After she broke her neck in a car accident at age 28, Renée Tucker’s doctors told her that her newly repaired spine would never be as strong as it was before. Another accident could paralyze her.
She’s not allowed to run or ride on roller coasters, but the Buckingham Township mother of two has mostly been able to lead a normal life. Now that she’s 51, though, she’s worrying more about her health. She often feels some dizziness and pain when she stands up, symptoms her doctors have not been able to explain. Any ache in her neck makes her anxious. She’s much more afraid of falling than she used to be.
She’s seen that some people her age, even those who’ve taken good care of themselves, have had major health problems.
"I just have this kind of sense of impending doom, that it's going to get worse and not be manageable," she said of her health. "As I get older, I feel weaker and weaker."
While plenty of people ignore their health all their lives, Tucker’s worries about her increasing vulnerability are common in later life. Doctors and mental health experts said the 50s, 60s and up can be when symptoms provoke more anxiety than they once did.
This is when many first experience serious illnesses like diabetes and heart disease. Even if they don’t have a chronic illness, people are more aware of their mortality. Chest discomfort we could attribute in our youth to sore muscles can seem much more ominous. Stomach distress might be cancer. A headache could be a stroke. Every forgotten name might mean Alzheimer’s disease.
It’s hard to avoid the message that the risk of almost everything bad, including death, goes up with age. That’s why age mostly determines screening for breast, prostate and colon cancer. It’s why doctors start paying closer attention to your heart.
A little worry is normal, but ...
Barbara Grabias experienced the newly heightened anxiety recently when she felt chest pressure. She worried that something was wrong with her heart. She went to the doctor and learned she had acid reflux, a condition easily remedied by over-the-counter medicine.
Older people “are more conscious of little pings and pangs in their body,” said Grabias, 77, who lives near Washington Square. “It’s probably when I got to be 70 is when I started to think more of the preciousness of health.”
What first triggered it for Barry Jacobs, 61, was nearing the age at which his father died of cancer: 52. A psychologist who works as a consultant at the Health Management Associates Philadelphia office, Jacobs was especially anxious until he made it to 53. He said age changes the way people feel about their bodies. Most can’t run as fast or lift as much weight. They have more aches and pains. “We don’t trust our bodies as much after a while,” he said.
Holly Lange, president and CEO of the Philadelphia Corp. for Aging, had a hip replacement in 2015. Now in her 60s, she has back pain. It reminds her of her late mother, who had to use a wheelchair in her 80s: “I worry because my mother had a bad back for years, so I’m turning into my mother.”
She thinks it’s common for people in her age group to worry more about their health. “I think it’s part of the aging process that the older you get, the more symptoms you might have,” she said.
For most of us, health worries are allayed by test results. We might lose some sleep temporarily, but we gain renewed appreciation for health we can no longer take for granted. For some, though, the distress is extreme enough that life starts to revolve around health fears. There are hours spent on the Internet that can fuel cyberchondria and constant doctor visits.
Health experts say that worries about health exist on a continuum. A little worry is normal and may be good, because it prompts people to see their doctors. A lot can be crippling.
Tim Scarella, a psychiatrist at Harvard Medical School, said health anxiety is a problem when people become hypersensitive to changes in their bodies, and when they are not reassured when the doctor tells them they don’t have anything serious. The key question is, “How much does that worry make you miserable or keep you from engaging in your life?”
Neil Skolnik, a primary care doctor with Abington-Jefferson Health, is hesitant to even use the word anxiety, which he thinks has negative connotations, for most older patients. “I would be slow to equate increased awareness and concern with anxiety,” he said. "As people get older, they are more likely to get serious illness, so it is natural that they are more concerned about their health.”
Are we really worrying more, or about different things?
Seetha Chandrasekhara, a psychiatrist with Temple Health, thinks that for those who are inclined to worry, the focus of fear changes over time. In their 20s, people may be anxious about school, first jobs, or dating. Health becomes a bigger issue later in life, when symptoms increase and peers get sick.
There’s not much research on how health worries change over the lifespan. Renée El-Gabalawy, a psychologist at the University of Manitoba, thinks medical definitions have stymied science. What used to be called hypochondriasis — the patient who was always going to the doctor when there was nothing wrong — did not include the many patients who had symptoms but were worrying too much about them. The medical terms used since 2013 are somatic symptom disorder, which includes people with real symptoms, and illness anxiety disorder, in which patients without unusual symptoms worry excessively about getting sick.
While most mental illnesses becomes less common with age, El-Gabalawy said somatic symptom disorder does increase with age and illness. Not much is known about the broader category of health anxiety, which includes more normal worry. Based on her clinical experience, she estimates that “well over 50%” of older patients experience some level of health anxiety.
Thomas Fergus, a psychologist at Baylor University, has found that worries about health are more likely to lead to increased use of medications, doctor visits, and lab tests, and thus higher costs in older patients than in young ones.
Doctors may be making fears worse
Doctors may be feeding health anxiety without realizing it, experts said, by cavalierly sending patients for tests. Waiting for results can be hard on people of all ages. “Oh, wow,” Scarella said patients think, “the doctor thinks it’s enough to test for.”
Doctors can calm patients by saying they’re trying to rule out something that’s extremely unlikely. If they think the threat is bigger, they can promise to give the patients results as soon as possible and take care of them if something is wrong. Neesha Patel, a geriatrician at Cooper University Health Care, said patients often fret over tests that doctors consider routine. Before mammograms, she warns older women that modern mammograms often lead to more testing. “Please do not worry if that happens,” she tells them.
Jeffrey Millstein, a primary care doctor at Penn Medicine, routinely asks his patients what they are most worried about when they come to see him. “That’s a way to get some of those fears out on the table,” he said.
If your anxiety is on the milder end of the spectrum, it can help to know that worry is normal. Accept it and know it will pass. Good nutrition, exercise and meditation can help.
Dawn Mechanic-Hamilton, a Penn Medicine neuropsychologist, said to not underestimate the importance of sleep. Sleep problems become more common in later life. Lack of sleep can affect mood and tolerance for distress.
For more serious health anxiety, cognitive behavioral therapy is the gold standard. It helps patients re-frame catastrophic ideas about their health.
El-Gabalawy said doctors should be aware that continuing to order tests they think are unnecessary because of patient worries may reward “safety behaviors,” such as seeking frequent reassurance. “The best treatment for all anxiety is sitting through distress and allowing it to naturally disappear,” she said.
Ellen Langer, 72, a Harvard University psychologist who studies mind-body interaction and mindfulness, thinks we’d all do better to think about aging differently. “People too frequently mis-associate age and illness,” she said. That can be a self-fulfilling prophecy. “I believe the amount of control we have over disease is enormous.”
One thing people can do is train themselves to pay attention to their bodies differently. We all notice when something feels a little wrong. It’s also important to notice how often we feel fine.
We can also often talk ourselves out of stress by really thinking about what’s causing it. “Stress results from two things,” Langer said. “One is that you think something is going to happen, and two is, when it happens, it’s going to be awful. You need to question both of those.”
We’ll all feel better if we realize that a lifetime of experiences will help us cope. “We’ll just sit back and let whatever happens happen,” Langer said.