it’s still common in older adults. Some symptoms of anxiety—including shortness of breath, chest pain, and heart palpitations—overlap with common medical conditions, and certain medications can cause symptoms that mimic anxiety. That can make it challenging to diagnose anxiety in an aging population.

Anxiety also shows up as persistent worry and rumination, as well as fear, agitation, restlessness, and insomnia, accord­ing to Ellen Lee, M.D., a postdoctoral research fellow in geriatric mental health at the University of California, San Diego.

If you experience any of these symptoms, make an appointment with your healthcare provider. Here’s what you need to know about three types of treatment, which are often used together.

Talk Therapy

Regular appointments with a therapist can be effective for treating the symptoms of anxiety. In fact, research has shown that cognitive behavioral therapy (CBT)—which focuses on reframing unhelpful thought patterns and behaviors—can lead to long-term reductions in anxiety symptoms among older adults.

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If you have a phobia, such as a fear of falling, Lee suggests a form of CBT called exposure therapy: Repeated exposures to a trigger (sometimes via virtual reality) can teach you coping skills that will help reduce anxiety.

CBT might be the most common research-­backed form of behavioral therapy, but more informal approaches to talk therapy can also be effective, says Kim G. Johnson, M.D., assistant professor of psychiatry, behavioral sciences, and neurology at Duke University in Durham, N.C.

Even social interactions can help with coping skills, Johnson says. “You don’t have to be alone with anxiety.” 

Medication

Medications such as selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines can be effective for treating anxiety. But there are some special considerations for older adults.

SSRIs—also used to treat depression—need to be taken consistently and often in higher doses to treat anxiety. That can increase the risk of side effects.

They have a better safety profile than benzodiazepines, however, which are prescribed to an estimated 9 percent of adults between ages 65 and 80. These have been linked to serious side ­effects, such as delirium, impaired memory, and balance and mobility problems. There’s also a risk of dependency. For these reasons, they should be considered as an anxiety treatment for seniors only after other options have failed, Andreescu says.

“Older adults are more vulnerable to developing drug-related side effects, so we take a ‘start low, go slow’ approach, prescribing lower starting doses and increas­ing them over a longer period of time,” Lee says. 

Lifestyle Changes

Regular exercise and mindfulness—a way of focusing attention on the present moment—can help treat anxiety.

“Anxiety starts as a problem with the mind, but it affects the body, too,” Andreescu says. Mindfulness practices, such as yoga and tai chi, which “anchor you in your body, can help.”

One small study found that eight weeks of yoga classes seemed to reduce symptoms of anxiety; separate research published last year showed that exercising for 45 minutes at least three times per week was associated with improved mental health.

Meditation, breathing exercises (see below), and massage can also help. 

Breathe In, Breathe Out

Whether or not you have clinical anxiety, it’s common to feel overwhelmed, stressed, or worried. One way to help ease these feelings, says Johnson at Duke University, is to learn to stay in the present.

“The past has a lot of guilt and regret, and the future has a lot of uncertainty and fear,” she says. This simple breathing exercise can help you center yourself, think clearly, and find calm:

1. Breathe in for three to four counts.

2. Hold your breath for a moment.

3. Breathe out for five to six counts.

4. Repeat.

Editor’s Note: This article also appeared in the July 2019 issue of Consumer Reports On Health.