“Lorraine’s” at-home caregiver always arrived on time and ready to perform her homemaking tasks, but Lorraine could never decide what she wanted her caregiver to do. Lorraine couldn’t make any decisions about what she needed help doing, so she’d go into the kitchen and make breakfast, leaving her caregiver alone in the living room to figure out what to do with her time. When Lorraine would finally give direction, she would then inevitably change her mind. Her caregivers, of which there were several, felt like they could never please Lorraine.
In addition to her indecisiveness, Lorraine had a flat affect and reported vague physical complaints which were not of concern to her medical doctor. Her physician had been telling her for many, many months that she was suffering from depression. Unfortunately, Lorraine refused to seek help for her depression. Because or her religious beliefs, she was waiting for “God to make it better,” even though her care management nurse, her physician, and her home care nurse each had recommended a trial of antidepressant medication. I also did my best to convince Lorraine to try an antidepressant but to no avail. After three years, Lorraine was still waiting for God to heal her depression. It was affecting her relationships and, unfortunately, she eventually lost her elderly home care service as well. It was just too frustrating for caregivers to work with Lorraine. They felt helpless.
What exactly is depression? According to the Mayo Clinic, it is a “medical illness that causes a persistent feeling of sadness and loss of interest. Depression can cause physical symptoms, too.” People with depression tend to isolate themselves. They lose interest in life and usually have sleeping and/or eating problems, two of the most common symptoms of depression. Not having an appetite, weight loss, weight gain, and eating too much can all be symptoms. Not being able to get to sleep, awaking in the middle of the night, or not being able to sleep at all can also be symptoms, as well as wanting to sleep all of the time. It is estimated that 5-6 million people over the age of 65 have depression. One study indicated that as many as 25% of the elderly are depressed.
When we think of depression, we associate it with a dictionary definition characterizing it as “extreme gloom, feelings of inadequacy, and an inability to concentrate.” While depression may manifest itself in typical ways—having “the blues,” crying, or exhibiting a feeling of hopelessness—according to Kay King of NAMI Minnesota, depression sometimes comes out sideways. Other common symptoms of depression include (but are not limited to):
Vague Physical Complaints
Feelings of Guilt
Feelings of Helplessness
Lack of Energy
Weight Loss or Gain
Decreased Cognitive Function
If you are taking care of elderly parents and find they have been experiencing several of these symptoms for 2-3 weeks or more, you should definitely have them evaluated for clinical depression. While most everyone experiences “down” periods at certain times in their lives, real depression is more than an occasional period of feeling blue. It is an ongoing medical condition that people cannot choose to control, stop, or “snap out of.”
In addition to common physiological and environmental causes, depression in seniors can also be caused by side effects of prescription drugs, thyroid issues, and even some medical procedures. It is not uncommon for a cerebral vascular accident, for example, to bring on depression after the stroke. Additionally, chronic illnesses, such as diabetes, cancer, or heart disease, can also bring about depression. While coping with a chronic illness is always difficult, it is not normal to become clinically depressed. Treatment for depression, in some cases, may actually improve symptoms of other conditions. Other contributors to depression in the elderly are grief, loss, loneliness, chronic pain, memory loss, alcoholism, boredom, and feeling that life no longer has purpose or meaning.
If you suspect the senior in your life is experiencing depression, it’s important to take your concern seriously and to intervene as quickly as possible. Not only will depression affect quality of life, but white men over the age of 85 are at the greatest risk for suicide of all age-gender-race groups, 2.5 times higher than the rate for men of all ages. Depression is not a normal part of aging, and fortunately, it is a treatable medical condition.
Unfortunately, those who are now seniors grew up in a time when there was much more stigma around mental illness. They are terrified by any suggestions of mental illness, fearing they’ll be “locked up.” They come from an era when people were ashamed to admit they had family members with mental illness for fear of being called “crazy.” If someone had depression, it was kept hush-hush. We now know that depression is a treatable medical condition just like high blood pressure, diabetes, or asthma.
If you suspect the seniors in your life are suffering from depression, please take your concern seriously. Encourage them to talk to their doctor or a licensed mental health professional. The best treatment for depression is a combination of anti-depressant medications along with professional counseling (psychotherapy). Nonmedical interventions, such as having regular family visits, regular exercise, senior companion care services, hobbies, as well as increasing social activity and having something meaningful to do, can also be helpful. Most people who have depression, with the right treatment, can live much more meaningful and quality lives. There is no need to suffer.
Paul R. Blom, Owner/CEO
Right at Home