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Podcast with Dr. Manshes
Anxiety in Later Life
Arthur Andonis:
Dr. Manshes, thank you for being with us again.
This is already our fourth podcast together,
and I think if there’s one thing that connects all our conversations – it’s trying to understand the changes that happen in later life.
Not always sharp.
Not always obvious.
Sometimes hard to even name.
In previous episodes, we talked about trauma, memory, and the difference between emotional reactions and cognitive decline.
Today, I’d like to take this in a slightly different direction.
Not something dramatic – but something that often begins quietly.
Sometimes as a small thought.
Sometimes as hesitation.
Sometimes as a vague discomfort that’s hard to explain.
Anxiety.
But not general anxiety – rather very specific fears that appear with age: fear of losing memory, fear of falling, fear of being exposed in front of others.
Let’s start with a basic question.
1. When does natural concern in older age turn into anxiety — or even a phobia?
Dr. Manshes:
In older age, there’s a fear that people don’t always talk about directly.
But it’s almost always there.
It’s the fear of losing memory.
And it’s not just a fear.
For some people, it becomes something much broader.
Sometimes it starts with a small thought.
A pause.
A moment of uncertainty: “Wait… what was that called?”
But gradually, for some people, it stops being just concern.
Because at this stage of life, memory is not only memory.
It’s part of identity.
Who I was.
Who I am.
And maybe who I can still be.
And when someone says, “I’m afraid I’ll forget,” often what they really mean is: “I’m afraid I’ll lose myself.”
And that’s where the shift happens.
It’s no longer a specific fear.
It becomes central.
It enters thoughts.
It shapes behavior.
And at that point, we’re no longer talking about concern.
We’re talking about anxiety.
What does that look like?
People start organizing their lives around the fear.
Avoiding conversations about memory.
Avoiding social situations.
Creating distance — sometimes even from close family.
Small things become very significant: a forgotten name, a small technical mistake, a brief moment of confusion.
And it’s no longer seen as “this happens to everyone.”
It becomes:
“This is it.”
“It’s starting.”
“This is happening to me.”
And when that thought repeats again and again, it stops being just a thought.
It becomes a state.
Tension appears.
Constant scanning for “symptoms.”
Attempts to hide them.
And over time, a protective pattern forms.
The paradox is that the attempt to protect oneself leads to avoidance.
And then the person begins to withdraw from life – even before anything has actually happened.
2. How can someone cope with the fear of memory loss in older age?
Dr. Manshes:
The first step is simply to recognize that this fear is valid.
It’s not an exaggeration.
And it’s definitely not “just a mood.”
It’s a very fundamental fear connected to time, the body, and identity.
And that’s exactly why it needs to be approached carefully.
Not fought immediately – but understood first.
There are several directions that can help.
Not as a single solution – but as a process.
- Separating fear from reality
When we look more closely, we often find that there is no significant functional impairment.
What people feel as “mental fog” is often created by anxiety itself.
Stress affects attention and access to memory.
And sometimes just understanding this already reduces tension.
- Cognitive activity — but not as a test
Not to prove that “everything works.”
But to remind ourselves that the brain is still active.
Attention games.
Learning something new.
Talking about the past.
Not as an exam – but as an invitation.
- Emotional work
Here we go deeper.
Fear of memory loss is often also fear of losing control.
Losing roles.
Losing who we used to be.
In therapy, we don’t only work with memory – we work with meaning.
- Self-relationship
Sometimes a small shift in the question changes everything.
Instead of asking: “What did I forget?”
We can ask: “What in me is still there?”
And to be clear – this is not a philosophical idea.
It’s a way to regain a sense of stability.
Because the goal is not only to preserve memory.
The goal is to stay connected to yourself.
And sometimes, when a person stops constantly checking themselves – there is more calm, and even better focus.
And we see the same mechanism of fear in other situations as well.
3. If we continue this topic — there’s another very common fear: fear of falling. What’s really behind it?
Dr. Manshes:
Fear of falling is much more than a physical fear.
When an older person is afraid of falling, it’s not only about pain or injury.
Often, there’s something deeper behind it: the feeling that if it happens —they may not return to how they were before.
And that changes everything.
The body becomes tense. Movements become more cautious.
Even simple actions start to feel more complicated.
And here’s the paradox: the fear of falling itself actually increases the risk of falling.
We see this in research as well.
When someone is afraid, the body shifts into a state of tension.
Movements become less natural.
Coordination is affected.
And this is no longer just “psychological.”
It becomes a physical response.
But it doesn’t stop there.
From a psychogeriatric perspective, fear of falling is also a fear of losing control.
Losing independence.
And sometimes — a sense of personal value.
I often hear phrases like:
“I don’t want people to help me.”
“I don’t want to be pitied.”
And at that point, it’s no longer about the fall itself.
It’s about what the fall represents.
So when we work with this fear, we’re not only working with the body.
We’re also working with confidence and how a person experiences themselves.
4. How can someone cope with fear of falling — both physically and emotionally?
Dr. Manshes:
To cope with fear of falling, it’s important to understand one thing: this is not only about stability.
It’s about a sense of safety.
So the approach needs to be both physical and emotional.
- Physical work that restores control
This is the foundation.
Tailored physical activity.
Balance exercises.
