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It is helpful to identify several of the most salient age-related themes, contexts, and expressions of anxiety in the later adult years. As might be expected from the preceding discussion, these age-related phenomena are mediated by all the factors that contribute to making a particular individual
that particular individual.
The following characteristics tend to be more common and salient
among older adults:
Anxiety frequently arises from realistic concerns. Clinicians who are primed to recognize and treat neurotic disorders in younger adults have sometimes felt powerless as well as disoriented when first called upon to work with elders.
Although neurotic men and women grow older and take their anxieties with them, there are also many people whose sense of security has been challenged by emergent circumstances. In such instances, it is neither accurate nor useful to see them as tilting with windmills of their own devising or merely stewing in long-term conflicts.
They are facing genuine threats (or, at least, the plausible “threat of a threat”) to their health, independence, self-esteem, and so forth.
There are many implications. For example, in a study of more than a thousand male veterans (aged 25 to 90), it was found that there were some men with high, moderate, and low levels of expressed anxiety at every age level.
A provocative difference showed up when highly anxious men of various ages were compared with each other on their reporting of physical complaints. Young and middle-aged anxious men reported more physical symptoms than adjusted men of the same age.
But anxious elderly men reported fewer physical symptoms than less anxious men of the same age. The investigators then constructed a discrepancy index that compared the number of complaints reported by the men with the actual findings of very thorough medical examinations. The age-anxiety pattern again showed a reversal.
Young and middle-aged men with high anxiety reported more illnesses than their physicians could find, but in old age, the less anxious men reported more illnesses. The anxious elderly men underestimated and underreported the actual hazards to their health, while anxious young men could afford to focus on symptoms because they did not truly think their lives were in danger.
The adjusted elderly men seemed to be actively monitoring their own physical status in a realistic manner, while elevated anxiety in old age seems to interfere with attending to realistic health problems.
This is but one illustration of what one might discover when starting with the recognition that there are realistic emergent sources of anxiety in the later adult years, along with the perpetuation of neurotic conflicts.
Furthermore, there can be a variety of interactions between realistic agerelated concerns and pre-existing neurotic patterns. For example, the realistic threat of reduced financial circumstances can unmask or intensify earlier fears such as being exposed as a failure or “losing one’s substance.”
An elderly woman living alone with some difficulty may be alarmed when a neighbor of the same age is admitted to a nursing home— an alarm that has one foot in reality and the other in a lifelong hypersensitivity to being unloved and abandoned.
