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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