Elderly Depression - Research Paper Example

 Elderly Depression Introduction In general terms, depression is defined as a medical illness in which an individual has persistent feelings of discouragement, sadness, and lack of self-worth. Recent years has witnessed a widespread depression among the elderly. It is estimated that elderly depression affects nearly 6 million Americans who are aged 65 years and above (Duckworth, 2009). Available data indicate that older people are at risk for depression and have the highest rates of complications associated with depression, as well as suicide caused by depression. The challenge is compounded by the fact that the health profession and their resistance to treatment underserve the elderly. It is estimated that only 10 percent of those suffering from elderly depression receive treatment for the condition (Lovestone and Howard, 2006). This can largely be attributed to different display of depression symptoms among the elderly and therefore delay in treatment. Among many old people, depression is often confused with the effects of other illnesses and the medicines and therapies used in treating them (Blazer, 2002). This choice of elderly depression for this paper was informed by the need to understand the condition since my father has suffered elderly depression severally. This paper will focus on the various dimensions of elderly depression including causes, risk factors, and treatment among others. As people grow older, the face significant changes in life that can put them at risk for depression. Medical, psychological, and social studies have found out a number of risk factors that contribute to depression among the elderly. The first main cause of elderly depression is health problems (Williamson, Shaffer and Parmelee, 2000). Disability and illness, cognitive decline, severe or chronic pain, and damage to body due to disease or surgery may be a great cause of elderly depression. There are numerous medical conditions that can cause depression among the old people. It is important to be aware of the medical problems that can cause elderly depression, either directly or through a psychological reaction to a disease or illness (Chew-Graham, Baldwin and Burns, 2008). Any chronic condition, especially if it is life-threatening, disabling, or painful, can result to depression or lead to worse depression symptoms. The medical conditions that have been identified to cause elderly depression are: stroke, diabetes, lupus, thyroid disorders, Parkinson’s disease, cancer, Alzheimer’s disease and dementia, multiple sclerosis, Vitamin B12 deficiency, and heart disease (Duckworth, 2009). It is also important to note that isolation and loneliness have been identified as major causes of elderly depression. Many old people are living alone and their social circle is dwindling due to relocation or deaths. This has serious implications on how elderly people live their lives and react to life situations. Also, as people grow beyond 65 years, their mobility decrease due to loss of driving privileges or illnesses (Lovestone and Howard, 2006). This situation further leads to isolation and loneliness and will most likely cause depression. Elderly depression has also been associated with reduced sense of purpose among the elderly. More and more elderly people tend to have feelings of purposelessness, as well as loss of identity because of physical limitations on activities or retirement. Studies have found out that elderly people have multiple fears that contribute to depression (Unutzer, 2007). Many elderly persons fear dying or death and are anxious over health issues or financial problems. Immediate or recent bereavement of family members, pets, spouse or partner and friends also leads to elderly depression. It is worth noting that elderly depression can also be a side effect of certain medications often prescribed to elderly people to treat conditions such as hypertension. Depression in the elderly people can be compounded and complicated by dependence on drugs and substances such as alcohol and anti-depressants (Blazer, 2002). Various studies have identified risk factors for depression in the elderly. The factors that increase the risk of elderly depression include: stressful life events; being unmarried, widowed, divorced, or single; being female; certain medicines; family history for major depressive disorder; previous depression history; and lack of supportive social (Duckworth, 2009). Older women tend to be at a greater risk than men because, generally, women are twice as likely as men to suffer from major depression disorder. Biological factors such as hormonal changes are some of the reasons that have been cited to make women more vulnerable to elderly depression. Besides, the stresses of maintain relationships or for caring for loved ones typically fall heavily on women, thereby contributing to higher depression rates. Widowed and unmarried individuals and those who lack supportive social network tend to have heightened depression rates (Lovestone and Howard, 2006). While many of the usual depression symptoms may be seen, depression in the elderly may be difficult to detect. This is because common symptoms such as appetite loss, trouble sleeping or insomnia, and fatigue can be part of the physical illness or aging process (Blazer, 2002). As a result of this, early depression signs may be ignored or be confused with other conditions that are common among the elderly population. It is for this reason that it is important to understand the early and late symptoms of elderly depression. It is equally important to ensure that exams and tests are taken to see whether one is suffering from elderly depression. The nurse or doctor should examine and ask questions to the elderly or his or her caregiver on his or her symptoms and medical history. Also, urine and blood tests may be taken to look for any physical illness (Williamson, Shaffer and Parmelee, 2000). If elderly depression is not established through initial exams and tests, it is important that the elderly person be referred to a mental health