Depression in Elderly

December 2010 (View PDF)

Introduction
Why aren’t seniors getting the help they need?
How do I know if its depression?
Why is it important to treat depression in the elderly?
What factors can increase the risk of depression in the elderly?
Possible Treatments
What Factors Protect Seniors From Depression and Build Resilience?

Introduction

Getting old in our society is depressing – right? WRONG!

Aging means a series of progressive losses including withdrawal from work, loss of purpose, reduced independence, loss of friends, increased poverty, the risk of developing an illness leading to long-term disability, isolation and loneliness. Why wouldn’t you be depressed – right?

According to Health Canada, older Canadians are healthier, more affluent, are living longer and more independent lives than ever before. Seniors are physically more active, are engaged with their families and in their communities and are becoming international globetrotters. They are challenging many of the negative stereotypes we hold about aging and showing us that life is for living with vigour and vitality.

However, it is true that some seniors struggle from time to time with mental illness. For seniors living in the community, it is estimated that 5% to 10% will experience a depressive disorder that is serious enough to require treatment. And the rate of anxiety and depression dramatically increases to 30% to 40% for seniors living in institutions.

The great news is that most people with depression (over 80%) respond well to treatment and achieve a complete and lasting recovery. Sadly, 90% will NOT seek out the help they need or their depression will be missed or ignored, denying them beneficial treatment for mental health problems.

Why Aren’t Seniors Getting the Help They Need?

  • Depression in the elderly can be very difficult to recognize. It can easily be overlooked as a symptom of another medical condition.
  • Family, friends and medical personnel often see depression as a normal part of the aging process and the inevitable result of the losses of life we all will experience.
  • Many seniors were raised to be self-sufficient and stoic in the face of life’s challenges making them reluctant to complain about how they are feeling or ask to for help. They are used to working hard to solve their own problems and feel ashamed by their inability to cope.
  • Some seniors (and possibly even their friends and family) don’t know that depression is an illness and that treatment is available and works!

How do I Know if it’s Depression?

A depressive illness is more than just feeling sad. Depression affects the whole person including their feelings, thinking and physical health. It also lasts a long time. It’s important to know what to watch for. Anxiety and slowing of thoughts are common symptoms. For many seniors depression is often expressed through many vague complaints of physical aches and pain. The most common symptoms of depression include:

Physical Changes

    • Changes in appetite – with a resultant weight loss or weight gain.
    • Sleep disturbances- with trouble falling asleep, staying asleep or sleeping too much.
    • Sleep, when it comes, does not restore and refresh. People often report feeling worse in the morning with the mood lifting as the day goes on.
    • Decreased energy, with feelings of weakness and physical fatigue.
    • Some people experience agitation with restlessness and have a need to move constantly.
    • Phantom pains, headaches, muscle aches and pains, with no known physical cause.
    • Stomach upsets – constipation.

Changes in Thinking

    • Thoughts may be confused or slowed down which makes thinking, concentrating or remembering information difficult.
    • Decision-making is difficult and often avoided.
    • Obsessive ruminations, a sense of impending doom or disaster.
    • Preoccupation with perceived failures or personal inadequacies leading to a loss in self-confidence.
    • Becoming harshly self-critical and unfairly judgmental.
    • In extreme cases, there can be a loss of being in touch with reality, perhaps hearing voices (hallucinations) or having strange ideas (delusions).
    • Persistent thoughts of death, suicide or attempts to hurt oneself.

Changes in Feeling

    • Loss of interest in activities that were once a source of pleasure.
    • Decreased interest in and enjoyment from sex.
    • Feelings of worthlessness, hopelessness, and excessive guilt.
    • Deadening or an absence of feelings.
    • Sense of overwhelming or impending doom.
    • Loss of self-esteem.
    • Feeling sad, blue and down in the dumps that may be worse in the morning lifting as the day goes on.
    • Crying for no apparent reason.
    • Irritability, impatience, anger and aggressive feelings.

