Baby Boomers’ Retirement Dilemma

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)

Grandparents Raising Grandchildren: How to Cope and Succeed

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

Are you one of the 2.9 million grandparents in America who are raising their grandchildren? Although there are many good reasons to do this, it brings increased responsibility, stress and sacrifices that you probably didn’t anticipate for your “golden” years. Kin caregiving becomes necessary in families of all backgrounds and socioeconomic statuses and for many reasons, from military service to parental illness or death to child abuse or neglect. Census data reveal a significant increase in kin caregiving recently, probably due to the recession. When called to provide care, you may be relieved that the children can be safe with you, but now you have a lot to do. You’ll need to take care of getting the children enrolled in school, apply for financial and medical benefits, make sure they are seen by a pediatrician, perhaps arrange for counseling, consider pursuing custody or guardianship. The list goes on and on. So how do you do this and still find time for yourself? Many grandparents respond to the children’s needs first and try to take time for themselves later. Many never get to it — an understandable choice, but ultimately you need to take care of yourself to be able to do the best you can for your grandchildren. How Can You Cope? Becoming a kin caregiver evokes many emotions, from the joy of having your grandchildren with you to feeling angry and resentful about your adult child being absent or about your losing so much — your time, possibly your job, your independence, sleep, your financial security.

How can you cope?

• Staying healthy is important. Don’t miss your annual physical or ignore symptoms that are new for you. Fit in some exercise. Walking is a lot better than nothing.

• Have some fun. Stay in touch with friends. Do things you enjoy.

• Find reliable people to talk with — a trusted friend or family member, clergy or a counselor. Alternatively, join a support group where you can talk with others in similar situations and learn about services and resources for you and your family.

• When you feel overwhelmed and that you can’t possibly get everything done, make a list of things to do, decide what has to get done now and what can wait, and schedule when you will do them. Literally, put them on your calendar.

• Talk with your grandchildren about what you’re finding difficult. They may be having a tough time emotionally, but they also may be able to help more than you think.

All of this is easier said than done, and you can certainly expect that there will be times when you feel that you just can’t take it anymore. That’s par for the course when raising children. Sometimes it’s wonderful to be with the kids; sometimes it’s enough to make you furious or bring you to tears. But sometimes caregiving can overwhelm anyone. You may not be able to do the things that really have to get done or lose patience more than you used to. You may feel hopeless or helpless or lose pleasure in everyday life. You may have trouble sleeping, more than the usual physical aches and pains, or be drinking too much. You may be withdrawing from the friends and support you need. These are all signs that your coping is running short and when you need to recognize that you need to take care of yourself in order to care for your grandchildren. Raising grandchildren can be very satisfying, and it is always a challenge. Take care of your kids and take care of yourself. That’s the best caregiving of all.

This post was co-written with Deborah Langosch, Ph.D., L.C.S.W., the Project Director of the Kinship Care Program at the Center for Trauma Program Innovation at Jewish Board of Family and Children’s Services in New York City.

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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

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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.”

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Seniors Exercise to Hip Hop

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Wealth: Bonds for the Boomers

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Old Age Prompts Suicidal Thoughts

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