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Depression, Disease, And Aging
Aging brings many changes in health, social relationships, work situation, and other dimensions of life, and old age has been examined as one aspect of life development, showing how earlier stages contribute to the coping mechanisms older people have and how they apply these to new situations. A number of the changes accompanying old age can create stress and depression, and in turn these psychological states can contribute to the onset of disease or to the course disease takes. Studies have also shown that untreated depression can contribute to a higher suicide rate for the elderly.
How the elderly person is affected may depend on his or her closest relationship. The aging process for many includes physical or mental deterioration which can place considerable strain on the life partner, who now has to contend not only with his or her own diminished function because of aging but also must take on a new role as caretaker. The result for the caretaker-partner is increased tension and stress at a time of life when stress should be reduced, and this stress can itself contribute to the physical and psychological problems of the elderly leading to impaired function, increased deterioration, and even suicide. How well an individual does in his or her new role as the partner deteriorates will depend on that individual's own reserve of inner strength and what sorts of external support they receive from family and community.
An interview was conducted with an 86-year-old black man named Andy who faces many of these issues in his own life today. He has been living alone for three years. He is a widower, but he sees his present independent life as a continuation of what his mother taught him about taking care of himself. He works three days a week at Wal-Mart as a greeter. He retired from the Navy after serving for 25 years, and he left the Navy when he was 43 years old. He then taught at a Junior college until retiring once more at the age of 77. He lives in a three bedroom, two-bath home that he owns. He lives alone, as noted, but he does have his grandchildren visit on weekends, which he enjoys greatly. He suffers from congestive heart failure, diabetes, and hypertension. These problems developed over his lifetime, but depression in old age may exacerbate them as he must face these problems alone. In this, he is similar to many other elderly people, some of whom may have a wife or husband but may still experience bouts of depression over their health problems, loss of control, changing lifestyle, and other issues. In addition, as research shows, the husband or wife who acts as caregiver may face many of the same issues with the added burden of having to care for their loved one.
At every stage in life we are faced with the need for individual and social adjustments because of changes in roles, expectations, and patterns of behavior. Among the critical factors for the adjustment of the older couple is their ability to perform successfully in their new roles and the value placed on these roles by others in their social milieu. Patterns of aging have been changing in society as life expectancy has changed. The typical couple twenty years ago had a life expectancy that enabled them to live together approximately 31 years after marriage. Longer life expectancy has increased this time and also means that any children are likely to be themselves married and moved out by the time either husband or wife begins to deteriorate. The typical older family today consists only of the husband and wife, and approximately two-thirds of all aged persons are husband-wife couples living alone, most of whom maintain their own households (Cox, 1988).
Depner and Ingersoll-Dayton (1985) note that the older the couple becomes, the more support they are likely to require. However, family structures having changed, they are also more likely to have only each other for immediate support, thus placing the burden on the one who has deteriorated the least.
Medley (1976) describes three ideal types of marital relationships common among older couples. The first is identified as "husband-wife" and is one in which intimacy is stressed. The second is "parent-child" in which one partner assumes the role of parent and the other the role of child, with the "parent" behaving in a nurturing, protective, and dominant manner toward the other partner. The third is "associates" in which couples act most often as friends. Each of these types of marital relationship can be successful, but it seems evident that the second type, parent-child, is likely to develop even more widely than it would otherwise as a consequence of the deterioration of one partner. This can lead to depression for the caregiver as well as for the individual afflicted by disease.
There are various levels of deterioration possible in aging, and it is likely that the experience of the caretaker-partner depends to a great degree on the level of deterioration in the other partner. One of the more devastating forms of deterioration is seen in Alzheimer's patients as they gradually lose mental ability and even physical functioning. Gruetzner (1988) discusses the experience of the caregiver under these circumstances and states: "The caregiver experience is characterized by the adjustment of the Alzheimer's patient and his family to the illness" (Gruetzner, 1988, p. 1). There is help available to assist in this process from family members, community resources, and medical personnel. The disease itself is characterized by a deterioration in mental activity and in consequent behavior. The patient displays uncharacteristic behavior, neglecting household chores or other work activities and personal hygiene. The patient denies that there have been any behavior changes, and delusions will develop. Gruetzner writes:
Alzheimer's disease is a condition of unknown origin that causes gradual loss of abilities in memory, thinking, reasoning, judgment, orientation, and concentration. Alzheimer's disease is not the result of normal aging, but it does occur more frequently in persons who are 65 years of age or older (Gruetzner, 1988, pp. 5-6).
For the caregiver, the loss of memory on the part of the other partner is devastating because it cuts links to the past that can often be supportive.
Mental health professionals emphasize that depression is not something the patient will simply "get over" but is rather a disorder that must be treated. Depression is technically known as major depressive disorder. It must be understood and treated, and the patient must learn how to live with the problem from day-to-day. First, depression has no single cause and may result from a combination of events and factors. Depression is not only a state of mind but also involves physical changes in the brain. Among the factors that can play a part in depression are family history, trauma and stress, personality factors, physical conditions, and other psychological disorders (Causes of depression, 2004).
Schnie and Willis (2002) note some of the different models of development proposed to explain the course of adult life, the two types being the continuous model and the stage model, each with different features to recommend. They note that the stage approach provides "a sharper contrast between periods of development that are different in important theoretical aspects" (Schnie & Willis, 2002, p. 27).
A key stage approach is that of Erikson. Erikson's formulation of the eight stages has roots in Freud, but Erikson has added various innovative dimensions. Freud presented an important model of psychosexual development, and he felt that during the first five years of life, the individual was confronted with a series of conflicts which he or she would resolve with varying degrees of success. Freud did not emphasize development to the same extent after this first five-year period, and Erikson has tried to conceptualize these later periods in greater detail and has also developed an analysis of man's over-all development in these eight stages (Evans, 1969, pp. 11-12).
In these eight stages, each critical encounter with the environment will dominate at a particular period in the life cycle. The conflicts are not completely separated -- all eight conflicts are present in the individual at birth, and each of the conflicts continues to play a role, if a minor one, throughout life. The first stage is basic trust vs. mistrust as the infant must develop sufficient trust to let its mother out of sight without anxiety. The second stage is that of autonomy vs. shame and doubt, and this sense is usually developed through bladder and bowel control and parallels the anal stage of traditional psychoanalytic theory. The third stage is that of initiative vs. guilt, the last conflict experienced by the preschool child and occurring during what Freud called the phallic stage. The child now must learn to appropriately control feelings of rivalry for the mother's attention and develop a sense of moral responsibility. The fourth stage is industry vs. inferiority, the conflict beginning with school life or the…[continue]
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