The process of aging brings about many changes in an individual’s health. Decreased muscle strength and flexibility, wrinkled skin, and vision changes are just a few of the common physical changes that occur with the aging process. Cognitively, the mind may become less sharp due to decreased blood flow to the brain, changes in diet, or decreased stimulation. But does depression naturally follow these other issues?
Let’s begin with a definition of depression. Depression is a prolonged sense of emptiness or hopelessness, and a loss of interest in activities. It may last for an extended period of time and affect the individual’s ability to complete the tasks of daily living, or it may present as a chronic attitude of gloominess while the individual continues to function. The symptoms of depression can include: loss of appetite or overeating; decreased concentration; frequent feelings of irritability, anxiety, sadness, or guilt; problems sleeping or sleeping all the time; difficulty making decisions; general fatigue; and frequent aches and pains. Many of these symptoms can also be the result of other disease processes or the side effects of medications. If an elderly person simply accepts some of these symptoms as part of “getting older,” he/she may not verbalize the presence of the symptoms to their physician or family members, thus making an accurate diagnosis difficult. In addition, depression may sometimes be mistaken for dementia, due to a similarity of symptoms. A thorough review of the individual’s mental functioning can help distinguish between the two conditions.
There are a number of factors that can contribute to depression. A family history of depression can lead to a greater likelihood that an individual will develop depression. In addition, differences in brain chemistry or the presence of certain chronic diseases, such as thyroid disorders, may place some individuals at a greater risk for developing depression. Vascular depression is caused by decreased blood flow to the brain due to the stiffening of blood vessels as one ages. The presence of stress caused by life changes is a primary risk factor for the development or worsening of depression in the elderly. Potential stressors include chronic pain or disease, loss of a spouse or close friends, a move from one’s home, and loss of independence (such as giving up driving). Whether or not these stressors lead to depression is influenced by the individual’s perception of the stressor, ability to cope, and social support system.
Depression can be treated in a number of ways. First, it is important to determine if the depression is related to another illness or a medication. Discuss the presence of ALL symptoms with a physician, whether or not they seem significant or related to each other. In addition, the physician should be aware of all medications that are being taken, including vitamins, herbal remedies, and over-the-counter products. Avoiding alcohol, illegal drugs, and sleep aids can help in reducing symptoms of depression. Exercise can provide both physical and emotional benefits by increasing the presence of certain chemicals in the brain that help one to “feel good,” and providing opportunities for increased socialization and distraction from negative thoughts. If antidepressant medications are tried, be aware that they can take several weeks to begin working. Counseling or psychotherapy services may be needed if other interventions are ineffective. Often, a combination of treatments is more effective than a single treatment.
So, is depression a normal part of the aging process? NO, it is not. It is important to diagnose and treat depression in older adults because depression contributes to higher mortality rates. In addition, a depressive episode that is untreated or undertreated can lead to a more intense episode of depression in the future. Men who are older than 65 are the highest risk group for suicide. At any age, depression is painful to experience personally, or to watch a loved one experience. Accurate diagnosis and compliance with treatment can improve the quality of life not only for the individual, but for family members as well.
Karen E. Kaslow, RN, BSN
Elder Care Coordinator