ELDERLY DEPRESSION AND HOW IT CAN BE OVERCOME

Although depression is not a normal outcome of aging, it is dangerous and one of the most significant barriers to aging well. ^[i] Fewer than 5% of older adults have major depressive disorder in any given year^[ii], but as many as 20% have significant symptoms of depression.^[iii] It is frequently unrecognized and untreated^[iv], resulting in much unnecessary suffering and lost opportunities to age well.

Fortunately, depression in old age can be overcome.  How?  There are four general, not mutually exclusive, approaches—(1) lifestyles that promote mental health in old age, (2) getting professional help, (3) developing skills to manage disturbing moods yourself, and (4) getting help informally from family, friends, and community resources such as clergy.

Mental Health Promotion: To vastly oversimplify, the keys to avoiding depression in old age are being physically healthy (a mix of luck and self-care), being physically and mentally active, being involved in personally satisfying activities and relationships, and achieving a sense that you have had a life of meaning and value.^[v]

Once depressed, however, maintaining such a life can be very difficult.  Despair can dissolve a sense of achievement in life and create the conviction that there’s no point trying to stay well, active, and involved.

Professional Interventions

Screening can be a first step towards dealing with a depressive disorder.  It should be routine in primary and specialty health care and in settings where older adults live or congregate, such as senior centers^[vi], but unfortunately it is not.

The most common screening instrument, the PHQ-9,^[vii] is filled out and scored by the person being screened, but diagnosis by a professional is needed to confirm a positive finding.

Treatment can be effective.^[viii] The most common forms of treatment are medication and psychotherapy.  Both cognitive and interpersonal therapies have been shown to be effective^[ix].  The combination of medication and psychotherapy appears to be most effective.^[x]

Great care is needed regarding medication for older adults, keeping doses as low as possible to avoid potentially severe side effects but as high as necessary to have a therapeutic effect.

Although highly controversial, electro-convulsive therapy (ECT) appears to be effective for some people with severely disabling depression who do not respond to other treatment.^[xi]

Increasingly, treatment for depression is provided by primary care physicians. They often do not have the time or training to provide sound treatment.^[xii] Various models of care management within primary care settings have emerged to provide needed follow-up and psychotherapy.^[xiii]

Many people with major depressive disorder need treatment by a mental health professional such as a psychiatrist, psychologist, clinical social worker, or nurse.  Unfortunately, there is a great shortage of trained geriatric mental health professionals.

Self-management: Some people with depression, particularly those with recurrent depressive episodes, develop effective self-management skills, sometimes on their own, sometimes with the help of a mental health professional.  These include self-observation skills that make it possible to anticipate depressive episodes, recognize them when they occur, resist the powerful urge to withdraw, remain active and involved with other people, control suicidal impulses, and know when to go for help.

It is very important not to confuse self-management, which can be effective long-term, with self-medication with alcohol and other drugs, which cannot.

Informal Interventions:  Most people who seek help turn to non-professionals—to family and friends they trust and to respected figures in their communities, especially clergy.

People who are willing, and have enough time, to spend with a person who is depressed can be extremely helpful.^[xiv] Talking—not about the depression but about anything of interest, having fun, socializing, or even  taking a walk can counter depression.

Spiritual experience is particularly helpful to people who find comfort through faith or religion.^[xv]

Informal interventions may not be enough for people with “moderate” or “severe” depression or during periods of profound hopelessness, psychosis, or suicidality.  Then professional help may be essential.

Do these approaches to overcoming depression work for all older adults who are depressed?  Of course not.  There are some who reject any offer of help because they are in a state of denial, feel too hopeless to believe that help is possible, or are too weary to make any effort.  There are people with depression who anger so easily or who are so unpleasant that they drive away all but the most saintly people who might be helpful.  And there are some people who do not respond to any form of treatment.

But these are the exceptions.  Yes, depression can be dangerous and is a barrier to aging well, but it is not an inevitable outcome of old age; and, when it occurs, it can usually be overcome.

Need help for yourself or someone you care about?

