By Rita L. Calderon, MSW, LCSW-R
|Consequences of Treating versus Not Treating Depression|
|Who Has it, How Many, What Kind?|
|Causes of Depression|
|Identifying Depression in Older People|
Caregiver stress and caregiver depression are receiving much attention in America today. This is because caregivers are talking about their feelings and frustrations in caring for the sick and elderly. Many older people suffer from depression too, but recognizing and addressing it is not as clear cut.This is partly because of the negative stigma and misperceptions about depression and mental health services held by many older people.
Elderly people of all economic classes and ethnic groups in a sense have their own “elder culture,” with their own way of viewing mental health. In fact this culture of older people can be similar in certain ways to other cultures. Many, though certainly not all, older people, like many people of Hispanic, African American, Asian other cultural and ethnic groups, share some similar ideas about depression. Because of these cultural influences, many senior citizens may downplay the real impact of depression because this is what people of their generation were taught.
Traditionally depression has been called “the blues.” Many older people who grew up during the Great Depression feel they should just “get over it ” rather than seek professional help. Unfortunately, people cannot get over it their depression and move on. Their low moods can become “infectious,” affecting their caregivers and families, and the situation is frustrating and discouraging for both the older person and the caregiver.
Many seniors view depression – and seeking professional help for it – as something foreign and mental health services as something for “crazy people,” not for them. Older people have pride in having lived so long and often feel too proud to seek outside help.
Also, some seniors may see emotional problems as too private to share with a “stranger,” i.e., the therapist. In the past they may have shared feelings with their families who cared for them, but now have a hard time adjusting to living alone. Some people shared private feelings with their local priest, but demographics are changing, priests relocate, etc. With all these lifestyle changes many elderly people feel isolated and left out of society.
These factors are reasons that addressing depression in the elderly is so important. But the consequences of not treating depression can place older people at greater risk for additional health problems, both physical and mental. This can lead to individuals not getting dressed, not getting out of the house and getting exercise. This in turn can lead to hypertension, diabetes, and earlier deterioration of the heart, the lungs, the bones and muscles, etc. It can also lead to deeper, debilitating depression.
Caregivers of the elderly are in an excellent position to help older people to understand that “normal” people suffer from depression and that they can benefit enormously from professional help. With proper identification of depression, it can be treated and resolved, improving their sense of well being and their physical health. In many cases treatment can turn their lives around.
Of the 35 million Americans who are 65 and older, about six and a half million suffer from some form of depression. Most of these people have had depression on and off for much of their lives, while others have developed it later in life. Depression affects the elderly across economic lines, although poverty is an important factor.
Much evidence points to depression as a brain illness. However, what triggers it varies. Some people with a long history of depression seem to have a pessimistic attitude about life in general, regardless of circumstances. Others get depressed later in life and only when faced with a difficult event; this is sometimes called a “reactive” depression because it is a reaction to stressful events. This type of depression may be temporary and easier to resolve.
The older people get, the more major life events they experience which can cause depression. Some of the major risk factors to look out for are:
- Death of a loved one
- Medical illness
- Social isolation and loneliness
- Divorce, separation, abusive relationships
- Economic and other chronic stress
- Caring for an ill spouse or adult child
- Estrangement from family
- General decline of one’s former abilities
- Relocation or other major lifestyle change
When older people have little to do, and feel they are no longer capable of their former activities like working, driving, sports, etc., they may experience a loss of feeling competent. They can feel that their best years are behind them and that there is not much purpose to life. They may not be suicidal, but they may have lost their desire to live; this condition in clinical terms is called apathy, and it can get much worse if not addressed.
Some symptoms of depression in the elderly are:
- Loss of appetite for food or overeating
- Disruption in sleep patterns (either too little or too much, especially excessive napping during the day)
- Loss of desire for things they used to enjoy, such as reading, walking, etc.
- Loss of interest in prior social activities, including family activities
All of this sounds so gloomy. It is easy to look at the life of an older person and think, “I’d be depressed too if it were me.” But aging can be a time of peace and fulfillment and even freedom from prior burdens. No one should have to suffer prolonged depression when there is treatment available.
An over-arching issue for many older people is social isolation and loneliness. When people are more connected socially, they feel much better. Talking to a therapist is often the first important link in helping the elderly to regain connection and enhance their ego strength. Treatment options are diverse: individual counseling or therapy, therapeutic groups, and referrals to community centers and structured social activities.
Clinical social workers can make a proper assessment as to the presence of clinical depression, its severity, and how best to treat it. Sometimes medication is needed and sometimes not; the social worker makes a referral to a certified psychologist or psychiatrist who can prescribe medications. All of these mental health professionals can make assessments if there are more serious problems like suicidal thoughts, or the need for hospitalization.
Often counseling or psychotherapy alone is sufficient, with regular monitoring for the need of medication. Counseling and psychotherapy by a certified clinical social worker/ psychotherapist helps because it is a very specific type of “active listening” with feedback and guidance. Clinical social workers are professionally trained to ask the right questions, and to encourage and help people express in their own words what is working and what is not working so well in their lives. In this way older people learn, or re-activate, coping skills to make them feel better and manage their emotional and practical lives much more effectively.