During a rare trip outside of her home to pick up prescriptions, Anita V. spotted a homeless man at a red light. As the 82-year-old grandmother rolled down her window to pass along a few spare dollars to him, she didn’t think twice about the kind gesture. After all, she was no stranger to helping others. But as soon as she returned home from the pharmacy, a pang of fear coursed through her body.

“Could I have gotten the coronavirus from him?” she wondered. 

Although she had not been wearing her mask, Anita made sure she didn’t touch the man during the 30 second-encounter, nor had she rolled down her window for more than a few inches to hand him money. The chances of her contracting the virus from him — if he had it — were low, but still the worry plagued her. 

She decided to keep the incident to herself, but the worry ate away at her. Her sleep suffered, she lost much of her appetite, and ignored phone calls from family and friends. She began going to bed before sundown each night, only to wake up by 3 a.m., riddled with anxiety. 

After a week, she confided in her youngest daughter that she’d slipped the man some money and told her about the worry that followed. She later told her husband about the incident, and despite a normal temperature reading and lack of symptoms, she suggested they both be tested. He told her he felt fine and didn’t need testing. 

She tried to get tested at a pharmacy but learned they were not offering a test. She then inquired about getting tested in her doctor’s office, and was told they were offering tests only to those with symptoms or who’d been exposed to someone with the virus. 

For weeks, the fear, guilt and worry consumed her, despite her physicians and family members’ assurance she was not ill — if she had been exposed to the virus, she would have symptoms. Regardless, she was convinced she’d been infected.

But soon the pandemic did hit close to home for Anita. Her brother-in-law passed away from complications of the virus, and she began to spiral emotionally, landing in the emergency department. One negative coronavirus test and a full lab work-up later, she was sent home with an antibiotic for a small bladder infection and a sense of relief. After spending more than a month racked with anxiety, she could finally relax. 

Anita’s story is one of many similar experiences of seniors who are experiencing mounting anxiety associated with COVID-19. While those with a high risk for developing complications related to COVID-19 can never be too cautious, older Americans may be most vulnerable to emotional suffering brought on by the pandemic. 

Understanding the Fear 

Dustin Webb, a licensed clinical social worker and administrator at Texas Health Behavioral Health in Dallas, says Anita’s experience is a prime example of how the elderly, a population that is already prone to more anxiety, is coping with what he calls the “invisible threat” of COVID-19. 

Mortality is certainly something that’s already there in the minds of our older population. I think that a lot of people assume that somehow that means that they accept it or are okay with it. That’s a false assumption.

“Anita’s story is one you see frequently with people, especially in the geriatric population where health is concerned,” Webb says. “In general, anxiety is the result of our mind responding to perceived danger. Our brains kick in to work through how to protect ourselves from that danger. When you aren’t able to get quick closure, you end up stuck in a cycle of anxiety that is not only difficult to get out of, it gets progressively worse.”

Perceived danger is key to anxiety surrounding the pandemic, not just for our older population, but everyone. The virus is invisible; you can’t see it with your naked eye, you can’t look at something or someone and know for sure that the virus is there. And it seems every bit of news or social media we consume further adds to our anxiety. While the danger of contracting COVID-19 is very real, our perceived danger may be higher than reality.  

Webb explains, “a curious thing about the fear of the unknown is that while we navigate it, we often find our way to worry and panic before we find our way to exploration. The moment that anxiety grabs hold, and we are feeling the physical consequences of that worry, our rational, problem-solving mind takes a back seat. We’re then guided by that uncomfortable feeling and how to get past that as much as, if not more than, the original problem. In Anita’s case, an outside observer might look at the situation and clearly see how to respond to that worry and find answers. But her family members or health care providers are not sitting with that intense anxiety like she is.” 

In addition to a higher than normal perceived amount of danger, Webb says anxiety may be affecting seniors more than the general population because of something that has been brought to the forefront of many people’s minds right now — our mortality. 

