Panic Attacks in the Elderly: Symptoms, Causes & Support for Seniors

Panic attacks involve sudden feelings of intense fear, as well as physical symptoms like trouble breathing and a racing heart. Panic attacks can be frightening for the person experiencing them, as well as family members and caregivers who witness them. If you or your loved one is experiencing panic attacks, you probably have questions about their symptoms, causes, and treatments. 

The good news is that once you identify the problem, there are many effective ways to treat them. Through a combination of therapy, relaxation techniques, medication, and caregiver support, seniors who experience panic attacks can feel more like themselves again soon.

Read on to learn about the signs of panic attacks in the elderly and how to cope with them.

Key takeaways

• Panic attacks can look like abrupt feelings of fear, and may include symptoms like a rapid heartbeat, trouble breathing, and racing thoughts.
• Panic attacks can be scary for both seniors and their loved ones, but they are treatable. Treatment usually involves a combination of therapy, medication, and calming techniques.
• In seniors, it can sometimes be difficult to distinguish panic attacks from medical episodes like heart attacks, so if you aren’t sure if you’re having a panic attack or not, you should seek emergency medical care.

What is a panic attack?

A panic attack is when you experience sudden and intense feelings of fear and impending doom. Noticeable physical symptoms, like a fast heartbeat or heart palpitations, chest pain, sweating, and shortness of breath accompany these feelings. You might also feel detached from reality, experience a fear of losing control, or a fear of dying. 

These attacks seemingly come out of nowhere and hit hard. However, they’re short-lived, usually peaking around 10 minutes. 

Panic disorder is a type of anxiety disorder that’s characterized by having multiple and recurring panic attacks. Panic disorder affects about 2.7% of U.S. adults, which amounts to about 6 million people.  

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), panic disorder is diagnosed when:

• You have recurrent and unexpected panic attacks.
• You experience at least a month of persistent concerns that you’ll have more panic attacks.
• You end up changing your behavior to avoid situations that may trigger another panic attack.

While panic attacks are a main symptom of people with panic disorder, you can have panic attacks without having panic disorder. 

Why seniors face unique challenges

 Up to 17% of seniors experience an anxiety disorder. Late-onset panic disorder is not common in older adults, meaning that panic disorder rarely starts for the first time in old age, but it is possible.

According to the American Association for Geriatric Psychiatry, recognizing panic attacks and seniors — and getting a proper diagnosis — can be challenging. Here’s why:

• Older adults may be less likely to report mental health symptoms due to stigmas or old, ingrained ideas that emotional challenges are meant to be private.
• It can be harder for older adults to recognize their anxiety symptoms.
• Elderly adults who’ve lived with an anxiety disorder for their whole lives may be used to the feelings and think they are normal.
• Medical misdiagnosis in elderly patients is common. Physicians may miss an anxiety diagnosis and attribute it to a medical condition, prescription drug, or life stressor, like losing a loved one.  

Recognizing symptoms in older adults

On a personal note, my own elderly mother has experienced panic attacks, especially when she’s had to undergo uncomfortable medical procedures. I can tell you firsthand that panic symptoms in older adults can be intense and frightening.

Panic symptoms in the elderly are similar to those experienced by younger adults. One saving grace is that usually, panic attack symptoms in seniors are less severe, happen less frequently, and typically involve less avoidant behavior than in younger adults. However, every senior is different, and some may experience more debilitating panic attacks than others.

Panic attack symptoms usually involve:

• Physical symptoms: Fast heartbeat, sweating, nausea, chest pressure, shallow breathing, and feeling dizzy.
• Emotional/cognitive symptoms: Sudden feeling of terror or doom, depersonalization, feeling like you are “going crazy,” and racing, uncontrolled thoughts.
• Behavioral symptoms: Avoiding triggers or places where you previously had panic attacks and constant worrying that another panic attack will happen.

Common causes and triggers of panic attacks

Panic attacks have many possible causes, but elder panic attack triggers may be different than triggers for a young person.

