Emotional Care
 Late Life Depression
There are countless reasons seniors may feel sad later in life. Many are widowed and have lost close friends. Countless numbers are separated from family or suffering from ill health. They may feel guilty for having feelings of sadness which may in turn intensify those emotions.
Holidays can be a difficult time for seniors who feel sad and depressed. Often they will hide these feeling from friends and family because they don't want to worry anyone. And they may often try to deny them. But feelings of sadness are a normal part of mourning the lose friends and loved ones, loss of abilities, of freedoms, sometimes their very selves as they grow older. Life can feel like it is contracting inward, assaulting the pride of independence and robbing every dignity. These emotions must be recognized and acknowledged for what they are in order to move through them and move back to a natural state of joy and gratitude. No matter what has been lost, joy and gratitude can always be found for something, even if it is simply another beautiful day with breath in the body and sunshine on the face. The point is sadness left unchecked can spiral into depression. And serious depression will seriously rob all possibilities of any quality of life.
Following are some suggestions that will help to prevent or lessen feelings of sadness.
- Don't isolate yourself, especially during the holidays. If you can't be with family, invite some close friends over.
- Volunteer your time. Many churches or civic groups would be glad of your help. Helping others is a great way to forget your own troubles.
- Try to avoid alcohol. Many seniors develop alcohol dependence after retirement or loss of a loved one. Alcohol is a depressant and will intensify those feelings of sadness.
- Watch your finances. Most seniors are on a fixed income. Set a budget for gift giving during the holidays and stick to it. Don't feel guilty if you can't afford to buy grandchildren expensive gifts. It’s you they will remember, not the gifts. Overspending will cause worry over bills after the holidays are over.
- Don't deny or try to hide your feelings of sadness. Very often just being able to share your feelings with someone can help
- Spend some time organizing and mounting photographs taken during special events and holiday. Take time to relive the fun and friendship.[i]
DEPRESSION SCALE
The following test is a useful tool to help detect depression in a senior relative or in yourself if you are unsure you or your relative are suffering from its effects. Depression is often shrugged off as temporary sadness or just a “low point” in life. However, its cumulative effects can cast a long lasting pall over quality of life if left unacknowledged and unaddressed. If this test reveals or you suspect depression, consult a professional counselors, psychologist or psychoanalysts.
Choose the best answer for how you felt this past week. Circle yes or no
- Are you basically satisfied with your life? Yes NO
- Have you dropped many of your activities and interests? YES no
- Do you feel that your life is empty? YES no
- Do you often get bored? YES no
- Are you hopeful about the future? Yes NO
- Are you bothered by thoughts you can't get out of your head? YES no
- Are you in good spirits most of the time? yes NO
- Are you afraid that something bad is going to happen to you? YES no
- Do you feel happy most of the time? yes NO
- Do you often feel helpless? YES no
- Do you often get restless and fidgety? YES no
- Do you prefer to stay at home, rather than going out? YES no
- Do you frequently worry about the future? YES no
- Do you feel you have more problems with memory than most? YES no
- Do you think it is wonderful to be alive now? yes NO
- Do you often feel downhearted and blue? YES no
- Do you feel pretty worthless the way you are now? YES no
- Do you find life very exciting? yes NO
- Do you worry a lot about the past? YES no
- Is it hard for you to get started on new projects? YES no
- Do you feel full of energy? yes NO
- Do you feel that your situation is hopeless? YES no
- Do you think that most people are better off than you are? YES no
- Do you frequently get upset over little things? YES no
- Do you frequently feel like crying? YES no
- Do you have trouble concentrating? YES no
- Do you enjoy getting up in the morning? yes NO
- Do you prefer to avoid social gatherings? YES no
- Is it easy for you to make decisions? yes NO
- Is your mind as clear as it used to be? yes NO
Count number of CAPITALIZED (depressed) answers
Score: _____(Number of "depressed" answers)
Normal 5 +/- 4
Mildly depressed 15 +/- 6
Very depressed 23 +/- 5 [ii],[iii]
Depression simply refers to a depressed mood or episode. Depression is an affective disorder that has no chronological, cultural, or biological barriers. Anyone can be afflicted at any time. When feelings become inappropriate, extreme, and dysfunctional, they are deemed to be a mood disorder. Normal sadness eventually disappears without treatment but depression continues to affect every aspect of a person’s life.
