Elderly Depression

Click on a topic:

Loss Medical Disorders Isolation Family Stressors Treatment Depression checklist Elder Abuse

It was once considered normal to equate depression with aging, but the two do not necessarily go hand in hand. Although there is an increased number of stressors related to aging, depression is not a normal part of aging. Chronic and physical illness, which may accompany aging, are often associated with depression, as are the inability to function and work due to chronic illness and/or pain. There are many illnesses that increase in frequency with age -- heart disease, joint disease, and diabetes, for instance. Although an elderly person should and must treat a physical problem or illness, physical treatment alone may not treat the "emotional" response to the illness. Often depression is not recognized in the elderly person, and if it is, it is not seen as a treatable condition. This is unfortunate because the elderly person is allowed to suffer when in fact treatment is available. Depression is -- at any age -- a treatable condition. Sometimes physical symptoms, such as upset stomach, are the way in which an elderly person may express his or her depression, and the person is simply viewed as a chronic complainer. Again, a health care and mental health professional may be required to differentiate between the two (physical versus emotional problem). There is also pseudodementia, which is actually a depression that appears like a dementia, because of cognitive dysfunction (trouble thinking). It is not due to organic brain disease and can be treated. These are all reasons that a person who appears confused, depressed, or whose personality has suddenly or gradually changed, or complains a lot about physical symptoms (e.g., stomachaches, headaches) should have a physical exam by a health care practitioner or family physician and also an evaluation by a mental health professional.

Loss

In some way loss is a normal part of aging -- personal losses and the loss of others, maybe friends, status, and possessions. If there is the loss of a loved one, the older person will experience bereavement with signs similar to depression -- sadness, loss of appetite, trouble sleeping, passive thoughts of suicide or death. If, however, a preoccupation with the loss continues beyond 2 - 3 months, then a major depression may have occurred. Major depression -- whatever the cause -- requires evaluation and treatment by a mental health professional. An evaluation by a health care practitioner or family physician may help determine if the problem is also caused by something physical (medical disorder).

Medical disorders

If there is any possibility of depression, a physical exam is always warranted. The thyroid may be the cause of the problem (hypothyroidism) or prescribed medications, herbals, or over- the- counter medications. A developing, yet undiagnosed cancer, or possibly emphysema, or a lung disorder. Hypoglycemia or trouble with carbohydrate metabolism or undiagnosed adult-onset diabetes. Blindness or partial blindness (macular degeneration) or cataracts can result in sensory deprivation and illusions (misperceiving something real, such as a shadow at night) that then can become real. Blindness and isolation are poor companions and can result in misperceptions, anxiety, depression, and paranoia.

Isolation

We as humans are social beings and need the company of others. Isolation can cause various problems including depression. In some sense we can then suffer from human sensory deprivation(touch/vision). Isolation prevents us from " checking in" with others for a reality check, and confirmation that our thoughts are valid and in perspective. We also don't have someone to laugh with -- which is known to release stress-reducing endorphins. Without the ability to check reality we can become reclusive, paranoid, and distrust others and ourselves.

Family stressors

With aging there may come loss for the older adult as well as the adult children, especially if there is a medical illness, actual loss (death of a spouse[parent] or close friend), onset of a medical disorder or chronic illness. The older adult who can no longer function independently forces family to once again reconnect. The older children can no longer avoid the parent and ignore unresolved issues that may have been swept under the rug for years. The aging parent and situation can now re-activate previously avoided family stressors or unresolved family issues. A daughter (or son) and only child must now care for an older adult, where the relationship was strained beforehand. This reunion causes stress for both the elderly parent and the adult child. Very often, even if there are several adult children in a family, one child becomes the sole caretaker for the elderly parent or parents. More often than not, this is a female adult child. This one adult child who has unfairly assumed most of the responsiblity for the parent may now resent the other siblings. " Caregiver burden" may develop with one sibling assuming sole responsibility for a very ill parent or one with Altzheimer's, requiring around the clock care. Often the female child closest in proximity to the parent becomes the caretaker, especially in our society, where families (adult children) move to other states, if not other countries. Stress can also result from adult children who are often dealing simultaneously with their children in high school or the cost of their children going off to college, upcoming retirement, and an aging parent, that needs both physical and emotional care. These are adult children who are sandwiched between two generations in need. Unresolved family issues are somehow magnified when the elderly person requires care and the caretaker must care for the older parent and remains resentful. This is a time for soul searching and self-evaluation. If at all possible, it is a time to recognize that the once-perceived powerful person has aged and in reality holds no more influence and is now in need of support. It is a time, if at all possible, for mending -- and then letting go. Mannerisms and triggers remain, but some kind of common understanding and meeting ground is needed to move through these waters. It is so hard to let go, because it is also recognizing the frailty of the older adult -- and it is accepting the end of the battle and any further wasted energy on the part of the older parent and the child (now adult) in arguing over old wounds. If the elderly parent is cognitively sound, it may be time to discuss old wounds and share feelings. Even if there are mixed feelings, it may be time to focus on the positive feelings (mixed means there are positives as well as negatives) and to share the love that does exist. This is a time for family members to reconcile and if possible, let by-gones be by-gones. The older person will not likely change and all that might have been (wished for) is now gone. This is also a positive period of reconnecting, recognizing the weaknesses and strengths of the older person, accepting, and letting go. Family support, if at all possible, is important for the aging adult and especially if there is depression. If resentment of the older adult is very strong, then support and counseling may be needed and should be sought by the adult caregiver.

Treatment

There is treatment for elderly depression in the form of support, psychotherapy, and/or medication. There are tools to help determine if an elderly person is depressed and medications to treat depression if severe enough. Again, a physical exam may be needed to assure that depression is not due to a physical cause. If there are social and psychological needs, there is often a county office on aging in the Guide to Human Services of the local telephone book. Sometimes both physical as well as psychological support can be provided. Your local Visiting Nurse Association may be able to direct you to any appropriate services in your area. The local newspaper is also a great resource for Community Services and self-help and support groups for the elderly and those caring for older parents. If you don't find what you need at your first contact, continue looking until you find the help you need.

Depression Checklist

Do you or an elderly family member have any of the following:

If you have checked 3 or more boxes above (uncheck when done), then it is suggested you seek out a mental health professional and a health care practitioner or your family physician, for further follow up and an examination. If you feel hopeless or wish you were dead, you should seek help immediately. ( See If you're suicidal.)

Please refer to the Bibliotherapy page and the section on Geropsychiatry for helpful resources on Caregivers and Late Life Depression. Also see the section on Depression in Bibliotherapy.

If you would like to discuss your situation with Psychoptions, click here for services.

Elder Abuse

Although this section is about elder depression, I think that elder abuse deserves mentioning. Elder abuse can take many forms and is not just physical in nature, although it does include physical abuse of the elderly. It can include psychological abuse, including verbal abuse, witholding of food or treatment, holding an elderly family member essentially hostage, and using their funds for personal gain or advantage. An abused elderly person may not say anything for fear of later reprisal and because they are dependent upon the abuser in some way. If you (caregiver) find yourself becoming angry or overly frustrated with an elderly parent, then you must seek help and support for yourself. Do not wait until your anger gets out of control. If you know of anyone physically or psychologically abusing an elderly person you should report this to your local office of aging. There is usually an Elder Abuse hotline in the Human Services section of the telephone book. Abuse of any kind of the elderly, no matter what the reason, is not acceptable and should not be tolerated.

[Top]