Changes in Behaviour

    • Withdrawal from social and leisure activities.
    • Failure to make important decisions.
    • Neglecting duties such as housework, gardening, paying bills.
    • Decrease in physical activity and exercise.
    • Reduced self-care such as personal grooming, eating.
    • Increased use of alcohol or drugs (prescription and non-prescription).

Why is it Important to Treat Depression in the Elderly?

  • Depression throws a dark cloud over our emotional well-being, draining away pleasure and robbing people of hope. Depression can lead seniors to further isolation and despair.
  • Depression tends to last much longer in the elderly and can result in unnecessary or premature placement in institutional care.
  • If depression is not managed, it can compromise the treatment of other conditions and can increase the risk of prolonged disability or early death.
  • Untreated depression can also leave seniors more vulnerable to developing other serious health conditions such as heart disease, infections and immune disorders.
  • Depression can make people feel angry, irritable and anxious. This can rob families of the pleasure of their loved one’s company and place an additional burden on care providers.
  • The risk of suicide in elderly is high and it is particularly high for depressed elderly men.

What Factors Can Increase The Risk of Depression in the Elderly?

  • The presence of other illnesses which compromises your ability to get around and be independent.
  • Some medications or the interaction between medications are associated with depression.
  • Living with chronic or severe pain.
  • Living alone without a supportive network of friends and family.
  • The recent death of a loved one.
  • Fear of death.
  • A previous history of depression.
  • A family history of major depressive disorder.
  • A past history of suicide attempt(s).

Illness Increases the Risk of Depression

There are a number of medical conditions that are associated with depression in the elderly. Some are:

    • Heart problems including having a stroke
    • Low thyroid activity
    • A lack of vitamin B12 or folic acid
    • Low blood pressure
    • Rheumatoid arthritis
    • Cancer
    • Diabetes

Many commonly prescribed medications are associated with depression or making depression worse such as:

    • Blood pressure medications
    • Beta-blockers
    • Steroids
    • Digoxins
    • Sedatives

If you are being treated with any of these medications, it is important to talk with your doctor to rule out their use as the cause of your depression. Don’t stop your medications without advice as a sudden discontinuation can have serious health consequences when your body struggles to adjust.

Possible Treatments

Medication

Usually relief is felt within a few weeks of starting medications, however it can take longer for older people to feel better. Sleep and appetite are usually the first to improve. Don’t expect a complete recovery right away. It usually takes about ten to twelve weeks to lift out of depression. Often those close to you who will see an improvement in your mood before you begin to feel it.

Build Social Supports

The paradox of depression is that at a time when you most need to draw people close – you may want to avoid contact with others. However, most people find that the support of family and friends, participation in a self-help group or talking with a professional counsellor can be very helpful in overcoming depression.

Dealing with social isolation is an important part of healing and can help prevent further episodes of illness. Lots of studies show us that being part of a supportive family, being part of a religious group or being active in your community is an important part of health, wellbeing and improved quality of life. Consider joining a support group for depression as part of your recovery.

Talk Therapy

Psychotherapy can be very helpful in dealing with losses, solving challenging problems or dealing with the social impact of depression. Cognitive therapy can help you look at your thought patterns which may be negative and self-criticizing. It will also help you make the connection between your thoughts, feelings and behaviours. What you think affects how you feel and how you behave.

Electroconvulsive Therapy (ECT)

ECT is a treatment that uses electrical impulses to change the chemical balance in the brain. It is often used as a treatment of last resort for those patients who have not responded well to other forms of treatment, who remain a suicide risk, or have other serious medical conditions that prevent the use of medication. It remains controversial, so it is important to do your research so you can make an informed decision.

Suggested Readings

What Factors Protect Seniors From Depression and Build Resilience?

Have you ever wondered why some people just seem happy or are able to weather the inevitable storms that life throws their way with wisdom and grace?

