Depression and the Elderly

Depression is a problem that affects millions of Americans, and the elderly are not immune. Sometimes, having to deal with medical issues and the deaths of loved ones can make it more common in people over 65. But depression is not a typical sign of aging, and if you or any of your loved ones are feeling depressed there are places where you can get help. Recognizing the signs and symptoms of depression is very important, as is breaking the isolation and withdraw that some seniors experience. An article by HelpGuide.org describes the common symptoms and treatments for depression.

Depression is a problem for many older adults

Loss is painful—whether a loss of independence, mobility, health, your long-time career, or someone you love. Grieving over these losses is normal, even if the feelings of sadness last for weeks or months. Losing all hope and joy, however, is not normal. It’s depression.

If you have depression, you are not alone. According to the National Institutes of Health, of the 35 million Americans age 65 or older, about 2 million suffer from full-blown depression. Another 5 million suffer from less severe forms of the illness.

Although depression in the elderly is a common problem, only a small percentage get the help they need. There are many reasons depression in older adults is so often overlooked. Some assume seniors have good reason to be down or that depression is just part of aging. Elderly adults are often isolated, with few around to notice their distress. Physicians are more likely to ignore depression in older patients, concentrating instead on physical complaints. Finally, many depressed seniors are reluctant to talk about their feelings or ask for help.

The consequences of this oversight are high. Untreated depression poses serious risks for older adults, including illness, alcohol and prescription drug abuse, a higher mortality rate, and even suicide. So it’s important to watch for the warning signs and seek professional help when you recognize it. The good news is that with treatment and support, depressed seniors can feel better. No one, whether they’re 18 or 80, has to live with depression.

Causes of depression in the elderly

Many elderly adults face significant life changes and stressors that put them at risk for depression. Those at the highest risk include older adults with a personal or family history of depression, failing health, substance abuse problems, or inadequate social support.

Causes and risk factors that contribute to depression in the elderly include:

Loneliness and isolation – Living alone; a dwindling social circle due to deaths or relocation; decreased mobility due to illness or loss of driving privileges.

Reduced sense of purpose – Feelings of purposelessness or loss of identity due to retirement or physical limitations on activities.

Health problems – Illness and disability; chronic or severe pain; cognitive decline; damage to body image due to surgery or disease.

Medications – Many prescription medications can trigger or exacerbate depression.

Fears – Fear of death or dying; anxiety over financial problems or health issues.

Recent bereavement – The death of friends, family members, and pets; the loss of a spouse or partner.

Is it grief or depression?

Although a grieving person may experience a number of depressive symptoms such as frequent crying and profound sadness, grief is a natural and healthy response to bereavement and other major losses. There is a difference, however, between a normal grief reaction and one that is disabling or unrelenting. While there’s no set timetable for grieving, if it doesn’t let up over time or extinguishes all signs of joy—laughing at a good joke, brightening in response to a hug, appreciating a beautiful sunset—it may be depression.

Signs and symptoms of depression in the elderly

Recognizing depression in the elderly starts with knowing the signs and symptoms. Depression red flags include:

Sadness
Fatigue
Abandoning or losing interest in hobbies or other pleasurable pastimes
Social withdrawal and isolation (reluctance to be with friends, engage in activities, or leave home)
Weight loss; loss of appetite
Sleep disturbances (difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness)
Loss of self-worth (worries about being a burden, feelings of worthlessness, self-loathing)
Increased use of alcohol or other drugs
Fixation on death; suicidal thoughts or attempts
Depression without sadness

Older adults don’t always fit the typical picture of depression. Many depressed seniors don’t claim to feel sad at all. They may complain, instead, of low motivation, a lack of energy, or physical problems. In fact, physical complaints, such as arthritis pain or headaches that have gotten worse, are often the predominant symptom of depression in the elderly.

Older adults with depression are also more likely to show symptoms of anxiety or irritability. They may constantly wring their hands, pace around the room, or fret obsessively about money, their health, or the state of the world.

Depression Clues in Older Adults

Older adults who deny feeling sad or depressed may still have major depression. Here are the clues to look for:

Unexplained or aggravated aches and pains
Hopelessness
Helplessness
Anxiety and worries
Memory problems
Loss of feeling of pleasure
Slowed movement
Irritability
Lack of interest in personal care (skipping meals, forgetting medications, neglecting personal hygiene)

Adapted from American Academy of Family Physicians

Helping a depressed friend or relative

The very nature of depression interferes with a person’s ability to seek help, draining energy and self-esteem. For depressed seniors, raised in a time when mental illness was highly stigmatized and misunderstood, it can be even more difficult. Some seniors don’t believe depression is a real illness. Others are too proud or ashamed to ask for assistance, for fear of becoming a burden to their families. With such roadblocks, assistance from others can mean the difference between suffering and recovery.

If a senior citizen you care about is depressed, you can make a difference by offering emotional support. Listen to your loved one with patience and compassion. Don’t criticize feelings expressed, but point out realities and offer hope. You can also help by seeing that your friend or family member gets and accurate diagnosis and appropriate treatment. Help your loved one find a good doctor, accompany him or her to appointments, and offer moral support.

Other tips for helping a depressed elderly friend or relative:

Invite your loved one out. Depression is less likely when people’s bodies and minds remain active. Suggest activities to do together that your loved one used to enjoy: walks, an art class, a trip to the museum or the movies—anything that provides mental or physical stimulation.

