Depression in the Elderly

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Bob is a retired secondary school mathematics teacher. He and his wife, Betty, who live in East Sussex, have three grown children, but they don’t see them often. Two of their children are working overseas and the third lives in Scotland, and Bob and Betty can’t afford to travel as much as they’d like to.

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Shortly after he left his job, Bob developed nerve deafness in both ears that so far can’t be improved with a hearing aid. He tried to learn to lipread, but found it difficult because he is nearsighted and doesn’t like using glasses. Betty has osteoarthritis that restricts her mobility, so Bob does most of the housework, including the cooking.

Over a period of two months, Bob started to have difficulty sleeping. He woke up every two or three hours during the night, and by four in the morning he was wide awake and couldn’t get back to sleep. He had pains in his stomach after he ate that made him think he had cancer, but he didn’t want to upset Betty, so kept it to himself. He had difficulty remem¬bering where he had put things, and what to buy at the grocery shop when he got there. The cooking and housework seemed like more and more of a burden. He didn’t know how he and Betty would manage in their house as they got older, yet he hated the thought of moving into sheltered housing. He worried about this constantly when he awoke at night.

Bob finally spoke to his doctor about his fear of having cancer. The doctor did a series of tests, including blood tests and an electrocardiogram as well as an ultrasound of Bob’s abdomen. He reassured him that there was no sign of cancer. Fortunately, his doctor has elderly parents and is sympa¬thetic to the needs of the elderly; he arranged to have a local community agency provide in-home help three hours a day, as well as a noontime meal, so Bob and Betty could have a hot lunch. The doctor also suggested that Bob try anti-depressants to improve his low mood.

With fewer household chores looming over him, Bob decided he could spend some time on his own interests. He had always been intrigued by stories he had heard of some of his ancestors, Huguenots who emigrated from France and settled in Sussex. He decided to take a course in local history and delve into the past. He joined a local historical society, and he and Betty made several new friendships.

Currently, the average lifespan at birth is seventy-six years. At the beginning of the twentieth century it was only forty-six. In fact, you now have a twenty times greater chance of living to one hundred than if you had been born in 1900. Infectious diseases are easily treated in most cases, and nutrition in Western countries has greatly improved. Blood pressure medications are helping to control the frequency of heart attacks and strokes. New diagnostic and surgical techniques let us deal with many problems before they are life-threatening.

Sometimes, when we’re young, we see the elderly as unhappy and lonely, with little reason to live. Fear of our own old age probably clouds our view, leading us to stereo¬type the old as depressed. In fact, depression occurs less in the elderly than in the young. It may be that, as we age, we are more able to cope with changes because of our life experiences.

Statistics about the depressed elderly are not readily available, because researchers have trouble getting a ‘clean’ sample to study; illnesses, loneliness, physical restrictions, and the deaths of family and friends are common by the time we reach old age, and all of these complicate the picture. Yet major depression occurs in only 5 to 10 per cent of the healthy elderly. According to a large American study, even people who had recurrent depression as younger adults are less likely to have an episode in old age. When depression occurs for the first time in old age, it’s important to look for a physical cause.

Symptoms of depression in the elderly can be different from those in younger people. When you are elderly, you don’t often speak of feeling sad or depressed. Depression is less likely to show up as guilt and self-blame. Instead, you may be irritable; you may worry too much, and complain of numerous physical discomforts, such as headaches, muscle pains, stomach troubles, constipation, weight loss and sleeping troubles. You may feel confused, slow in your thinking, forgetful, and not very interested in your family and friends. You may even express indirect suicidal thoughts, such as ‘Why am I still here?’ or ‘I’d be better off dead.’

As we age, we face physical and psychological changes. We may lose the intimate partner who has been our best supporter. We may see less of neighbours and friends because we don’t get out as much. We probably no longer work, so we miss out on sharing news and gossip with younger colleagues. Children and grandchildren tell us less, to ‘protect’ us. We may have less power and status. Loss of hearing, sight and mobility make us more dependent on family members. Our sexual experiences change in scope and frequency. Memory loss worries us.

Living alone is isolating, but living in a residential facility can be demeaning and restrictive. Fear of further disabilities and restrictions leaves us frightened about the future. Having to look after a partner who is suffering from disabilities or dementia may leave us exhausted and depleted, but placing this loved partner outside the home causes us great anguish.

People who had difficulty coping with change and with other people’s idiosyncrasies in the past are likely to have even greater difficulties as they age. Those who are content and comfortable physically are more likely to avoid despair in later years.

Being elderly doesn’t always mean being inactive. Increased leisure gives you time to investigate interests you always wished you could explore. Late-life learning in areas you’ve enjoyed, such as music or art, is available, usually at lower rates, from community colleges and universities. Perhaps the skills you used during your paid work can be turned to volunteer work; for example, one retired businessman developed management plans for public agencies that couldn’t afford a paid consultant. Staying involved by volunteering at the local daycare, hospital or seniors’ club can also be enjoyable. You may find it meaningful to write an informal autobiography, a wonderful legacy for your grandchildren. Keeping fit by walking or working out at a gym will increase your stamina, and may also keep your spirits up. The Internet and e-mail are fantastic for staying in touch. (Your grandchildren can teach you to use the Internet, if necessary.) Many people find support from spiritual and religious communities, as well.

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