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Depression Among Elderly: Common But Not Normal

By: Lucia Dela Cruz, PhD, RGC article_4

When the world lost one of its greatest Hollywood actors, Robin Williams, people were left in a state of shock. How could someone who seems to have everything — talent, fame, and fortune — commit suicide by hanging himself? But it was found out later on that the actor was struggling with Parkinson's symptoms, anxiety attack, depression, and paranoia— the kind of condition that puts you in an ugly place and makes everything else irrelevant. Robin was 63 years old then, which makes us wonder whether depression impacts older people in a different way than younger individuals.

While the proverbial phrase “the spirit is willing but the body is weak” is periodically experienced by younger people, it aptly describes the condition of the elderly which can lead to clinical depression if not given proper attention. It’s true that the period of old age (senescence) is expected to be tough and rough, not only in the person’s physical condition but also in his psychological and emotional state.

But how and when do we know when an elderly is under depressive attacks? Some signs according to authorities are: “when there’s a feeling of emptiness without apparent reason/s; having difficulty remembering or can’t make decisions the way they did before; having no interest doing the usual leisure activities; feelings of hopelessness or pessimism; feelings of guilt, worthlessness, or helplessness; lack of appetite; complaints of aches and pains that keep coming back while the physician can't find anything wrong.” When these symptoms go on and on and on for weeks and months, the elderly are definitely suffering from clinical depression.

Reaching the golden years definitely involves an array of life stressors that can lead to depression especially if the older adult has to work to continuously earn a living. Some of them find it hard to cope with the transition from full-time promising careers to retirement, while others are grudgingly forced to retire due to serious health issues which eventually lead to financial crisis. More so, the lack of mobility, either due to physical condition or have limited options because of low socioeconomic status, can result in social isolation and loneliness. Though Filipino elders are part of a resilient culture, our older adults said in a report that their depression occurs when: “you feel lonely and with so much problems yet no one to talk to; when you couldn’t handle your problems and experiencing difficult trials; when you have a family and children who are still studying and you have daily expenses yet you have no income; when you are sick but couldn’t buy the prescribed medicines; when disaster like a strong typhoon hit us and leave us with nothing; in the occurrence of the biggest problem but we could not do anything to solve it and nowhere to go to get the needed support.” Suffice it to say that the lack of income security, poor health, challenged integrity, lack of family support, and disasters are some of the common causes of depression among our Filipino elderly.

Clinical depression in the elderly is common according to some reports, but it doesn't mean that it's normal. Globally, an estimated 350 million people suffer from depression and it occurs in 7% of the general older population. Late-life depression affects about 6 million Americans ages 65 and older. In most societies, symptoms of depression in older people are often overlooked and untreated because these coincide with other problems they encountered. Clinical depression is different from a common depression which involves a feeling of sadness or having “down” moods which everyone experiences every now and then.  Oftentimes, these feelings would instantly pass after a good movie or a chat with closed or trusted friends. For the elderly, the symptoms are often mistaken as the effects of multiple illnesses or medicines that they take. This makes it hard to detect whether they are struggling with depression or simply experiencing the effects of other conditions. Nevertheless, the weakening physical condition of the elderly has the greater contribution leading to depression.

Heart attack, as one of the most common reasons of death among the elderly, happens to be the usual outcome of depression. Depression is connected with an increased risk of cardiac diseases and an increased risk of death from the illness. At the same time, depression reduces the elderly's ability to recuperate. Studies of nursing home patients with physical illnesses show that the presence of depression significantly enhances the possibility of death from those illnesses. There are two more serious types of clinical depression and these are major depression and bipolar disorder. Some people have “dysthymia” (a persistent depression that has symptoms such as fatigue, low self-esteem, insomnia, and appetite disturbances but is not severe enough to amount to a psychosis) which is less intense than major depression but can persist for at least two years. The most common form of depression is reactive depression, which is diagnosed as an adjustment disorder with depressed mood. This refers to the mild or moderate depression that occurs after a significant loss, or in response to serious life adjustment problems. Major depression makes it almost impossible to carry out usual activities such as sleeping, eating, or even enjoying life. It’s as if pleasure is a thing of the past. This type of depression can occur once in a lifetime or, it can recur several times. People with major depression need psychological counseling, and may also need medication to regain control of their lives.

As a reminder, clinical depression is a whole body disorder. It affects the way you think and the way you feel, both physically and emotionally. It isn't "normal" to feel depressed all the time when you get older. In fact, survey says that most of the older people feel satisfied with their lives. However, it was reported in another survey that around 3 out of 100 seniors experience clinical depression. This is a serious problem, and can even lead to suicide. But there is good news. Nearly 80% of the people with clinical depression can be treated successfully with psychotherapy. Sometimes a combination of psychotherapy and medication works better, especially if you have a very disturbed sleep, or can't get yourself out of bed to do anything.  Even the most serious depressions usually respond rapidly to the right treatment. But first, the presence of depression has to be recognized. Older adults, as well as the younger ones, have to be familiar with the difference between the typical depression and clinical depression. It is important to make sure that you and the elderly person you are taking care of are aware of it. In case of serious symptoms, the older adults have to be evaluated and treated, even if their depression is not very alarming yet. Staying and talking with them from time to time are the initial steps you can do to check on their conditions. Monitoring their daily activities is basically a good reference as you would be able to identify the changes in their moods and behaviors.

To sum it all up, we should all be concerned about our elderly not because we, too, will grow old someday but because “it is the duty of every culture to take care of its elderly,” (from the movie “Going in Style”). It is our duty to take care of them because without our elders, there will be no history. 


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Keywords: psychotherapy , reactive depression, dysthymia, bipolar disorder, heart attack, senescence, senior citizen, clinical depression   
  
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