Some of the possible causes and triggers for panic attacks in the elderly include:

• High levels of stress
• Trauma
• Loss, grief, and chronic grief
• Personal and family history of anxiety disorders
• History of mental illness
• Cognitive decline
• Dementia, including Alzheimer’s disease
• Alcohol and caffeine use
• Substance abuse
• Certain prescription medications
• Fear about aging or dying
• Fear of medical procedures
• Fear of falling
• Stress about finances
• Fear of being left alone or uncared for

Depression

Although depressive symptoms are different from anxiety and panic attack symptoms, they often co-exist. Additionally, research has found that elderly people who have depression are also more likely to experience late-life anxiety, which can include panic attacks.

Cognitive decline and dementia

Cognitive decline issues are common in the elderly, and having any type of cognitive deficit as you age increases your risk of anxiety.. Research estimates that anxiety symptoms are common in up to 71% of people with dementia, and anxiety disorders are common in up to 21% of dementia patients.

Loss

Seniors deal with bereavement and loss often, and they can experience increased symptoms of both depression and anxiety. In particular, seniors who’ve lost a spouse experience higher rates of both panic disorder and generalized anxiety disorder (GAD), especially in the first six months following the loss.

It’s also important to keep in mind that sometimes panic attacks don’t have a clear cause or trigger. This may be more likely in elderly patients with cognitive decline, who may be less able to articulate what they are experiencing. Whatever you think may be causing panic attacks, it’s vital to seek treatment, support, and care.

Distinguishing from other conditions

 One of the challenging things about panic attacks is that they can be difficult to distinguish from other mental health conditions, as well as other serious health conditions.

Heart attack vs. panic attack

Heart attacks and panic attacks share many of the same symptoms, like a fast heartbeat, sweating, and nausea. However, panic attacks tend to come on faster than heart attacks, and last for a shorter period of time, typically around ten minutes. Heart attacks also often involve pain that radiates to your arms, neck, jaw, back, or stomach, but panic attacks usually don’t.

If you aren’t sure if you or your loved one is having a panic attack or a heart attack, you should seek emergency medical care. This is especially important in the elderly population, who are more prone to serious medical emergencies like heart attacks. 

Panic attacks vs. anxiety attacks

Many people wonder about the differences between panic attacks and anxiety attacks. That’s understandable, because they share many of the same symptoms, and some people may even use the terms interchangeably. The difference between them is that:

• Panic attacks typically last for shorter periods of time, often feel like they come out of nowhere, and are much more intense than anxiety attacks.
• On the other hand, anxiety attacks are characterized by worry about specific life stressors, like work, illness, or relationship issues, and come along with feelings of chronic and excessive worrying and anxiety.

Anxiety disorders vs. panic attacks

Many people with anxiety disorders (like generalized anxiety disorder) experience panic attacks. However, you can have panic attacks and not have panic disorder or another anxiety disorder. Many people have intermittent panic attacks but don’t have an official anxiety disorder diagnosis.

Immediate relief techniques

Panic attacks happen when the “fight or flight” system in your body is triggered. When this happens, hormones like adrenaline and cortisol are released, causing symptoms like a racing heart, nausea, and feelings of fear and doom.

That’s why using deep breathing exercises and grounding techniques for panic attacks can be so powerful. They send a message to your body that everything is okay, allowing the nervous system to calm down.

Deep breathing exercises

There are many different types of breathing techniques for panic attacks, but the most effective ones involve deliberate, slow breathing.. For example, in a breathing technique called “4-7-8 breathing,” you inhale for four counts, hold your breath for seven counts, and then exhale for eight counts.

Progressive muscle relaxation

Progressive muscle relaxation is a technique where you sit or lie still. Next, you slowly move through different parts of your body, tensing or gently squeezing a specific muscle group, then letting go and relaxing it.

3-3-3 rule for panic attacks

When you experience panic attacks, it’s common to feel detached from yourself and your surroundings. That’s why techniques that ground you in your senses can help calm you down. The 3-3-3 rule involves looking around the room you’re in and identifying three things you see and three things you hear. It also involves moving three parts of your body. This helps you become more present in your body. 

