Living With Social Anxiety Disorder as an Older Adult

You can thrive as an older adult even with social anxiety.
Getty / Hans Neleman

Older adults living with social anxiety disorder (SAD) experience many of the same life disruptions of those who are younger. They may have the following feelings:

  • A fear of being evaluated negatively by others
  • Anxiety around people with authority
  • Freezing up during public speaking

Eating in front of others or using public restrooms are other common concerns.

While the common perception is that anxiety and/or shyness lessen with age, this is only partly true.

While the prevalence of anxiety disorders has been shown to be slightly lower in older adults, many older adults still suffer with social anxiety, or may be newly diagnosed in older age. Sometimes, physical and mental health complaints can overlap, and a diagnosis of anxiety may be missed.

SAD in the elderly can have a significantly impairing effect on their quality of life. If left untreated, social anxiety may lead to other mental health disturbances, such as depression. This is why, if you are an older adult living with severe anxiety, or have a parent or other relative that you know is struggling, it is important to seek help.

Social Anxiety and Older Adults

Individuals who are older tend to have more worries in general, be they related to:

  • Health
  • Money
  • Physical or mental challenges
  • Loss of independence
  • Fear of death

Physical complaints can sometimes become intertwined with mental health issues.

For example, older adults with health problems such as those related to the thyroid or cardiovascular system may experience physical symptoms that overlap with mental health problems. What's more, older adults experiencing dementia may have anxiety as well.

If, as an older adult, you visit your doctor and complain of a racing heartbeat, shortness of breath, or trouble thinking clearly, those might be first interpreted as physical rather than mental symptoms.

It is for this reason that doctors and mental health professionals must become more aware and alert to potential anxiety disorders in seniors.

Prevalence of Social Anxiety in Older Adults

Between 5 percent and 10 percent of older adults have anxiety disorders; they tend to be about twice as common in women as in men. In fact, anxiety disorders have been shown to occur twice as frequently in older adults as depression.

Older adults with anxiety disorders are more likely to have the following characteristics:

  • Lower education level
  • Unmarried
  • Three or more chronic conditions

In addition, older adults who have experienced a stressful event—such as the death of a spouse—are more likely to suffer with social anxiety disorder.

While it is true that prevalence rates for social anxiety disorder decrease with age—it is still common—with about 5% of older adults having experienced the disorder at some point in their lives.

Symptoms of Social Anxiety in Older Adults

Anxiety in older adults tends to go undiagnosed and untreated, because it is often confused with other issues such as physical health problems.

In contrast to younger persons, older adults might express their anxiety symptoms as medical or somatic problems rather than psychological distress.

Often, they will seek out a medical doctor rather than a mental health professional.

And, particular to social anxiety disorder, they may feel embarrassed to talk about their social fears. While those with panic disorder are likely to attribute anxiety symptoms to a physical cause, this is not typically the case with those who have SAD.

Instead, you may have some sense that social anxiety is possibly causing your racing heart and shortness of breath, but you have trouble articulating that when in the doctor's office, because you don't want to be judged.

In this way, it is a triple-threat to be an older adult with social anxiety:

  • You have symptoms that could easily be confused as having a physical cause in older age.
  • You are nervous to tell your doctor what you are really thinking (or nervous to be sitting and talking with the doctor in the first place).
  • You may be more likely, as an older adult, to describe your symptoms in a physical way, if you are able to talk about them at all. You might get something out like "My hands are trembling" or "My heart is racing," but without explaining your feelings of social anxiety, these symptoms are likely to be misinterpreted.

What Can You Do?

Go to your doctor with a pre-written explanation of what you have been feeling and hand it over. It really can be that simple and you don't have to overthink this too much. If you know you will feel intimidated once you get into the office, simply prepare a summary of your concerns. If you have a good doctor, he or she should be willing to take the time to read what you have written.

By the same token, if you have a parent who you think is experiencing social anxiety, it is important to encourage that person to meet with his/her doctor specifically about the anxiety symptoms. Plan to go along to help explain the situation, or help prepare that summary in advance to make things easier.