specialist to assist in diagnosis and treatment. So, what are the symptoms of elderly depression? It is not always easy to distinguish between the elderly depression symptoms and symptoms for physical illnesses and other situations such as grief (Chew-Graham, Baldwin and Burns, 2008). However, with depression, it is always easier to identify the constant feelings of despair and emptiness. Elderly depression may also be characterized by slow body movements and speech, as well as hearing and seeing things that are not there. Additionally, elderly depression is characterized by feeling of worthlessness and hopelessness due to factors such as loneliness and isolation. It is also possible to see a depressed elderly person displaying pervasive and intense sense of guilt (Lovestone and Howard, 2006). This symptom may also be accompanied by preoccupation with dying or thoughts of suicide. Elderly depression can also be identified by seeing inability to function at home or work on the part of the elderly person. Elderly depression is often characterized by: social withdrawal, irritability, hallucinations, vague complaints of pain, loss of appetite, delusions, confusion, weight loss, inability to sleep or insomnia, and memory problems (Unutzer, 2007). It should also be noted that depression in elderly people somewhat differ from depression in other populations in the society. Elderly people with depression often have severe sadness feelings that are frequently not acknowledged or shown openly. Sometimes elderly people do not admit to being depressed (Williamson, Shaffer and Parmelee, 2000). Therefore it is important for one to be in a position to identify some general clues to know if an old person is experiencing depression. These clues may include: moving in a slower manner, help-seeking, vague and persistent complaints, and demanding behaviour. Depression impacts elderly people differently than other members of society. Elderly depression frequently occurs with other disabilities and medical illnesses and tends to last longer. Elderly depression doubles the risk of cardiac diseases and enhances the risk of death from diseases and illnesses (Blazer, 2002). It also reduces the ability of an elderly person to rehabilitate. It has been found out that elderly depression increases the risk of suicide. It is because of these reasons that elderly depression is considered as a major public health problem. Considering the changes in the circumstances of the elderly people and the perception that elderly people are expected to slowdown, family and doctors may miss the symptoms and signs of elderly depression. Consequently, effective treatment and rehabilitation gets delayed and thereby forcing elderly persons to struggle with depression, unnecessarily (Duckworth, 2009). Since the nature and consequences of elderly depression are dire, it is important for the condition to be diagnosed appropriately and treated. A physical exam can determine if elderly depression symptoms are being caused by physical and any other medical illness. Concerns on medical grounds and their treatment are common in the elderly population (Chew-Graham, Baldwin and Burns, 2008). A review of the medications of individuals is important as a simple medication change can minimize symptom intensity in many cases. A psychiatric and clinical interview is a key assessment aspect. It will also be helpful to speak with close friends and family members in making a diagnosis. Imaging studies and blood tests have proved to be helpful so far because they rule out other medical conditions that would need a different intervention path (Unutzer, 2007). Questions have been raised over the years whether depression and elderly depression can be treated. The treatment prognosis for this condition is good. Existing evidence indicate that once diagnosed, about 80 percent of clinically depressed persons can be treated effectively by electroconvulsive therapy (ECT), psychotherapy, medication or any combination of these three. Recently, a new treatment transcranial magnetic stimulation (TMS) has gotten a clearance from the FDA, and can help to treat mild depression (Williamson, Shaffer and Parmelee, 2000). Medication has proved to be effective in treating depression for majority of elderly people. Four different antidepressant medications groups have been effectively used in treating depressive illness: monoamine oxidase inhibitors (MAOIs), tricyclics, norepinephrine and serotonin reuptake inhibitors (NSRIs), and selective serotonin re-uptake inhibitors (SSRIs). Medication adherence is particularly important, even though it can present challenges among the forgetful elderly persons (Lovestone and Howard, 2006). Considering that all medicines have certain side effects and benefits, the selection of the best treatment is based on the tolerability of the side effects. ECT may be very useful in treating of severe depression in elderly people. For elderly persons who are carefully selected, ECT can be a critical lifesaving intervention. Medications can be extremely beneficial for elderly persons in treatment of the depression symptoms. Often, medications are combined with cognitive behavioural therapy or supportive psychotherapy in improving their effectiveness. A number of studies have shown that some depressed elderly people may need to try more than one medication to obtain an optimal (Blazer, 2002). Considering the fact that elderly depression results to psychosocial consequences, psychosocial treatment plays a very important role in the care of elderly patients who have significant lack coping skills, lack of social support, or life crisis to deal with their life situations (Duckworth, 2009). Due to large numbers of elderly individuals living alone, lacking contact with a primary care physician or having inadequate support systems, special efforts are needed to identify and locate these people to provide them with necessary care. Natural supports such as bridge friends and church should be encouraged. While there are services available in helping elderly people, the problem of clinical