Each week, I do therapy and counseling sessions in a veterans hospital with a lot of elderly patients walking around. So many of these senior patients are on medication, suffering from physical ailments. My doctor friend and chief of the surgery, Dr. Nap, once told me that it can be a challenge to recognize that diagnosis is not always simple. This is true, especially among soldier-veteran elderly patients who are generally reluctant to admit or face emotional distress.
In late-stage life, there is usually a high rate of chronic illnesses and medications. Some illnesses, like cardiac or lung problems, produce symptoms that are the same to those going through psychological anxiety or panic attacks -- erratic heartbeat, shortness of breath, and difficulty breathing. An elderly patient's condition can also be complicated by the onset of Alzheimer or dementia, since anxiety or fears appear to be part of these medical disorders.
Therefore, for late-life or senior patients, there is always a need to separate the medical and psychological/emotional/spiritual causes of depressive disorder/anxiety/fear symptoms. Sometimes, we can be surprised by our blind spots and misperceptions that we don't pay close attention to what elderly patients are really telling us.