Depression in the elderly

The Baltimore Sun

Depression affects more than 6.5 million of the 35 million Americans who are 65 years or older, according to the National Alliance on Mental Illness. But often the symptoms of depression, which can include fatigue, overall sadness and loss of interest in activities, go unidentified or ignored among the elderly, says Veronica Poklemba, a clinical nurse specialist at Levindale Hebrew Geriatric Center and Hospital in Baltimore.

Why is it of particular importance to identify and treat depression in the elderly?

Depressed people are in a more difficult position in terms of coping with their physical health problems: It is very hard to follow the diet you need to follow if you are diabetic or put energy into rehabilitation after a stroke.

Another aspect is that, according to a [National Institutes of Health] study, the elderly have the highest rate of completed suicides. In addition, 20 percent of those who commit suicide have visited their primary care physicians on the day they die. Forty percent have visited the doctor within one week of committing suicide. And 70 percent have visited their primary care doctor within one month.

Why does depression among the elderly so often go unidentified?

They aren't talking about it to their doctors. There is a stigma [about mental health] to many in this generation. And the physicians are in a time crunch. The elderly have many physical problems and so the physical problems are being addressed. But the elderly aren't inclined to talk about [mental health] issues.

What are some of the symptoms of depression?

Key signs are changes in appetite -- it can go up or down. Sleep difficulties are a symptom, including trouble falling asleep, waking up in the middle of the night, waking up very early and not being able to go back to sleep, or excessive sleeping. Other symptoms include having difficulty concentrating, decreased energy, lack of interest in the usual activities.

Can depression also cause physical symptoms?

Since their viewpoint often becomes negative, the depressed person focuses on various aches and pains. A lot of elderly people spend a lot of time going to doctors thinking there is something to be fixed, but all they can do is focus on health issues that would not seem so huge if they were in a better mood.

What causes depression among older people?

They often have a lot of reasons for what's called "situational" depression -- which implies that there are things going on in their lives that contribute to depression.

Maybe they are moving from their homes of 30 to 40 years; that is a dramatic change.

In many cases, they also may be living alone, and their friends may no longer be around. They may be dealing with a serious health issue. ... There may be a period of time during which a person is somewhat depressed after losing a significant other, but you would expect that within a few months they would begin to return to activities or interests.

Once diagnosed, how is depression treated?

I use cognitive behavioral therapy, which means that you help the person look at how their thinking and behavior influence their moods. If you can look at changing your behavior and thoughts, you can change your mood.

Therapy seems to work in about 80 percent of cases. Medication also can be used. Research has tended to show that some people do well with therapy and others do well with medication and even more people do well with both.

What steps can an elderly person take to maintain good mental health?

Do the opposite of the symptoms: Keep involved, stay active, keep doing the things that you have enjoyed.

Exercise is important. Some people think that means joining a gym. It can -- or it can be taking a walk. Exercise increases serotonin, which is a chemical that stabilizes moods. And so does sunlight. ...

Another thing to remember is that alcohol is a depressant. If you're a little down, someone might say "maybe you should have a little wine at dinner." You may feel a little lift initially, but ultimately, it is a depressant.

What steps can family members take if a loved one seems depressed?

Be supportive; invite them out to do things that they have typically enjoyed. Perhaps even point out to the person that they don't seem to be as active as before. ... Get them to talk to a primary care physician. Some people assume that because someone is older or because they have ailments or have suffered a loss, it is natural to be depressed.

But you don't have to be depressed just because you are older. Sometimes you just need a little help. What I have found in screening a large number of elderly individuals is that a large majority are coping well and leading satisfying lives.

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