depression need to be detected before treatment starts (Chew-Graham, Baldwin and Burns, 2008). Depression is a chronic disease like arthritis or diabetes. Although getting well may seem to be the main challenge, staying well after treatment is the real objective. It is therefore recommended that treatment should be administered for six months to one especially for people who are experiencing their first depression episode. In the case of elderly people who have had two or three episodes during their lifetimes, it is important for treatment to be extended up to two years after remission (Williamson, Shaffer and Parmelee, 2000). Treatment may be life-long for elderly people with more than three depression recurrences. The first treatment steps for elderly depression are: treating any illness that may cause the symptoms; stopping to take medications that may result to worse symptoms; and avoiding sleep aids and alcohol. In an event that these steps do not assist, medications to treat depression and therapies might be used (Lovestone and Howard, 2006). Medical practitioners and particularly the mental health practitioners prescribe lower antidepressants doses to elderly people, and gradual increase in the doses depending on how elderly people respond to treatment. It has been proved that depression frequently responds to medications and treatment in general. Usually, the outcome is usually better for people who have access to friends, family, and social services who can assist them stay engaged and active (Unutzer, 2007). However, there are worrisome complications, the most worrisome being suicide. Therefore, families should pay closer attention to elderly persons who live alone and are depressed. It is important for elderly individuals and particularly persons close to them such as family, friends and caregivers to call health care provider if elderly person feel persistently hopeless, worthless, or sad. Also, when elderly person is having trouble to cope with life stresses, it is important for them to be referred to therapy options (Chew-Graham, Baldwin and Burns, 2008). Apart from medications, overcoming depression often involves other options such as self-help for elderly people. Elderly people can learn to adapt to change, be socially active, and staying physically active, as well as feeling connected to loved ones and to the community. The more active an individual is socially, mentally, and physically, the better he or she will feel (Blazer, 2002). Therefore, exercise will be important; physical activity is powerful in boosting the moods of elderly persons. As a matter of fact, research has indicated that exercise may just be as effective as antidepressants to relieve depression. Its main benefit is that it does not come with side effects. One may not be required to hit the gym to exercise, doing light housework, taking a short walk, and taking stares are example of safe exercises that can help boost the mood and build strength of the elderly person. Also, connecting with others is the other alternative way of addressing elderly depression (Duckworth, 2009). Getting the support of others can help elderly people lift the depression fog and keeping it away. It can be hard for an individual to maintain perspective and sustain efforts required in beating depression. While an elderly person may not feel like reaching out, one can make an effort of connecting to others and limiting the time they are alone (Williamson, Shaffer and Parmelee, 2000). If an elderly person cannot get out socializing, he or she can invite friends and family members to visit, or keep in touch through email or over the phone. It will also be important for an elderly person to bring his or her life into balance (Blazer, 2002). Learning emotional intelligence skills and new emotional management skills is critical especially when one is feeling overwhelmed by pressures and stress of daily life. The other self-help tips of combating and preventing elderly depression include: getting enough sleep; maintaining healthy diet, participating in activities they enjoy; taking care of a pet; creating opportunities to laugh; volunteering time to help others and expanding social network; and learning new skills(Lovestone and Howard, 2006). Conclusion The above discussion describes various aspects of elderly depression in details. As has been noted, there is a widespread depression among the elderly. Available data indicate that older people are at risk for depression and have the highest rates of complications associated with depression, as well as suicide caused by depression. Several causes of elderly depression have been identified, as well as the symptoms of this condition. It is critical to understand the causes and symptoms so as to help address this condition and assist the elderly people to live a normal life. There are various treatment options for elderly depression; depression can be treated through medications and various therapy options and this can be important in assisting them recover and avoid the complications of elderly depression. In addition to medications and therapies, it is important that elderly people suffering from depression engage in self-help activities that can help combat depression such as exercises and connecting with others. References Blazer, D. G. (2002). Depression in late life. New York: Springer Pub. Chew-Graham, C., Baldwin, R. C., & Burns, A. S. (2008). Integrated management of depression in the elderly. Cambridge: Cambridge University Press. Duckworth, K. (2009). Depression in Older Persons Fact Sheet. Retrieved on 26 July, 2013 from http://www.nami.org/Template.cfm?Section=By_Illness&template=/ContentManagement/ContentDisplay.cfm&ContentID=7515 Lovestone, S., & Howard, R. (2006). Depression in elderly people. London: M. Dunitz. Unutzer, J. (2007). Clinical practice: late-life depression. N Engl J Med, 357:2269-2276. Williamson, G. M., Shaffer, D. R., & Parmelee, P. A. (2000). Physical illness and depression in older adults: A handbook of theory, research, and practice. New York: Kluwer Academic/Plenum Publishers. Read More