So have researchers and they have learned a lot about what builds healthy resilience, makes for a happy engaged life and helps us cope during difficult times. Some of us are just blessed with a happy, easygoing temperament. The rest of us may have to work at it. What have we learned about how to maintain good mental health throughout the life cycle?

The self-help mantra is, “Never get too angry, too lonely, too tired or too hungry”. This is really good advice for living a healthy balanced life. People who have experienced a mood disorder learn quickly how true this motto is. If your balance is off in one of these areas it is important to take active steps to gain control of your health and well-being.

Having Strong Family, Friendships and Community Support

Health Canada reports that more and more elderly are spending time alone – going days at a time without seeing or talking to another person. This is not good for our mental health and can lead us to become too inward in our thinking.

Changes in our social network are an inevitable part of life. Family members grow up, move away or get busy with their daily lives. Retirement takes us out of the mainstream of working life. As we age, death becomes an unfortunate companion robbing us of people we loved and cared for. Sickness can sap our strength and take away our vitality. All of these changes can cause us to lose valuable sources of support and connection.

You may feel it is too late to build new friendships – that too much effort is required to add new interests and people into your social network. But it’s worth the investment. Research shows us time and time again that people with a well-developed social network have better physical and emotional health and an improved quality of life.

Tips for Building Social Supports

Take the time to consider what you like. Start small – adding one new thing at a time. Be patient – it may take some research to find the activities that will suite you best. Become a risk taker – try doing something you have never done before. Buddy up with someone else in trying new things out. Lend a helping hand to others. There is nothing that builds confidence like helping others. Become a joiner.

    • Check out the local community centre for special seniors clubs and social programs.
    • Join a book club, choir, bridge group or gardening club.
    • Let your family know you would like to spend more time together. Be specific.
    • Take up a new hobby.
    • Become a mentor for a young person.
    • Volunteer your time.
    • Get involved in a political party.

Volunteer

Find out about how to get involved in your community. There are volunteer bureaus across the country that can help you find just the right kind of activity to suit your interests and needs.

Get Physically Active

Recent research has found that moderate exercise and weight lifting – yes lifting barbells – has a remarkable ability to treat depression in the elderly. In fact, moderate exercise has been found to be as effective in treating mild depression as medication. Strengthening your muscles has also been found to reduce the risk of falling and hip fractures – the number one reason seniors end up in institutional care.

Just Do It!

An exercise program should include active movement to build balance and coordination, stretching to improve flexibility by moving your joints through their full range of motion, ways to strengthening your muscles, and, finally, activities to get your heart pumping. Consider joining a senior’s exercise program in your community to strengthen your social network as well as your body.

Health Canada has a useful Physical Activity Guide to Healthy, Active Living for Older Adults. It’s free, easy to read in large type and provides useful tips for increasing physical activity for the elderly.

Exercise Your Mind

Along with aging often come subtle changes in brain functioning. It may not seem as easy to remember names. Learning new skills can seem harder. But just like your body, a healthy nimble mind requires active exercise. Think of ways you can challenge your brain. Play chess, bridge, computer games or do crossword puzzles. Consider taking an adult education course – anything that will exercise the grey matter.

Eat Well

Diet plays an important role in preventing illness and keeping us well. The absence of essential minerals and vitamins is associated with many serious health problems including depression. Many elderly people neglect this important part of their health. If you live alone, it may not seem worth the effort to cook yourself a meal. Depression can also rob people of their appetite. Use the clock to tell you when to eat if your body doesn’t let you know when you are hungry. Restore balance by starting to keep track of what you are eating.

Tips for Healthy Eating

    • Consider taking a multi-vitamin every day.
    • Build variety into your diet.
    • Keep healthy foods easily available.
    • Choose whole grain and enriched grain products.
    • Choose fresh foods over manufactured foods.
    • Choose dark green and orange vegetables more often.
    • Lower the fat level in your milk and choose leaner cuts of meat. Consider poultry, fish, dried beans and lentils as an alternative to red meat.
    • Drink plenty of water.
    • Take care in your use of alcohol.
    • Strive for a healthy body weight.
    • Use Canada’s Food Guide as your reference to healthy eating.

