Wednesday, July 3, 2013

Depression: How to Recognize It in Seniors

Depression in older adults is relatively common. Yet, the causes and symptoms in this population tend to be misunderstood and too often overlooked. Medication interactions, life circumstances, and simple aging can make depression hard to recognize. Even though depression is never normal, older people tend to suffer from the condition in disproportionately high amounts and are a segment of the population least likely to get treatment.

More than seven million elderly adults suffer from depression. But, these huge numbers are in stark contrast to the fact that only about ten percent of these individuals ever receive treatment for the disorder. As a matter of fact, about five million older adults have what is called subsyndromal depression which is depression that is so "mild" as to not meet the criteria for a diagnosis of depression. Subsyndromal depression is common in the elderly, and may indicate an increased risk of developing major depression. Recognizing and treating depression in older adults becomes especially important as the "Baby Boomer" generation ages and places unheard of pressures on healthcare in this country.

Depression is not "just part of getting old"
On average, from one to five percent of older people may suffer from depression. However, those numbers drastically increase to a whopping 13.5 percent for individuals who reside in a home or institutional healthcare setting. These numbers appear to indicate that older individuals needing more care may suffer from depression either because of the lack of control they feel they have over their own lives or because of existing medical conditions.

Depression occurs for a number of reasons. Like the rest of the population, senior citizens may experience depression for many of the same reasons. However, seniors also have a host of other issues that complicate things.

Factors that influence depression in the elderly
Several factors - including psychological factors, environmental factors, and physical factors - contribute to depression in the elderly. Any one or a combination of several of the following factors may be responsible for depression in older people.

Psychological factors include:
• Life events - either traumatic or unresolved
• A previous or family history of depression
• Body image issues. As we age, we often experience discomfort with physical changes such as surgeries, heart attacks and stroke, amputations, etc.
• Frustrations that may be the result of memory loss (caused by aging or disease)
• Dealing with the loss of friends, family members, spouse.
• Dealing with changes in living conditions or situations such as moving in with family, housing in an extended care facility, or moving into a nursing home
• Loss of independence. Allowing a caregiver access to the home can make older people especially anxious. They may also feel that their independence is being diminished if they need help.
• Existing psychological conditions such as low self-esteem, anxiety disorders, etc.

Environmental factors include:
• Social isolation. A reduced ability to get around and the loss of close friends and family members (including a spouse) may contribute to depression.
• Retirement.
• Decreased mobility including the loss of driving privileges.

Physical factors include:
• A family and personal history of depression
• Existing medical conditions such as cancer, diabetes, heart attack and stroke, Parkinson's, and Alzheimer's.
• Medication interactions and side effects. Certain pain medications, high blood pressure drugs, hormones, heart meds, arthritis treatments, chemotherapy treatments, and drugs prescribed for psychological disorders may contribute to depression.
• Chemical imbalances and other changes in brain function.
• Chronic and/or severe pain.
• Previous or ongoing substance abuse.

Caregiver assistance in identifying the signs of depression
Caregivers may be the most important asset in identifying signs of depression in the elderly. Caregivers, whether they are relatives or professionals, are important because they interact with the elderly person daily. This daily contact may enable a caregiver to pinpoint problems before anyone else, even the older person's physician.

One of the interesting differences between older adults who suffer from depression and younger people is that older adults often have difficulty understanding that they are depressed. Medical professionals and family members often ask "are you depressed?" The answer is almost always "no." This is because older adults don't often associate what they are feeling with depression. They may also feel that admitting to depression signifies weakness.

Older people may experience more "sad" events than the rest of the population. They may also interpret these events far differently than younger people. For instance, the loss of a close friend can not only be viewed as a sad event, it may also remind the older person of his/her own mortality. On top of that, older people may have fewer friends, making the loss of one especially heart wrenching. But, it's often hard to tell the difference between sadness, grief, and actual depression. The primary difference is that sadness and grief are temporary. An elderly person that is "sad" for an extended period of time after such an event may be depressed. Caregivers are in a unique position to identify small changes in behavior that may signal the onset of something serious.

The symptoms of depression in older adults may include:
• memory problems
• confusion
• social withdrawal
• loss of appetite
• weight loss
• vague complaints of pain
• inability to sleep
• irritability
• delusions (fixed false beliefs)
• hallucinations
• persistent and vague complaints
• help-seeking
• moving in a more slow manner
• demanding behavior

The difference between depression and dementia
There are several symptoms common to both depression and dementia that make one hard to distinguish from the other. These two disorders may also be comorbid, meaning that it is possible to have both at the same time. Some of these shared symptoms may include loss of interest in once-favored activities and pastimes, social withdrawal, memory loss, sleep problems, and difficulty concentrating.

The Mayo Clinic has identified three factors that differentiate depression and dementia. These factors may be key in identifying depression in the elderly. In general, elderly adults who have dementia as opposed to depression:
• May have symptoms of depression that are less severe
• May experience episodes of depression that don't last as long or recur as often
• Talk of suicide and attempt suicide less often

Diagnosing depression in the elderly correctly is imperative to administering the correct treatment plan. Treatment for senior depression may include:

• Antidepressants. SSRIs (Celexa, Zoloft, Effexor, and Wellbutrin) are often prescribed for older people who have depression and dementia. These medications have a lower risk of side effects and drug interactions than other antidepressants.
• Exercise. The symptoms of depression can be alleviated with regular physical activity. Researchers believe that exercising in the morning may be most helpful.
• Emotional and mental support. Counseling services and support groups are available for elderly individuals suffering from depression.
• Electroconvulsive therapy (ECT). Especially when depression and dementia are diagnosed together, ECT may be the most effective form of treatment. Some elderly individuals with severe depression respond best to ECT and this treatment offers fewer side effects for the elderly.

Although elderly women are twice as likely as older men to suffer from depression, men, as in the general population, are subject to the highest rate of suicide in the United States. Untreated depression is serious. Elderly people with untreated depression may experience a decreased quality of life and may be at increased risk of suicide. Understanding the causes and recognizing the signs is crucial in helping seniors live happy and healthy lives.

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