Understanding Depression In The Elderly

Feelings of sadness, hopelessness, and discouragement can occur at any age but they more frequently occur in the elderly. When these feelings linger and affect one’s ability to function, then clinical 'depression' is the result. Depression can come suddenly after the loss of a loved one or slowly due to the chronic affects of aging. Growing older can mean more chronic health problems, taking more medications, lingering pain and stiffness in the joints, being less mobile, having more difficulty with self-care needs, and relying on others for help. Any of these conditions can be demoralizing and discouraging to someone who had been independent and healthy.

We know that people can become depressed when they no longer are able to do the things that once seemed so easy to do.

When we are younger we have many more friends and acquaintances; and we spend more time ‘doing’ and ‘creating’. We are motivated by raising a family, being productive in our chosen vocation, and enjoying leisure and hobby activities. As we age, family and friends either move away or pass away, and life can become much more lonely. The nuclear family, as was common years ago when several generations lived under one roof, is no longer a common occurrence.

The lack of family and social support can make it difficult for an older person who is struggling to live independently.

Medical research has verified that our brain chemistry changes as we age, and when a difficult circumstance does arise in life, it can more easily trigger symptoms of depression. Also, some medical conditions can preclude depression in the elderly; this includes heart attack, stroke, dementia, etc. When an individual is taking multiple medications, the drug interactions can sometimes have secondary effects, especially in the elderly. Symptoms can include lethargy, low energy levels, decreased motivation and even depression.

When the individual is seeing several doctors and taking many medications, the risks for drug complications and side affects increase.

'Life's circumstances' can often take their toll on the elderly. No one gets through life without regrets and disappointments. As we age these circumstances can accumulate and weigh us down. Unfulfilled dreams, goals that were never accomplished, divorce, job retirement, others who have hurt us, or the death of loved ones; these are some of life’s challenges that can lead to poor self esteem, discouragement and depression.

Financial difficulty and a lack of adequate income can be a significant source of stress for the elderly. Many rely on their Social Security benefits to live on and these funds can quickly disappear when monthly expenditures include multiple medications, doctors and hospital bills, etc. Sometimes the elderly cut corners by not eating adequate meals, and not spending money on other items that they may need. Stress, relating to financial matters, is often an overlooked area of depression in the elderly.

Some of the other subtle symptoms of depression: There is little or no socialization and interaction with others (they will always have an excuse why they cannot participate in social gatherings with family and friends), neglecting hobbies or activities that once were enjoyable, the person prefers to keep the rooms darkened during the daytime, there is an excess of clutter and a disorganized appearance to rooms (as the person lacks the energy and motivation to stay organized), they prefer just to watch TV rather than do functional tasks, and they will typically sleep longer than 9 hours at night.

The long-term effects of depression in the elderly can lead to other health-related problems. Hypertension (high blood pressure) and myocardial infarction (heart attack) are two ailments that occur more often in those who are under mental duress. The immune system is compromised with stress, and is less able to protect against many types of ailments. The person who is depressed will often skip meals or not eat healthy meals, and may subsequently end up hospitalized with an electrolyte imbalance or will be diagnosed with ‘malnutrition’. They may not be taking their prescribed medications daily. They may become sedentary and weaker. When weakness occurs, they are more likely to fall at some point.

What can be done:
The first step is to simply 'acknowledge' and 'accept' that you may be depressed, and that it is affecting your ability to function and interact with others. It is no disgrace to acknowledge these symptoms, as you would with any other medical condition. The brain is an organ that can have complications just like any other organ in our body. The next step is to be willing to discuss your circumstances with someone, such as a family physician, clergy, or a close relative or friend. This is often the hardest aspect for someone who has been struggling with loneliness and depression for any length of time. An anti-depressant may be needed if your physician feels it may help. Sometimes this is needed for just a short period of time. Get a thorough physical exam. Hypothyroidism can mimic the symptoms of depression in the elderly. Finally, make an effort to find activities that are mentally and physically stimulating, and will take your mind off of your circumstances. Our self-esteem is often bolstered by doing activities that we find challenging!

Some strategies to alleviate depression

• Make an effort to be around other people. Volunteer to help others in need. Some hospitals and skilled nursing facilities use volunteers to help transport residents, and to sit and visit or read aloud to them.

• Find a local senior center that provides activities and social gatherings. This can be a fun place to get to know others in an informal setting. Some places will provide transportation at little or no cost for those who need it.

• If you previously attended church but now are unable, try to find a church that provides transportation with a wheelchair accessible van (if required). Some churches host senior activities and support groups. If unable to attend church, some churches provide recorded sermons that can be mailed to those who cannot attend services.

• Whenever possible, stay physically active, as this can help alleviate the symptoms of depression.

• Stay mentally active by reading a good book or getting books on tape or CD from a local library. The library often will deliver them or mail them, if requested.

• Find new hobbies and leisure activities that can be enjoyed, which are within your physical abilities. Diversional activities can often help alleviate depression. Music is also an effective mood lifter.

• Make a 'to do list' for each day. Set goals. Try and find reasons to get out of bed and accomplish tasks, no matter how small or insignificant they may seem.

• Discuss your medications and any possible drug interactions that you are concerned about, with your physician. Let them know about any side effects you may be having. Also, let the physician know if you are having difficulty paying for your medications. Many drug companies offer free or low cost medications for those who cannot pay for them.

• The local Agency On Aging is a good resource for seniors and their family. Talk to someone there about your circumstances and they can often provide resources and solutions.