Episode Transcript
Intro: This is #OurAnxietyStories, the Anxiety Canada podcast, with John Bateman. This is the place where people from all walks of life share their anxiety stories to remind you that you are not alone. If you have an anxiety story you’d like to share, contact us at anxietycanada.com/ouranxietystories.
Mark Antczak: Hi, I'm Mark Antczak, and you're listening to #OurAnxietyStories, the Anxiety Canada podcast that can be found on anxietycanada.com or any of the major streaming platforms. Today I'm talking to Dr. Andrea Iaboni, who is a geriatric psychiatrist and scientist at Toronto Rehab as part of the University Health Network in Toronto, and an associate professor of psychiatry at the University of Toronto. She is also the co-lead on a project tasked by the Canadian Coalition for Senior Mental Health to develop clinical guidelines for the assessment and treatment of anxiety in older adults. Hi, Andrea.
Dr. Andrea Iaboni: Hi.
Mark Antczak: How's it been going today?
Dr. Andrea Iaboni: Oh, it's great, thanks.
Mark Antczak: Excellent. So, we'll start this interview as we always do on this podcast. What is your anxiety story?
Dr. Andrea Iaboni: I have two anxiety stories, if that's okay?
Mark Antczak: Absolutely. Please.
Dr. Andrea Iaboni: I hope I'm not ruining your format.
Mark Antczak: Not at all.
Dr. Andrea Iaboni: My first anxiety story is really the work I do as a geriatric psychiatrist. So, I've been practicing for more than 15 years. I see older adults every day in a lot of different settings, and everywhere I go, whether it's hospital, or a rehab center, or in the community, or long-term care, I see older adults with anxiety. The truth is, I love working with older adults with anxiety. I find it very rewarding. I really enjoy helping people find ways to cope with their anxiety, to move past it, and find ways to get back to the things that are important and meaningful to them. So that's my first anxiety story.
My second anxiety story is as a family member of somebody, an older adult, with anxiety, and that a few years ago I got a phone call from my father telling me that he had been having trouble sleeping. Actually, he'd been having trouble sleeping for a few months, and actually, he had a big bag of medications that he had been prescribed. Sleeping pills, things he had got from over the counter, and none of them were working. He was really concerned about his sleep. So, I really had some intense empathy then with other family caregivers that I had come across over the years in terms of having a family member who's struggling, but who's not really telling you very much. Here I am a geriatric psychiatrist and I found out about his difficulties two months in after he's already seen a lot of doctors. So that's my second anxiety story, helping my dad through a tough spot.
Mark Antczak: Right. So really kind of seeing him go through the system, having to navigate his own mental health. Did this kind of prompt a lot of the motivation to create some change in your role?
Dr. Andrea Iaboni: I mean, absolutely.
Mark Antczak: How did that influence you?
Dr. Andrea Iaboni: Yeah, I mean, ultimately in talking to my dad, I came to understand that the source of his sleep problems was some anxiety he was having in relation to a transition. He was downsizing his house of 30 years, and that had created a lot of anxiety, and then subsequently his sleep problems. But that had been missed through that whole time where he was getting sleeping pills prescribed to him by the primary care providers, so the real root cause of his issues wasn't being addressed. You'd think as a geriatric psychiatrist I would have been able to leap to the rescue, but of course I wasn't going to care for my family member myself. I had to get him help. Then facing the inefficiencies in our healthcare system, and how slow things are, and how you have to really advocate for someone, even as a geriatric psychiatrist who knew the system, it was still not easy to get him the help that he needed at that time. So yes, a lot of recognition of the challenges that caregivers face when they're trying to help an older adult.
Mark Antczak: I could imagine even in your professional role navigating it from that lived experience of I should know how to do this, or this should be easier. Why is it this difficult? I'm guessing that was kind of like an a-ha, eye-opening moment for you.
Dr. Andrea Iaboni: Absolutely. Yeah, it should be more straightforward. It should be recognized more quickly. The treatment steps should be clear to take, but there aren't existing guidelines actually for treating anxiety in older adults. So that's why we have been able to get this project going and work towards this.
Mark Antczak: So, I guess that segways into one of our main questions here, which is why are these guidelines so important? Because it sounds like they're quite novel or it sounds like they're addressing some issues that you've been identifying here.
