Managing Anxiety in Older Adults

July 30, 2026

 

Anxiety. Everyone feels it at one time or another. It can be mildly annoying or debilitating. Not surprisingly, older adults aren’t immune. In fact, 10-20% of older adults have some sort of anxiety disorder; and this condition can be exacerbated by change, stress, uncertainties, fears, and concerns. Keeping eyes and ears open to the signs of anxiety and knowing how to address them promptly will help clinicians and caregivers provide age-friendly, person-centered care and support.

 

What you need to know about anxiety

Here are 10 insights to boost recognition and management of anxiety in older adults:

• There are four general categories of anxiety: mild, moderate, severe, and panic-level. Mild anxiety is most common and most often a response to a situation such as a move to a new setting, concerns about an event in the news, or stress related to the holidays. Mild anxiety can usually be managed with efforts such as mindfulness meditation, refocusing, and goal-setting support. People with mild or moderate anxiety may also benefit from counseling or psychotherapy. For severe and panic-level anxiety, physicians and pharmacists should work together to determine the best combination of nonpharmacologic and pharmacologic interventions.
• Generalized anxiety disorder (GAD) is the most common type of anxiety. This generally involves excessive worry about things like life, family, finances, or work. Other types of anxiety disorders include phobias, panic disorder, and obsessive-compulsive disorder.
• Symptoms of anxiety include lingering fears and worry, restlessness or feeling on edge, racing heart, sweating, sleep disruptions, irritability, preoccupation with or fixation on an issue or concern, and problems concentrating.
• Triggers for anxiety in older adults include health issues such as a new diagnosis, loss of independence or autonomy, lifestyle changes such as a move or retirement, loneliness or isolation, and grief or loss.

 

“There are so many potential issues behind someone’s anxiety and so many possible interventions, whatever the root cause is,” said Demetra Antimisiaris, PharmD, BCGP, FASCP, associate professor emerita, University of Louisville. A move to a new senior living or long-term care community is an example of an event that can trigger tremendous anxiety. “There are new sights, sounds, and smells; changes in routine; unfamiliar people; and more. These kinds of things can not only cause anxiety but lead to insomnia, loss of appetite or overeating, social withdrawal, and even depression.” The care team should anticipate what new residents are experiencing and take steps to ease the transition.

 

Age-friendly, person-centered solutions

Anxiety management is not a one-size-fits-all solution. It depends on the cause of the anxiety, as well as each person’s preferences, their personal and medical history, and their goals. “It is important to know the person’s baseline personality and if they have a history of depression or anxiety disorder or a diagnosis of dementia,” said Charles Crecelius, MD, PhD, CMD, a semi retired geriatrician and a past president of PALTmed, the Society for Post-Acute and Long-Term Care Medicine. This will help determine the type and level anxiety and point to potential interventions that are most likely to be successful.

Antimisiaris stressed the need to prioritize nonpharmacologic interventions for anxiety. She said, “Although pharmacologic treatment is often necessary, clinicians should have a conservative approach to starting new CNS-active medications.” She noted that in new care or residential settings, some behaviors are the result of unrecognized situational anxiety, and these can be addressed by efforts such as refocusing the individual on positive things within their control, working with them to resolve or move past the situation, and engaging them in activities they enjoy. She added, “It’s really important as clinicians for us to be aware of what the root cause is of some of this anxiety. It’s our job to reach out to the person and learn about the situation that is causing them to feel anxious.” Antimisiaris offered, “We should keep an index of local psychiatrists and therapists who specialize in older adults and aging.”

People may try to self-medicate anxiety by drinking alcohol, taking over-the-counter sleep medications, and smoking or substance use, which actually can make their anxiety, as well as other health issues, worse. “The care team and family members need to be on the lookout for signs that someone is using inappropriate or even dangerous solutions for their anxiety,” Antimisiaris said.

 

Anxiety Interventions
Some common anxiety management strategies include:

• Environmental changes
  For new residents, familiar furniture or bedding, photos, artwork, and other items can ease anxiety and increase comfort. Aromatherapy, with soothing scents such as lavender, also is calming. Watching news programs on TV can actually be a source of situational anxiety, Crecelius noted. He suggested having televisions in common areas tuned to classic movies or TV shows or other positive, upbeat, familiar programming.
• Activities and engagement
  Favorite activities and social engagement can distract from issues causing anxiety. They also let people focus on positive aspects of their life, increasing confidence and a sense of control. Additionally, individuals can interact with others who may share their concerns and challenges, making them feel less alone and part of a like-minded community.
• Counseling and psychotherapy
  Interventions such as cognitive behavioral therapy (CBT), an evidence-based approach to help people identify and change their negative thoughts and behaviors, can help ease anxiety and provide residents with coping skills for managing anxiety in the future. Support groups for people who share concerns or issues causing anxiety may also be helpful.
• Healthy habits
  These include regular exercise, good sleep hygiene, healthy diet, and limited intake of alcohol and caffeine.
• Medications
  As with many conditions, medications to treat anxiety should be used only after nonpharmacologic interventions have been tried and proven unsuccessful, or in severe and panic-level cases. As always, the adage “start low and go slow” applies. Among the medications considered safe for anxiety treatment in older adults are SSRIs, SNRIs, and buspirone. It is important to note that several medications can trigger or exacerbate anxiety. These include stimulants, corticosteroids, and thyroid hormones. “Particularly if someone has ongoing or chronic anxiety, it will be useful to have a physician or pharmacist review their medication regimen, including their use of over-the-counter products, for possible causes of or contributors to their anxiety,” said Antimisiaris.

 

Ultimately, said Crecelius, there is much we can do to help older adults feel less anxious and focus on positive aspects of life. This means, for example, reminding them about what they’ve accomplished in life and focusing on what they can do instead of what they can’t. Additionally, older adults should be encouraged to be involved in positive change such as fundraising for a new youth center or participating in a pet adoption fair. “We also need to remind them that it’s their job to enjoy life because they’ve earned that right,” he said.

 

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