Depression in the elderly doesn't have to be a given




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Depression in the elderly doesn't have to be a given

By Mariko Thompson, Long Beach Press Telegram
October 20, 2003

Going gray doesn't have to mean getting the blues. But in too many cases, depression in seniors goes ignored or untreated.

According to the National Institute of Mental Health, nearly one in 10 Americans suffers from depression in any given year. Among the 35 million Americans over the age of 65, an estimated 2 million suffer from a clinical form of depression and another 5 million report depressive symptoms.

Depression can have a significant impact on health. Though seniors make up 13 percent of the U.S. population, they represent 18 percent of suicides. Studies also have found that depressed seniors recover more slowly from major illnesses such as pneumonia and have health care costs that are 50 percent higher.

Yet a recent UCLA study found that fewer than one in three depressed seniors had received effective treatment for depression within the previous three months. Older men, African-Americans and Latinos were the least likely to report treatment. Signs of depression include crying spells, withdrawal and social isolation, expressing feelings of helplessness or hopelessness, acting in an agitated or combative manner, and changes in eating and sleeping habits.

"Families tend to think depression is normal, when it isn't," said Hopey Witherby, program director of inpatient geriatric psychiatry at Sherman Oaks Hospital . "We try to rationalize the behavior when we probably should look for treatment instead."

For older Americans, periods of sadness are inevitable, as family members and friends die and their own health declines. They also tend to experience a loss of identity, once they no longer play the parent and provider, said Robert Kessel, a therapist who provides counseling at the West Hills Retirement Center .

"It's a matter of reframing ideas, of looking at things in a different way," Kessel said. "Some people experience coming into a retirement home or special care facility as a loss of independence. Reframing it as getting some support in order to maintain your independence is a better way to look at it and a less depressing way."

Last year, Stella Pauley, 81, had to adjust not only to a new home, but to a new city . Pauley had spent 50 years in a small Massachusetts town, but health concerns no longer allowed her to live alone. Her daughter, Jan Lyons, a geriatric social worker in Woodland Hills, spent a month in Massachusetts trying to find Pauley a new living situation. Lyons finally decided to bring Pauley to California .

"I had good contacts here because of work," she said.

Lyons placed Pauley at the West Hills Retirement Center . At first, Pauley was reclusive, spending the days crocheting in her room. Knowing her mother needed to establish new friendships, Lyons resisted the impulse to visit daily. The center's staff persisted, befriending Pauley and introducing her to other residents. Pauley soon became friends with a woman who is now her roommate. It took nearly six months, but Pauley is active, taking morning walks and playing Scrabble.

"It's not deep psychology," Lyons said. "It was realizing that other people face the same things -- and they're having fun."

Pauley pulled out of her funk by connecting with a new social group and participating in activities. For those who don't live in a senior community, a multipurpose senior center or adult day-care center can provide those opportunities.

Sometimes, access to services that assist with daily living can boost the spirits. If the person has difficulty shopping, arranging for a grocery service might help. Or if they're worried about getting to the doctor on time, a transportation service can be the solution, said Carol Danziger of ONEGeneration, a multipurpose senior center in Reseda.

"If they're home-bound and we find they are depressed, it's frequently not in a vacuum," Danziger said. "Often there are environmental issues. Taking care of daily needs eliminates the worry."

If depressive symptoms persist, families should talk to a doctor. At the geriatric psychiatry program at Sherman Oaks Hospital , the patient first has a thorough medical evaluation to rule out any physical causes. Then the program tests for type of depression, Witherby said. Treatment components include identifying recreational activities that provide enjoyment, counseling and antidepressant medication.

"It's expected that you'll be unhappy," Witherby said. "But when it's depression and it becomes more severe, it needs to be treated."

Robert Petrie, 71, of Santa Clarita knows he needs to stay healthy to take care of his wife, Marie. For more than two years, Robert has been Marie's primary caregiver and her biggest cheerleader. Marie, 58, suffered a massive stroke and wasn't expected to survive. She has since regained her ability to walk and talk, though much more slowly than before.

"Sometimes I lose it," Robert said. "I start to cry and tell her I can't handle this, that I've got to relax for a bit."

Robert knew the signs of depression since his wife had also struggled with it. So when melancholy persisted, he went to see a therapist. Robert now takes antidepressant medication. He also enrolled Marie in Santa Clarita Adult Day Health Care, where she receives physical and speech therapy and participates in recreational activities. The program gives Robert a respite from caregiving duties, which experts say is critical to avoiding depression and burnout.

"The caregiver can go take care of the things that they need to do," said Linda Alexander-Lieblang, program director of Santa Clarita Adult Day Health Care. "They've been putting all of their stuff on hold to take care of someone else. You can't take care of someone else if you're not healthy, physically and emotionally."

According to the Family Caregiver Alliance, 20 percent of caregivers suffer from depression. When the person in need of care suffers from dementia, rates of depression for caregivers soar to 40 percent. Besides respite, regular exercise and support groups also can help stave off caregiver burnout.

An ongoing National Institutes of Health study called REACH is examining the best practices for reducing stress and depression among caregivers of dementia sufferers. At Stanford University , researchers found that a class combining coping skills and group therapy was more effective in alleviating depression and stress than a support group alone.

"If you offer it as a mental health program, they won't come," said Dolores Gallagher-Thompson, professor of research in the psychiatry department at Stanford University . "We called it a class and that's a lot more appealing. It doesn't make people feel stigmatized."

Stigma still remains an obstacle to treatment. Depression in seniors won't be adequately addressed as long as it continues to be viewed as a personal failing instead of a health problem, Kessel said.

"You can't really separate mind and body," Kessel said. "From a holistic perspective, that boundary between mental and physical health should not be there. It should be health and well-being. We can certainly do better."
SYMPTOMS OF DEPRESSION

Persistent sad, anxious or empty feelings.

Feelings of hopelessness and pessimism.

Feelings of guilt, worthlessness or helplessness.

Loss of interest or pleasure in usual hobbies and activities.

Decreased energy, feelings of fatigue.

Difficulty concentrating, remembering or making decisions.

Insomnia, early-morning awakening or oversleeping.

Loss of appetite or overeating.

Thoughts of death or suicide.

Restlessness or irritability.

Persistent physical symptoms that do not respond to treatment, including headaches, stomach disorders and chronic pain.
Source: National Institute of Mental Health