By Deborah P. Rattle, MSSW, CSW
For many, growing older offers a time for reflection, rejuvenation and opportunities for exciting new challenges and rewards. Conversely, the difficult changes that many older adults face – the death of a spouse, adult children living far away, financial stress, medical problems – can present great challenges and, for some, a path to depression. But, depression is not a normal or necessary part of aging. Contrary to some opinion, growing old and depression do not have to go hand-in-hand.
Everyone, older adults included, feels sad or blue at times in their lives, but these feelings generally pass with time. When the feelings don’t pass, it’s time to seek advice from a physician or other behavioral health professional.
As with other medical experiences, however, it’s best to be prepared to be your own best advocate. Why? Some health professionals mistakenly think that persistent depression is an acceptable response to other serious illnesses and the social and financial challenges that may accompany aging. Exacerbating this belief, many older adults describe their symptoms of depression in physical health terms – leading the healthcare professional to concentrate only on the physical complaints and ignoring the consideration of depression as the root, not the symptom, of illness.
Unfortunately, this approach contributes to low rates of diagnosis and treatment in older adults. Additionally, many older adults have difficulty acknowledging depression – seeing it as a sign of weakness or a personal failure. Recent data from the Centers for Disease Control indicated that among adults age 50 or older, 7.7% report current depression and 15.7% report a diagnosis of lifetime depression.
Unacknowledged and untreated depression not only prevents older adults from enjoying life and its rewards, it takes a heavy toll on physical health and can complicate existing medical conditions. Untreated depression also increases the risks of alcohol and prescription drug abuse and suicide. Research also reveals a higher mortality rate for those who go untreated.
But, there is good news. With treatment and support, depressed older adults can get better. No one, whether they are18 or 80, has to live with depression.
Effective treatments – through medication and counseling – are widely available. The first step to success is talking openly with a physician, spiritual counselor or behavioral health therapist. These professionals can guide older adults in determining the most appropriate intervention to ease the depression and accompanying symptoms.
As important as appropriate medical care and counseling are to addressing depression, the effects of lifestyle decisions can’t be overlooked. Having and maintaining a strong and close social network is important at all ages. Cultural experience indicates this importance grows as we age.
In our community, there are many opportunities for fellowship and social support – faith-based senior health ministries, older adult higher learning courses at local colleges/universities and senior adult activity centers. Senior centers are located in many neighborhoods and offer older adults opportunities to learn and master new skills, take part in group outings or wellness programs and enjoy gratifying volunteer opportunities and experiences in intergenerational programs.
Due to increased interest and awareness of depression in the general population, as well as the older adult community, both the US Department of Health & Human Services and the World Health Organization recommend priority action in identifying and treating depression. These websites illustrate effective programs for addressing depression among older adults:
1. IMPACT (Improving Mood-Promoting Access to Collaborative Treatment).
2. PEARLS (Program to Encourage Active Rewarding Lives for Seniors). The PEARLS Implementation Toolkit can be found at http://depts.washington.edu/pearlspr.
3. Healthy IDEAS (Identifying Depression, Empowering Activities for Seniors).
Causes and risk factors that contribute to depression in the older adult include:
Loneliness and isolation – Living alone; dwindling social circle due to deaths or relocation; decreased mobility due to illness or loss of driving privileges.
Reduced sense of purpose – Loss of identity due to retirement or physical limitations on activities.
Health problems – Illness and disability; chronic or severe pain; cognitive decline; damage to body image due to surgery or disease.
Fears – Fear of death or dying; anxiety over health or financial issues.
Persistent sadness or “empty feelings.”
Feelings of hopelessness and/or pessimism.
Feelings of guilt, worthlessness and/or helplessness.
Loss of interest in activities or hobbies once pleasurable.
Fatigue, decreased energy.
Difficulty concentrating, remembering details and making decisions.
Insomnia, early morning wakefulness or sleeping too much.
Overeating or loss of appetite.
Thoughts of suicide, suicide attempts.
Persistent aches or pains, headaches, cramps or digestive problems that don’t ease – even with treatment.
(Source: National Institute of Mental Health)
Image from: www.circleofrights.org/older-adults-and-depression/
Deborah Rattle, MSSW, CSW is the Planning Officer for Seven Counties Services, Inc., the largest comprehensive behavioral healthcare organization in Kentucky. She also serves as a lecturer and part-time practicum faculty for the Kent School of Social Work Field Education Office at the University of Louisville. Rattle is president of the KIPDA Region Mental Health & Aging Coalition and co-president of the KY State Coalition on Mental Health & Aging. She has over two decades of experience in developing and implementing programs that enhance the behavioral health of older adults.