A comment that has frequently been made by doctors and many well-meaning individuals is that their patient or family member is depressed because they are “old”. Also, these comments may be made because someone has been placed in a nursing home or has had some level of reduced functioning. Depression however, is not a natural consequence of getting old, being placed in a nursing home or developing some level of reduced functioning or disability. Depression is a pathological mental condition that can be disabling, resulting in prolonged suffering due to severe mood change which if left untreated can result in increased disability or even premature death.
How much depression are we talking about?
The National Institute of Mental Health’s, Epidemiological Catchment Area Study has concluded that approximately 1 million of the nation’s 31 million people aged 65 and older may possibly suffer from major depression. They have also concluded that possibly another 5 million may have depressive symptoms that are severe enough to require treatment.
Depression misdiagnosis and special problems:
One of the more difficult aspects of depression among the elderly is that it is so frequently misdiagnosed and untreated. A National Institutes of Health consensus report titled Diagnosis and Treatment of Depression in Late Life stated that “What makes depression in the elderly so insidious is that neither the victim nor the healthcare provider may recognize its symptoms in the context of multiple physical problems of many elderly people.”
Many older people live alone and have very limited support systems. They may find it very confusing at times to understand the multiple systems available to provide for their medical care and mental health needs, as well as their need for social services and financial assistance.
On the positive side, there are now growing numbers of specialists to provide care to the geriatric community. Their understanding includes the unique interaction between the medical and mental health needs of seniors, as well as some of the factors which inhibit them from getting necessary services.
Stigma of Depression:
A phenomenon which I have witnessed frequently in my years as a geriatric psychologist is that there is a significant stigma attached to mental health concerns among the elderly, that is much higher than among the younger age groups. This stigma frequently undermines seniors getting the care they need due to their embarrassment over their need for professional help for emotional problems.
In addition, frequently family and friends fail to perceive signs of distress and do not encourage treatment. Older depressed patients more often will mention physical complaints to their primary care physician rather than report subjective feelings of depressed mood. They will frequently report insomnia, loss of appetite, low energy and lack of interest in normal activities more so than reporting a subjective state of low mood or depression. Unfortunately, many times the patient, family and even doctor will see the symptoms as part of the “normal process of aging”.
Depression frequently goes untreated or misdiagnosed due to the multitude of medical issues, financial concerns, losses due to death and disability, loss of status and self-identity, fears of death, social isolation and a variety of other psychological, medical and social concerns. Any one of these issues may trigger stressors or life changes that are difficult to handle resulting in grief or depression.
The higher prevalence of medical concerns and the use of medications also complicates the diagnosis and presentation of depression among the elderly. While depression may frequently be the primary disorder, it may also be a byproduct of an underlying medical cause such as Parkinson’s Disease, stroke, cancer or even a reaction to prescription medications.
Dementia and Depression:
The incidence of dementia can also be a factor in confusing the presentation of depression among the elderly. Depression is known to exacerbate an underlying dementia or to cause a certain level of dementia sometimes referred to as pseudo-dementia or a false dementia. Symptoms of depression have been known to mimic symptoms of dementia such as disorientation, distractibility or memory loss which may be seen in individuals with Alzheimer’s disease.
On the Positive Side:
Fortunately, depression among the elderly is just as treatable as it is among the younger populations. You and your loved ones should never be satisfied with a diminished quality of life at any age due to depression. Psychotherapy and medications have been demonstrated to be just as effective among our seniors as among younger individuals. However, many well-meaning friends, family members and even doctors do not have the training or understanding to recognize the unique qualities associated with depression among the elderly and therefore do not recommend or encourage the necessary treatment.
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