Long-term management & treatment

If you or your loved one is experiencing panic attacks, you should visit your primary care provider to rule out any underlying medical conditions that might be causing your symptoms. Your provider can also discuss any medications you are taking, and whether these may be contributing to feelings of anxiety or panic.

Here’s the important thing to remember: Panic attacks can be scary, but they are highly treatable. Treating panic disorder usually involves therapy in combination with medication and lifestyle changes.

Speaking from personal experience, my mother’s panic attacks are well managed with a combination of medication (an antidepressant), counseling, and lifestyle modifications, such as getting enough sleep and having caregivers manage some of the daily tasks (housekeeping, meal preparation) that were overwhelming to her.

Therapy options

Therapy is an essential way to manage panic attacks. Cognitive behavioral therapy (CBT) is a highly effective treatment for panic attacks. CBT for seniors with panic attacks involves learning to become more aware of the thought patterns that contribute to panic attacks. You will also learn coping mechanisms and breathing/grounding techniques to manage your panic attacks.

Medication

Medication is a powerful way to treat panic attacks for many. Antidepressant medications are the first-line treatment for panic attacks and panic disorder in elderly individuals. Of these, selective serotonin reuptake inhibitors (SSRIs) for the elderly are usually preferred. Fast-acting anxiety medications are usually not recommended for panic disorder treatment in the elderly. For example, benzodiazepines are risky in older adults due to an increased fall risk and increased risk of memory loss.

If your doctor or psychiatrist recommends medication for panic attacks, they will discuss the benefits and risks of the medication with you and help you make an informed choice about whether the medication is best for you. They will also go over any other medications or supplements you are taking to ensure there are no potential adverse interactions.

Preventing future episodes

Once you identify the problem and get help, it’s possible to manage and prevent panic attacks. Preventing panic attacks in the elderly means sticking to whatever treatment plan you have in place, and leaning on your therapist, medical team, and family members for support.

Here are some tips for preventing panic attacks:

• Meet regularly with your therapist and follow their treatment plan.
• Take your prescribed medications, and contact your physician if you have questions or concerns about your medication.
• Manage life stressors and share any new stresses you are experiencing with your loved ones or therapist.
• Engage in hobbies you enjoy and find opportunities for meaningful social engagement.
• Get daily exercise and sunshine.
• Make sure to get enough sleep each night.
• Follow a nourishing, balanced diet.

How caregivers can help

 When your loved one is experiencing a panic attack, you will likely have strong and intense emotions. I’ve been there, feeling helpless and scared as I watched my mother have a panic attack. While this can be a powerless feeling, you actually have more power than you might realize.

Caregiver support for panic attacks in the elderly is a necessity. Caregivers are often the first people to notice when something is amiss in their elderly family member.

Here are some ways that you can support your loved one:

• Create a calm, supportive environment.
• Act as a trusted person your loved one can open up to about mental health struggles.
• Arrange therapy appointments and accompany your loved one to therapy.
• Practice breathing and grounding techniques with them.
• Help with medication management and doctor appointments.
• Assure your loved one that what they are experiencing is anxiety and that the panic will pass soon.

When to seek specialized senior counseling

If you are experiencing panic attacks, you don’t have to handle them on your own. It may feel like there is no way out when you are in the middle of a panic attack, but panic attacks are actually highly treatable. Therapy and counseling can help you effectively manage your panic attacks.

Sailor Health therapists can help you learn techniques to decrease panic attacks and manage symptoms. You should reach out for help with panic attacks when:

• You are having recurring panic attacks.
• Your panic attacks are making it difficult for you to participate in your daily routines and activities.
• You are avoiding situations because you fear you’ll have another panic attack.

Sailor Health is here for you. Our therapists can help you from the comfort of your own home. We offer therapy for panic attacks by computer, smartphone, and even by landline. Most services are covered by Medicare, which typically means a $0 copayment.

Get started today.

References‍

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