Dr. Andrea Iaboni: Yeah. I think that as a geriatric psychiatrist, one thing that I really believe is that anxiety is a bit different in older adults, as it is through a lot of different stages of life. One of the reasons is that there are a lot of transitions and changes that happen in later years from retirement through to downsizing, through the losses that people experience, and then health issues that may arise. So, anxiety in older adults could signal a lot of different potential issues that are very specific in older adults. That's why the guidelines are useful in terms of taking a primary care provider or another healthcare provider through the sort of algorithm of what might be going on in this person. Yeah, that's one reason why we want these guidelines.
Mark Antczak: Right. So just kind of offering some more structure, offering perhaps some information, from the sounds of it, where perhaps there might be some errors among primary healthcare practitioners.
Dr. Andrea Iaboni: Yeah, but it's not straightforward in some ways. A perfect example is the ways in which anxiety in older adults can interact with their health conditions. So, you can have someone who's anxious because they have a new illness or a disability related to that illness, and that creates all kinds of difficulties adjusting. So that's one way, but then some chronic illnesses can actually produce symptoms of anxiety. So, you can imagine someone with lung disease, they might experience breathlessness, a feeling like they can't get enough air, and then that would set off all kinds of alarms in their brain, and then can create panic experiences for them. So those are two different ways that anxiety and medical illness interact. The ways in which then anxiety influences people's ability to get treatments further. If they're really anxious, they might not go to a doctor, they might not take their medications. There are even more ways. Older adults have a lot more comorbidities and so there is that complexity. So, it's helpful, I think, to have guidelines that sort of lay some of that out in how to tease some of these issues apart.
Mark Antczak: Gotcha. So, would you say that prior to these guidelines being established, it was a little bit harder to disseminate some of these differences? Because it sounds like there might've been maybe some assessments that weren't as thorough or perhaps some diagnoses that might've been missed.
Dr. Andrea Iaboni: Yeah. It's complicated, like I said. So, I think that the hazard is that someone, an older adult presents with anxiety with one symptom, like sleep problems or having trouble breathing, and it's either dismissed as just anxiety or it's thought to be just the medical illness and the intersection with the anxiety is not seen. So just increasing awareness of how anxiety in older adults can interact with their medical conditions and also with things like medications. So, another reason for doing this is that treatments in older adults also need to be a little different.
Mark Antczak: That's right.
Dr. Andrea Iaboni: Yeah, older adults are more vulnerable to certain side effects. They metabolize drugs differently. They may be on more medications and then there are interactions. There are medications that actually can cause anxiety that older adults are more likely to be prescribed. So that's an important reason for having an older adult-specific guideline, I think.
Mark Antczak: Right. I mean, as far as the Canadian population goes, as far as I'm concerned, the average age is getting older and older with every passing year. Would you say that this is becoming a more prominent challenge, and this is kind of why the guidelines are being created?
Dr. Andrea Iaboni: Yeah, I think that's right. Our population is aging and the number of specialists who specialize in older adults is not really increasing as quickly as the population. There aren't many geriatric psychiatrists and geriatricians out there. So, making sure that the skills and the knowledge that we have can be shared, can be accessed more easily and through things like these guidelines I think is really important.
Mark Antczak: Okay. So, from the perspective of our listeners, perhaps someone who may have someone that's older in their family who may be navigating some mental health challenges, how could some of this information or these guidelines be helpful for them, or how could they use it, I guess, is the question?
Dr. Andrea Iaboni: Yeah. So, the guidelines, there are two parts of them. One is the one that's really focused on the healthcare provider, which I've kind of been talking about mostly here. But the idea is that we'll also have a version that is meant for an older adult or their caregiver to read to understand better what their symptoms are about, and what some of the possible treatments might be, and what some of the pros and cons of the different treatments are. I think one thing that we know is really important in anxiety is having information, because information, what we would call, I guess, education or psychoeducation, I think is a really important treatment for anxiety because I guess a lot of the anxiety arises out of not understanding or not knowing what's going on. So, you can actually wipe that whole part of the anxiety out by providing information. So, I think the hope is that the guidelines will fill in that gap a little bit for family members and older adults as well.
Mark Antczak: I can certainly attest to the impact of just having to normalize or educate someone on say, an intrusive thought they're having and it not meaning who they think they are, or just having to say, "Yeah, this is OCD," or, "Yeah, this is what anxiety is, or how it manifests." It's just normalizing that and being able to give them that understanding.
