Anxiety in older adults: symptoms, causes and getting help in the UK

The Royal College of Psychiatrists describes anxiety as the unpleasant feeling we get in a stressful, threatening or difficult situation, or when facing a problem. It is not in itself a mental health condition, and it can be helpful for short periods, keeping us alert. Age UK similarly says a small, manageable amount of anxiety from time to time forms part of our internal warning system.

It becomes a problem when it is very strong, when you feel anxious all or most of the time, when there is no obvious reason, or when it gets in the way of daily life. Generalised anxiety disorder (GAD) is the diagnosis the NHS gives when someone often feels very anxious about lots of different things. The Royal College of Psychiatrists says people with GAD have many worries at the same time, out of proportion to the situation and hard to control.

The NHS groups symptoms into physical, mental and behavioural. Many of the physical ones look like heart, stomach or breathing problems. The Royal College of Psychiatrists notes that people sometimes worry that their symptoms signal physical illness, which can make anxiety worse.

• Physical: a faster, irregular or more noticeable heartbeat, light-headedness, headaches, chest pains, indigestion, stomach cramps, breathlessness, sweating and shaking.

• Mental: feeling tense or nervous, being unable to relax, worrying about the past or future, difficulty concentrating, not sleeping and a fear of the worst happening.

• Behaviour: avoiding places and situations that create anxiety, struggling to enjoy leisure time, or compulsive behaviour such as constantly checking things.

• Age UK adds being withdrawn, feeling agitated and restless, getting tired easily and problems with thinking and making decisions.

There is rarely one cause. The NHS says generalised anxiety disorder does not usually have an obvious cause, but the chance is higher with another anxiety disorder, close relatives with anxiety or depression, a history of stressful or traumatic experiences, a painful long-term health condition such as arthritis, and a history of drug or alcohol misuse. The Royal College of Psychiatrists adds that genes, social environment and life experiences all play a part.

Age UK points to common changes in later life: bereavement, money or housing worries, retirement, disability or poor health, relationship or family problems, and becoming a carer. It also notes that for some people there is no clear reason at all. Thinking about what has changed can help you and your GP understand what is going on.

Anxiety and low mood often occur together. Age UK says it is not uncommon to feel low and worried at the same time, and that doctors are increasingly used to treating people who feel both.

The NHS advises seeing a GP if you are struggling to cope with anxiety, fear or panic, if things you are trying yourself are not helping, or if you would like a referral to an NHS talking therapies service. If you are 18 or over you can also refer yourself directly without going through a GP. Age UK says to make an appointment if you worry all or most of the time and have physical symptoms such as a fast heartbeat, shaking or sweating.

Anxiety can be hard to bring up. The Royal College of Psychiatrists lists thoughts that stop people seeking help, such as feeling you should manage alone or that others have bigger problems, and says no one should struggle alone. If you are in a mental health crisis, the NHS says urgent help is available and points to its urgent mental health help page; if life is at risk, call 999.

Age UK says there are no specific tests to diagnose anxiety, though a GP may do blood tests to check for other conditions with similar symptoms. The GP will ask about symptoms, your mood and any changes, and may use a questionnaire. The NHS says a GP may diagnose GAD if you often worry about a wide range of things, it affects daily life, you find it hard to control and you have felt anxious a lot of the time for at least 6 months.

It helps to prepare. Age UK suggests listing your symptoms, when they are worse and how long you have had them, explaining circumstances that could be contributing, and bringing a list of all medicines and supplements you take, including those bought without a prescription.

The NHS says the main treatments a GP may offer for GAD are talking therapies, usually cognitive behavioural therapy (CBT), medicines such as a type of antidepressant called an SSRI, and referral to a community mental health team. A GP will usually advise trying talking therapies before prescribing medicine or referring you on. Age UK describes talking treatments as particularly effective for older people and says that if a previous attempt did not help, you can try again.

Self-help matters too. The NHS suggests talking about your feelings, using self-help CBT resources, calming breathing exercises, regular exercise such as walking or swimming, regular meals and enough sleep, and not avoiding situations that make you anxious. It advises against relying on alcohol, cigarettes, gambling or drugs to relieve anxiety, and against too much caffeine because it can disrupt sleep. Age UK says St John's wort is not recommended by doctors or NICE and can interact with prescription medicines.

Recovery is usually gradual. The NHS says treatment can help you manage symptoms but may take time. Peer support can help: the Royal College of Psychiatrists describes self-help groups and charity-run peer support, and the NHS lists Mind, Rethink Mental Illness and Anxiety UK as national charities offering information and support groups.

Family and friends can help by listening without judgement, encouraging a GP visit and offering to go along. Mind and Rethink Mental Illness both publish guidance for carers, as the NHS notes. If the person is also low in mood, withdrawn or no longer coping with day-to-day tasks, say so to the GP as well.

On the NHS, talking therapies are free and you can self-refer, while the GP can arrange medicines or a community mental health team referral. Some older adults choose private counselling or psychiatry for quicker access or more session time. The therapies used, such as CBT, are the same; the differences tend to be in waiting time and choice of therapist. Check any therapist is registered with a recognised professional body and tell your GP so that your care stays joined up.