• To reach local mental health helplines call 1-800-273-TALK.
• To find a geriatric psychiatrist, go to www.gmhfonline.org/gmhf/find.asp.
• To find a clinical psychologist, go to http://locator.apa.org/
• To find a clinical social worker, go to www.helpstartshere.org/find-a-social-worker

(Michael Friedman is Adjunct Associate Professor, Columbia University Schools of Social Work and Public Health.   Lisa Furst is Director of the Training and Technical Assistance Center of The Geriatric Mental Health Alliance of New York and co-author of Depressed Older Adults: Education and Screening)

How to Live to 104

Longevity Secrets from 100-year-old Doctor

Visit msnbc.com for breaking news, world news, and news about the economy

IF YOU WOULD LIKE TO SUBSCRIBE TO RECEIVE UPDATES ON BLOG POSTS, PLEASE ENTER YOUR EMAIL ADDRESS ON THE LEFT SIDE OF THE SCREEN WHERE IT SAYS “SUBSCRIBE“.

To become a Fan of ImagineAge on Facebook, click here!

If you enjoyed this blog, click the button below to share it!

Life After Dementia

Life After Dementia

BLOGGER: MICHAEL FRIEDMAN, L.M.S.W

I am afraid of developing dementia, the most common form of which is Alzheimer’s disease. The possibilities are horrifying — the ineluctable loss of memory and other cognitive functions; dependency on others to dress me, to feed me, to change my diapers; slipping into a fog, where I cannot recognize even people I love.

But is dementia inevitably a cruel, distorted end of a human life?

When I was younger, I thought so.  I had no doubt that I would prefer death to living in a demented state; that I would want to take my own life; and that, if I missed the timing and could not act on my own, I would want someone else to do it for me.  “Just shoot me,” I said to my wife — knowing, of course, that she would not and could not, but hoping that she would act swiftly as my health care proxy to have any kind of life support — including food and water — removed when I was no longer myself.

As I have become old (I am now 68), my thinking has changed.  When the time comes, if the time comes, I may want to live — even if I cannot engage in witty conversation; even with the need for someone to help me hobble on a walker to get out for a breath of air; even with the indignity of someone cleaning me after I mess my diapers.

What we expect and want for ourselves changes over time.  That is the fundamental insight of developmental psychology.  When I was a child, being a child seemed right.  When I became a teenager, I fought against being a child.  As a grown-up, my adolescence was an embarrassing memory.  I am happy now not to be driven to succeed at the work, which largely and happily defined my existence as an adult.  The low-stress life I am fortunate to have now feels right to me.

What will feel right when I am very old?  Will I care if I can no longer analyze public policy?  Will I be deeply distressed if I cannot write or teach?  Will I suffer if I cannot tell a joke or have an informed conversation about politics, world events, and the fields of knowledge and activity that have been central to my life?

Or will a visit from someone I like make my day?  Will my daughter and grandchildren (if I have them) be a source of constant interest?  Will watching world events on the TV with only faint understanding be enough?  And when the time comes, if it comes, will the feel of the sun on my face be enough for me to want to live?  Will a caring hand on my shoulder, the taste of French fries, the sound of jazz, the sight of a beautiful painting or sunset be enough?  I do not know the answer.

I do know that dementia unfolds in stages.  Although many people in the early and mid-stages are devastated by the growing loss of important abilities and develop mood or anxiety disorders, others have “full” lives that include the pleasures of friendships, love, and sex; the satisfaction of participation in social and communal activities; and even the discovery of new interests.  In fact, some experts on dementia (see, for example, John Zeisel’s book, “I’m Still Here“) maintain that diminished cognitive functions result in the release of capabilities that have been suppressed by the very cognitive abilities that are now in decline — particularly the willingness to take creative risks and the openness to human affection and intimacy.

There are, as we all know, people with dementia who become depressed, frightened or angry — some so angry that they are abusive to people who try to care for them.  There are some people with dementia who wonder why they are alive, or wish for death.

But there are also people with dementia who experience pleasure, who feel love, and who are at peace.

So, even though I still fear developing dementia, I no longer say with any sense of certainty, “Just shoot me.”

IF YOU WOULD LIKE TO SUBSCRIBE TO RECEIVE UPDATES ON BLOG POSTS, PLEASE ENTER YOUR EMAIL ADDRESS ON THE LEFT SIDE OF THE SCREEN WHERE IT SAYS “SUBSCRIBE“.

