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24 November, 2016

Depression in older adults

Do you feel very tired, helpless, and hopeless? Have you lost interest in many of the activities and interests you previously enjoyed? Are you having trouble working, sleeping, eating, and functioning? Have you felt this way day after day? If you answered yes, you may be experiencing depression.

Everyone feels sad from time to time. However these feelings are short-lived and last only a few days. Depression is where these feelings are severe, or long lasting. It leaves you feeling “down” most of the time and finding it hard to “cope” from day to day. Depression is increasingly common affecting one in every ten people. It affects 1 in 5 over the age of 65.

Depression is not a normal or necessary part of aging. As you get older, you may go through a lot of changes—death of loved ones, retirement, stressful life events, or medical problems. It’s normal to feel uneasy, stressed, or sad about these changes. But after adjusting, many older adults feel well again. Depression is different. It is a medical condition that interferes with daily life and normal functioning.

Depression is a common problem in older adults. It is not a sign of weakness or a character flaw. And its symptoms affect every aspect of your life, including your energy, appetite, sleep, work, hobbies, and relationships. Unfortunately, all too many depressed individuals fail to recognize the symptoms of depression, or don’t take the steps to get the help they need. There are many reasons depression in older adults is so often overlooked:

  • You may assume you have good reason to be down or that depression is just part of aging.
  • You may be isolated—which in itself can lead to depression—with few around to notice your distress.
  • You may not realize that your physical complaints are signs of depression.
  • You may be reluctant to talk about your feelings or ask for help.

The general rule of thumb is that an individual can be diagnosed with depression if they experience five or more depressive symptoms for more than two weeks. 

Depressive symptoms include;

  • Feelings of overwhelming sadness and hopelessness
  • Loss of interest or pleasure in everyday activities or hobbies that are usually enjoyed. 
  • Sleep disturbances – Older people need less sleep. However if you notice a dramatic change in a short period of time/are not waking up feeling rested having difficulty sleeping, waking early, not being able to fall asleep, feeling overly tired, or having no energy to get out of bed
  • Changes in appetite — often reduced appetite and weight loss, but increased cravings for food and weight gain in some people
  • Unexplained or aggravated aches and pains
  • Feelings of hopelessness or helplessness
  • Having recurrent thoughts of death, suicide or self-harm.
  • Cognition-some people think that it is part of aging or that they have dementia and are afraid to look into it. However poor attention and concentration can be part of depression. Never assume that a loss of mental sharpness is just a normal sign of old age. 
  • Feeling restless, worrying more than usual, feeling panicky
  • Loss of self-worth (worries about being a burden, feelings of worthlessness or self-loathing)
  • Dwell on bad times from the past
  • Slowed movement and speech
  • Neglecting personal care (skipping meals, forgetting medications, neglecting personal hygiene)

 

While depression and sadness might seem to go hand and hand, many depressed people claim not 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 worsening headaches, are often the predominant symptom of depression in later life.

Is it grief or depression?

As we age, we experience many losses. Loss is painful—whether it’s a loss of independence, mobility, health, your long-time career, or someone you love. Grieving over these losses is normal and healthy, even if the feelings of sadness last for a long time.

Distinguishing between grief and clinical depression isn’t always easy, since they share many symptoms. However, there are ways to tell the difference. Grief involves a wide variety of emotions with good and bad days. Even when you’re in the middle of the grieving process, you will have moments of pleasure or happiness. With depression, on the other hand, the feelings of emptiness and despair are constant.

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.

What if it’s not depression, what if it’s dementia?

Symptoms of Depression

Symptoms of Dementia

Mental decline is relatively rapid

Mental decline happens slowly

Knows the correct time, date, and where he or she is

Confused and disoriented; becomes lost in familiar locations

Difficulty concentrating

Difficulty with short-term memory

Language and motor skills are slow, but normal

Writing, speaking, and motor skills are impaired

Notices or worries about memory problems

Doesn’t notice memory problems or seem to care


Other causes of depression:

It’s important to be aware that medical problems can cause depression either directly or as a reaction to the illness. Any chronic medical condition, particularly if it is painful, disabling, or life-threatening, can lead to depression or make depression worse. 

These include:

  • Parkinson’s disease
  • stroke
  • heart disease
  • cancer
  • diabetes 
  • thyroid disorders
  • multiple sclerosis

Symptoms of depression can also occur as a side effect of many commonly prescribed medications. While the mood-related side effects of prescription medication can affect anyone, older adults are more sensitive because, as we age, our bodies become less efficient at metabolizing and processing drugs.

Medications that can cause or worsen depression include:

  1. Beta-blockers (e.g. Lopressor, Inderal)
  2. Sleeping pills
  3. Tranquilizers (e.g. Valium, Xanax)
  4. Medication for Parkinson’s disease
  1. Ulcer medication (e.g. Zantac, Tagamet)
  2. Steroids (e.g. cortisone and prednisone)
  3. Estrogens (e.g. Premarin, Prempro)

If you feel depressed after starting a new medication, talk to your doctor. You may be able to lower your dose or switch to another medication that doesn’t impact your mood.

