(Excepted from “Recovering Wellness” Oasis project – Doug Kreider, University of Hawaii at Manoa)
Depression among older adults is far more common than most of us are willing to admit. Some estimates place the condition in 8-20% of older adults nationwide. Here in Hawaii late life depression is a significant problem, affecting an estimated 26,000 residents age 65+, plus the additional impact on many members of their ohana.
This especially affects seniors in nursing homes, who have lost much of their personal dignity to physical conditions they have little or no control over. They are not able to make many personal decisions concerning schedules, activities or even what they will eat and drink. And on top of all that – they are living somewhere unfamiliar, among other people they usually do not know and sometimes cannot even communicate with.
Importance of Identifying Depression in Seniors
It is important for caregivers to understand that while we may be able to identify factors that can promote depression; the condition itself is NOT a normal condition of aging. There is a widespread belief that nothing can be done for the elderly and sick because they “have reason to be depressed.” Many seniors are too ashamed to ask for help, and sometimes diagnosis is complicated due to health symptoms (memory loss, neglect of personal appearance, irritability or anxiety, pacing or fidgeting, lack of energy) that can point to both depression or other health problems.
However, it is important to remember that depression is a treatable in over 90% of those affected. Improving a senior’s mental health condition can also bring steady changes to their overall quality of life, which grows increasingly more important over time.
Depression is linked to premature death from related illnesses and conditions, and even suicide (adults over the age of 85 commit suicide at almost twice the rate of all other ages combined).
Classifications of Depression
There are three basic classifications of depression:
1. Clinical or Major Depression. This is classified as having multiple signs of depression for 2 or more weeks, not better accounted for by grief or trauma.
2. Dysthymia. A condition of a sad mood or other signs of depression lasting for 2 or more years.
3. Bipolar Disorder. This is characterized by extreme mood changes, between depression and extremely high mood, called mania.
Normal expressions of grief or disturbance brought on by trauma appear as depression but they are not depression in the terms outlined above. Grief has a declining pattern of emotion while depression severely lengthens or makes chronic these conditions. Be aware of cultural practices involving grief and time lines.
Symptoms of Depression
- Feeling sad for longer than two weeks (with or without reason)
- Inability to enjoy life
- Lack of interest in favorite activities
- Sleeping too much or too little
- Changes in appetite or weight
- Trouble concentrating, slowed thinking
- Memory problems
- Thoughts of death or suicide
- Irrational thinking, hallucinations, or paranoia
- Lack of energy or fatigue
- Agitation or restlessness
- Feelings of hopelessness or helplessness
- Feelings of worthlessness or excessive guilt
- Physical complaints or pain
- Social isolation
- Irritability, (overly critical of self or others)
- Excessive anxiety or worry
Recognizing depression can be tricky. Symptoms that could reflect depression could also be caused by physical conditions, disease, environmental factors or chemical imbalances from medication interaction or side effects from medication. Depression can occur in conjunction with other conditions or on its own.
For older adults, depression is often disguised or it “masquerades” as something else, like physical complaints or pain, changes in thinking, concentration or memory, or even as anxiety or worry. As a result, many individuals with depression are misdiagnosed and not treated appropriately.
Some factors/diagnoses that are often may cause depression include dementia, endocrine disorders, vitamin deficiencies, Parkinson’s disease, chronic pain, anxiety, and/or alcohol or drug use.
How Caregivers Can Help
If you are dealing with loved one or care recipient who exhibits any of the above symptoms, the first step is recognizing that depression is a real possibility. Any change in the senior’s quality of life requires help: Set up an appointment with a health practitioner to assess the situation and for possible recommendations for mental health professionals. You may wish to consult a geriatric specialist, especially.
Psychotherapy is effective (80%) as are medications (up to 75% ). Electroconvulsive therapy is rated at 90% effective and is not the frightening thing we have seen portrayed on television. A new technique called deep brain stimulation (DBS) is also showing significant promise in treatment-resistant depression. When other treatments are not enough, hospitalization may be needed.
You can also address home environmental factor to help reduce stress. Develop supportive relationships and increase social interaction for the senior. This may include religious involvement, increased family visits, or other group settings. Maintain a healthy lifestyle for the senior, including diet (cut back on fatty and sugary foods) and encouragement of daily exercise, (even if it’s just a ten-minute walk!)
Most importantly, encourage your loved one to communicate with you, clearly and often, so you will know their emotional state and how to provide help. Create a safe emotional environment where feelings can be expressed without fear of judgment or argument. Clarify what you hear by repeating it back (“Did I hear correctly that…?”)
Your role as a family caregiver may become an obstacle in helping a loved one with depression. Old family conflicts may rear up and surprise you with their intensity. Practical issues of caregiving may be brought up as problems contributing to their depression. Know your limitations and keep a list of resources if you ever need to contact a third party for your loved one to communicate with safely.
Communication is such an overlooked therapy and with most older adults, that is where we start. Create the safe emotional environment where feelings can be expressed without fear of judgment or argument. Clarify what you hear by repeating it back. “did I hear correctly ______” etc. Your role as caregiver might actually get in the way of your helping your loved one. Parent and child roles often get reversed during caregiving. Old family conflicts may rear up and surprise you with their intensity. And practical issues such as distance, finances and unresolved conflicts can get in the way. If you see any of these as creating likely barriers to your communication, involve someone else in the process of evaluation.
Closing Thoughts
SHIFT-ing our actions and thoughts about depression and mental health conditions in general will give us a road map for action.
Step back
Have awareness
Identify the problem
Find possible solutions
Take action
When addressing depression, don’t jump to conclusions. Step back and analyze the situation. Have awareness – educate yourself and get adequate information. Talk with others to help identify the problems and then work to find solutions. Weigh the benefits and risks.
The Hawaii program ACCESS (on Oahu (808-832-3100 or toll-free 1-800-753-6879) exists not only for suicide crisis help but for general help in locating resources to help with mental health problems.
Disclaimer: The commentary and opinions in this article are not to be construed as providing medical or legal advice. Consult your own health professional before acting on any suggestions or recommendations. Doug Kreider works with the mental health research department at the University of Hawaii. He holds an MA and MPH and is a well respected geriatric specialists in Honolulu. This paper compiled by The Caregiver Foundation with permission from Doug Kreider. The Caregiver Foundation is a non-profit registered in the State of Hawaii and works to promote Caregiver education, produce workshops and seminars and promote the establishment of Community based caregiver support groups. Call (808) 625-3782 for more information.