Courtesy of Harley A. Rotbart, M.D.
Lou, my beloved grandfather, lived almost 101 years and obsessively worried every single day of his adult life — probably because his adult life began before it should have. As a child in Russia, he watched helplessly as his mother and sister were killed during a vicious pogrom in their village.
Lou (I called him Zadie) made his way to America, and immediately began imagining the worst about his fate, and his family’s fate, in his new country. I believe Zadie lived as long as he did because he was afraid of what would happen to his children, grandchildren, and great-grandchildren if he wasn’t here to protect them.
When I was a third-year medical student in New York City, he called from Denver very early one morning, waking me and my roommates. He had been listening to his transistor radio on one of his many sleepless nights of worry, and had heard that a Staten Island Ferry boat had crashed, injuring numerous passengers.
There were more than seven million people in the city, and Zadie called at 4 a.m. to make sure I wasn’t one of those injured. It was from him we learned the importance of telling white lies and omitting certain truths with our elderly parents and grandparents.
Before accusing me of infantilizing and patronizing my older family members, hear me out. Anxiety disorders can be debilitating for the elderly. A comprehensive review of the subject found 10 to14 percent of those 65 and older meet the criteria for these diagnoses, a significantly higher figure than for the more widely recognized depression syndromes in the same demographic.
Indeed, depression and anxiety disorders often occur together. Anxiety disorders are underdiagnosed in the elderly, largely because the symptoms are often assumed to be just another manifestation of aging. Additionally, the clinical assessment of the elderly for anxiety is more complicated than for younger patients because the signs may differ from those classically described in the diagnostic manuals.
A large national study showed an increased incidence of general anxiety disorder beginning after age 55, and the National Alliance on Mental Illness notes that, like depression, obsessive-compulsive disorder tends to worsen in old age. Factors contributing to the prevalence and severity of anxiety disorders in the elderly include a host of concomitant medical problems that interact with anxiety in a complicated way.
From the review article cited earlier:
The co-morbidity between medical illness and anxiety disorders poses difficulties for…diagnosis and detection of anxiety. Researchers have suggested that older adults may be more likely to attribute physical symptoms related to anxiety to medical issues… In turn, many physical conditions, such as cardiovascular disease, respiratory disease, hyperthyroidism, and pulmonary and vestibular difficulties, can mimic the symptoms of anxiety…making it difficult to establish the underlying cause…
Furthermore, the symptoms that result from medical illnesses may produce fearful bodily sensations that may result in the subsequent development of anxiety disorders.
As an example, more than 40 percent of patients with Parkinson’s disease meet the criteria for an anxiety disorder. Dementia is also associated with anxiety in a bidirectional way — anxiety can accelerate cognitive decline, which in turn can increase symptoms of anxiety. Added to this morass are the side effects, which can include anxiety, of many medications taken by older patients.
The elderly clearly are an at-risk population for anxiety disorders. Which brings us back to white lies. Zadie’s well-earned anxieties, obsessions and worries accelerated greatly as he got older, and we realized they could largely be prevented if we simply didn’t share the complete truth with him all the time. This became known in our family as the Zadie Filter.
When we took our children to the mountains, we told him we were headed to Colorado Springs; he’d been to Colorado Springs many times and knew it was a flat highway drive from Denver. No high mountain passes or narrow roads without guardrails.
When he begged my sons to become doctors so they would serve behind the front lines in the event they were drafted (this was long after the military draft ended, which was still not reassuring enough for Zadie), they so promised. When our daughter started driving, Zadie warned her it wasn’t safe for a girl to drive alone in case she had car trouble; she promised she would always have company in the car.
Zadie died when his great-grandchildren were still teenagers, and so he never had to know that the boys didn’t go into medicine and that his great-granddaughter drives alone.
My mother, Zadie’s daughter, inherited his anxieties, and as she has entered her mid-80s her symptoms have also markedly increased. On the other side of the family, my mother-in-law’s issues with anxiety began with her Parkinson’s disease and have worsened as her neurological condition has progressed.
With our mothers, we also rely on the Zadie Filter. Our white lies and omissions reduce their worries — which is not to say we can protect them from all triggers (they still read the newspaper and watch the nightly news), but even a bit of relief for them is relief for us as well.
Our parents live for the most part on fixed incomes, so when we’re able to cover some of their expenses without their knowing, we do so, and they worry a little less about their bills. All it takes is a little white lie: “The apartment manager waived your heating bill this month because you’ve been such a good long-term tenant,” or, “Of course I used your credit card when I paid for your medicines.”
My mother accidentally found out that our son broke his finger (playing flag football during finals week!) when a well-intentioned friend asked her how her grandson was doing after his injury. She was upset we hadn’t told her — but only for a few moments, until we explained that it had happened a week before, that he was all splinted up and was in no pain. All of which was 100 percent true, and she didn’t lose a minute of sleep worrying about it.
Last week, after pressing our law student son (he of the broken finger) about a school transcript issue I’ve been worried about for him, he assured me it had been taken care of. Our daughter in grad school goes into bars only when she’s with a large group of friends, and our college son is the designated driver for all of his fraternity functions.
And so it begins.
Dr. Harley A. Rotbart is professor and vice chairman of pediatrics at the University of Colorado School of Medicine and the author of “No Regrets Parenting.”