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A Letter from
A Newsletter for Caregivers
Vol. 13, Issue 3
June 2012
A Publication of the Indiana Association for Home & Hospice Care, Inc.
Depression in the Older Adult
D
epression is not a normal
part of aging, yet it is a
common medical condition
and can be treated. Depression is
often under-recognized and undertreated in the older adult because many
believe that depression is a character
flaw or a normal reaction to the losses
which often accompany the aging
process. These losses can include
social isolation, death of friends/
family, loss of functional abilities, loss
of independence, and transition from
the home environment. It is thought
that only 10% of depressed older adults
actually receive treatment.
Untreated depression can worsen
the home care client’s other medical
illnesses and is associated with a higher
rate of disability. In other words,
depression can cause the client’s
medical and cognitive symptoms
to appear worse. In clients with
other medical conditions, those with
depression have a higher mortality rate.
In addition, depression is a risk factor
for suicide.
The suicide rate in the US is highest
among older adults, particularly older
men. People over 65 make up about
13% of the population, but commit
20% of all suicides. These rates do not
even include passive suicides, which
may result from stopping or abusing
necessary medications. It has been
reported that many of the older adults
who were successful at committing
suicide had visited their doctor within
a month of their death. This further
demonstrates that depressive symptoms
are difficult to recognize, even by
physicians and nurses.
Possible Causes of
Depression
There is no single cause of depression.
Imbalances in certain brain chemicals,
particularly serotonin and dopamine,
are thought to be involved in the
development of depression. Brain-
imaging technologies, such as magnetic resonance imaging (MRI), have shown
that the brains of people who have depression look different than those of people
without depression. The parts of the brain involved in mood, thinking, sleep,
appetite, and behavior appear different.
Psychological issues impacting depression can include difficulty in adjusting to
stressful or changing conditions or losses. Studies show that most seniors feel
satisfied with their lives, despite having more illnesses or physical problems.
However, some older adults have problems adjusting to life’s stressors.
Depression is not
a normal part of
aging, yet it is a
common medical
condition and can
be treated.
It is thought
that only 10%
of depressed
older adults
actually receive
treatment.
Studies have demonstrated that certain factors further predispose individuals
to depression. These may include being female, living alone, those who are
isolated, recent bereavement and loss of functional abilities. Certain personality
traits may increase one’s risk for depression such as low self-esteem, dependency,
and pessimism. There is also thought to be an inherited or familial tendency to
develop depression. Those who had been diagnosed with depression previously in
their lives are also more likely to develop depression in later life.
Finally, researchers have demonstrated that those with certain diagnoses are more
vulnerable to developing depression. Some of the conditions most likely to
contribute to depression include: Parkinson ’s disease, stroke, cancer, dementia,
diabetes, and chronic or severe pain. Finally, it is thought that many medications
used to treat older adults can cause symptoms of depression or side effects that
look like depression. Medications such as anti-hypertensives, psychotropics, pain
medications, steroids, and anti-convulsants are some of the many medications
that can contribute to depression. Sometimes depression can develop without
any obvious cause.
Symptoms of Depression
There are many types of depression, both major and minor. In some types of
depression the symptoms may be worse in the morning and improve throughout
the day. In all cases, the symptoms must be present for at least two weeks before
a clinical diagnosis of depression can be made. Older adults may not have the
“usual” sad effect that may present in younger persons with depression. Often,
their experience of depression presents with more physical complaints, such as
sleep disturbances, fatigue, and complaints of pain or constipation. This can
contribute to a problem with recognizing depression as many of these complaints
can be thought to occur because of the frailty or diagnoses co-existing in the
older adult. Older adults also may present with anxiety and irritability which
also can be over-looked as issues that are resulting from some other physical and
environmental problem.
Some of the more common symptoms of depression include:
• Loss of ability to experience pleasure.
• Withdrawal from usual activities.
• Unreasonable fears.
• Guilt.
• Lack of personal hygiene.
• Feelings of worthlessness, discouragement, and hopelessness.
A Letter from Home | June 2012
Page 2
•
•
•
•
Depressed mood or sadness.
Sleep changes.
Appetite changes.
Confusion/inattention/forgetfulness.
Many older persons with depression will not recognize they are indeed depressed.
In fact, if you asked them if they felt “depressed” the response would often be
a resounding “No!” However, if the older adult no longer feels joy in activities
which they had always liked or has a vague feeling of panic or fear, they may need
to be assessed further by a professional.
Treatments
Depression can be successfully treated in nearly all older adults. Medications
are often quite effective, but may take up to 6-12 weeks to begin working.
Anti-depressant medications are generally well tolerated; but side effects can
occur in any medication, especially the elderly who may be more vulnerable to
interactions.
In many cases therapy and/or lifestyle changes, such as exercise can be helpful in
overcoming depression. Also, your interaction with the client can be helpful in
assisting the client by both knowing how to recognize the symptoms of depression
and how to work with those who are depressed.
Things you can do to help
•
•
•
•
•
•
•
Report any signs of depression to your supervisor.
Provide support and encouragement to your client.
Recognize that depression is an illness and the symptoms are part of the disease.
Observe client for pain. Report signs of pain.
Observe the client’s sleep and appetite pattern. Report changes.
Work with the client to provide self-worth. It is easy in a client with depression to step in and take over; but this can cause dependency and decreased worthlessness. Work with the patient to help them do their own ADL’s as much as they are able.
Take time to listen to the person.
Page 3 The suicide rate
in the US is
highest among
older adults,
particularly older
men.
People over 65
make up about
13% of the
population, but
commit 20% of all
suicides.
A Letter from Home | April 2012
A Letter from Home
A Newsletter for Caregivers
A publication of
iahhc.org
Depression Quiz
True or False:
1.
Untreated depression can make a client’s existing condition appear worse. True or False
2.
Treatment for older adults with depression is more difficult than in younger people. True or False
3.
Depression is a normal part of aging. True or False
Circle the Correct Answer:
4.
Other diseases that may contribute to developing depression include all BUT:
a.
Dementia
b.
Stroke
c.
Pneumonia
d.
Diabetes
5.
Depression is thought to be caused by all the following EXCEPT:
a.
Environmental stressors, such as relocating
b.
Psychological stressors, such as bereavement
c.
Genetic factors-family history
d.
Weakness
6.
Suicide is a risk factor in:
a.
Older adult men with depression
b.
Those with a sad affect
c.
Those with sleep disturbance
d.
Those on anti-depression medications
Answers:
1. True 2. False 3. False 4. C 5. D 6. A
A Letter from Home | June 2012
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