 

What can I do?

5 aspects of wellbeing- Social, Financial, Career, Physical, and Community Wellbeing

Get out in to the world. Try not to stay at home all day, even when feeling down. Go to the park, take a trip to the hairdresser, or have lunch with a friend.

  • Volunteer your time. Helping others is one of the best ways to feel better about yourself and expand your social network.
  • Take care of a pet. A pet can keep you company, and walking a dog, for example, can be good exercise for you and a great way to meet people.
  • Create opportunities to laugh. Laughter provides a mood boost, so swap humorous stories and jokes with your loved ones, watch a comedy, or read a funny story
  • Remind yourself that depression is an illness - not a sign of weakness. You are not being lazy or letting other people down.
  • Tell someone if you feel so low that you have thoughts of taking your own life.
  • Watch your drinking. Alcohol can make depression worse. It can also react with any tablets you are taking.
  • Sleeping- avoiding alcohol and caffeine, keeping a regular sleep-wake schedule, and making sure your bedroom is dark, quiet, and cool.
  • Exercise-30 minutes 5 times/day. Park farther from the store, take the stairs, do light housework, or enjoy a short walk. Safe exercise.
  • Eating-every 3-4 hours. Not eating for too long can result in fatigue and irritability. 
  • Try not to panic about not sleeping properly. It will get better when the depression lifts.
  • Try not to change the tablets you are on without discussing it with your doctor. If your tablets have side-effects, tell your doctor or nurse.
  • Be kind to yourself - you may need to change your routine while you are unwell.
 

What about professional help?

Less than half of those with depression get any professional help, despite the fact that depression is very treatable. Untreated depression can cause strain on relationships, drug and alcohol use, and suicidal thoughts or attempts. With proper assessment and diagnosis, recovery from depression can begin within weeks of commencement of a treatment plan. Most people go on to live healthy and happy lives with treatment. 

Older people tend to think more about physical problems than about feeling depressed. You may have been brought up not to bother the doctor unless you have a physical complaint. Sometimes the first sign of depression can be a constant worry about having a physical illness, even when your doctor can't find anything wrong with you. If he or she tells you that you are depressed, it may feel as though you are not being taken seriously. This isn't the case. 

If you or someone you love is experiencing symptoms of depression, your first point of contact is your GP. Following assessment by your GP, they may recommend that you are referred for an assessment at a community mental health clinic or alternatively, your GP may suggest that you need to come into hospital.

There are three main different types of treatment. 

Medication

Treatment of underlying causes e.g. being low in vitamins or iron. 

Antidepressants. Side effects can be discussed withn your doctor and monitored appropriately. Antidepressants work a bit faster than talking treatments. Some people prefer talking treatments, whilst others prefer tablets. You can have both at the same time. 

Complementary therapies are helpful but need to be discussed with your doctor in case of side effects or medication interactions.

Talking therapies

Psychotherapy (or “talk therapy”) can be very effective. It helps by teaching new ways of thinking and behaving, and changing habits that may contribute to the depression. Psychotherapy can help you understand and work through difficult relationships or situations that may be causing your depression or making it worse. They are very safe. But, sometimes psychotherapy can bring up unhappy memories from the past. A good therapist will know how to deal with this. If you have concerns, you should discuss them with your GP or therapist.

Practical help

A social worker can help you to get advice on financial or practical support - or even moving house. However, it is usually best to put off big decisions like this until you are feeling better. Professionals can also help you find ways to spend time with other people, such as support groups and day centres in your local area. This can be important because it's easy to lose touch with people when you are depressed.

What role can family members play in helping someone with depression?

For depressed older individuals, raised in a time when mental illness was highly stigmatized and misunderstood, it can be even more difficult to ask for assistance, or to fear becoming a burden. Listen. Offer moral support.  Suggest activities to do together that your loved one used to enjoy: walks, an art class, a trip to the museum or the movies. Depression is less likely when people’s bodies and minds remain active. 

Schedule regular social activities. Group outings, visits from friends and family members, or trips to the local community center can help combat 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 good foods.

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.

If you have concerns about suicidal behavior contact a health professional immediately.

Depression is a very common illness that only becomes more common as we age. For many people over 65 depression carries a stigma and this can often discourage people from seeking help. Although we experience losses as we age and this brings a certain amount of sadness, depression is not a normal part of ageing and should be treated. Older individuals may not feel sad as such and may notice other changes such as increased fatigue and worsening physical problems with no clear explanation. Certain medications and medical illnesses can also cause or worsen depression. If you are concerned that either you or a loved one is depressed it is important to seek professional advice. Antidepressants and talk therapies are the main treatments for depression. It is also important to look after your own mental health by being kind to yourself, seeking out joyful activities and staying in regular contact with family and friends.