Sunday, December 11, 2005

anxiety (stress)

anxiety (stress) - Anxiety is a feeling of uneasiness, apprehension, or dread that all people experience at various times in their lives. When normal fear or nervousness becomes irrational or is not related to a specific cause then it becomes neurotic and needs to be treated medically. Anxiety is common in the elderly with quite varying symptoms. Some people have nonspecific complaints such as apprehension, "nerves," or a feeling of going to pieces. Others have complaints related to cardiac function, bowel function, or genitourinary symptoms. Still others complain of sweating, tremor, dry mouth, and blurring of vision.
Anxiety can be a major symptom of physical illness in the elderly but frequently is a reaction to conditions of everyday existence such as personal loss, fear of dying, dependence on others, or perhaps the need to make a change in residence. Often it is a prominent part of depressive illness or organic brain disease.
Symptoms include INSOMNIA, loss of appetite or obsessive eating, fear, panic, helplessness, tearfulness, tension, rapid heartbeat, shortness of breath, loss of the ability to concentrate, confusion, hypochondria, and poor compliance with established medical therapies.
In approaching the anxious elderly, both physician and family should establish an atmosphere of warmth and concern. A pat and a gentle hug convey a sense of caring. In assessing these people, it is important to remember the many losses to which they are vulnerable at this time in life. The anxiety may be a response to the loss of a friend or spouse, to reduced income, impaired health, and to a decline in coping capacity. Anxiety in response to such losses can usually be managed by psychotherapeutic means alone. The opportunity to discuss the situation and explore possible solutions are often sufficient for the older patient to gain better control of his or her anxiety, although this may take place only after several sessions. Reassurance, understanding, and a recognition of the physical symptoms involved by family and physician are encouraging to the anxious person.
Treatment should include making an effort to identify and alleviate the cause of anxiety. The person should be told when psychological stress appears to be related to the symptoms of his or her illness.
Environmental intervention should be used to create calmer, quieter surroundings. Sometimes use of deep muscle relaxation techniques, regular exercise programs, and mild analgesics or a small amount of alcohol before bed are helpful. Occasionally mild tranquilizers are helpful but should not be used for indefinite periods of time. At times, anxiety may coexist with DEPRESSION. In this instance, tranquilizers are definitely contraindicated.
See also DEPRESSION; PARANOIA.
Steinberg, F. U. Care of the Geriatric Patient, 6th ed.  St. Louis: C. V. Mosby Co., 1983.


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