Grief that lasts longer than two months, severe and persistent grief, can develop into clinical depression. People with clinical depression suffer from constant negative thoughts and as a result their self-esteem can become very low. Several symptoms warrant an examination by a psychiatrist; thoughts of suicide, substance abuse, bipolar disorder, and the presence of psychosis. Whether depression is acute or chronic, pharmacological and/or psychological intervention remains crucial to alleviate adverse emotional reactions.
Depression varies across age spans. Depression is found in all age groups, but strikes mostly middle-aged adults. The elderly are more likely to suffer from chronic depression which is associated with neuronal reductions, specifically in the temporal cortex grey matter. The elderly are more susceptible to brain changes of this nature. Lack of attention and intervention on behalf of health care professionals may result in unnecessary morbidity and mortality.
Prevalence
Unfortunately, depression in older adults is often misdiagnosed, under treated, or completely ignored because of ignorance or the belief that such emotional responses are natural part of aging. A lack of education and available pharmacological treatments is partially responsible as is the abundance of multiple somatic complaints which can interfere with the recognition of depression. For example, depression could easily be hidden if it is masked by another disorder such as alcoholism or dementia. Among older adults, dementia is most likely to conceal depression. It is difficult to estimate how many suffer from depression because their symptoms may be misinterpreted as due to other physical problems.
Criteria for a Major Depressive Episode
- Depressed mood
- Loss of pleasure or interest
- At least 4 (3, if both (1) and (2) are present) additional symptoms: increase or loss of appetite or significant weight gain or loss when not trying to lose weight, insomnia or hypersomnia, psychomotor retardation or agitation (observable by others), fatigue or loss of energy, feelings of worthlessness or excessive/inappropriate guilt, diminished ability to think, concentrate, or make simple decisions, recurrent thoughts of death, passive or active suicidal ideas
- Duration of at least 2 weeks, with the above symptoms being present most of the time, nearly every day
- Symptoms are distressing and/or interfere with functioning[iv]
If you or an adult relative is suffering from any type of depression from mild to chronic and/or severe, it is time to consult professionals who can bring relief. Professional services are very diverse, but below is a brief overview of some of the terms and their services for your convenience:
Counselors
A counselor or mental health professional exists to improve an individual's mental health. Because mental health covers a wide range of elements, the scope of practice greatly varies between professionals.
Psychiatrists
Psychiatrists are physicians in the mental health industry who specialize and are certified to treat mental illness using the biomedical approaches to mental disorders including the use of medications. As part of their evaluation of the patient, psychiatrists are one of only a few mental health professionals who may conduct physical examinations, order and interpret laboratory tests and EEGs, and may order brain imaging studies such as CT or CAT, MRI, and PET scanning. Historically psychiatrists have been the only mental health professional with the power to prescribe medication to treat specific types of mental illness.
Psychologist
A psychologist uses counseling techniques to help people with "normal" or "moderate" psychological problems, such as the feelings of anxiety or sadness resulting from major life changes or events.
Psychoanalysts
Psychoanalysis utilizes theories and methods based on the work of Sigmund Freud. Psychoanalysis seeks to discover connections among the unconscious components of patients' mental processes with the goal being the liberation of the patient from unexamined or unconscious barriers and past patterns of relating that are no longer serviceable or that inhibit freedom.
[i] Croft, Harry Dr., About: Senior Health “Holiday Blues” http://seniorhealth.about.com/od/mentalemotionalhealth/a/holiday_blues.htm
[ii] Yesavage JA, Brink TL, Rose TL, et al. Development and
validation of a geriatric depression rating scale: a preliminary
report. J Psych Res. 1983; 17:27..
[iii] Sheikh JI, Yesavage JA. Geriatric Depression Scale: recent
evidence and development of a shorter version. Clin Gerontol.
1986; 5:165-172
[iv] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Association; 1994.
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