Part 3–Paranoia and Fear in the Elderly

Apr 18th, 2011 | By | Category: Lifestyle, Health & Fitness

This is the third in a series of articles about paranoia and fear in senior citizens, particularly older seniors.  The first article dealt with distinguishing between paranoia and fear; the second talked about paranoia and avenues for caretakers to deal with and manage it.  This article will focus on fear in the elderly.

Fear is a very valuable defense mechanism.  All living creatures have a ‘fear’ response that helps us, in primitive language, survive.  When we are faced with actual or perceived danger, we become fearful and our biochemistry kicks in and triggers the ‘fight or flight’ response.  It’s innate and we are hard pressed to do anything about it.  Frankly, I don’t think we would want to.  So we need to start out with the premise that fear is normal, in the face of actual or perceived danger.

Fear needs to be seen on a continuum, from None to Paralyzing.  In between these two extremes lies a gazillion degrees of fear that can be described as realistic or irrational.

Elderly persons’ fear has an added dimension.  As we age, and particularly become more vulnerable in terms of mobility, cognitive skills and physical aging, a natural function of the vulnerability is to feel fear in situations where that would not have happened earlier in life.  For example, driving at night was never an issue before one of SCJ editors had cataract surgery and subsequently developed glaucoma several years ago.  Since then, she is aware of glaring lights and impaired night vision and feels a degree of fear about driving at night.  She is having a normal response to a situation that developed as a result of aging.  Normal (realistic) fear in such situations needs to be understood and supported.

Other kinds of fear can be induced externally–by what one reads, by what one is told, by what happens to a friend and by long-held beliefs about aging that may or may not be accurate.   These situations are the kind that get a little sticky when caretakers try to assist the elderly in managing fear; the stickiness occurs when the fear becomes irrational, that is the fear is not based on the reality of the situation.   A small degree of fear about falling may assist a senior to get a cane or a walker to stay safe; a high degree of fear (irrational) about falling may result in a senior sitting too much and losing muscle tone, thus further impairing mobility and increasing the likelihood of falling.  Many seniors have a fear of ‘being put in a nursing home’ against their will.  Obviously there are occasions in which such decisions have to be made for a variety of reasons; but an irrational fear of nursing homes/assisted living facilities prevents the senior from looking at such options realistically.

The caretaker is in a tough spot trying to help the loved one manage irrational fear.  Seniors who hold irrational beliefs associated with fear are not likely to let go of them easily.  Here are some suggestions that may be helpful:

  • Calmly reassure the elderly person that the situation, whatever it is, can be managed, and you (the caretaker) will provide support in dealing with the situation; this may have to be reiterated many times.
  • Part of the reassurance needs to include supporting the degree of fear that is realistic, and slowly leading the elder to confront the part that is irrational
  • Gently counter the irrational fear with reality–called reality testing.  If the elder also experiences some degree of dementia, this is not likely to work.  However, if cognitive skills are relatively intact, reality testing helps expose whatever is not ‘real’.
  • When you find some response that seems to work for your loved one, be prepared to repeat it over and over in order to provide the reassurance the elder requires to manage a very difficult emotional response.

There is probably no situation more difficult to address that trying to help your loved one manage the frightful emotions connected with fear.  Caretakers must exercise compassionate patience when loving your elder through such times.

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