PA Knowledge Base

Depression in older adults and the elderly

Many people of all ages suffer from depression. However as there is an aging population we will come across more elderly people who have it. Depression is not an inevitable part of aging, depression prevents a person from enjoying life like they used to. Depression effects mood, energy, sleep, appetite, and physical health. The very nature of depression interferes with a person’s ability to seek help, draining energy and self-esteem. Elderly people may have been raised in a time when mental illness was highly stigmatized and misunderstood, and may not believe depression is a real illness.

 

Signs and symptoms of depression in the elderly

Recognizing depression in the elderly starts with knowing the signs and symptoms which include sadness, fatigue, abandoning or losing interest in hobbies or other pleasurable pastimes, social withdrawal and isolation (reluctance to be with friends, engage in activities, or leave home).Weight loss or loss of appetite, sleep disturbances (difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness). Loss of self-worth (worries about being a burden, feelings of worthlessness, self-loathing), increased use of alcohol or other drugs, fixation on death; suicidal thoughts or attempts.

Many elderly people with depression claim not to feel sad. They may complain, of low motivation, lack of energy, physical problems. In fact, physical complaints, such as arthritis pain or worsening headaches, are often the predominant symptom of depression in the elderly.

Older people who deny feeling sad or depressed may have depression. Other signs to look for are unexplained or aggravated aches and pains, feelings of hopelessness or helplessness, anxiety and worries, memory problems, lack of motivation and energy, slowed movement and speech, irritability, loss of interest in socializing and hobbies, neglecting personal care (skipping meals, forgetting meds, and neglecting personal hygiene.

 

Causes of depression in older adults and the elderly

Significant life changes can put people at risk for depression. Causes and risk factors that contribute to depression in older adults and the elderly include: health problems including illness and disability, chronic or severe pain, damage to body image due to surgery or disease, decreased mobility due to illness, or loss of driving privileges, physical limitations on activities and cognitive decline.

There can be a loss of identity due to retirement, which can lead to loneliness and isolation, and the loss of friends, family members pets and their spouse due to death. They can also be facing their own fear of mortality. There can also be fear and anxiety over financial problems.

 

Medical conditions can cause depression in the elderly

It’s important to be aware that medical problems can cause depression in older adults and the elderly, either directly or as a psychological reaction to the illness. Any chronic medical condition, particularly if it is painful, disabling, or life-threatening, can lead to depression or make the symptoms of depression worse. These include:

  • Parkinsons disease
  • Stroke
  • Heart disease
  • Cancer
  • Diabetes
  • Thyroid disorders
  • Vitamin B12 deficiency
  • Dementia and Alzheimer’s disease
  • Lupus
  • Multiple sclerosis

 

Prescription medications and depression in the elderly

Symptoms of depression are a side effect of many commonly prescribed drugs. You’re particularly at risk if you’re taking multiple medications. While the mood-related side effects of prescription medication can affect anyone, older adults are more sensitive because our bodies become less efficient at metabolizing and processing drugs as we get older.

Medications that can cause or worsen depression include;

  • Clonidine
  • Beta-blockers (eg: Lopressor, Inderal)
  • Sleeping medication
  • Tranquilizers (eg: Valium, Xanax, Halcion medication for Parkinson’s)
  • Ulcer medication (eg: Zantac, Tagamet)
  • Heart drugs (those containing reserpine)
  • Steroids (eg: cortisone and prednisone)
  • Cholesterol drugs (eg: Lipitor, Mevacor, Zocor)
  • Painkillers
  • Arthritis drugs

If you suspect this is the case check the patient information leaflet or check on line. You should also encourage the person you are caring for to talk to their doctor. They may be able to change the dose or swap the medication.
Alcohol and depression in the elderly

People drink alcohol to deal with physical and emotional pain, or to help with getting to sleep. Alcohol can make you feel better in the short term, but using alcohol in this way can cause other problems. It makes symptoms of depression, irritability, and anxiety worse, and impairs your brain function. Alcohol also interacts badly with numerous medications, including antidepressants and it impairs the quality of your sleep.

