Maintaining my energy despite the anxiety of someone I am caring for
How can caregivers deal with the anxiety of the person they are helping without depleting their “energy bank account”? An interesting discussion on geriatric anxiety with Sébastien Grenier, psychologist and associate professor with the Department of Psychology at the Université de Montréal.
03 June 2022
What exactly is geriatric anxiety?
It’s anxiety like that found in other age groups, but with certain particularities. I don’t always like to use the term “geriatric” because it makes the person sound “very” old. I prefer to call it “anxiety in the elderly.” Even though I am the director of the Laboratory for the Study of Geriatric Anxiety and Depression!
What are the most common symptoms of anxiety?
There are different symptoms of anxiety that can affect the elderly: cognitive, behavioural or physical symptoms. The physical symptoms are the most common: hot flashes, dry mouth, sweating, heart palpitations, digestive problems, headaches and chronic pain. The most difficult task for doctors is to distinguish between the symptoms. What is caused by anxiety, by medication, by a physical illness? We talk about anxiety, but there are also what we call “anxiety disorders,” such as generalized anxiety disorder or panic disorder. What I mean is that there are different ways to define anxiety, and there are specific criteria that help doctors and psychologists make a diagnosis.
In your work and research, you are interested in anxiety resolution not only in older adults, but also in caregivers. Why do you do this?
For caregivers, who are often elderly themselves, there is a double challenge. The caregiver has their own challenges related to aging. In therapy, I see caregivers who are completely exhausted and don’t know what to do anymore. We never think that we will become caregivers one day in our lives. When this reality occurs, it causes a lot of stress. Stress is made up of four active components: unpredictability, loss of control, novelty and threatened ego (for example, when your skills are challenged or your abilities are doubted).
In your practice, you see couples in which one person is suffering from anxiety. Take, for example, an adult who is caring for an elderly parent who is suffering from anxiety. How can this caregiver protect themselves from this anxiety, from suffering from it themselves?
For caregivers to maintain a healthy distance, to preserve their energy and well-being, the idea is to establish a framework. The principle is twofold: increase their ability to adapt and prevent exhaustion. This can be done by learning breath control or meditation, exercising, treating ourselves positively (e.g., talking to each other the way we would to our best friend, remembering that not everything is bad, remembering good times) and focusing on the things we can control.
What suggestions do you have for helping caregivers maintain their energy?
I would suggest the following 8 points:
- Recognize yourself as a caregiver;
- Accept that you can’t fix everything. Caregivers are not doctors or psychologists, and they have their limits;
- Make sure to have enough spare energy to be able to spend some of it on the person they are caring for without depleting all their own energy. This means bringing energy in, like depositing money in one’s bank account, and taking out only the money that actually exists, avoiding overextending yourself. This is the concept of the “energy bank account” developed by psychotherapist Alexander Lowen;
- Invest and reinvest in what is important to us, to try to achieve a better balance;
- Be wary of things that are energy consuming;
- Seek support, accept to be helped;
- Learn about the illness of the person you are caring for, so that you can better support them and better understand their reactions. “The person I am caring for is behaving in this way or that way. Is this normal? How should I react?” What we know more about makes us less afraid;
- Learn to prioritize and delegate tasks to make time for yourself.
Are there any limitations to these suggestions?
They are not foolproof. When you are constantly crying, when you can no longer sleep well, you must break the silence. If you are experiencing extreme fatigue, if your worries persist, if you have lost interest in the activities you used to enjoy, if you are no longer able to function or if you no longer recognize yourself, you should consult a health professional.
The elderly are the focus of your career. What led you to become interested in them?
I have been a psychologist in private practice since 2002. When I saw older people, I found that things clicked well between them and me, compared to adolescents, with whom I had more difficulty. In my career, I also wanted to do research and work on the mental health of the aging person. There was little available research in the field of psychogeriatrics in Québec. When I completed my first postdoctoral fellowship in 2014, I set up the Laboratory on studies of late-life anxiety and depression (LEADER), housed at the research centre of the Institut universitaire de gériatrie de Montréal (CRIUGM). Since the beginning of the pandemic, the needs have greatly increased. There is now much more talk about the mental health of seniors. I already knew that this was an area of rapid evolution. Now it’s even more obvious.
Are the main symptoms of anxiety different in the elderly?
The somatic manifestations of anxiety are pretty much the same. The difference lies more in the way the symptoms are described. We notice excessive worrying: “If I go out this afternoon, I might fall and get hurt and be hospitalized.” These are scenarios like that. Younger people are worried too, but not about the same things. Older people worry less about finances and work, but more about health and the risk of falling. They worry about being abandoned by their children, being placed in a nursing home, losing their memory or getting Alzheimer’s disease.
What strategies should be used in therapy in these cases?
For a specific anxiety disorder, there is a specific treatment. Anxiety, in general, is characterized by anticipating events that might happen. It is the fear of being afraid and the feeling of losing control over one’s life. This worry is counterproductive because it tends to prevent the person from focusing on the present. Therapy is therefore about getting the person to focus on the present and to find concrete solutions in their own current life when problems actually arise. For example, if I am worried about my health, what am I doing about it today? Have I made an appointment with my doctor? Basically, the strategies consist of giving the person some direction so that they can regain control of their life. As we get older, we have to deal with the many losses, changes and bereavements that occur rapidly. Sometimes this becomes too much for an elderly person to cope with. This is when anxiety develops and is accompanied by a feeling of loss of control. The psychologist’s job is to give that control back to the person and to provide them with the keys to deal with one problem at a time, step by step. We can also teach proper breathing, meditation and relaxation practices.
There is one thing that strikes me. Anxiety rarely arrives on its own!
In 50% of the cases, when the psychologist or doctor detects anxiety in the elderly person, they will also diagnose depression. When we notice a significant change in the behaviour or mood of the person we are caring for, without any reason, we may suspect the presence of anxiety or even an anxiety disorder. If they cry, have trouble sleeping, are on edge, have difficulty carrying out daily activities, experience a marked loss of motivation or have trouble “getting started” in the morning, we should be concerned. This advice applies to both the caregiver and the person we are caring for!
Interview by Karine Cloutier, Project Manager, Communications at l’Appui pour les proches aidants. Thank you to Sébastien Grenier for this insightful conversation!
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