Sometimes — assistive devices.
Not only to prevent a fall, but to help the body feel stable again.
And when the body feels stable, psychological tension decreases as well.
- A conversation that helps understand the fear
Here we go deeper.
The question is not only: “Why are you afraid of falling?”
But: “What does it mean for you?”, “What do you think would happen after?”
Were there past situations that made this fear stronger?
Sometimes very specific memories come up.
And once we understand them, we can begin to work with them.
- Gradual return to activity
Not a sudden step.
But a process.
First — a short walk.
Then movement with support.
Then more independent activity.
The goal is not to prove that there is no fear.
The goal is to restore the feeling that the person can cope.
- Reconnecting with the body
Sometimes, in fear, the body starts to feel like a threat.
But through gentle movement, breathing, and gradual engagement — a sense of safety can return.
And that’s a significant shift.
And what about hope?
When a person feels even a small sense of control — something begins to change.
Posture improves.
Breathing becomes easier.
And a sense of self returns.
This is not about going back to youth.
And not about denying age.
It’s about understanding: “I’m still here. And I can still move forward in life.”
5. There’s another topic that often comes up in later life — social anxiety. But it looks different than in younger people. How does it show up?
Dr. Manshes:
Yes, and this difference is important.
We usually think of social anxiety as fear of embarrassment or being judged.
But in older age, it often looks different.
It’s less about: “How do I look in the eyes of others?”
And more about: “What might others notice about me?”
Not just fear of judgment, but fear of being “exposed.”
A person may no longer ask: “Will they like me?”
But instead:
“Do they see that I’ve changed?”
“Do they notice I’m not the same?”
And that’s a much more vulnerable place.
Sometimes there’s a fear of being rejected because of these changes.
How does this look in practice?
Not always in words — more often in behavior.
People start avoiding gatherings.
Skipping family events.
Reducing communication.
There may be discomfort when names are forgotten or details are missed.
Sometimes even answering the phone becomes difficult — out of fear it will be noticed.
You might hear phrases like:
“I don’t want to bother anyone.”
“You’re better off without me.”
“I’m no longer part of this.”
And here it’s important to pause and say clearly: this is not necessarily depression and not necessarily dementia.
Sometimes it’s simply fear of not being “good enough.”
Fear that others will notice change.
Why does this appear at this stage of life?
Because the way a person sees themselves changes.
We’re no longer evaluated through achievements.
And that’s not always easy to accept.
Memory may feel less stable.
Movements slower.
Sensitivity higher.
And interaction with others begins to raise deeper questions: “Who am I now, if I’m no longer who I used to be?”
And sometimes, to avoid facing that question, a person creates distance.
Not because they don’t need connection.
But because they’re afraid of losing themselves within it.
6. Can medication help with anxiety in older age?
Dr. Manshes:
Yes, it can.
But it’s important to understand this correctly.
Medication does not “remove” anxiety completely.
And it is not a solution by itself.
But in certain situations, it does something else.
It creates space.
Space in which a person can breathe a bit easier.
There are states where anxiety is so strong that a person simply cannot begin the process.
Not a conversation.
Not a meeting.
Not therapy.
And in those cases, medication does not replace psychological work —it makes it possible.
I sometimes explain it like this: it reduces background noise so something else can be heard.
And when that “gap” appears, a person can gradually return: to conversation, to connection, to a sense of control.
It’s also important to remember: in older age, we always approach medication carefully.
Individually.
Often starting with lower doses.
And always considering overall health.
The goal is not to suppress symptoms.
The goal is to help a person reconnect with themselves and with others.
So simply put: medication is not the solution.
But sometimes — it’s the beginning of the process.
Dr. Manshes:
Yes, it can.
But it’s important to understand this correctly.
Medication does not “remove” anxiety completely.
And it is not a solution by itself.
But in certain situations, it does something else.
It creates space.
Space in which a person can breathe a bit easier.
There are states where anxiety is so strong that a person simply cannot begin the process.
Not a conversation.
Not a meeting.
Not therapy.
And in those cases, medication does not replace psychological work —it makes it possible.
I sometimes explain it like this: it reduces background noise so something else can be heard.
And when that “gap” appears, a person can gradually return: to conversation, to connection, to a sense of control.
It’s also important to remember: in older age, we always approach medication carefully.
Individually.
Often starting with lower doses.
And always considering overall health.
The goal is not to suppress symptoms.
The goal is to help a person reconnect with themselves and with others.
So simply put: medication is not the solution.
But sometimes — it’s the beginning of the process.
To summarize the podcast:
Arthur Andonis:
Dr. Manshes, thank you for this conversation.
I think it helps us see anxiety in later life a bit differently.
Not just as a symptom, but as an internal process that carries both fear — and meaning.
And maybe the most important thing to remember is: this is not something a person has to go through alone.
Sometimes one conversation is enough to make things clearer.
To understand what’s happening and what can be done.
If you or someone close to you is dealing with anxiety, memory concerns, or a constant inner tension — it’s not always about finding a diagnosis right away.
Sometimes a professional perspective is enough to restore a sense of control.
For a private consultation with Dr. Manshes:
📞 Phone: +972-73-374-6844
📧 Email: [email protected]
💬 WhatsApp: +972-52-337-3108
