Chief executive of New Zealand’s Mental Health Foundation SHAUN ROBINSON discusses why depression in older people needs to be taken seriously.
While current world rates of clinical depression are thought to be no higher for people in the 65+ age group than for other sectors of the population, there is no room for complacency.
With increased life expectancy and the bumper crop of baby boomers now reaching retirement age, depression in later life will become more of a public health issue in future, so it’s important that information about depression and older people is widely available.
The fact that many older people are reluctant to seek treatment or are often misdiagnosed may account for some under-reporting of late life depression. It may also reflect the stigma that still exists, particularly in older age groups, around admitting ‘weakness’ or having a psychiatric illness. These factors may partly explain why the risk of suicide climbs steeply with age, especially among men.
Depression in older people can also manifest differently. For example, it will often present via physical symptoms that camouflage underlying emotional issues, the elder equivalent of a child complaining of a ‘sore tummy’ and not wanting to go to school. Often GPs don’t have time, or are not trained to ask, the emotional questions.
With conditions such as heart disease, stroke, Parkinson’s or Alzheimer’s, depression can be part of the illness, rather than a reaction to it. Blood pressure medications, tranquilisers, sleeping pills and yes, alcohol, can also depress mood so need to be monitored.
Trigger points for depression can come with the transitions or crises of later life: things like a change in self-image, retirement, redundancy, financial uncertainty, divorce, the death of a partner or spouse, a major illness or loss of hearing or eyesight.
What is depression?
So what is depression? That unwelcome black dog that no one ever whistles or welcomes?
The key thing about depression that differentiates it from grief or loneliness is that it is a state of persistent and ongoing unhappiness.
It is more than having the blues or being in the doldrums for a while. The depressed person loses interest in life’s pleasures. They may be irritable and withdraw from others. They will experience a change in sleeping patterns, loss of appetite, or sometimes a weight gain, and often have difficulty concentrating or become forgetful.
It is important to seek help early from your GP if you or anyone you know is experiencing some of these signs of something changing or of not being quite right.
Depression in older adults can be complex; it is often accompanied by anxiety and sometimes there is confusion between depression and dementia. Older adults who are depressed can really slow down and their cognition, motivation, even their facial expressions can change and these things can be misconstrued as dementia. On the other hand a GP may diagnose depression when someone is really in the early stages of dementia.
Another common issue is the blurring of lines between depression and grief. In its early stages, grief can be identical to depression. But grief occurs in response to a specific loss, and will gradually resolve over time.
Treatment, recovery and prevention
Treatment options for depression may include an antidepressant, a sleeping medication and ideally, psychotherapy sessions that include addressing unhelpful thinking patterns, advice on lifestyle changes, relaxation exercises and the importance of keeping up friendships and connections.
The Five Ways of Wellbeing – staying active, connecting to others, learning new things, taking time to notice and be mindful of the small joys in life, and giving to others – are practical but powerful ways to assist in recovery from depression. They are also great ways of ‘inoculation’ against the development of depression.
Because depression can be linked with cerebrovascular disease, lifestyle changes in mid-life can be another key to warding off late-life depression. These include reducing blood pressure and cholesterol levels, giving up smoking, regular exercising and eating a diet rich in fish, grains and greens.
Supporting an older person who is experiencing depression can be frustrating. Friends and family just have to hang in there. It’s about sensitivity and understanding what’s going on. Learn about depression and try to understand that it’s the depression that’s doing the talking, not the person.
Telling them to snap out of it or pull their socks up is a big no-no. You can be the one to help pull the socks up for them. Drop in for a cup of tea. Invite them to accompany you somewhere. Be the trigger for something nice to happen for them. And most importantly, don’t give up!
Going through a late-life crisis
Nine years ago, Lance Girling-Butcher could easily have turned his back on the world.
At 63 he was beginning to anticipate an active retirement from his high-profile job as editor of the Taranaki Daily News. Instead, he was literally plunged into darkness, spending several months in hospital and eventually losing his sight.
“The whole thing was very depressing,” he says, recalling a series of horrendous treatments that included three operations in one week.
“It was a double whammy. As well as the emotional reaction to losing my sight, I reacted to anaesthetic. I had this overwhelming sense of panic and deep despair – it was absolutely terrifying and it came in waves. It did fade away, but at the time I didn’t get a lot of help in coping with it.”
Luckily, as an experienced solo sailor he’d taught himself to handle panic. As well, he had the loving support of his family.
Although not clinically depressed, Lance went through a period of mourning.
“I couldn’t write, I couldn’t read, I couldn’t do anything. I’d lie awake at night thinking about all the things I wouldn’t be able to do.”
The turning point came late one night when he heard a radio programme about a blind pilot who’d flown halfway round the world using talking instruments.
“I realised that technology was going to be the answer for me,” he says.
A screen reader from the Blind Foundation allowed him to read and write again. Nowadays an IPhone6 Plus with GPS provides another vital technological aid.
Blindness has opened up a new and different world for Lance, who was recently named as the first Supersenior Champion by Senior Citizens Minister Maggie Barry and awarded the QSO in the last Queen’s Birthday Honours for services to the blind and seniors.
Among his many activities, he talks to older people who are experiencing sight and hearing loss.
“This is a generation that hasn’t grown up with technology. It’s the worst time of life when they’re least adaptable – the temptation is to just give up. Fear is the greatest inhibitor when you can’t see.”
Some days, he admits, he still has to make a conscious effort to go out the door.
“It would be so much easier to stay home.”
Luckily, he has a positive attitude and a good sense of humour. He also has an acute awareness of how vulnerable some older people are.
“They isolate themselves so they’re left lonely, lost and bored.”
“The message is that it isn’t the end of the world,” he says of his own life-changing crisis.
“But you can’t avoid going through the rough stuff.”