To become a Fan of ImagineAge on Facebook, click here!

If you enjoyed this blog, click the button below to share it!

What is Boomeritis?

Boomeritis

Prevent Hearing Loss

CNN: Prevent Hearing Loss

Brain Fitness Programs for All Ages

Number of Alzheimer’s Caregivers Rises

Did I Ever Tell You…?

BLOGGER:  MARY LANGUIRAND, PHD

There are days when it takes all the self control I possess to be with Carol, a pleasant 87 year old woman with mild age-related cognitive loss.  I can empathize with the complaints about the kids who don’t visit often enough, the aide who forgets to put her phone within reach, and the salad with the wilted lettuce.  However, I sometimes think that if I hear one more repetition of the story about how her husband bought her a cherished emerald ring in 1973, I may tear out my hair.  It’s a long story, it never changes, and I believe I’ve heard it at least twice a month for the past three years.

Short-term memory tends to fade with advanced age, as it is based on such factors as ability to attend to the environment, maintain focused concentration, and track complex information. As illness, diminished energy and perceptual changes erode some of those capacities, the ability to recall recent information diminishes.  In contrast, memories from years past strengthen, having been reviewed and repeated (and revised and edited) many times. Caregivers often marvel that Mom can’t remember her upcoming doctor’s appointment, but can tell you what she paid for milk in 1964.

You might think that listening to the same story over and over would be a neutral or—at worst—a mildly boring experience.  After all, we hear all sorts of things repeatedly—recorded messages on trains and busses, the music in TV jingles, liturgical passages at religious ceremonies—and many people find the familiar tolerable, and even soothing.  Why then, do so many caregivers report that hearing yet again about Dad’s heroic actions in the fields of Korea or Mom’s days as a cheerleader can drive them to drink?

Much of the frustration comes from the fact that this sort of repetition is one of the most inescapable “proofs” that someone has reached a point where they are more comfortable in the past than in the here-and-now, and that this isn’t likely to change.  The effort of attending to current realities is too much, and they’ve surrendered to the comfort of the familiar.  The content of these repeated tales is also rather telling, as it can give some clues to those events and experiences that impacted the person most profoundly: If a parent’s most cherished memory relates to things that happened long before you were born, what does that say about you?

Repetition apparently isn’t limited to the senior set…  When emailing a younger colleague recently, I shared a past experience that I thought resonated with some current events, and was quite chagrined when reminded that I’d already told that story.  I felt rather hurt that my misplaced effort at empathy (and the chance to recount how I’d saved the day ‘back in the day’) apparently generated boredom and annoyance, along with the message that I’m forgetful.  No kidding—I really don’t remember having told that one before…

Once I moved past the hurt feelings, I began to think about getting my act together and scoring some points in the present, instead of resting on past laurels, which is probably a good thing.   I also began to develop a new appreciation for Carol’s experience. I thought about my own response to her oft-told story about the emerald ring, and how I regularly discount her need to re-live a time when she felt loved and special. I just hope profoundly that I don’t communicate my impatience as clearly as my colleague did.

I can’t honestly say that the story took on a new glow when I heard it again, but I did realize that maybe Carol shares it with me because our interactions remind her of that time when she felt valued, and appreciated, with years of life yet to be lived and goals yet to be accomplished.  Maybe I need to put more effort into helping her to recapture those feelings in her current relationships.

Realize that when someone relates an experience to you you’re hearing about it for a reason.  Don’t just hear, listen.

Mary Languirand and Robert Bornstein are the authors of When Someone You Love Needs Nursing Home, Assisted Living, or In Home Care, published by Newmarket Press.  The second edition, revised and updated, was recently released.  Here’s the link: http://www.newmarketpress.com/title.asp?id=901

IF YOU WOULD LIKE TO SUBSCRIBE TO RECEIVE UPDATES ON BLOG POSTS, PLEASE ENTER YOUR EMAIL ADDRESS ON THE LEFT SIDE OF THE SCREEN WHERE IT SAYS ”SUBSCRIBE”.

To become a Fan of ImagineAge on Facebook, click here!

To join the ImagineAge Group on Facebook, click here!

If you enjoyed this, click the button below to share it!