Depression among all age groups has become a sad but telling condition of our times. Part genetic, part environmental, depression is common. It is a rare person who does not suffer depression at some time. But for too many, depression is a chronic life-altering problem.
An additional problem is the appearance and spread of chronic depression among the elderly. Seniors, families, and caregivers struggle with senior depression, a struggle that costs everyone time, money, and emotional sacrifice. And, as the Baby Boomer generation ages, cases of geriatric depression will multiply.
However, there is some reason to believe early awareness and treatment can forestall even more devastating results. But before we look at the signs and symptoms of senior depression, it is time to look further into the problem.
What are we dealing with?
Seniors will feel “down in the dumps” from time to time. We all do. It might be a situational response to bad news, the loss of a friend, or a personal disappointment. There is nothing unusual or worrisome about this.
However, if it alters their quality of life, it is a problem calling for attention. For example, if the senior stops socializing or eating if there are concerns about suicide or sudden changes in physical health, they must be checked out.
- Depression is a severe or prolonged state of sadness, melancholy, or unhappiness. It is routinely treated with medications and counseling. Depression persisting over two years is “dysthymia,” a sequence of major and minor periods of depression. It may be attached to Bipolar Disorder and/or Postpartum Depression, or it may be independent of other conditions.
- Subsyndromal symptomatic depression (SSD) refers to a state of depression that does not meet the criteria for a diagnosis of a major depression episode or condition. Two or more symptoms of SSD may indicate the potential for chronic depression especially if they are marked by isolation or withdrawal behaviors.
- Geriatric or Late-Life depression often lasts longer, and it often occurs along with other medical illnesses and disabilities in seniors. Often associated with cardiac conditions and risk for death, it reduces the benefits of rehabilitation. If chronic depression is characterized by two years duration, two years is a long time for seniors to wait in diagnosing the condition.
The CDC (Centers for Disease Control and Prevention) makes clear that geriatric depression is not normal despite some public assumptions. The CDC asserts, “Depression is a true and treatable medical condition, not a normal part of aging.” In fact, they continue on to say, “older adults are at an increased risk for experiencing depression.” A central problem arises when senior depression goes unrecognized and untreated by those close enough to notice.
The most radical treatment is Electroconvulsive Therapy (ECT) is used for treating psychotic depression in the elderly with a success rate of 80 percent, and modern technology proves safe and effective in treating seniors. But psychotic depression is not the topic here. Practitioners often treat chronic depression with Selective Serotonin Reuptake Inhibitors (SSRIs) generally tolerated well among seniors. However, the SSRIs also have negative side effects including agitation, diarrhea, dry mouth, insomnia, nausea, somnolence, and sweating. There is also the concern of increased renal issues as well as contra-indication for mixture with other medications.
Additional studies show positive responsiveness among seniors in positive and constructive environments in independent and assisted living facilities. For example, participants like companionship, and they valued assisted home care with architectural and interior design features that promote interaction and group exchanges from the location of lounges or layout of dining rooms.
Seniors like some control over their environments filling their rooms with personal tastes in linens, knickknacks, and furniture. It also makes them comfortable when environments emphasize themes and images of earlier days rather than contemporary looks.
This goes for sensory experiences, too. Seniors are disturbed by loud and unfamiliar music, offensive films and TV viewing, and bright lights. But they are pleased with permission to sustain their independence. Handrails, convenient seating, large bathrooms, and shuttles to worship, medical appointments, or shopping, all support their sense of independence and purpose.
Features of the environment that support function and independence were important to participants such as assistive.
What causes geriatric depression?
Geriatric depression occurs in many situations for many reasons. Depression may be a symptom or result of many health problems, some of which are generally unique to senior citizens: Alzheimer’s disease, Cancer, Dementia, Diabetes, Multiple sclerosis, Parkinson’s disease, stroke, and Vitamin B-12 deficiency.
But it is also prominent among those living alone outliving close friends and loved ones. Unable to move around and losing their driving licenses, they have a reduced sense of purpose, self-confidence, and status. Or, they worry about money and deteriorating health.
8 signs and symptoms to watch for:
- Personal isolation: Seniors can do well living on their own. Many rely on beloved pets, active hobbies, and proactive voluntarism. However, noticeable changes in their behavior may be symptomatic. If they stop calling family members or drop out of meetings with friends, they may have a problem. If they end their physical activities or quit their voluntary work, it may be a sign of progressive loneliness resulting from their increased isolation.
- Memory loss: Apparent memory loss may signify geriatric depression, but it may also reveal other cognitive issues like Alzheimer’s disease or dementia. They are not necessarily connected, but memory loss should be addressed. Some memory loss is typical of later life, but it is a condition worth diagnosis. www.PegasusSenoirLiving.com/services/memory-care/ for instance, works to identify just what memory loss means in a given case and how to treat them individually.
- Substance abuse: Some senior citizens self-medicate with alcohol, illegal drugs, or prescribed medications. They do so under the mistaken impression the intoxication provides escape from their physical and emotional pain. Unfortunately, addiction only exacerbates their illness and symptoms.
- Lost life purpose: Seniors will lose a sense of purpose after successful careers, loss of a spouse, and physical problems affecting their mobility. Family and caregivers can create circumstances to encourage meaningful engagement with people and the world. Seniors can be introduced to new environments where they will interact with other people young and old, whey they might learn a new skill or hobby, or where they might compete with others. Anything that sparks their imagination or challenges their creativity helps. Involvement in charity work or voluntary participation in schools, hospitals, and libraries are options. And, any proactive task that gets the senior out of their residence will open new doors.
- Physical exercise: Any physical activity is healthier than none. But participation in organized exercise will improve physical, emotional, and cognitive health. The exercise can be “passive” efforts in yoga, Tai Chi, shuffleboard, or golf, but if the senior’s health and mobility permit, they should be involved in the active exercise to increase and enrich their blood flow to flush body and brain systems. They might play tennis, jog, or swim to meet such goals.
- Personal appearance: A change in personal appearance or hygiene may indicate a problem with depression. If they lose interest in their hairstyle, clothing, or makeup, it may indicate their disinterest, loss of purpose, and isolation. This is especially true if the person has long taken pride in their looks. Caregivers can open a discussion on the change, help with their dressing and hairdo, and bring it to their attention while shopping.
- Eating issues: Senior citizens normally reduce their food intake. But if they suddenly or progressively lose weight, it may indicate they are not eating what they need to stay well. They can reduce sugars and refined carbohydrates leading to the effects of low blood sugar. They do need lean protein, complex carbohydrates, and omega fats, but they might be encouraged to eat smaller meals every four hours rather than three big meals a day.
- Altered senses: Eyes, ears, and dexterity suffer from wear and tear, so changes can cost seniors their connection with others and the world around them. Still, they might resist diagnosis or devices to compensate for sensory loss. Pride in the personal image may, for instance, discourage a person from securing hearing aids. The hearing problem and the reluctance to care for it only compound the depression.
The final sign!
Suicide, of course, is the ultimate sign of geriatric depression. The New York Times cites suicide as the cause of death for 14.9 percent of men over 65. “Elderly white men have the highest rate: 29 per 100,000 overall, and more than 47 per 100,000 among those over age 85.” But they also believe the incidence of suicide is under-reported.
Reaching a stage where death appears the only option is indeed sad, even devastating, to friends and loved ones. And, in many cases, the suicide option seems the only way to end terrible suffering. Without judging their decisions, caregivers should want to alleviate their suffering and related depression.