Express Your Feelings

Recent research suggests that the ability to express your feelings clearly and directly has a positive and beneficial effect on mental health, life satisfaction and personal well-being. Talking about concerns helps you organize your thinking and clarify your thoughts. Keeping a personal diary is helpful even if you never share these thoughts with others. It can also help you gain insight into your moods by tracking what is going on in your life and how you are feeling. In this way you can take steps to address problems before they become overwhelming. Consider participating in our discussion forum and chat line as a way of linking to others available at www.mooddisorderscanada.ca.

Feed Your Soul

Having a strongly held belief system has been found to be one of the protective factors for good mental health. If you are not currently involved with a religious group, consider finding a place of worship in your community that makes you feel welcome. If you don’t have strong religious beliefs or a group to which you hold affiliation, try learning more about different religious groups. Perhaps by exploring other beliefs you will find a spiritual home. But spirituality is not confined solely to religion. Many people find great conform in art, nature, theatre, and other pursuits.

Music Soothes the Savage Breast – Singing Ignites the Soul

There is nothing more stirring than listening to music – except perhaps playing it or singing along. In fact, music can help to sooth anxious nerves and lift your spirit. Consider joining a choir or sing along to your favourite tunes. Just make sure you add a large dose of music to your day.

Turn Loneliness into Solitude

Too much time alone can leave us feeling distant, isolated and lonely. This can worsen feelings of depression. We all have our own comfort level about how much time we like to be with others. Pay attention to how you are spending your time. If you are spending too much time alone, take steps to add balance. That said, finding comfort in one’s own company is also an important part of a happy healthy life.

Care for a Pet

Looking after a pet is a big responsibility and a lot of work. But boy, is it worth it. Scientists have looked closely at the effect that pets have on our health. They have found that seniors who live with and care for pets have better physical health and mental well-being than those who don’t. They are also better able to cope with stress and are more physically and socially active. Pets have even been found to lower blood pressure. Having a pet has also been found to reduce the risk of suicide in people when they are depressed. Their unconditional love and affection provides valuable company, keeps you active and helps to draw others to you.

Keep a Positive Attitude

Being thankful is a cornerstone of emotional well-being. In fact, some research suggests that maintaining a positive outlook on life can boost your immune system and protect you from illness. Sickness and loss has a nasty way of dominating the thinking of people as they age. While your aches and pains and past surgeries are of pressing concern and interest to you – they may not make good conversation for others. Try to avoid dwelling too much on the negatives of life. Instead take time to count your blessings. Seek out positive people. Broaden your network to include people of different ages and backgrounds. Get out of the rut of daily life by trying new things. Become a great conversationalist by sharing stories. Keep up on current affairs and popular shows. Share with others what you like and what you value. Make sure to take an interest in their views too. Listen actively to what they say and ask questions. Everyone has a fascinating story to tell if you just take the time to ask. Focusing on positive communication helps to bring people close and helps you keep your thinking open to new ideas.

Practice Mindfulness Meditation

People who practice daily meditation have significantly lower rates of depression and higher levels of life satisfaction. Meditation helps you learn how to discipline your mind to focus on the moment, so that you don’t dwell on the past and worry less about the future. Yoga and Ti Chi have also been found to have huge mental health and physical benefits.

Suggested readings:

Laugh out Loud and Laugh a Lot

Research again shows us that there is powerful healing in laughter. It changes our brain chemistry in a positive way and helps us look at problems in new and creative ways. So – go rent a Marx Brothers film or whatever brings a smile to your face.

Ask for Help if You Need it

Don’t be afraid to ask for help. It is a sign of strength, health and maturity. Working through concerns with a professional can bring out new ideas and offer a fresh perspective in solving problems. Having help can help you stay in charge of making your own decisions.