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Features for Senior Citizens
Watch for Depression in Older Loved Ones During the
Holidays
Late-life depression is more common that once
believed
By Kara Gavin
 December 5, 2006 - So you’re heading home to see
Mom and Dad this holiday season – or maybe Aunt Sue or Grandpa George.
If you’re like many Americans, it may have been weeks, months or even
years since you’ve seen them last. And as they – and you – grow older,
these holiday reunions grow more special each year.
But what if you notice that one of your older
relatives isn’t quite their old self? That they’re more anxious, more
irritable, less joyful or quieter than they once were? That they seem
focused on talking about people who have died, or have lost interest in
things that they used to enjoy – including holiday traditions and
festivities?
It’s possible that these changes add up to signs of
late-life depression, which may affect as many as one in seven older
people. It’s especially common among those who have suffered a serious
physical problem, whether it’s a heart attack, cancer, lung disease, or
problems with their hips and joints.
Helen C. Kales, M.D., hears this tale many times
each year, from patients who come to see her after their family members
notice a serious change in their behavior at the holidays and encourage
them to seek help. As a geriatric psychiatrist who specializes in
helping older people cope with depression and other mental illness,
Kales knows that it often takes the prompting of a family member to help
an older person recognize their symptoms.
“One of the big things that happens at the holidays
is that families who are coming in from out of town spot these symptoms
and changes for the first time. For instance, their parent or relative
isn’t taking as good care of themselves or their home as they used to,”
says Kales, a member of the
University of Michigan Depression Center. “It’s a myth that
depression is a normal part of aging, and that you just get old and
tired and sad naturally. Normal aging is not associated with depression,
and late-life depression is just as treatable as any other form.”
Kales, who treats older patients with depression at
the
U-M Geriatrics Center and the
VA Ann Arbor Healthcare System, notes that older people who have
experienced mental health problems in the past, and those who have
significant physical health problems that limit their lives, face the
highest risk of developing late-life depression.
But even otherwise healthy elders can find
themselves feeling depressed after a serious blow like the death of a
spouse, sibling or close friend, or the loss of their social network
when they move to an assisted living facility or to live with relatives.
All of these “triggers”, as they are called, can combine with the
special pressures and interrupted routines of the holiday season to
create an even greater risk of depression during the holidays. Such
feelings may pass as Christmas, Hanukkah and New Year’s Day fade into
memory. Or, they can lead the person to develop more serious and
prolonged depression lasting weeks or months. That’s when it’s important
to get help.
People in their seventies, eighties and nineties
may also be less likely to recognize their increased tiredness, loss of
appetite, and mood swings as signs of depression, Kales says, both
because of other physical problems they have, or simply because of the
era in which they grew up.
“They were taught to pick themselves up by their
bootstraps and not to cry when things went wrong,” she explains. “So it
may be really hard for them to talk about having emotional problems or
experiencing depression. They may feel like they need to be stoic and
power through it.”
In other words, the generations that witnessed the
Great Depression may be less likely to recognize their own depression.
Fortunately, younger people have grown up in an era
when research has shown that depression is a physical illness rooted in
brain chemistry and genetics, and not in personal failings or weakness.
That’s why it’s so important for them to speak up to their relatives if
they notice something wrong, says Kales, who is an assistant professor
of psychiatry at the
U-M Medical School and Director of the Geriatric Psychiatry Clinic
at the VA. Sometimes, it may even be worthwhile to mention those
observations to the loved one’s main doctor, who can check on things
further at the next office visit.
So what can be done for an older person who
develops temporary or more lasting depression? The easiest prescription,
Kales says, is simply to get out of the house and connect with other
people.
“That’s actually a hard thing to do, because in
depression people feel unmotivated, and feel like being isolated – but
it can become a vicious cycle because the more they stay in and don’t
connect with others, the worse they feel,” she explains. “They need to
try to get over that hump, and get out there. And what I find is that
they often feel much better once they’ve done it.”
 Another easy way for older people to confront those
blues is to treat themselves to something they haven’t done or had in a
while, like a nice dinner or a little present – especially at the
holidays. And don’t forget exercise, no matter what form it takes, Kales
adds. “We know that exercise causes all kinds of good hormones to be
released, and for older people that can make depression lessen.”
One thing to avoid, or at least to cut back on, is
alcohol. “It’s very important that older people who are feeling low
should minimize their use of alcohol,” Kales cautions. “Sometimes they
might use it to help them go to sleep or improve their mood, but the
bottom line is that alcohol is a depressant and helps mess up their
sleep.”
For those whose depression symptoms continue for
weeks or months despite these measures, Kales emphasizes two things:
counseling, also known as talk therapy, and medication.
Talk therapy, which can be done with the help of a
psychologist, mental health social worker or psychiatrist, involves
developing new ways of thinking about one’s situation – and confronting
negative thoughts and moods.
Older people may conjure up a stereotype of going
to a “shrink” as something that will make them recite their childhood
feelings while lying on a couch -- but that’s not the way it’s done
these days at all, Kales says. Counseling, whether alone or in groups,
has been proven to help people get better and stave off future bouts of
depression. “Even though people are getting older, you can teach an old
dog new tricks,” as the saying goes, Kales explains.
When other approaches don’t do enough, older people may want to consider
some of the modern antidepressants that have been introduced in the last
two decades, Kales says – much better than the mental health treatments
of old that they may be familiar with.
Interestingly, older people usually need to start
with much lower doses of antidepressants than younger people, because of
changes in their drug metabolism and use of other medications as they
age. But importantly, many older people need the same final dose as
younger people, so it’s important to “start low, go slow” but “don’t
stop” when increasing the antidepressant medication. Ultimately, the
choice of drug, and of dose, varies from person to person, and it may
take patience to find something that works. It’s best if this
trial-and-error process is guided by someone experienced in treating
depression, or even someone who specializes in treating older people’s
depression.
The bottom line is that families need to keep their
eyes and ears open for signs of depression in older relatives,
especially at the holidays when they have a chance to get together and
spend some time. And if someone seems to need help, don’t be afraid to
speak up and reach out.
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Facts about late-life depression |
|
●
About 15 percent of older
people may be experiencing depression at any given time.
●
Depression is different from
temporary “blues” or mourning for a lost loved one, in that it
lasts longer, and doesn’t let up from day to day.
●
Symptoms can include anxiety,
irritability, loss of pleasure in activities, feelings of
hopelessness and worthlessness, and worsened physical pain.
●
Some of the symptoms of
depression that are most common in younger people, such as
prolonged sadness, may not be as common in older people.
●
As older people develop
age-related health problems like heart disease, complications of
diabetes, lung disease, joint problems and vision or hearing
loss, they may start to experience symptoms of depression. In
other words, their physical illness can ‘trigger’ a bout of
depression.
●
Other triggers for depression
include the loss of a loved one, the loss of social networks of
friends and acquaintances because of a move, and even the hubbub
of the holidays. |
Find more on the Web
at:
>>
U-M Depression Center: Depression in older adults
>>
Free online self-test for depression from the U-M Depression Center
>>
Geriatric Mental Health Foundation: Mental Wellness in Older Age
depression toolkit
>> To find a mental
health professional who specializes in diagnosing and treating older
people, visit
www.gmhfonline.org/gmhf/find.asp, or
http://www.eldercare.gov/.
>> Or call the
national Eldercare Locator service toll-free at 1-800-677-1116 weekdays
between 9 a.m. and 8 p.m. ET.
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