 

Depression self-help for older adults and the elderly

  • Dealing with depression is not just a case of taking medication, it is also about learning to adapt to change, staying physically and socially active, and feeling connected to your community and loved ones. It is about spending time with people and doing activities you enjoy or trying new things.
  • Physical activity has a powerful mood-boosting effects, it may be just as effective as antidepressants in relieving depression. The best part is that the benefits come without side effects. Even if a person is ill, frail, or disabled, there are many safe exercises that can be done even from a chair or wheelchair.
  • Getting the right support plays a big part in dealing with depression and keeping it away. It is important to make an effort to connect to others and limit the time you’re alone. As a personal assistant we can really encourage our employer in getting out and seeing friends and relatives.
  • It is important to get enough sleep. Symptoms of depression can be worse if we do not get enough sleep, we should all get 7 to 9 hours of sleep.
  • A healthy diet is really important to help with recovery in depression, eating and drinking sugary and unhealthy food and drink should be avoided. It is important that food provides nourishment and energy.
  • We should encourage our employer to pursue whatever hobbies or pastimes bring or used to bring them joy, or try new activities.
  • Volunteering helps people to feel better about themselves and expands their social network.
  • A pet can be good company particularly for those who live alone.
  • Learning a new skill can aid recovery.

It is worth remembering that depression treatment is just as effective for elderly adults as it is for younger people. As with any depression each problem which lead to this needs to be addressed and dealt with which can be a painful process. Therapy helps people work through stressful life changes, heal from losses, and process difficult emotions. It can also help them change negative thinking patterns and develop better coping skills. Older people who are on antidepressant medication need to be carefully monitored due to the changes in their metabolism.

 

Alternative treatments

Herbal remedies and natural supplements can be effective in treating depression, in some cases they are safer for older adults than antidepressants. However some herbal supplements may cause interactions with certain medications and carry side effects, so advice needs to be sought from their GP before taking them.

These include omega-3 fatty acids which can boost the effectiveness of antidepressants or work as a standalone treatment for depression. St. John’s wort can help with mild or moderate symptoms of depression but should not be taken with antidepressants. Folic acid can help relieve symptoms of depression when combined with other treatments.

If an elderly person you care about is depressed, you can make a difference by offering emotional support. Listen to your loved one with patience and compassion. You don’t need to try to “fix” someone’s depression; just being there to listen is enough.

Don’t criticize feelings expressed, but point out realities and offer hope. You can also help by seeing that your friend or family member gets an accurate diagnosis and appropriate treatment. Help your loved one find a good doctor, accompany him or her to appointments, and offer moral support.

 

How we can help as a Personal Assistant

  • Look out for the signs of depression and encourage your employer to act if you think they may be depressed by going to see their GP as soon as possible.
  • Suggest activities to do together that your employer used to enjoy: walks, an art class, a trip to the museum or the movies—anything that provides mental or physical stimulation, including visiting friends or family in activities were your employer agrees.
  • Try to schedule regular social activities. Be gently insistent if your plans are refused: depressed people often feel better when they’re around others.
  • Plan and prepare healthy meals. A poor diet can make depression worse, so make sure your employer is eating right, with plenty of fruit, vegetables, whole grains, and some protein at every meal.
  • Encourage your employer to follow through with their treatment plan and stay alert to ensure that it is helping. If it isn’t, look into other medications and therapies and encourage them to see their GP again.
  • Ensure all medications are taken as instructed. Remind your employer about the use of alcohol while on medication.
  • Watch for suicide warning signs. Seek immediate professional help if you suspect that your employer is thinking about suicide.

Although this article has focused on depression in the elderly the treatment is the same other than the dose of antidepressants so this can be useful for all people in our care no matter how old they are. It is also very easy not to notice depression on others as there are often very slow changes to a person so when you notice it, act.