Anxiety in later life

Many older adults live with worry that does not let up. It might be worry about health, money, a spouse, or what comes next. It can show up as poor sleep, an upset stomach, a tight chest or feeling tired all the time. Because these signs look like ordinary aging or a medical problem, anxiety is easy to miss.

This guide is for older adults and the people who care about them. It explains how anxiety can look in later life, why it happens, and what helps. For the clinical basics, see Anxiety in later life in our library. Here we go deeper into daily life after 65.

Signs of anxiety in older adults

Everyone worries sometimes. Anxiety becomes a problem when it does not go away, shows up in many situations, and gets in the way of life.³ In generalized anxiety (constant, hard-to-control worry), the worry is present most days for at least six months.³

Common signs include:^3,2

• Worrying about everyday things and finding it hard to stop
• Feeling restless, on edge or unable to relax
• Trouble concentrating or feeling your mind "go blank"
• Trouble falling asleep or staying asleep, or feeling tired all day
• Headaches, muscle aches, stomach trouble, trembling, sweating or shortness of breath
• Being irritable or easily startled

Older adults may also:

• Ask the same reassuring question again and again
• Stop driving, shopping or seeing friends because of worry
• Check doors, the stove or the bank account many times
• Visit the doctor often for symptoms that tests cannot explain

You can take our free anxiety test or the anxiety symptoms checklist to see where you stand. These are not a diagnosis, but they can help you start a conversation with your doctor.

Why anxiety is easy to miss after 65

Several things make anxiety hard to spot in later life.

It hides behind the body. People with anxiety often come to the doctor with body complaints, sleep problems or pain instead of worry.¹ A racing heart or shortness of breath can come from anxiety, a heart problem, or both. Always get new chest pain or breathing trouble checked first. Our page on panic attacks explains when to call 911.

It overlaps with illness and medicines. Doctors may do a physical exam to look for other causes of anxiety symptoms.³ Some medicines can also affect mood. See Medicines that can affect mood and memory.

Screening tools were made for younger people. The U.S. Preventive Services Task Force (USPSTF) recommends anxiety screening for adults under 65. For adults 65 and older, it found too little evidence to recommend for or against routine screening. It also noted that some tools not designed for older adults can give wrong results.¹ This does not mean anxiety is less important after 65. It means you may need to bring it up yourself.

People expect to feel worse with age. Many people think worry and poor sleep are just part of getting old. They are not something you have to accept.

What can trigger anxiety later in life

Anxiety in later life can start for the first time, or it can be a lifelong pattern that gets worse. Common triggers include:

• Loss. The death of a spouse, friends or siblings. See Grief and widowhood.
• Health changes. A new diagnosis, a heart problem, breathing trouble or chronic pain. Life changes like serious illness can lead to anxiety when the hard feelings last.²
• Fear of falling. A fall, or even a near-fall, can make people afraid to leave home. See Falls and fear of falling.
• Isolation. Living alone, losing a driver's license, or hearing loss can cut people off. See Technology and staying connected and Hearing loss, mood and memory.
• Money worries and scams. Fixed income, rising costs, or being targeted by fraud. See Scams, financial exploitation and stress.
• Caregiving. Looking after a spouse with dementia or serious illness is a heavy load.
• Alcohol and caffeine. Alcohol misuse often goes along with generalized anxiety, and cutting back on caffeine may help.³ See Alcohol and older adults.

How anxiety affects daily life

Untreated anxiety can shrink a person's world. People may stop going out, give up hobbies, or avoid the doctor. Poor sleep can make the next day harder. Anxiety and depression often happen together.

The good news: treatment helps, and it is never too late to start.

What helps

Practical steps you can start this week

1. Write down what you notice. For one week, note when worry shows up, what your body feels, and how you slept. Bring this to your doctor.
2. Make a list of every medicine. Include vitamins, sleep aids and allergy pills. Ask your pharmacist whether any could cause anxiety or interact with each other.
3. Say the word "anxiety" at your next visit. For example: "I have been worried most days for months and it is affecting my sleep. Could this be anxiety?"
4. Practice one calming skill daily. Five minutes of slow breathing or a short walk counts. Pick one from Self-help for anxiety.
5. Cut back on caffeine and alcohol, especially in the afternoon and evening.³
6. Face one small avoided thing. If you stopped going to the store, start with a short trip at a quiet time, with a friend if needed.
7. Make a calm plan. Use our Calm Plan to list your warning signs, what helps, and who to call.

Paying for care

Medicare Part B covers outpatient mental health care, including individual and group therapy. You can see psychiatrists, psychologists, clinical social workers, nurse practitioners, and licensed marriage and family therapists and mental health counselors. After the Part B deductible, you usually pay 20% of the Medicare-approved amount. Medicare also covers one depression screening a year in primary care.¹⁰ Read more in Medicare and mental health care and Finding a therapist.

For family caregivers

You may notice anxiety before your parent or partner does. Look for:

• Calling you many times a day with the same worry
• New refusal to go out, drive or see friends
• Many doctor visits for symptoms that tests do not explain
• Trouble sleeping, or new use of sleep aids or alcohol

What helps:

• Listen first. Try "You've seemed worried lately. What's been on your mind?" Avoid "There's nothing to worry about."
• Do not take over everything. Doing every task for someone can make avoidance stronger. Offer to go along instead.
• Go to an appointment together, with their permission, and share what you have seen.
• Bring every pill bottle to a medicine review. Ask about benzodiazepines and sleep aids.⁸
• Look after yourself too. See Caregiver burnout.

Special situations

Living with dementia. Anxiety can happen in people with memory loss. It can look like pacing, restlessness, or repeated questions. Calm routines and reassurance help. See Repeated questions and Depression, delirium and dementia. A sudden change in anxiety or confusion can be delirium and needs medical care the same day.

Living alone. Worry can grow when there is no one to talk to. A regular phone call, a senior center or a volunteer program can help.

Language barriers. Anxiety is hard to describe in a second language. You have the right to ask for a medical interpreter. Therapy by phone or video may make it easier to find someone who speaks your language.⁶

Frequently asked questions

Isn't it normal to worry more as you get older?

Some worry is normal, especially during hard times. But worry that lasts for months, is hard to control, and disrupts your sleep or daily life is not a normal part of aging.³ It can be treated.

Does therapy work for people in their 70s and 80s?

Yes. Trials of CBT in older adults show real benefits, including in primary care clinics and by phone or video.^4,5,6 Some therapists adapt the pace, use written notes, or include memory aids.

I've taken a benzodiazepine for years. Should I stop?

Do not stop on your own. Stopping suddenly can cause serious withdrawal, including seizures.⁹ Ask your doctor whether a slow, planned taper is right for you.

Will Medicare pay for a counselor?

Medicare Part B covers therapy with licensed mental health counselors and marriage and family therapists, as well as psychologists and clinical social workers. You usually pay 20% after the deductible.¹⁰

When to get help

See your primary care provider if:

• Worry or tension has lasted for several weeks
• It keeps you from sleeping, going out, or doing things you enjoy
• You are using alcohol or extra pills to calm down
• You feel hopeless or down most days

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.