Download Understanding Depression in Later Life

Sean Brotherson, Ph.D.
Extension Family Science Specialist
Jane Strommen, Ph.D.
Extension Gerontology Specialist
Divya Saxena, M.S.
Extension Associate
Lesson Objectives
 Understand key issues relating to depression,
anxiety and suicide in later life
 Learn about signs of depression and
related mental health concerns in later life
 Explore specific strategies for managing
depression or related issues in later life
 Gain knowledge of specific resources to deal
with depression and related concerns in later life
 Educate the community about geriatric mental health
Understanding Depression in Later Life
2
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.
Understanding Depression in Later Life
3
Answer - False
Myth
Reality
Depression occurs only
when people experience
major trauma in life.
Depression is a commonly
occurring mental health
condition that may arise
due to a variety of factors,
including genetic
influences, body changes,
life stress, personal losses
or other influences.
Understanding Depression in Later Life
4
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.
Understanding Depression in Later Life
5
Answer - False
Myth
Reality
Depression can be
overcome simply by telling
yourself to feel better or
pulling yourself up alone.
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.
Understanding Depression in Later Life
6
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.
Understanding Depression in Later Life
7
Answer - False
Myth
Reality
Individuals dealing with
depression are emotionally
weak or unstable and
seeking help is a sign of
weakness.
Depression is a condition
that anyone can
experience. Seeking
assistance from competent
professionals often is
necessary and signals
wisdom, understanding and
strength.
Understanding Depression in Later Life
8
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
Understanding Depression in Later Life
9
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 percent of people over age 55 residing
independently in the community suffer from major
depression in any given year.
(www.surgeongeneral.gov)
Understanding Depression in Later Life
11
Symptoms of Depression
 Difficulty falling asleep
 Sleep more than usual
 Have trouble making
decisions
 Feel tired all the time
 Think about suicide
 Feel less energetic than usual  Have problems
concentrating
 Feel nervous or unable
 Irritability
to sit still
 Lack motivation
 Experience an increase
or decrease in appetite or
weight
 Feel sad or blue most of the
day nearly every day
 Lose his or her temper
more easily than usual
 Lose interest in things that
he or she used to enjoy
Understanding Depression in Later Life
12
Risk Factors for Depression
 Social isolation
 Personal history of:
• Chronic medical illnesses
• Chronic pain
• Loss of physical
functioning
• Prior depressive episodes
• Reliving bad past
experiences
• Recent significant loss
• Multiple recent stressors
 Family history of:
•
•
•
•
Recurrent depression
Bipolar disorder
Mental health issues
Alcohol abuse or
dependence
(www.positiveaging.org)
Understanding Depression in Later Life
13
Anxiety Often Goes Along
With Depression
Understanding Depression in Later Life
14
Anxiety
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 percent of the
population over age 55 suffers
from an anxiety disorder in any
given year.
(U.S. Department of Health and Human Services)
Understanding Depression in Later Life
15
Symptoms of Anxiety
 Excess or undue worry or
fear
 Fatigue
 Disturbed sleep
 Jumpiness, jitteriness,
trembling
 Muscle aches, tension
 Dizziness,
lightheadedness
 Gastrointestinal upset
 Racing heartbeat, chest
discomfort
 Shortness of breath or
the feeling of being
smothered
 Numbness or tingling of
hands, mouth or feet
 Dry mouth, sensation of
a lump in the throat,
choking sensation,
clammy hands, sweating
Understanding Depression in Later Life
16
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)
Understanding Depression in Later Life
17
Grief, Loss and Depression
www.youtube.com/watch?v=_thfjbAtTT8
Understanding Depression in Later Life
18
Older Adults Experience
Many Losses







