Depression continues to be one of most common medical conditions for the elderly.
Percentages of elderly with the illness
Degree of increase in suicidal tendencies of depressed
Wrong assumption that aging necessitates depression.
Difficulty of healthcare providers in recognizing depression.
Increased tendency toward suicidal tendencies in many depressed.
Other individuals immune to depression and suicide despite life problems.
Individuals may not even recognize their own depression
Myths associated with aging including depression
Symptoms may take months to worsen and show up
Aging individuals should be treated similar to younger patients when seen by doctor.
Depression can mask itself in many ways
Up to family and healthcare providers to be vigilant and notice changes.
With care, individuals can be helped.
Depression ranks as one of the most common medical problems in the elderly. The occurrence of this illness among community-dwelling older individuals ranges from 8 to 15% and among institutionalized individuals, about 30%. Depression is also listed as one of the greatest risk factors for suicide in this population: White men aged 65 to 69 have a 45% greater predisposition to commit suicide; 70 to 74, an 85% greater tendency; and over 85, more than three and a half times greater inclination. If recognized in time, a significant number of individuals could easily be treated by pharmaceuticals and/or therapy for their depression. Yet, despite the high percent of cases, the problem often goes undiagnosed or ignored by a large number of healthcare professionals. "The elderly depressed are chronically undertreated, in large part because we as a society see old age as depressing. The assumption that it is logical for old people to be miserable prevents us from ministering to that misery..." (Solomon, 2001, pg. 188)
How can such high numbers of incidence be decreased? Is there a way for healthcare providers and social workers to recognize which individuals will take such drastic measures and intervene before it is too late? Unfortunately, this appears easier said than done, since detection problems contribute to these statistics (Evans 2000, p.1). Studies show that the elderly do not easily talk to others about their depression and concerns due to the stigma of getting psychiatric care. They will visit their primary-care physicians, but do not mention that they are suffering any depressive symptoms such as feeling helpless, no longer enjoying friends and family, memory loss, sleeping difficulty, anxiety and extreme lack of energy. In fact, adds Evans (ibid, pg. 3) "it has been estimated that approximately 80% of the elderly who commit suicide have visited a doctor within a month prior to their death. All too often, the signals that an older person is depressed are confused with signs of aging."
Research indicates that even mental healthcare practitioners have difficulty identifying depression, since the alarms may or may not go off. A study at the University of Iowa (Holkup, 2003, pg. 8) graded warning signs, determining those that would be most in need of psychiatric intervention. The research also provided a profile of the typical elder who commits suicide. The warning signs were under four categories: 1) verbal clues -- comments concerning the wish to die; 2) behavioral clues -- failing a suicide attempt, especially since most elderly are successful the first try; stockpiling medication; purchasing a gun; making or changing a will; putting personal affairs in order; giving money or possessions away; donating one's body to science; having a sudden interest or disinterest in religion; neglecting oneself; having difficulty performing household or social tasks; deteriorating relationships; declining health status; and scheduling an appointment with a physician for vague symptoms. 3) situational clues -- circumstances that are causing stress such as death of a spouse or major illness and 4) Syndromatic clues -- depression with anxiety; tension, agitation, guilt, and dependency; rigidity, impulsiveness, and isolation; and changes in sleeping and eating habits.
The survey (Holkup, ibid) also noted that some individuals have a greater risk of personal violence compared to others because of their personality makeup, daily situation or mental/physical history. These risk factors include living alone and feeling islolated, being retired or unemployed, depression (Over three-fourths of elderly victims are reported to suffer from some sort of psychiatric disorder at the time of their death [De Leo, 2004]), and suffering from alcohol abuse or dependence (Alcohol abuse and dependence are present according to different studies in 3-44% of elderly suicide victims [ibid]), loneliness (Up to 50% of victims, particularly women, are reported to live alone and be lonely [ibid]), hopelessness, sense of fatalism, low self-esteem and/or decreased life satisfaction. In adition, these individuals may have a family or personal experience of suicide and mental illness such as depression and/or chemical dependence, in addition to a history of a broken home, harsh parenting, and/or early childhood trauma.
Studies have also been conducted that show traits that cause immunity to suicidal thoughts. Holkup's survey also found signficantly lower incidences of suicide in individuals who have the potential for understanding, relating, benefiting from experience, and acceptance of help; the capacity for loving, wisdom, sense of humor and social interest; the possession of a sense of purpose in life; a history of successful transitions and coping independently; strong family support system; presence of caring health providers; regular religious affiliation; commitment to peronal values; and flexibility in coping skills.
Sometimes, the individuals may be depressed and do not even recognize themselves that they are ill, because they have felt this way for a long period of time and it has become part of their persona. Kiecolt-Glaser and colleagues studied 49 former caregivers of a spouse with dementia, 42 current caregivers of a spouse with dementia, and 52 matched controls who were not caregivers. Even several years after a spouse's death, former caregivers did not improve on several measures of psychological well-being. For example, 41% of former caregivers had mild-to-severe depression two to three years after the spouse's death, which was not significantly different from the 43% depression rate among current caregivers. By contrast, the depression rate was 15% among controls.
One of the reasons why physicians do not recognize the serious nature of their patients' mental health is because of the myth that exists about older individuals frequently suffering from depression. Treatment is not suggested, since it is believed that nothing can be done for depression associated with aging. Or, family members or healthcare providers confuse depression with evidence of the onset of Alzheimer's Disease. (Rosenfeld, 1999, p. 6). This physician relates the story about a man whose children were convinced he had Alzheimer's because he'd become withdrawn for no apparent reason. His wife had died several years before, and he lived alone. The children put him in a retirement home, where he fell in love with another resident. His depression disappeared, and the couple married and had a very enjoyable life for many years.
A study of depressed patients found that the elapsed time from onset of symptoms to accurate recognition of depression ranged from three to 36 months, during which patients often, if they received any treatment at all, were treated for other illnesses "while family difficulties worsened, financial resources were depleted and suicidal risk continued" (Galton, 1975, p. 69)
Other myths about aging include: Most completed suicides are terminally ill; elders who commit suicide do not have close family members; suicidal behavior is a normal response to stresses experienced by most people; there is nothing that can be done to stop an elderly suicide; most suicide elders will self-refer to obtain mental health care; and suicidal elderly do not exhibit warning signs of suicidal intent. There are many individuals in their 70s and 80s who are leading very productive lives. Also, people age in different ways at different times of their lives. In addition, there are probably many different normal aging trajectories with varying trends for different genetic and socio-cultural subpopulations.
Thus, it is not any wiser to make assumptions for the elderly as it is for younger individuals. If a middle-aged or young adult sees a healthcare provider because he/she is feeling out of touch or more despondent than usual, it is hoped that tests would be run for both mental and physical problems. The same should hold true for someone in their later years as well. It comes as no surprise that individuals undergo physical, mental and emotional changes as they age. People do undergo some memory reduction, slowing down physically, chronic pain and grieving if a loved one or friend passes away. Many elderly also become more anxious and impatient because they are not able to do everything as in younger years.
In addition, the elderly undergo physical changes that can also impact mood (Solomon, 2001, p. 189). Levels of all neurotransmitters are lower among old people. The level of serotonin in people in their 80s is half of that of those in their 60s.
True depression, therefore, can be difficult to spot in these populations. It has often been called "the great masquerader" (Galton, 1975, p. 68), because it mimics a host of…