The good news is that most older people do not suffer from depression. The bad news is that a significant number do so. Estimates of the incidence of clinical depression among the elderly range from 5-10% in the community, and up to 40% or more who live in Residential Care. If you add in the number of people who have many of the symptoms of depression, but do not meet the clinical criteria,the rates would be even higher
We often think of depression as causing crying, sadness, and low mood. But depression is more than just feeling sad, it affects thinking,feeling, and physical health. In addition to the typical symptoms, depression can also present in an individual as agitation and anger, anxiety, decreased appetite, sleep disturbance, apathy, lack of energy, excessive guilt, or ruminating about the past.
Depression in the elderly can be surprisingly difficult to catch. Older people often don’t like to admit something is wrong, or they don’t want to bother anyone. They feel they/ their mood is not important. If you ask an older person if they are depressed they may say no, but then exhibit the signs of depression through complaints about their health (such as stomach aches or headaches), their family or the food in the nursing home. They may withdraw from family, friends, activities. To probe how they are feeling, you might want to ask if they are feeling blue or down in the dumps, or have the feeling that life isn’t worth living.
It is important to note that the symptoms of depression do not always mean there is an underlying mood disorder; they can also point to a physical illness, such as a heart problem, stroke, hypothyroidism, vitamin deficiency (B12 or folic acid), low blood pressure, or arthritis. Similarly, the side effects of some medications can include depressed mood. These medications include blood pressure medications, beta blockers, steroids, digoxin, and sedatives.
Depression can be both the cause and/or result of other concerns. These include:
- social isolation
- medication management
- malnourishment and dehydration
- illness and falls
- loss of sight or hearing
Depression can often be misdiagnosed as dementia. If an older person presents with complaints of difficulty concentrating, making decisions, remembering, and carrying out tasks they can often be told “it is just old age.” Family members may be told it is the beginning of dementia. The result can be a complete investigation will not be carried out and the depression is left untreated.
This is not to suggest that depression and dementia do not occur concurrently. In fact, there is a high incidence of depression in people with dementia. As the dementia gets worse, it can become even more difficult to diagnose the depression for what it is. The person with dementia may not be able to express the concept; this is another reason why it may not be treated.
When thinking about whether someone is depressed, it may help to ask oneself if what the person may really be feeling is a sense of uselessness or lack of meaning or purpose in their lives.Often, to an extent, this may reflect the state of their lives. Without work (often seen as a place to “give back”), and with limited ability to do tasks or activities, it can be hard for an older person to feel useful or find some purpose for being. This can be especially true for Nursing Home residents, thus the higher depression rate mentioned at the beginning of this article. Thinking about meaning and purpose helps guide family or caregivers towards a way of helping, by answering the question, “What will bring you some feeling of meaning or purpose to their life?”
The earlier a depression is caught the easier it may be to manage and treat it both effectively and appropriately. This is why it is important to be aware of change in mood before it ends up as an actual clinical depression. Untreated depression can lead to suicide, or the neglect of self that ends up in hospitalization, institutionalization, or death.
Caregiving for Someone Who is Depressed
It can be extremely difficult to be the caregiver for someone who is depressed. The harder you work, the more helpless and frustrated you may become if your efforts aren’t producing any “results.” It may seem like your loved one is being difficult or stubborn or just not trying, especially if the depression manifests in apathy and indifference. It is important to remember that the nature of depression does not mean that someone does not want to respond, but that they are not able to do so. If they were able to, they would not be depressed. They simply do not have the energy, drive, or hope. What they see may be a blackness, despair, or no way out. Caregivers caring for a depressed person often need some help to maintain a balance or perspective or even to let off some steam.
Unfortunately, the attention often goes mostly towards the person who is depressed, leaving the caregiver to find the support they need on their own. They need to be able to monitor their own mood and watch for signs of stress and burnout. Caregivers can seek out support groups,a mental health professional, the Social Worker in the Nursing Home, or friends and clergy to whom they can talk, and who might be able to take over some of the burden for a while. Caregivers also need to make sure they take care of themselves by taking time for themselves,their interests and activities, and exercise. This provides the energy need to keep involved in a healthy way.
Responding to Depression
- Listen and be there emotionally.
- Connect the person to others and activities.
- Consider seniors housing to combat isolation.
- Bring in pets.
- Engage a Companion
- Find a qualified therapist.
- Involve the physician.
- Review medications and medication management.
- Maintain nutrition
- Assess for sleep disorders.
- Review pain management.
- Involve the person in exercise.
- Garden or cook a meal together.
- Support the Caregiver.
- Listen some more.