Living With Social Anxiety Disorder as an Older Adult

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 for older adults.

Physical Vs. Mental

Physical complaints can sometimes become intertwined with mental health issues. As an older adult, your anxiety might go undiagnosed and untreated, because it may be confused with other issues such as physical health problems.

For example, if you have health problems such as those related to the thyroid or cardiovascular system, you 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, your doctor might interpret those symptoms 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 older adults.

Prevalence of Social Anxiety in Older Adults

Between 5 percent and 10 percent of older adults have anxiety disorders in general, and 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.

Who gets anxiety disorders among older adults? Those with the following characteristics are more likely to suffer from anxiety:

• Lower education level
• Unmarried
• Three or more chronic conditions
• Having suffered from a stressful event such as the death of a spouse

Some people think that anxiety and/or shyness lessen with age. In fact, while the prevalence of anxiety disorders has been shown to be slightly lower in older adults, many still suffer from social anxiety or are newly diagnosed in older age.

Symptoms of Social Anxiety in Older Adults

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

• A fear of being evaluated negatively by others
• Anxiety around people with authority
• Freezing up during public speaking
• Fear of eating in front of others
• Fear of using public restrooms

In contrast to younger persons, you might also express your anxiety symptoms as medical or physical problems rather than psychological distress. Rather than seek out a mental health professional for your symptoms, you probably talk to your family doctor about them.

Fearful of Seeking Help

And, particular to social anxiety disorder, you may feel embarrassed to talk about your social fears. Although you may have some sense that social anxiety is causing your racing heart and shortness of breath, you have trouble saying that at 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 note 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, 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.

Social Anxiety Disorder Discussion Guide

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Outcomes of Social Anxiety in Older Adults

Social anxiety disorder can have an impairing effect on your quality of life as an older adult. If left untreated, it may lead to other mental health disturbances, such as depression. 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 also be less independent and place a larger burden on their families. They may have all of the following:

• Lower life satisfaction
• Impaired memory
• Increased loneliness

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

• Cognitive-behavioral therapy (CBT)
• Exposure therapy
• Interpersonal therapy (IPT)

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, you may forget to take your 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 if you have 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.

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, 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 ignore them 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.
• Existential anxiety about end-of-life issues should also not be ignored. Consider talking to those around you if you feel like life has become meaningless.

When Its Your Older Parent Who Has Social Anxiety

If you have a parent who you think is experiencing social anxiety, 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.

A Word From Verywell

Fortunately, SAD is a problem that is possible to address—with 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.