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Objectives:

1. Discuss the problems of the older adult and depression.
2. Identify the clinical signs and symptoms of depression.
3. Discuss reasons older adults fail to seek medical treatment for their depression.
4. Causes and risk factors that contribute to depression in older adults and the elderly include:
5. Identify clinical signs and symptoms of depression in the older adult.
6. Describe self-help suggestions for depression in the older adult.
7. Discuss the benefits of counseling and therapy for the older adult with depression.

 

The number of Americans 65 years old and older is growing rapidly. It is estimated that by the year 2030, every fifth American will be over the age of 65. It is important that nurses keep up on the most recent findings regarding care of the older adult. The five most common cognitive diagnoses seen in the older adult are referred to as the “five D’s”. The five D’s include: dehydration, drugs, depression, dementia, and delirium.  This course will review depression.

The Older Adult and Depression

Depression is the most common form of mental health disorder affecting almost 7% of the American population, about 14.8 million people. Approximately 15% of individuals over the age of 65 have significant depressive symptoms and about 3% suffer from major depression. In older age, depression is associated with higher suicide rates than in the younger depressed population. Although older Americans make up 13% of the population, they account for 18% of all suicide deaths. If left untreated, depression can affect mood, physical heath, impair memory and concentration, and prevent enjoyment in life. It must be reinforced that depression is not a normal part of aging. Depression isn’t a sign of weakness or a character flaw. It can happen to anyone, at any age, no matter the background or accomplishments in life. Regardless of age, no one should live with depression. Depression is treatable at all ages of life. Sadly, a large number of older adults fail to recognize the symptoms of depression, or don’t take the steps to get the help they need.

 

Some of the reasons older adults fail to seek medical treatment for their depression include:

• They assume they have good reason to be down, or that depression is just part of aging.
• They can become isolated, which can be depressing, and have few people around to notice their symptoms or encourage them to seek help.
• They do not realize their physical complaints are signs of depression.
• They don’t feel comfortable talking about their feelings or asking for help.

 

Causes of Depression in Older Adults

The significant life changes facing older adults put them at significant risk for depression.  Causes and risk factors that contribute to depression in older adults:

• Health problems – Illness and disability; chronic or severe pain; cognitive decline; damage to body image due to surgery or disease.
• Loneliness and isolation – Living alone; a dwindling social circle due to deaths or relocation; decreased mobility due to illness or loss of driving privileges.
• Reduced sense of purpose – Feelings of purposelessness or loss of identity due to retirement or physical limitations on activities.
• Fears – Fear of death or dying; anxiety over financial problems or health issues.
• Recent bereavement – The death of friends, family members, and pets; the loss of a spouse or partner. Loss is painful—whether it’s a loss of independence, mobility, health, your long-time career, or someone you love. Grieving over these losses is normal and healthy, even if the feelings of sadness last for a long time. Losing all hope and joy, however, is not normal or healthy. Grief and clinical depression can be difficult since they share the same symptoms. Grief involves a wide range of emotions and a mix of good and bad days. When a person is in the grieving process they can have moments of pleasure or happiness. However, when a person is depressed, the feelings of emptiness and despair are constant. When a person shows no signs of joy or is unable to laugh or smile, depression should be considered.

 

Clinical signs and symptoms of depression in the older adult include:

• Constipation
• Low energy
• Low libido
• Agitation, anxiety or crying
  • Intense, pervasive sense of guilt
  • Slow speech and body movements (psychomotor retardation)
  • Thoughts of suicide or a preoccupation with dying
  • Feelings of hopelessness or worthlessness
  • Inability to function at work, home and/or school
  • Seeing or hearing things that aren’t there
  • Sadness
  • Fatigue
  • Abandoning or losing interest in hobbies or other pleasurable things.
  • Sleep disturbances-difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness
  • Social withdrawal and isolation- reluctant to be with friends or engage in activities or leave home
  • Weight loss or loss of appetite
  • Increased use of alcohol or other drugs

 

Prescription Medications and Depression in the Older Adult

The older adult uses one-third of all prescription drugs and one-fourth of all OTC drugs. Symptoms of depression are a side effect of many commonly prescribed drugs, especially if taking multiple medications. Older adults are more sensitive to the side effects of medication because, as we age, our bodies become less efficient at metabolizing and processing drugs.

