Download UNDERSTANDING DEPRESSION IN LATER LIFE Sean Brotherson

UNDERSTANDING
DEPRESSION IN
LATER LIFE
Sean Brotherson, Ph.D.
Extension Family Science Specialist
Lesson Objectives
• Understand key issues relating to
depression in later life
• Learn about signs of depression in
later life
• Explore specific strategies for managing
depression in later life
• Gain knowledge of specific resources
to deal with depression in later life
True or False?
Depression only develops when
someone has had a major traumatic
experience in life, such as the death of
a spouse or a heart attack.
Answer - False
• Myth – Depression occurs only when
people experience major trauma in life.
• Reality – Depression is a commonly
occurring mental health condition that may
arise due to a variety of factors, including
genetic influences, body changes, life
stress or other influences.
True or False?
Individuals dealing with depression
usually can overcome it if they just
work to cheer themselves up or pull
themselves up by their bootstraps.
Answer - False
• Myth – Depression can be overcome simply
by telling yourself to feel better or pulling
yourself up alone.
• Reality – Depression is a complex medical
and mental health condition that typically
improves with a variety of approaches, which
may include therapeutic support, social
support, exercise, diet, rest and medication.
True or False?
Seeking assistance from a doctor or
mental health professional for
depression is a sign of inability to
handle your problems or personal
weakness.
Answer - False
• Myth – Individuals dealing with depression
are emotionally weak or unstable and
seeking help is a sign of weakness.
• Reality – Depression is a condition that
anyone can experience. Seeking assistance
from competent professionals often is
necessary and signals wisdom,
understanding and strength.
Depression in Later Life
• Can cause problems with thoughts,
feelings and behavior
• Causes physical difficulty, emotional
fatigue and mental anxiety
• Can be treated effectively when diagnosed
• Is everyone’s responsibility
Who is at risk for
depression?
Aging community members who:
• Live alone
• Are economically disadvantaged
• Have no relatives or friends nearby
• Have experienced recent losses (job, pets, friends,
family members, moves, etc.)
• Have been ill or have a progressive or chronic illness
• Have personal experience or a family history of
anxiety or depression
• Have undergone significant challenges with family
stress, economic stress or other concerns
What is depression?
Definition: A mental health condition
characterized by an inability to concentrate;
insomnia; loss of appetite; physical tiredness or
fatigue; feelings of extreme sadness, guilt,
helplessness and hopelessness; and thoughts
of despair, discouragement and death. Also
called clinical depression.
Prevalence: 3.8% of people over age 55
residing independently in the community suffer
from major depression in any given year.
(www.surgeongeneral.gov)
Symptoms of Depression
• Difficulty falling asleep
• Sleep more than usual
• Feel tired all of the time
• Feel less energetic than
usual
• Feel nervous or unable
to sit still
• Experience an increase
or decrease in appetite or
weight
• Feel sad or blue most of the
day nearly every day
• Have trouble making
decisions
• Think about suicide
• Have problems concentrating
• Be irritable
• Lack motivation
• Lose his or her temper more
easily than usual
• Lose interest in things that
he or she used to enjoy
Risk Factors for
Depression
Personal history of:

Chronic medical illnesses

Chronic pain

Loss of physical
functioning

Prior depressive episodes

Recent significant loss

Multiple recent stressors
Social isolation
Family history of:

Recurrent depression

Bipolar disorder

Alcohol abuse or
dependence
(www.positiveaging.org)
Anxiety Issues
Definition: Anxiety issues represent a
mental health condition involving the
presence of anxiety so intense or frequently
present that it causes difficulty or distress for
the individual.
Prevalence: 11.4% of the population over
age 55 suffers from an anxiety disorder in
any given year.
(U.S. Department of Health and Human Services)
Symptoms of Anxiety
• Excess or undue worry
or fear
• Racing heartbeat, chest
discomfort
• Fatigue
• Disturbed sleep
• Shortness of breath or the
feeling of being smothered
• Jumpiness, jitteriness,
trembling
• Numbness or tingling of
hands, mouth or feet
• Muscle aches, tension
• Dry mouth, sensation of a
lump in the throat, choking
sensation, clammy hands,
sweating
• Dizziness,
lightheadedness
• Gastrointestinal upset
Risk Factors for Anxiety
Personal history of:
• Depression
• Anxiety disorder
• Chronic medical illness
• Loss of significant
person during childhood
• Cognitive impairment
• Alcohol
abuse/dependence
• Social isolation
Family history of:
• Alcohol abuse
• Anxiety disorders
• Mood disorders
Other factors:
• Female gender
• Exposure to traumatic
event
(www.positiveaging.org)
How can I help?
• Knowing the signs of depression can
help you understand when someone
may need a kind word, a referral to a
mental health professional or
encouragement to seek help.
• Consider the suggestions in the
following material to understand what to
watch for and how you might help.
What should I look for?
Physical Appearance
1. Dirty clothing, skin or hair
2. Body odor, unshaven, hair uncombed
3. Little attention to clothing to wear,
appearance
4. Significant weight loss or weight gain
5. Fatigue or exhaustion from lack of sleep,
despair, etc.
www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf
What should I look for?
Emotional State
• Anxious, nervous, fidgety
• Lack trust, suspiciousness, blaming
• Angry, hostile, irritable
• Rapid mood changes
• Statements such as “no one cares” or
“I’m all alone”
• Sense of discouragement, lack of hope,
helplessness
www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf
What should I look for?
Personality Change
The person’s usual character or personality
may seem different than in earlier years.
▪ Decreased social contacts, isolation from others
▪ Sloppy appearance, lack of care for surroundings
▪ Lack of eye contact, limited social engagement
▪ Preoccupation with health concerns, losses, life
challenges or sadness
▪ Lack of interest in hobbies, friends, or things the
person formerly enjoyed
▪ Difficulty making decisions
www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf
What should I look for?
Living Conditions
▪ Walks not shoveled, lawn not mowed
▪ Neglect of pets, farm animals or family members
▪ Little or no food
▪ Old newspapers or dirty dishes lying around –
limited care of surroundings
▪ Calendar on wrong month – little attention to time
▪ Shades drawn, garden/flowers neglected – signs
of isolation
www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf
What can I do to help?
• Express sincere concern
• Demonstrate kindness
• Listen; be supportive and gentle
• Use calm tone of voice and manner
• Exhibit a nonjudgmental attitude
• Refer the person for help or contact a
family member
www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf
Protective Factors in
Managing Depression
• Effective clinical care for ongoing depression or anxiety,
including medication if needed
• Easy access to a variety of clinical interventions and
support for help seeking
• Family and community support
• Support from ongoing medical and mental health-care
relationships
• Healthy living practices that include sufficient sleep,
healthy diet and regular exercise
• Skills in problem solving, stress management and
conflict resolution
• Cultural and religious beliefs that encourage hope,
optimism and personal support efforts
Seeking Treatment and
Support for Depression
• Social stigma associated with mental health
problems prevent many people, especially the
aging, from seeking professional help.
• For many people, the initial entry point for
assessment of mental health concerns is their
primary physician or general practitioner
• Begin by seeking an opportunity for a medical
screening about anxiety or depression. Or talk
to a trusted counselor, pastor or friend.
Barriers to Diagnosis
and Treatment
•
•
•
•
•
•
•
Age-related changes
Illness
Attitudes of others
Denial
Alcohol or drug use
Health complaints
Stigma
Sharing Your Concerns
• Avoid talking to the person if he/she is
upset or under the influence of drugs or
alcohol.
• Be gentle and kind.
• Avoid a confrontational style.
• Avoid using labels because they may carry
a heavy stigma.
• Take into consideration the person’s age
and ability to understand.
Sharing Your Concerns
• Be consistent and patient in your
expression of concern without exerting
undue pressure.
• Be direct; treat the individual as an adult.
• Give specific examples of behaviors that
concern you.
• Use statements such as “I am concerned
about you.”
Sharing Your Concerns
• Be prepared with referral information.
• Don’t be discouraged if the person is not ready to
accept your assistance.
• Don’t worry if you don’t say things perfectly.
What is important is your message of concern is
conveyed and your willingness to help is
expressed.
• Encourage a person to get proper professional
assistance from a primary care doctor, mental
health professional or other trusted professional
source.
Resources
• Visit the North Dakota Mental Health and
Aging Education Project at:
www.ndsu.nodak.edu/ndsu/aging/mentalhealth/index.html
Mental Health
• Mental Health America of North Dakota at:
www.mhand.org
• Positive Aging Resource Center at:
www.positiveaging.org