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Eldercare: Dealing with Clinical Depression

It's estimated that 15 to 20 percent of elders suffer from some kind of depression — everything from the passing mood to the kind that requires medical attention, clinical depression.

Understanding clinical depression

Clinical depression is a deep sadness that persists over weeks and months, wreaking havoc with sleep and appetite, and the quality of your oldster's life and relationships. Clinical depression can cause your age-advantaged person's health to decline often leading to premature institutionalization as his ability for self-care becomes compromised. The blues and grief can develop into a full-blown clinical depression.

Finally, because depression can run in families, some people may have a biological predisposition that puts them at high risk for depressive illness.

Being aware of the signs

If your elder exhibits any of the following symptoms for more than two weeks, he or she needs to be seen by the doctor:

  • Complains of feeling "empty," hopeless, sad, or scared.
  • Shows lack of interest in everyday activities.
  • No longer enjoys formerly pleasurable pastimes.
  • Cries often (sometimes for no apparent reason).
  • Complains of lack of concentration, faulty memory, and trouble with decisions.
  • Expresses feelings of worthlessness or guilt.
  • Has thoughts of suicide or has made an attempt.
  • Complains of headaches, backaches, or stomachaches that don't respond to treatment (when physical problems hide depression, the condition is called a masked depression).
  • Uses more alcohol, drugs, and tobacco.
  • Pays less attention to grooming and hygiene.
  • Sleeps too little or too much, has trouble falling asleep, and may wake up early, unable to fall asleep again.
  • Appears tired and sluggish.
  • Eats more or less than usual, resulting in significant weight gain or loss.
  • Frequently becomes agitated, hostile, or disoriented.
  • Adopts depressive positions and gestures (including sad facial expressions, being stooped over, and staring across room) that indicate sadness.

Searching for causes

A depressive illness can be triggered by an upsetting event or a series of upsetting events, such as moving to a new place, experiencing financial problems, or coping with a newly diagnosed disease.Unrelenting stress also breeds depression. Worry, loneliness, and living in a situation in which no amount of effort improves your circumstances are additional depression-makers. And the list goes on. All sorts of medical conditions and the drugs to treat them may cause depressive symptoms.

If your elder has had a heart attack and is depressed, see the doctor to determine whether counseling and antidepressant medication are needed. Twenty percent of heart attack patients end up severely depressed.

Seniors who display memory problems, confusion, disorientation, and difficulty concentrating are often mistakenly assumed to have dementia when the real problem is untreated depression. This situation is so common that it has its own name — pseudodementia. Left untreated, it can result in premature institutionalization for the senior and heartache for him and his family. Be aware that depression can also co-exist with other psychiatric illnesses, including anxiety disorders. Note that elders in the early stages of Alzheimer's disease often suffer from depression.

Healing through reminiscence

Reminiscence is the work and play of old age. It's not only an enjoyable pastime, it also serves the elder well by helping him forgive, forget, and re-cast past transgressions and disappointments by highlighting the positive events and reshaping the negative events of the past.

The older people get, the more time they tend to spend reflecting on the past. Done well, reflection decreases depression. Scientists studying reminiscence in the elderly have learned that recounting the past is therapeutic, especially when a listener points out how the elder was loved and admired and notes his accomplishments and other positive qualities. Reminiscence brings the past into the present and reminds the older person that he isn't just an old man but also a father, a businessman, a teacher, and a sportsman.

Although reminiscence is useful for most elders, be aware that for some the process only intensifies their despair and low self-esteem. In this case, don't encourage reminiscence. You may have more luck after your elder has received medical treatment for depression.

Healing through re-igniting interest in others

Most depressed people (at all ages) turn their attention inward, obsessing about their own shortcomings and problems, the ills of society, and their dismal future. Any time you can redirect your elder's attention outward, away from his own misery (even for a short time), you have made an inroad to elevating his depression. Gently convince, cajole, and persuade your elder to participate in a support group, become a volunteer, and stay involved in the lives of family and friends.

Talking sadness away

Depression almost always responds to treatment, yet 75 percent of elderly sufferers never get treatment. A medical evaluation is the first step to determine whether illness (including cancer, diabetes, Parkinson's disease) or side effects of drugs (including drugs used to treat high blood pressure and arthritis) are contributing to the problem. Once the doctor rules out those possibilities, he may suggest psychotherapy (talk therapy), which involves counseling with a social worker, psychologist, or psychiatrist individually or in a group. Talking with a trained therapist can give the elder a less pessimistic view of life, enhance his coping skills, and assist in finally setting to rest things that have troubled for him for decades

Taking medicine

Left untreated, a severe depression can debilitate your elder, worsening his medical conditions and affecting his ability to care for himself. Fortunately, 80 percent of people treated for severe depression respond to medications. Most people do best on a combination of antidepressants and talk therapy.

Medication generally takes about two weeks to kick in, and it may be as many as four to six weeks before the elder feels better. In the meantime, talk therapy helps your elder to discover more effective ways to deal with life's problems, including depression.

Some age-advantaged people resist going to a doctor for depression because they believe depression comes from moral weakness or that it's punishment for the sins of their youth. Explain that it's an illness, not a reflection of a character flaw. Remember that depression left untreated can lead to ever more serious problems, including deteriorating health, abuse of alcohol and drugs, and suicide.

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