Medications that can cause or worsen depression include: blood pressure medication, beta-blockers, sleeping pills, tranquilizers, calcium-channel blockers, medication for Parkinson’s disease, ulcer medication, heart drugs containing reserpine, steroids, high-cholesterol drugs, painkillers, arthritis drugs, and estrogens. If there is a possibility that any of these medications could be contributing to or causing depressive symptoms, contact your doctor to have the dose lowered or discuss having the medication changed to another one.

Self-help for depression in older adults

The more active you are—physically, mentally, and socially—the better you’ll feel. The following are self-help suggestions:

• Exercise- Research suggests it may be just as effective as antidepressants in relieving depression. The best part is that the benefits come without side effects. Even if you are ill, frail, or disabled, or in a wheelchair, there are many safe exercises you can do to build your strength and boost your mood.
• Connect with others to get the emotional support you need to lift the fog of depression. If you can’t get out to socialize, invite loved ones to visit you, or keep in touch over the phone or email.
• Get enough sleep- When you don't get enough sleep, your depression symptoms can be worse. Aim for somewhere between 7 to 9 hours of sleep each night.
• Maintain a healthy diet- Avoid eating too much sugar and junk food. Choose healthy foods that provide nourishment and energy, and take a daily multivitamin.
• Participate in activities you enjoy or volunteer time helping others. This will make you feel better about yourself and expand your social network.
• Learn a new skill
• Take care of a pet- Pets are proven to be therapeutic and can be good company, caring for them provides solid exercise and gives a sense of purpose to the caretaker.
• Laugh more- Catch comedic television shows and/or movies; read funny books and/or magazine articles.

 

Medical treatment for depression in the older adult

Depression treatment is just as effective for elderly adults as it is for younger people. However, since depression in older adults and the elderly is often the result of a difficult life situation or challenge, any treatment plan should address that issue. If loneliness is at the root of your depression, for example, medication alone is not going to cure the problem.

 

Antidepressants

Older adults are more sensitive to drug side effects and vulnerable to interactions with other medicines they’re taking. Recent studies have also found that SSRIs such as Prozac can cause rapid bone loss and a higher risk for fractures and falls. Because of these safety concerns, elderly adults on antidepressants should be carefully monitored. In many cases, therapy and/or healthy lifestyle changes, such as exercise, can be as effective as antidepressants in relieving depression but without the dangerous side effects.

 

Counseling and therapy for older adults

Therapy works as a method to treat depression because it addresses the underlying causes of the depression, rather than just the symptoms.

• Supportive counseling includes religious and peer counseling. It can ease loneliness and the hopelessness of depression, and help you find new meaning and purpose.
• Therapy helps you work through stressful life changes, heal from losses, and process difficult emotions. It can also help you change negative thinking patterns and develop better coping skills.
• Support groups for depression, illness, or bereavement connect you with others who are going through the same challenges. They are a safe place to share experiences, advice, and encouragement.

 

References:

Areán, P. A., Raue, P., Mackin, R. S., Kanellopoulos, D., McCulloch, C., & Alexopoulos, G. S. (2010). Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction. The American journal of psychiatry, 167(11), 1391.

Byers, A. L., Yaffe, K., Covinsky, K. E., Friedman, M. B., & Bruce, M. L. (2010). High occurrence of mood and anxiety disorders among older adults: The National Comorbidity Survey Replication. Archives of general psychiatry, 67(5), 489.

Mental Illness Facts and Numbers, National Alliance on Mental Illness. (March 2013). http://www.nami.org/factsheets/mentalillness_factsheet.pdf

McIntosh, J.L.. & Drapeau, C.W. (for the American Association of Suicidology). (2012). U.S.A. suicide: 2010
official final data. Washington, D.C: American Association of Suicidology.

Lloyd, S. J. (2011). Emotional Intelligence: A Predictor for Depression as Related to Coping Skills in Older Adults (Doctoral dissertation, NORTHCENTRAL UNIVERSITY).

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