“Mortality is certainly something that’s already there in the minds of our older population. I think that a lot of people assume that somehow that means that they accept it or are okay with it. That’s a false assumption,” Webb explains. “I find that many seniors who have come to accept their mortality have a sense of fulfillment with the life they’ve lived so far. They feel that they’ve led a meaningful life and contributed positively to the people around them. Conversely, those who struggle with their mortality often say they have a sense of unfinished business. Because of the pandemic, people who fall in that latter group worry they may not have time to enjoy those experiences or make those contributions.”   

Bridging the Gap

While some seniors are willing to talk about their mortality, many don’t want to burden their loved ones with their concerns, so they keep their anxiety or fears to themselves, just as Anita initially did. 

“When you ask an older person why they do this, you often hear that they are stuck in guilt or shame. You hear things such as, ‘I’ve lived a long time and should know how to take care of myself. I can’t expect my children to stop what they’re doing to take care of me. They have their own lives. That’s not fair to them,’” Webb says. “So rather than unloading those troubling thoughts and getting that sense of relief, they are left with only their thoughts. They’re left with no outside checks or balances to keep them from falling into that anxiety cycle.” 

So what can a concerned loved one do if they fear a senior member of their family or friends might be struggling right now? Webb says the first step is just starting the conversation, no matter how awkward it may feel for you or them. If they minimize their situation or insist that they’re okay despite evidence to the contrary, ask, then ask again. Be willing to circle back. 

Webb adds, “I really like a popular commercial that is getting a lot of airtime right now. The young lady breaks an uncomfortable silence and says, ‘You haven’t seemed like yourself lately. Are you okay?’ It’s simple, but it’s very intentional. Start with an observation to let the other person know that you’re paying attention and that you care. Then ask simple but open-ended questions inviting the other person to tell you how they’re feeling or what they’re thinking. For example, ‘I’ve noticed that you aren’t as talkative as you normally are lately. I’ve been thinking about you a lot. How are you doing?’” 

In addition, Webb says to try to avoid saying things such as, ‘Mom, everything is going to work out,’ or ‘Dad, you’ll be fine,’ because these statements, while maybe a genuine attempt to quell fear, lack the substance that an anxious person needs, and often are interpreted as being dismissive. Instead, commit time to the conversation and seek the root cause of their fears. 

“Say, ‘What is it that you’re really stuck on? If that happens, what will that mean to you?’” Webb explains. “You can use a process called inference chaining with seniors, too. For example, ‘If this happens, what would happen next? And then what would happen next? And if that happened, what would that cause?’ You keep going until they can’t answer it anymore as a way to get to their endgame.

“At that point, it’s crucial that you acknowledge that fear and the pain it’s causing. If they hear that you understand them, they’ll be open to discuss the next steps. Then you can discuss what they wish they could do to get past that fear. In Anita’s case, it was simply taking a COVID test. You’d be surprised at how often their wishes can be accomplished.”

Webb adds physical signs to watch for in seniors include: 

• Changes in their normal appearance
  
• Changes in sleep, appetite or normal routine
  
• Unexplained weight loss 
  
• Poor concentration, forgetfulness or irritability 
  
• Fidgeting or an inability to keep still
  

Putting Your Care First

For seniors who are experiencing intense anxiety during these times, Webb recommends  focusing on self-care.  

“Commit time every day to doing things that you know are good for you. For some people that can be something intellectual like reading or meditating. For others it can be a distraction to get away from their active minds, like exercise, cleaning or spending time with others,” he explains. “Making this a routine when you’re feeling well makes it more likely that you’ll be able to engage in these activities when you’re starting to not feel well. It’s also a good way to help clue you in if you are struggling. ‘I missed my ‘me time’ yesterday and today. Something isn’t right.’”

If you see that your loved one is struggling beyond your ability to help, be supportive but firm in seeking out help. A good starting point is always a primary care physician (or physician who knows them best). That familiarity can help with trusting the recommendations for next steps, whether that includes a mental health professional, medications and/or support groups.

The Texas Health Behavioral Health helpline is available 24 hours a day, seven days a week at 682-549-7916. To learn more about the services offered by our Behavioral Health centers, please visit TexasHealth.org/Behavioral-Health.