By Angel Peralta, Care Coordinator with VNSNY CHOICE Health Plans
As summer gives way to fall and the days grow shorter and cooler, many people—especially those who are elderly and homebound—can experience a bit of an emotional downturn. For most of us, this seasonal “depression” is quite normal, and presents no cause for concern. But it’s good to be mindful of a few common symptoms that might indicate more serious depression, which can lead to bigger issues and be easy to overlook.
According to the National Alliance on Mental Illness (NAMI), depression affects more than 6.5 million of the 35 million Americans aged 65 or older, with prevalence being especially higher for seniors who are homebound.
Depression is not a normal part of aging. Depression interferes with your daily life. Depression can often trigger a downward spiral that can result in a series of health issues. Many people suffering from depression never seek treatment. But the majority, even those with the most severe depression, can get better with treatment. Medications, psychotherapies, and other methods can effectively treat people with depression.
Research shows that 10 to 20 percent of older patients seen by a primary care physician suffer from depression – and among the homebound, that figure may be as high as 46 percent. Even more worrisome, the elderly represent 16 to 20 percent of the nation's suicide rate, with the highest suicide rates in males 80 years and older. The National Institute of Mental Health (NIMH) considers depression in people age 65 and older to be a major public health problem.
Depression in the elderly may be overlooked
Depression in the elderly is frequently ignored because it is often mistaken for other aging-related illness or loss. Seniors themselves may ignore the symptoms, believing their suffering is a result of growing older and therefore they are expected to slow down. In addition, many seniors experience loss of social support systems due to the death of a spouse or siblings, retirement, or moving to a different home. Reactions to these losses may be misunderstood and not diagnosed as depression.
Physical conditions like heart disease, stroke, hypertension, diabetes, cancer, dementia, and chronic pain further increase the risk of depression among the elderly. Certain medicines or combination of medicines have side effects that may contribute to depression, as does social isolation and living alone. As a result, effective treatment often gets delayed, leaving many elderly people to unnecessarily struggle with depression.
According to the NIMH, warning signs of geriatric depression include:
- Persistent sad, anxious, or "empty" feelings
- Feelings of hopelessness or pessimism
- Irritability or agitation and restlessness
- Fatigue and decreased energy
- Feelings of guilt, worthlessness, or helplessness
- Difficulty concentrating, remembering details, and making decisions
- Overeating, or appetite loss
- Thoughts of suicide, suicide attempts
- Sleeping too much or too little, awakening frequently
- Loss of interest or pleasure in activities
- Thoughts of death or suicide, including suicide attempts
What to do if you notice any of these warning signs:
- The most important thing is to help your loved one get an assessment, diagnosis and treatment.
- There are many ways to effectively treat depression in the elderly, from cognitive behavioral therapy to medications.
- Be observant - have a conversation with your loved one to probe further how he’s feeling or what’s bothering him and listen carefully.
- Give him an opportunity to speak, and listen to what he says.
- Depressed older adults often talk about the physical symptoms of depression first (“I’m not sleeping well,” or “I’m just not hungry.”).
- Reassure him that with a little help, he can enjoy life again. And talking about it is the first step. Keep in mind he may be holding back because he doesn’t want to create an additional burden for the person who is caring for him.
- Tap into home and community resources and supports to help identify depression and other chronic illnesses and make referrals to appropriate medical care.
- Speak with the home care aide who may be in the home on a daily or weekly basis about any observed changes in behavior, eating, sleeping patterns, etc.
- If the older adult is enrolled in a coordinated care program like the managed long term care (MLTC) plan where I work, (VNSNY CHOICE), be sure to ask the (community-based) nurse coordinator to monitor the care and connect the older adult to the right resources.