Outcomes of Social Anxiety in Older Adults

Anxiety in older adults has been shown to be associated with the following:

  • More medically unexplained symptoms
  • Chronic illness
  • Physical disabilities
  • Low physical quality of life

People over age 65 with an anxiety disorder are three to ten times more likely to be hospitalized than individuals with anxiety who are younger.

Older people with social anxiety may be less independent and place a larger burden on their families. They may have:

  • Lower life satisfaction
  • Impaired memory
  • Increased loneliness

Older adults with social anxiety disorder may feel misunderstood. People may think that their anxiety is something that they should have "grown out of" and may have little empathy for their situation.

All this means that older adults with social anxiety need a lot of empathy. They need your love and support if they are your parents or loved ones. And if you are an older adult living with social anxiety, don't get down on yourself, and be proud of small accomplishments.

Treatment of Social Anxiety Disorder in Older Adults

Treatment of social anxiety disorder in older adults follows much the same course as that for younger individuals. Talk therapies such as the following are often used:

In addition, medication (e.g., SSRIs) may be prescribed.

Treatment of SAD may be complicated in older adults because of depression, other medical problems, and medication compliance.

For example, an older adult may forget to take medication because of cognitive deficits or confusion related to multiple medications. Interactions between medications and sensitivity to medications can also be common concerns.

Complementary and alternative medicine may also be used with older adults living with social anxiety. Biofeedback, progressive muscle relaxation, yoga, massage therapy, music, dance, spiritual counseling, acupuncture, meditation, prayer, and art are all avenues that may be explored with older adults experiencing social anxiety.

Living With Social Anxiety as an Older Adult

Below are tips for living with social anxiety disorder if you are an older adult:

  • When describing symptoms to your doctor, be sure to share any complaints that you have related to your mental functioning, in addition to your concerns about physical issues.
  • If you live alone because of the loss of a spouse, try connecting with supports in your community to help you through your grief and loss of social connection.
  • Don't feel ashamed of a diagnosis of social anxiety disorder in old age. Left untreated, SAD can lead to additional physical and mental health problems. It is better to manage mental health issues as they arise than to try and sweep them under the rug and potentially have to deal with even bigger issues later.
  • Participate in therapy and adhere to any prescribed medication. If you have difficulty following the doctor's prescriptions because of confusion or having multiple medications, let him/her know that you need assistance. Try to enlist a family member to help you keep track or get you to appointments.
  • Join groups to participate in complementary activities such as yoga. Spending time in a group will also give you a chance to forge new friendships and work on overcoming your social anxiety.

A Word From Verywell

Social anxiety disorder later in life can be severely debilitating. When coupled with other physical and mental health issues, it can lead to much lower quality of life. Fortunately, SAD is a problem that is easy to address—with proper diagnosis and treatment. If you have not already sought out the advice of your doctor or a mental health professional, it is important to do so as soon as possible.

Sources:

Chou K-L. Social anxiety disorder in older adults: evidence from the National Epidemiologic Survey on alcohol and related conditions. J Affect Disord. 2009;119(1-3):76-83. doi:10.1016/j.jad.2009.04.002.

Gauthier J. Anxiety Disorders in the Elderly. www.anxietycanada.ca/english/pdf/ElderlyEn.pdf

Gretarsdottir E, Woodruff-Borden J, Meeks S, Depp CA. Social anxiety in older adults: phenomenology, prevalence, and measurement. Behav Res Ther. 2004;42(4):459-475. doi:10.1016/S0005-7967(03)00156-6.

Heimberg RG, Stein MB, Hiripi E, Kessler RC. Trends in the prevalence of social phobia in the United States: a synthetic cohort analysis of changes over four decades. Eur Psychiatry. 2000;15(1):29-37.

How anxiety presents differently in older adults. http://www.mdedge.com/currentpsychiatry/article/64224/anxiety-disorders/how-anxiety-presents-differently-older-adults.

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