Living situation
Relationship
Identity/status
Health
Finances
Independence
Mobility
Understanding Depression in Later Life
19
Grief vs. Depression
Stages of Grief
 Denial, numbness,




shock
Bargaining
Anger
Depression
Acceptance
• Loss of appetite
• Loss of interest in
everyday tasks
• Loss of sleep or
sleeping too much
• Physical complaints
• Sadness, tearful
• Anxiety
• Anger, irritability
Understanding Depression in Later Life
20
Is it grief or depression?
Grief
 Intense feelings
generally begin to
lessen three to six
months after the loss.
Depression
 Typically, depressive
symptoms will not resolve
without some kind of
intervention.
 Timelines are very
individual and depend
on many factors.
 Integrating loss into
normal life can take one
to two years.
Understanding Depression in Later Life
21
Suicide
Research
consistently
has shown a
strong link
between
suicide and
depression.
Understanding Depression in Later Life
22
Suicide and Older Men
White men 85
and older are
more likely to
commit suicide
than Americans
in any other age
group, taking
their lives at
twice the rate of
the 15- to 24year-old group.
Suicidal
behavior in
older men can
be a reaction to
a perceived loss
of social status.
Suicide may be
linked to loss of
impulse control.
Understanding Depression in Later Life
23
Suicide and the Older Adult
Watch for These Signs
 Withdrawal from activities they
ordinarily enjoy
 Negative thoughts, including
frequent talk about death
 Strong feelings of guilt
 Decline in hygiene or
appearance
 Stockpiling medication
Understanding Depression in Later Life
24
At risk for suicide?
Call for help:
 FirstLink has a 24-hour Suicide Lifeline,
1-800-273-TALK (8255), which is connected
to a national network of crisis services. Call
specialists help those who are having thoughts of
suicide or have a concern about someone.
Seek help:
 Go to the nearest emergency room for evaluation
 Go to: www.suicidepreventionlifeline.org
Understanding Depression in Later Life
25
Depression: What should I look for?
Physical Appearance
 Dirty clothing, skin or hair
 Body odor, unshaven, hair uncombed
 Little attention to clothing worn, appearance
 Significant weight loss or weight gain
 Fatigue or exhaustion from lack of sleep,
despair, etc.
www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf
Understanding Depression in Later Life
26
Depression: What should I look for?
Emotional State






Anxious, nervous, fidgety
Lack of 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
Understanding Depression in Later Life
27
Depression: 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
Understanding Depression in Later Life
28
Depression: 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, mail 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
Understanding Depression in Later Life
29
Key Help Factors in
Managing Depression
 Seek effective medical care or
sources of support and treatment
 Identify and increase support from
family and community members
 Have a regular support checkup
(weekly, etc.)
Understanding Depression in Later Life
30
Key Help Factors in
Managing Depression
 Focus on healthy living
practices
 Increase personal skills
in stress management
 Explore cultural and
religious beliefs that
encourage hope,
optimism and personal
support efforts
Understanding Depression in Later Life
31
Seeking Treatment and
Support for Depression
 Focus on getting help and
getting better, not on being
embarrassed due to depression
or anxiety.
 Start with your personal doctor.
 Begin by seeking an opportunity
for a medical screening,
 Talk to a trusted counselor,
pastor or friend.
Understanding Depression in Later Life
32
Barriers to Diagnosis
and Treatment







Age-related changes
Illness
Attitudes of others
Denial
Health complaints
Alcohol or drug use
Stigma
Understanding Depression in Later Life
33
What can I do to help?





Avoid talking to the person if he/she is upset.
Be gentle and kind.
Avoid a confrontational style.
Avoid using labels.
Use age- and ability-appropriate
language.
Understanding Depression in Later Life
34
What can I do to help?
 Be consistent and patient in
your expression of concern.
 Be direct in your approach.
 Exhibit a nonjudgmental
attitude.
 Give specific examples of
behaviors that concern you.
 Use statements such as
“I am concerned about you.”
Understanding Depression in Later Life
35
What can I do to help?
 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.
 Encourage the
person to get proper
professional assistance
from a primary-care
doctor.
Understanding Depression in Later Life
36
Where to get help?
 Visit your doctor.
 Seek counseling with a
mental health professional.
 Call 2-1-1 for
confidential listening
and support, in addition
to information and
referral. Call specialists
are trained in crisis
intervention, including
suicide intervention.
Understanding Depression in Later Life
37