Schedule regular social activities. Group outings, visits from friends and family members, or trips to the local senior or community center can help combat isolation and loneliness. Be gently insistent if your plans are refused: depressed people often feel better when they’re around others.

Plan and prepare healthy meals. A poor diet can make depression worse, so make sure your loved one is eating right, with plenty of fruit, vegetables, whole grains, and some protein at every meal.

Encourage the person to follow through with treatment. Depression usually recurs when treatment is stopped too soon, so help your loved one keep up with his or her treatment plan. If it isn’t helping, look into other medications and therapies.

Make sure all medications are taken as instructed. Remind the person to obey doctor’s orders about the use of alcohol while on medication. Help them remember when to take their dose.

Watch for suicide warning signs. Seek immediate professional help if you suspect that your loved one is thinking about suicide.
For more tips, see Helping a Depressed Person: Taking Care of Yourself While Supporting a Loved One.

Depression self-help for seniors

If you’re depressed, you may not want to do anything or see anybody. But isolation and inactivity only make depression worse. The more active you are—physically, mentally, and socially—the better you’ll feel.

Some ways to combat and prevent depression include:

Getting out in to the world – Try not to stay cooped up at home all day. Go to the park, take a trip to the hairdresser, or have lunch with a friend.

Connecting to others – Limit the time you’re alone. If you can’t get out to socialize, invite loved ones to visit you, or keep in touch over the phone or email.

Participating in activities you enjoy – Pursue whatever hobbies or pastimes bring or used to bring you joy.

Volunteering your time – Helping others is one of the best ways to feel better about yourself and regain perspective.

Taking care of a pet – Get a pet to keep you company.

Learning a new skill – Pick something that you’ve always wanted to learn, or that sparks your imagination and creativity.

Enjoying jokes and stories – Laughter provides a mood boost, so swap humurous stories and jokes with your loved ones, watch a comedy, or read a funny book.

Maintaining a healthy diet – Avoid eating too much sugar and junk food. Choose healthy foods that provide nourishment and energy, and take a daily multivitamin.

Exercising – Even if you’re ill, frail, or disabled, there are many safe exercises you can do to build your strength and boost your mood—even from a chair or wheelchair.

Getting professional help for depression

While support and self-care can help depressed seniors, professional help should also be pursued. If you see the signs and symptoms of depression in yourself or an older relative, schedule an appointment with a doctor for a thorough evaluation, including a complete physical and lab workup. This is particularly important since many medical conditions, medications, and even certain physiological changes of aging can cause depression or compound the problem.

Diagnosing depression in the elderly

Before being diagnosed with depression, elderly adults should be screened for common health issues that can affect mood. These include:

Hormonal imbalances
Thyroid problems
Vitamin B12 deficiency
Other nutritional deficiencies
Electrolyte imbalances or dehydration
Illness and depression

When undergoing evaluation for depression, long-term or severe health issues should also be taken into account. Chronic medical conditions, particularly those that are painful, disabling, or life-threatening, can understandably lead to depression. Illnesses that affect the brain can also cause depression through the disease process itself.

Medical conditions that commonly trigger depression include:

Heart attack or disease
Parkinson’s disease
Stroke
Alzheimer’s
Multiple sclerosis
Cancer
Diabetes

Medication-induced depression

All medications have side effects, but some can actually cause symptoms of depression or make a pre-existing depression worse. Harmful drug interactions or a failure to take a medication as prescribed can also contribute to depression. For elderly individuals with multiple prescriptions, the risk of medication-induced depression is particularly high.

Medications that can induce depression include:

Steroids
Painkillers
Hormones
Arthritis medication
High blood pressure drugs
Heart disease medication
Tranquilizers
Cancer drugs

Make a list of all medications being taken and bring it to the doctor. He or she can help you determine if any of the prescriptions are causing depression symptoms.

Treatment options for the elderly

Depression treatment is just as effective for elderly adults as it is for younger people. Therapy, support groups, and medication can all help relieve symptoms. However, health issues should always be considered in an older adult’s treatment plan.

Any medical issues complicating the depression must be addressed and resolved. For example, many seniors suffer from chronic pain. Pain that interferes with daily activities can prevent depression recovery, so it must be managed as part of the treatment plan.

Antidepressant treatment

Antidepressant medications may help ease the symptoms of depression in the elderly. However, if the depression is due to loneliness, poor health, or other lifestyle issues, medication may not be the best choice.

Antidepressant use in older adults also comes with safety concerns that it’s important to be aware of. Older adults are more sensitive to drug side effects and vulnerable to interactions with other medicines they’re taking. Depressed seniors may also forget to take the medication. Furthermore, recent studies have found that SSRIs such as Prozac can cause rapid bone loss and a higher risk for fractures and falls. Because of these risks, elderly adults on antidepressants should be carefully monitored.

Counseling and therapy

Studies have found that therapy works just as well as medication in relieving mild to moderate depression. And unlike antidepressants, therapy also addresses the underlying causes of the depression.

Supportive counseling includes religious and peer counseling. It can help ease loneliness and the hopelessness of depression.

Psychotherapy helps people work through stressful life changes, heal from losses, and process difficult emotions.

Cognitive behavioral therapy (CBT) helps people change negative thinking patterns, deal with problems in healthy ways, and develop better coping skills.

Support groups for depression, illness, or bereavement connect people with others who are going through the same challenges. They are a safe place to share experiences, advice, and encouragement.

This information is from HelpGuide.org, please visit their website to learn more.

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