Dr. Andrea Iaboni: Yeah, it means, in the example of someone who's having trouble breathing, just saying, "There's two things going on here. You're right, you have some lung problems, but then on top of that, you have this anxiety about your lung problem and the symptom, and it's causing these alarms in your brain." Giving that information can then suddenly be like, oh, I understand now, and it's not quite as scary, not quite as threatening as it was. So yeah, I think information is a huge component of helping anxiety, but I think also some concrete strategies as well. We're hoping that the caregiver information that will come out of this will be really specific about what you can do to help support someone with anxiety. It remains to be seen exactly what that will be, but we're kind of coming towards the end of the guidelines, and I'm hopeful that it'll be helpful in that way.
Mark Antczak: Gotcha. I imagine too, the guidelines, I guess the layman's person like myself, it gives a bit of an opportunity to see what we could advocate for or also where perhaps we could offer some guidance in case those aren't being followed.
Dr. Andrea Iaboni: Yeah. I've already talked a bit about medications, but obviously there's a lot more than medications that help with that.
Mark Antczak: Of course, of course. Yeah.
Dr. Andrea Iaboni: I don't want people to leave thinking that medications are the only treatment. There are a lot of psychotherapies out there. There are things like different skills that people can learn that can help them manage their anxiety better. So, knowing what those are, knowing that there is evidence behind them. It's amazing the studies that have been done that have shown... Even studies that are specific to older adults, because I think that's sometimes what happens, is people say, "Oh, that works, but my grandmother is not going to do mindfulness." They sort of discount the idea that an older adult could benefit from a more recently advocated-for treatment, something that may not be in their wheelhouse. But the evidence shows that older adults are actually able to learn mindfulness practices and that they're able to benefit from them, as just one example. So, I think sometimes a little bit of ageism can creep into in terms of what we offer older adults believing that psychotherapy wouldn't be what would interest them, but we do have good evidence in that area that it helps.
Mark Antczak: Yeah. Excellent, excellent. I guess for perhaps any of our listeners that may be in that older demographic, do you have any words of advice or any words of encouragement if perhaps they're thinking about seeking support for their mental health or they're not sure if they have mental health challenges?
Dr. Andrea Iaboni: Yeah, I guess I would say I think most people have some insight into the idea that things aren't going well, usually that they're not able to do what they were once able to do, and that the barrier is more in their head than in their body. So, I think the first important thing is to actually talk to someone and find that emotional support, that person that can help you work out what's going on, and that will make it a little bit more obvious about what to do next. Hopefully, if it makes sense, to go and connect with your primary care provider, to reach out to a community support like a social worker or someone that you trust to talk to about the anxiety that you're facing, and to be open to the idea that you have anxiety and that there might be a way to get better. Because I think sometimes that's also a barrier, is the feeling like you're just stuck and that there's no way out. That the treatments do help and that you just have to... Go ahead.
Mark Antczak: Acknowledging that piece around the hopelessness, I guess, of why bother? Why should I? Nothing can help me, but really, you're sharing here, if you think something's wrong, reach out to someone that you trust, someone that you think could help you. And even if they are not the ones that can help you, they can point you in the direction of someone that might be able to.
Dr. Andrea Iaboni: Yeah, yeah. That's the hope that you find your way. Knowing how to bring it up with your primary care provider is also probably important. Coming to them with some really specific information. I think that the hazard is, if you just say, "I'm not sleeping," then there's a very broad, a lot of reasons why you might not be sleeping. But you could say, "This, and this, and this have been really preying on my mind lately. I can't stop thinking about these things. It wakes me up in the middle of the night. It started this many weeks ago, or this many months ago." I think that kind of information really helps frame it for the family doctor that it's really a mental health or an anxiety struggle that you're having.
Mark Antczak: Okay, okay. Well, thank you for these very insightful words. Truly, Andrea, the work you're doing is so, so important. As we've talked about briefly, this is such a glazed over part of our mental healthcare system, oftentimes, where the research is so underdeveloped so it's amazing that there's work going into this. Thank you for your time today. Truly, it means a lot to us.
Dr. Andrea Iaboni: Thank you so much for having me.
Mark Antczak: Okay. Signing off till next time.
Outro: Thank you for listening to #OurAnxietyStories. If you’d like to support this podcast or Anxiety Canada, go to AnxietyCanada.com.
